Prospective cohort study of 298 youth pitchers followed over two seasons via postgame telephone interviews and pitch count logs. The study evaluated how often elbow and shoulder pain occur and which pitcher characteristics, behaviors, and pitch-volume thresholds independently predict each complaint. Elbow and shoulder pain were analyzed separately because the authors hypothesized — and confirmed — that they have distinct risk factor profiles.
When a youth pitcher's parent asks 'how many pitches is too many?', this paper is the answer. Before it, youth leagues limited innings per week without empirical pitch-count data — a policy that allowed younger, less efficient pitchers to throw more total pitches than older ones in the same league.
The 75-pitch per-game threshold for shoulder pain risk is the central clinical takeaway. When a young pitcher approaches that number, the shoulder pain risk nearly triples. Counsel coaches and parents to count pitches, not innings.
Arm fatigue is equally actionable. An OR of nearly 6 for elbow pain means a fatigued pitcher should come out of the game. Not finish the inning. Teach parents and coaches to watch for accuracy loss as a proxy for fatigue.
Elbow and shoulder pain require separate prevention conversations. Elbow risk is driven by age, weight, and cumulative load. Address it seasonally and across the whole year including non-league play. Shoulder risk is acutely pitch-volume driven and conditioning-dependent, so early-season shoulder complaints in a pitcher with fewer than 300 cumulative pitches may simply reflect inadequate preseason arm conditioning.
Prospective cohort study of 298 youth pitchers followed over two seasons via postgame telephone interviews and pitch count logs. The study evaluated how often elbow and shoulder pain occur and which pitcher characteristics, behaviors, and pitch-volume thresholds independently predict each complaint. Elbow and shoulder pain were analyzed separately because the authors hypothesized — and confirmed — that they have distinct risk factor profiles.
When a youth pitcher's parent asks 'how many pitches is too many?', this paper is the answer. Before it, youth leagues limited innings per week without empirical pitch-count data — a policy that allowed younger, less efficient pitchers to throw more total pitches than older ones in the same league.
The 75-pitch per-game threshold for shoulder pain risk is the central clinical takeaway. When a young pitcher approaches that number, the shoulder pain risk nearly triples. Counsel coaches and parents to count pitches, not innings.
Arm fatigue is equally actionable. An OR of nearly 6 for elbow pain means a fatigued pitcher should come out of the game. Not finish the inning. Teach parents and coaches to watch for accuracy loss as a proxy for fatigue.
Elbow and shoulder pain require separate prevention conversations. Elbow risk is driven by age, weight, and cumulative load. Address it seasonally and across the whole year including non-league play. Shoulder risk is acutely pitch-volume driven and conditioning-dependent, so early-season shoulder complaints in a pitcher with fewer than 300 cumulative pitches may simply reflect inadequate preseason arm conditioning.