Have you noticed the recent discussion regarding arm injuries in youth baseball?
The number and frequency of injuries are growing. Many are blaming “overuse” as the cause, but I’m not so sure. MLB and USA introduced initial “Pitch Smart” guidelines for baseball in 2014. Many tournaments follow those rules, or something similar. High schools in most states have also adopted similar rules. The rules address pitch count limits and the days of rest needed after reaching certain thresholds.
Elbow injuries, linked to the UCL (Ulnar Collateral Ligament), have become common. You’ve likely heard of the infamous Tommy John surgery. TJ surgery requires a full rebuild of the UCL, including a skin graft from a healthy ligament. Other surgeries only require UCL repair. Often referred to as Tommy John, but instead of a full rebuild, it’s just a repair with an internal synthetic brace. Getting the repair versus the full TJ surgery can cut recovery time by 3-6 months. In many of the cases that require a full TJ rebuild, the ligament shows evidence of overuse.
In some cases, doctors are finding the UCL detaches but does not show evidence of overuse. These injuries require the ligament to be reattached to the ulna or humerus and lined with an internal brace. Recovery for this surgery is much quicker than a full TJ surgery. Returning to throw can be around the 6-9 months. For pitchers, it can take a few months longer.
Why are we still seeing an increase in injuries when most are following the “pitch smart” guidelines? Many have posed a number of different theories, but it seems there is nothing definitive. It most likely is a combination of these factors.
Chasing velocity … especially for pitchers. Pushing too hard and fatigue can cause breakdowns in otherwise proper mechanics, increasing the chance of injury.
Specializing in baseball early on. Most believe a multi-sport athlete uses a better variety of movements and muscles, resulting in less stress on the arm.
Throwing at high intensity too often or too long. Here is where the pitch count theories came from. Referred to as acute overuse.
Year-round play - Between travel, school, tournaments, and showcases, players take very few breaks anymore. With fewer breaks, there is little time for full recovery and healing.
Improper mechanics - Throwing incorrectly can cause increased stress on ligaments, joints, and muscles.
While each of these alone can certainly contribute to injury, it’s likely a combination of these factors that causes injury. That makes sense, and one can easily just say “overuse” is the culprit.
My son recently had UCL repair surgery, and the doctor noted that the ligament simply detached from the humerus. He was pitching in Jupiter, FL in October 2025. We had monitored his pitch count and limited his number of appearances to avoid injury. He still ended up injured and required surgery. When the doctor completed the surgery, he said it wasn’t because of overuse. The ligament still looked “brand new.” The ligament simply detached from the humerus. The doctor reattached the ligament with the internal brace, and my son began his rehab. At the time of this post, he is at college for his freshman year, and should be ready to pitch for the Fall.
I theorize that as players have learned how to throw harder at younger ages, their bodies are just not able to handle that level of stress yet. Ages 15-19, from what I’ve been able to find, receive about 60% of TJ surgery or UCL repairs. Certainly there are some because of each of the reasons noted above, but there are many where those potential causes have been controlled. Injuries still happen.
With the growing number of pitching camps, lessons, workouts, and monitoring systems (Trackman, Rapsodo), players are able to squeeze every bit of velocity out of their bodies. This is being pursued by younger players every year. Just like younger athletes are told not to lift weights too early, I think players should avoid chasing velo until after puberty. Vélo is going to improve naturally with strength and size, but putting that strain on too early causes ligament failure. Moderation is key. While growing and improving mechanics, learn to pitch, not just throw. Master changing speeds and locating pitches. As the pendulum swings back to throwing strikes versus just throwing hard, you have time to master control.
Do you know of anyone, or have personal experience, where the injury was not due to overuse?
