title: Risk-Prone Pitching Activities and Injuries in Youth Baseball: Findings From a National Sample.
abstract: BACKGROUND
  There are relatively few published epidemiological studies that have correlated pitching-related risk factors with increased pitching-related arm problems as well as injuries.
  
  
  OBJECTIVE
  High pitching volume and limited recovery will lead to arm fatigue, thus placing young pitchers at a greater risk for elbow and shoulder problems and, subsequently, an increased risk for arm injuries.
  
  
  METHODS
  Cross-sectional study; Level of evidence, 3.
  
  
  METHODS
  A national survey was conducted among 754 youth pitchers (ages 9 to 18 years) who had pitched in organized baseball leagues during the 12 months before the survey. Self-reported risk-prone pitching activities were identified and compared with recommendations by the American Sports Medicine Institute. Relationships between self-reported pitching activities, shoulder and elbow problems, and injuries were assessed using multivariable logistic regression.
  
  
  RESULTS
  Of the 754 participating pitchers, 43.4% pitched on consecutive days, 30.7% pitched on multiple teams with overlapping seasons, and 19.0% pitched multiple games a day during the 12 months before the study. Pitchers who engaged in these activities had increased risk of pitching-related arm pain (odds ratio [OR] = 2.53, 95% confidence interval [CI] = 1.14-5.60; OR = 1.85, 95% CI = 1.02-3.38; OR = 1.89, 95% CI = 1.03-3.49, respectively). Nearly 70% of the sample reported throwing curveballs, which was associated with 1.66 (95% CI = 1.09-2.53) greater odds of experiencing arm pain while throwing. Pitching-related arm tiredness and arm pain were associated with increased risk of pitching-related injuries. Specifically, those who often pitched with arm tiredness and arm pain had 7.88 (95% CI = 3.88-15.99) and 7.50 (95% CI = 3.47-16.21) greater odds of pitching-related injury, respectively. However, pitching on a travel baseball club, playing baseball exclusively, or playing catcher were not associated with arm problems.
  
  
  CONCLUSIONS
  The results of this study, along with those of others, reinforce the importance of avoiding risk-prone pitching activities to prevent pitching-related injuries among youth pitchers.
authors.affiliation: Department of Social and Behavioral Sciences, Kent State University, Kent, Ohio, USA.
authors.forename: Jingzhen
authors.initials: J
authors.lastname: Yang
authors.affiliation: American Orthopaedic Society for Sports Medicine, Rosemont, Illinois, USA bart@aossm.org.
authors.forename: Barton J
authors.initials: BJ
authors.lastname: Mann
authors.affiliation: Performance Orthopedics, Troy, Michigan, USA.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Guettler
authors.affiliation: American Sports Medicine Institute, Birmingham, Alabama, USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Dugas
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Irrgang
authors.affiliation: American Sports Medicine Institute, Birmingham, Alabama, USA.
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Fleisig
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Albright
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000453:epidemiology; D001484:Baseball / Q000293:injuries* / Q000706:statistics & numerical data; D002648:Child; D003430:Cross-Sectional Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D000070599:Shoulder Injuries; D013178:Sports Medicine; D014481:United States; D000092464:Elbow Injuries
keywords: pitching injuries; risk factors; youth baseball