Caution About Year Round Pitching

March 3, 2020 | Baseball, Elbow

By Dev K. Mishra, M.D.

President, Sideline Sports Doc

Medical Director, Apeiron Life

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

March 3, 2020

Key Points:

  • A published clinical study shows that a substantial percentage of young baseball players have abnormal elbow MRIs and a high percentage also report regularly throwing with pain
  • Year-round pitching is strongly correlated with abnormal MRI and elbow pain
  • This study along with evidence from other studies shows the risk of year round sports participation and single sport specialization for the adolescent and teenage athlete

This week we’d like to highlight a recently published clinical study assessing elbow MRI abnormalities in young baseball players. This well conducted study is a three year follow-up to a previously performed MRI study. In the current study the authors found that 58% of the young players had MRI abnormalities on the most recent MRI scans, up from 35% on the initial preseason MRIs at the start of the study.

There is increasing evidence about the risk to the young player’s elbow from year-round baseball participation. The risk is especially high for year-round pitching. This study along with other available evidence suggests that year-round pitching is not only a risk factor for an abnormal MRI but also a risk factor for injury and loss of performance. Most sports medicine physicians recommend that young pitchers follow guidance from MLB’s PitchSmart. We also recommend multisport participation for athletes up until about age 14.

58% With MRI Abnormalities And 27% Throw In Pain

 We don’t need to dig too deep into the study details but there are a few key noteworthy items.  First, it was a well-conducted study. The researchers were able to follow these kids over a three year period and had 100% participation at the final evaluation- this doesn’t happen often in clinical studies. It would have been nice to see a larger group of players and also a comparison to non-baseball players.

While the elbow MRI findings are of concern, the bigger issue in my opinion is how many of the players are throwing in pain. 27% reported regularly throwing in pain, which is much higher than what I’d prefer to see (something much closer to zero percent would be good…).

This also means that not all of the players with abnormal MRIs are throwing in pain. Do the players with abnormal elbow MRIs eventually go on to develop elbow pain, loss of performance, and injury?  There’s some evidence from professional baseball that initially pain-free elbows with MRI abnormalities do eventually go on to have elbow pain and time on the disabled list. But cause and effect evidence in the young players is lacking.

Common Sense Take-Away: Avoid Year-Round Pitching And Promote Trusted Guidance On Pitch Volume

 There’s ample evidence suggesting that year-round play in any sport, with focus on a single sport, is a significant risk factor for injury. Repetitive motions such as pitching are particularly risky to the young growing body. Sports health physicians are in strong agreement that getting at least 2 months off from your primary sport each year is incredibly helpful. Promoting multiple sport participation for as long as possible into early teenage years seems to be protective from some injuries.

As we gain knowledge rules and regulations will eventually change but this can be a long, slow process. In the meantime I continue to recommend the MLB PitchSmart recommendations to our young throwers.



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Categories: Baseball, Elbow
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