Risk Factors for Arm Injuries in Youth Baseball Pitchers

Baseball season is upon us, which means it’s time to break out the bat bags and dust off the cleats! Before our athletes hit the field, let’s review some statistics related to arm injuries in youth baseball and examine a few ways we can help keep our youth baseball pitchers on the mound.

Prevalence of Arm Injury

There is growing evidence that suggests that arm injuries are common in youth baseball pitchers. It is estimated that between 26% and 35% of youth baseball pitchers experience either elbow or shoulder pain each year (1).  Arm Injuries in high school players may account for as high as 75% of total injuries resulting in loss of playing time (2). 

Modifiable vs. Non-Modifiable Risk Factors

Non-modifiable risk factors, such as height and weight, have been linked to arm injuries in adolescent baseball pitchers (3). While these factors are difficult (if not impossible) to change, a number of risk factors linked to arm injury in youth baseball are modifiable. These factors include shoulder range of motion and strength, mechanics, and factors related to competition, which is discussed below. 

Shoulder Range of Motion and Strength

Studies have shown that professional pitchers with decreased rotational motion  were 2.5 times more likely to sustain a shoulder injury and 2.6 times more likely to sustain an elbow injury (4,5). Furthermore, professional pitchers with limited overhead mobility are 2.8 times more likely to sustain elbow injury (5).

Similarly, pitchers with limited shoulder strength are at increased risk for arm injury. Research estimates that professional pitchers in the 5th percentile in rotator cuff strength have a 31% likelihood of sustaining an injury that requires surgery (6).

Pitching Mechanics

The pitching motion is comprised of six distinct phases, each with unique, but specific, movement requirements. Errors in movement during any phase may contribute to excessive stress on the shoulder and elbow during the throwing motion. Research suggests that amateur pitchers may experience up to 3 times the amount of biceps and rotator cuff muscle activity during the acceleration phase, which may contribute to overuse injuries in younger pitchers (7).


There are a number of modifiable risk factors related to competition. These risk factors include months per year of competitive pitching, number of pitches per appearance, and how often a pitcher throws with arm fatigue. While athletes who throw more than 80 pitches per appearance are roughly 3 times more likely to sustain an injury to the upper extremity, athletes who pitch more than 8 months out of the year are 5 times more likely to develop an injury to their throwing arm. Shockingly, research suggests that athletes who pitch with arm fatigue are over 36 times more likely to sustain an arm injury that results in surgery (3).

Modifying Risk Factors

It is important for adolescent baseball pitchers to maintain appropriate shoulder range of motion and rotator cuff strength to decrease the risk of arm injury. If deficits in shoulder range of motion or strength are present, adolescent baseball pitchers should complement their throwing programs with flexibility, mobility, and strengthening exercises. Because faulty mechanics may contribute to the risk of arm injury, pitchers should also ensure that they are working with knowledgeable coaches and clinicians to promote proper pitching mechanics.

In an effort to prevent overuse sports injuries in pediatric athletes, the National Athletic Trainers Association (NATA) advocates that athletes should avoid pitching with arm pain and participate in a comprehensive preseason and in-season preventative training program (8). Furthermore, in order to decrease the prevalence of adolescent pitchers throwing with arm fatigue, USA Baseball recommends the following pitch count limits and required rest recommendations. Following these guidelines will help ensure that our athletes remain on the field.

If you are struggling with baseball related injuries or want guidance on a preseason preventative training program, call for an appointment with Dr. TJ. at 770-500-3848.  For questions or to learn more, you can email Dr. TJ. at thomas@onetherapy.com. 

Dr. Thomas (TJ) Joyce, PT, DPT, SCS joins One on One Physical Therapy after completing the Sports Physical Therapy Residency at The Ohio State University. While at OSU, his research focused on the influence of shoulder range of motion on shoulder and elbow kinetics in baseball pitchers. Dr. TJ received his Doctor of Physical Therapy degree from Duke University and has a passion for working with high school, recreational, collegiate, and professional athletes across many sports and enjoys working with athletes of all ages. Dr. TJ is a Georgia native who earned his Bachelor of Arts degree in philosophy and religious studies from Rhodes College in 2011. During his time at Rhodes, he ran track and played middle infield for the baseball team. He is a Certified Strength and Conditioning Specialist and a Certified Olympic Weightlifting Coach. When Dr. TJ is not working with his patients, he enjoys lifting weights, playing sports, and cheering on his Georgia Bulldogs. 


  1. Lyman S, Fleisig GS, Waterbor JW, et al: Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc. 2001;33:1803Y10
  2. Shanley, E, MJ Rauh, LA Michener, and TS Ellenbecker. “Incidence of Injuries in High School Softball and Baseball Players.” Journal of Athletic Training. 46.6 (2011). 
  3. Olsen, Samuel, Glenn Fleisig, Shouchen Dun, Jeremy Loftice, and James Andrews. “Risk Factors for Shoulder and Elbow Injuries in Adolescent Baseball Pitchers.” The American Journal of Sports Medicine. 34.6 (2006): 905-912. 
  4. Wilk, KE, LC Macrina, GS Fleisig, R Porterfield, CD . Simpson, P Harker, N Paparesta, and JR Andrews. “Correlation of Glenohumeral Internal Rotation Deficit and Total Rotational Motion to Shoulder Injuries in Professional Baseball Pitchers.” The American Journal of Sports Medicine. 39.2 (2011): 329-35. 
  5. Wilk, Kevin E, Leonard C. Macrina, Glenn S. Fleisig, Kyle T. Aune, Ron A. Porterfield, Paul Harker, Timothy J. Evans, and James R. Andrews. “Deficits in Glenohumeral Passive Range of Motion Increase Risk of Elbow Injury in Professional Baseball Pitchers: A Prospective Study.” The American Journal of Sports Medicine. 42.9 (2014): 2075-2081. 
  6. Byram, IR, BD Bushnell, K Dugger, K Charron, FE J. Harrell, and TJ Noonan. “Preseason Shoulder Strength Measurements in Professional Baseball Pitchers: Identifying Players at Risk for Injury.” The American Journal of Sports Medicine. 38.7 (2010): 1375-82. 
  7. Calabrese GJ, Pitching mechanics, revisited. Int J Sports Phys Ther. 2013 Oct; 8(5): 652-60.
  8. Myers, Joseph B, Maria R. Pasquale, Kevin G. Laudner, Timothy C. Sell, James  Bradley, and Scott M. Lephart. “On-the-field Resistance-Tubing Exercises for Throwers: an Electromyographic Analysis.” Journal of Athletic Training (National Athletic Trainers’ Association). 40.1 (2005).