Protecting Youth Baseball Arms: The Role of Education, Communication, and New Technology

In recent years, there has been a well-documented rise in the incidence of shoulder and elbow injuries at the youth baseball level. As the season returns to full swing, sports medicine clinics will be tasked with the challenge of supporting player health in the current landscape of youth sports.

A large percentage of youth arm injuries are attributable to overuse. Although all ages and abilities are susceptible to this injury mechanism, it also provides a target for intervention. With effective education, improved communication, and the implementation of new technologies, players, parents, and health professionals can work together to keep arms healthy throughout the season.

The Role of Education

A knowledge deficit amongst parents and coaches remains one of the primary drivers of youth injury risk. Recommendations from the USA Baseball Medical & Safety Advisory Committee as well as from Major League Baseball have included pitch count limits, reduced use of breaking pitches, strategic showcase participation, and at least three months of refraining from baseball each year.¹ A recent study found that youth baseball players are less likely to sustain injuries if their parents have knowledge of and follow the Pitch Smart guidelines²; however, over 50% of coaches may be noncompliant with the published recommendations.³ Therefore, it is important for parents to be educated on injury prevention recommendations, as they can play a critical role in determining the frequency and intensity of an athlete’s participation. 

Improved Communication

Baseball remains a game with rich traditions and unwritten rules. Disclosing pain was historically considered taboo, and throwing through discomfort was expected. This can not only lead to an increase in injury risk but can also take a psychological toll on the youth baseball athlete.⁴ With the expansion of the showcase circuit, select teams, and private coaching, today’s athletes are pulled in more directions than ever.  As healthcare providers, we should encourage athletes to feel empowered to speak up regarding their health and ability.

Promising New Technologies

Technological advancements have made it easier for athletes, parents, and sports medicine practitioners to obtain objective data regarding arm stress and readiness. Historically, tracking of traditional metrics such as pitch count and pitch velocity has allowed for crude estimation of arm stress. More recently, wearable technology such as inertial measurement units (IMU) enable tracking of joint-specific workloads during the throwing motion. IMUs can measure arm speed and slot, as well as enable estimation of elbow varus torque. While the accuracy and validity of some of these devices has been questioned when compared to marker-based motion capture, the inter-subject reliability is sufficient for quantifying an athlete’s daily effort, including efforts outside of the game itself (eg, warmup throws), as compared to more simplistic metrics such as pitch count.⁵ Handheld dynamometers and app-based training software now allows for a portable assessment of shoulder motion and strength that can be used to monitor fatigue and guide daily workouts.  Future studies should evaluate these emerging technologies regarding their impact on injury risk.

By prioritizing education, fostering open communication, and leveraging new technology, young athletes can pursue healthy skill development while enjoying the game for years to come.

References

1. MLB Pitch Smart. https://www.mlb.com/pitch-smart/pitching-guidelines. 
2. Zabawa L, Alland JA. Association Between Parental Understanding of Pitch Smart Guidelines and Youth Baseball Player Injuries. Orthop J Sports Med. 2019 May 20;7(5):2325967119846314.
3. Knapik, D. M., Continenza, S. M., Hoffman, K., & Gilmore, A. (2018). Youth Baseball Coach Awareness of Pitch Count Guidelines and Overuse Throwing Injuries Remains Deficient. J Pediatr Orthop. 38(10):e623-e628.
4. Makhni EC, Morrow ZS, Luchetti TJ, Mishra-Kalyani PS, Gualtieri AP, Lee RW, Ahmad CS. Arm pain in youth baseball players: a survey of healthy players. Am J Sports Med. 2015;43(1):41-46.
5. Camp CL, Loushin S, Nezlek S, Fiegen AP, Christoffer D, Kaufman K. Are Wearable Sensors Valid and Reliable for Studying the Baseball Pitching Motion? An Independent Comparison With Marker-Based Motion Capture. Am J Sports Med. 2021;49(11):3094-3101.