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The American Journal of Sports Medicine 30:463-468 (2002)
© 2002 American Orthopaedic Society for Sports Medicine

Effect of Pitch Type, Pitch Count, and Pitching Mechanics on Risk of Elbow and Shoulder Pain in Youth Baseball Pitchers
Stephen Lyman, PhD*, Glenn S. Fleisig, PhD*,, James R. Andrews, MD* and E. David Osinski, MA
* American Sports Medicine Institute, Birmingham, Alabama
American Baseball Foundation, Birmingham, Alabama

Address correspondence and reprint requests to Glenn S. Fleisig, PhD, American Sports Medicine Institute, 1313 13th Street South, Birmingham, AL 35205


Background: Joint pain is thought to be an early sign of injury to a pitcher.

Objective: To evaluate the association between pitch counts, pitch types, and pitching mechanics and shoulder and elbow pain in young pitchers.

Study Design: Prospective cohort study.

Methods: Four hundred and seventy-six young (ages 9 to 14 years) baseball pitchers were followed for one season. Data were collected from pre- and postseason questionnaires, injury and performance interviews after each game, pitch count logs, and video analysis of pitching mechanics. Generalized estimating equations and logistic regression analysis were used.

Results: Half of the subjects experienced elbow or shoulder pain during the season. The curveball was associated with a 52% increased risk of shoulder pain and the slider was associated with an 86% increased risk of elbow pain. There was a significant association between the number of pitches thrown in a game and during the season and the rate of elbow pain and shoulder pain.

Conclusions: Pitchers in this age group should be cautioned about throwing breaking pitches (curveballs and sliders) because of the increased risk of elbow and shoulder pain. Limitations on pitches thrown in a game and in a season can also reduce the risk of pain. Further evaluation of pain and pitching mechanics is necessary.






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