Understanding the Rising Tide of Youth Baseball Injuries and the Quest for Safer Practices

Initial Signs and the Turning Point

It began with what appeared to be a simple forearm cramp. Sam Rosand, a high school junior, dismissed it as minor. Given that serious pitching injuries typically involve a sudden, audible pop in the elbow, he decided to continue pitching. With his final game of the 2024 season approaching, he felt that finishing the game was more important than resting. After the game, he underwent some basic assessments with the athletic trainers, which revealed no immediate abnormalities. Mild tightness is common among teenage pitchers, especially those who regularly throw fastballs exceeding 90 mph.

Following a few weeks of rest, Rosand resumed throwing, feeling confident that his arm was back to normal. However, upon returning to the mound, he noticed something alarming. His first pitch, which he anticipated to be in the high eighties, registered at just 73 mph. He was unable to complete his bullpen session, and pain in his elbow intensified.

“My elbow was just screaming at me,” Rosand recalls. “I knew something was seriously wrong.”

Diagnosis and Surgical Intervention

After consulting with medical professionals and undergoing an MRI scan, it was confirmed that Rosand had sustained multiple tears in his ulnar collateral ligament (UCL). Seeking a second opinion in New York, specialists recommended a comprehensive reconstruction of his UCL-commonly known as Tommy John surgery. This procedure has become increasingly prevalent among young athletes, reflecting a troubling trend in youth baseball.

The Surge in Youth Arm Injuries

Recent data indicates a sharp rise in elbow injuries among young baseball players, correlating with the escalating velocities of pitches at all levels of play. A December report from Major League Baseball highlighted a notable increase in injuries among professionals, which mirrors a surge at the amateur level. More young athletes are experiencing injuries that sideline them for a year or longer, often forcing them to restart their development from scratch and cope with the psychological toll of setbacks.

“When a player’s identity is built around their pitching prowess, an injury can feel like losing a part of themselves,” explains Rosand, who recently graduated after missing his senior season. “I hope the baseball community recognizes this epidemic and takes steps to address it.”

The Evolution of Velocity in Baseball

From Simplicity to a Competitive Chase

In the early days of baseball, players like Billy Wagner-who hails from Marion, Virginia-did not focus on specialized velocity training. Wagner learned to throw by long-tossing, tossing a football, or even working in a hayfield, developing an effective arm without the need for structured programs. Over his 16-year Major League career, he became a seven-time All-Star and is now enshrined in the Baseball Hall of Fame.

Today, however, the pursuit of velocity has become a defining feature of high school baseball. Coaches and players alike are caught in a relentless race to throw harder, often at the expense of mechanics and health. Wagner, now coaching at Miller School in Albemarle, observes that young athletes throw every pitch with maximum effort, driven by the belief that higher velocity equates to greater success.

The Social Media Influence and the Pressure to Max Out

Social media platforms are flooded with videos showcasing teenagers unleashing fastballs nearing triple digits, fueling the perception that velocity is the ultimate measure of talent. Training centers promise rapid improvements, often linking higher speeds to college scholarships and professional opportunities. For aspiring players, a radar gun reading can be as critical as their ERA, creating immense pressure to perform.

“Many young athletes and their parents believe that throwing 90 mph is essential for making it to the next level,” Wagner notes. “This obsession often overshadows the fundamental skills of pitching-control, deception, and strategic variation-that are crucial for long-term success.”

Velocity and Its Impact on the Game

While velocity combined with command can be a potent combination, the emphasis on speed has contributed to a measurable increase in pitch velocities over the past two decades. This trend coincides with a decline in batting averages, as pitchers overpower hitters more frequently. In top amateur showcases, the number of pitchers throwing at least 95 mph has skyrocketed-from five in 2014 to over 36 in 2023.

Eric Cressey, a renowned sports performance expert and director of player health for the New York Yankees, explains that pitchers throwing 90 mph or more are now commonplace, even among high schoolers. “Twenty years ago, a left-handed pitcher throwing 90 mph was a rare gem,” he says. “Now, they’re much more prevalent, and the bar for entry has risen dramatically.”

The Cost of the Velocity Race

From College to the Pros

Collegiate programs have adopted strict thresholds for recruitment, often requiring pitchers to throw at least 85 or 90 mph to garner attention. This creates a high-stakes environment where players feel compelled to push their limits prematurely. Coaches and trainers emphasize that the relentless pursuit of velocity often neglects essential pitching skills like location and pitch sequencing.

The Dangers of Overexertion and Mechanical Flaws

Many trainers advocate for maximizing strength and velocity through weighted ball exercises, pulldowns, and specialized routines. However, without proper mechanics, these efforts can lead to overuse injuries. Experts warn that young athletes often learn to throw with maximum effort before mastering fundamental mechanics, increasing their injury risk.

“It’s like trying to build a skyscraper without a solid foundation,” says Cressey. “Young pitchers are adding fancy wheels to a car that has no engine-focusing on the wrong priorities.”

Volume and Overuse: The Hidden Threat

Beyond velocity, the volume of pitching plays a critical role in injury risk. After a demanding season, many young athletes continue to throw during the off-season, either in other sports or through private training, often without adequate rest. This relentless cycle of throwing without sufficient recovery accelerates tissue breakdown and heightens the likelihood of injuries.

Research from the Sports & Fitness Industry Association reveals that children aged 6-17 participated in an average of just 1.63 sports in 2023, down from over two sports per year a decade ago. The trend toward early specialization-driven by travel teams and the desire to excel-significantly increases overuse injuries, especially when combined with year-round velocity training.

The Physical Toll of High-Intensity Throwing

The Biological Limits of the Elbow

Throwing a baseball with maximum effort exerts tremendous strain on the arm’s structures. For instance, at 90 mph, the inside of the elbow experiences forces comparable to holding six to eight bowling balls, all while the ligament endures repeated stress. The UCL, a ligament roughly the thickness of a credit card, is designed to withstand some stress but is not built for constant overload.

“It’s akin to snapping a celery stalk or a popsicle stick,” explains Christopher Ahmad, chief of sports medicine at New York-Presbyterian/Columbia University Medical Center and team physician for the Yankees. “Repeated stress weakens the ligament over time, leading to tears and injuries.”

The Rising Incidence of UCL Injuries in Youth

While Tommy John surgery has become common among Major League pitchers-more than a third have undergone the procedure-young athletes are now at an alarming risk. Data indicates that players aged 15 to 19 account for over half of all UCL injuries in the U.S. between 2010 and 2019. The 2024 MLB report shows that youth and high school players constitute over 40% of UCL surgeries annually at specialized centers.

Furthermore, many young athletes show signs of ligament wear even without tears, including calcifications and bone spurs, suggesting that their elbows are already compromised. The immature UCL, which doesn’t fully develop until around age 25, is especially vulnerable when subjected to early and aggressive velocity training.

Addressing the Crisis: Towards Safer Practices

While some injuries are unavoidable, the widespread nature of these issues prompts urgent action. Youth leagues worldwide have implemented pitch count limits-such as Maryland’s 105-pitch cap and Virginia’s 110-pitch limit-to mitigate overuse. Educating players and parents about injury risks is vital, and organizations like the Global Baseball Coaches Network actively promote safe practices and awareness.

Medical advancements are also underway. The latest innovation, known as Triple Tommy John (TJ3), combines ligament repair with an internal brace, providing additional support and reducing the likelihood of re-injury. Rosand, who recently underwent this procedure, has completed his recovery and is now preparing to play college baseball at Virginia. His experience has made him more cautious, emphasizing that velocity should develop naturally rather than through reckless effort.

Conclusion: Cultivating a Culture of Safety

Ultimately, the challenge lies in shifting the culture of youth baseball from a relentless pursuit of velocity to a balanced approach that prioritizes arm health. Coaches, parents, and players must recognize that sustainable success depends on proper mechanics, adequate rest, and a focus on overall athletic development. Only through such a paradigm shift can the sport preserve its future generations and ensure that young athletes enjoy the game without sacrificing their health.