PITCH SMART RECOMMENDATIONS FOR YOUTH BASEBALL

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Young pitchers are at risk for arm injuries due to a number of factors, and pitching while fatigued is perhaps the biggest risk for injury
  • MLB’s Pitch Smart guidelines are designed to reduce injury risk while still allowing for the competitive development of the young player.
  • Parents, coaches, and league administrators would be wise to implement the Pitch Smart recommendations for their pitchers

As spring and summer baseball is ramping up, I’d like to remind our readers of a terrific Grant Lewisresource for the young pitcher- MLB’s Pitch Smart guidelines. I’ve written about pitch counts, the “100 inning rule”, and pitching injuries in several other blog posts but it is worth pointing out some of the reasons why we should revisit this topic. Pitch Smart is an effort by Major League Baseball to critically evaluate factors responsible for injury risk to young pitchers and then create guidelines to minimize that risk. Pitch Smart is partnered with many of the brightest minds in sports health for throwers and has produced a set of recommendations based on evidence and experience.

The result of their effort is a set of age appropriate recommendations designed to keep young pitchers as healthy as possible.

We’ve definitely made progress in recognizing and putting in place recommendations to reduce injury risk, but as the website points out we still have some work to do. For example, a survey of youth pitchers published in 2014 showed that of the pitchers responding to the survey many were engaging in behaviors that risk the health of their arms:

  • 45% pitched in a league without pitch counts or limits
  • 5% pitched on consecutive days
  • 4% pitched on multiple teams with overlapping seasons
  • 2% pitched competitive baseball for more than 8 months per year

Those published statistics are a few years old and hopefully we’ve made some progress in this area thanks to the efforts of Pitch Smart and others.

Take a look at the age-specific guidelines. They are divided into 5 age groups. For example, in the 15-18 year group which would cover most of our high school aged athletes some of the key recommendations are:

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Players can begin using breaking pitches after developing consistent fastball and changeup

  • Do not exceed 100 combined innings pitched in any 12 month period
  • Take at least 4 months off from competitive pitching every year, including at least 2-3 continuous months off from all overhead throwing
  • Make sure to properly warm up before pitching
  • Set and follow pitch-count limits and required rest periods
  • Avoid playing for multiple teams at the same time
  • Avoid playing catcher while not pitching
  • Players should not pitch in multiple games on the same day
  • Make sure to follow guidelines across leagues, tournaments and showcases
  • Monitor for other signs of fatigue
  • A pitcher remaining in the game, but moving to a different position, can return as a pitcher anytime in the remainder of the game, but only once per game
  • No pitcher should appear in a game as a pitcher for three consecutive days, regardless of pitch counts

In my opinion, Pitch Smart’s recommendations are another example of much neededSideLineSportsDoc changes designed to keep young players playing longer and healthier. These are recommendations rather than rules, but if you are a league administrator I’d urge your league to have a close look at these recommendations and adopt them for your players.

Tips to Help Student Athletes Reach Peak Performance

Tips to Help Student Athletes Reach Peak PerformanceBy Athletico Physical Therapy

The Fall sport season is right around the corner! With the start of a new school year and a new sports team, the beginning of the season can be tough. Regardless of what sport is being played, there are many factors that can help student athletes have a great tryout and season, including the four tips outlined below.

ShoesProper equipment and gear at the start of the season can be a great way to prevent injuries and help athletes get an extra performance boost! Shoes are known for enduring lots of wear and tear. Worn out shoes can potentially cause foot pain and lead to overuse injuries that inhibit athletic ability. Investing in new shoes can provide athletes with more comfort, allowing them to reach peak performance. However, it is important to break in new shoes before playing in them. Doing so can help to prevent blisters and other discomfort that could occur.

Sleep: Getting a good night sleep helps athletes feel rested and ready for early morning trainings! Sleeping is essential for helping the body recover. In fact, the National Sleep Foundation notes that when sleep is cut short, the body doesn’t have enough time to complete all of the phases needed for things like muscle repair or memory consolidation. This is why it is important for athletes to gain enough shuteye before tryouts, practice and games!

Nutrition: As the season begins, the importance of nutrition should be remembered. Eating consistent healthy meals helps fuel the body and provides energy that is needed to perform. Athletes should focus on consuming enough carbohydrates from the proper sources. Good food sources include pasta, bread, cereal, fruit and vegetables. Carbohydrates are a significant contributor to an athlete’s energy, so it is important to eat the right amount. Protein can also influence performance and help the body maintain its strength. A few good sources of protein include meats, fish, beans, eggs and milk. By having a balanced diet, athletes will have the energy needed to succeed.

HydrationHydration is another aspect of nutrition that can affect performance. It is important to stay ahead of dehydration by drinking water consistently throughout the day. Athletes should always have a water bottle handy, including at practices so that enough fluids are consumed during physical activity. Since the recommendations for staying hydrated vary from person to person, consider learning more about sweat rate by reading Athletico’s “Hydration for Performance and Health.

Reaching Peak Performance

Student athletes have a lot to focus on during the school year. These tips can help athletes stay healthy and reach their peak performance for tryouts and games. Should any aches or pains during training occur, make sure to schedule a complimentary injury screen at your nearest Athletico so you can get back in the game as soon as possible.

Schedule a Complimentary Injury Screen

Counsel patients, parents on concussion risks in football

iStock-471035985.jpgDrs. Anthony Romeo and Gregory Cvetanovich co-authored this articlein Orthopedics Today about the rising awareness and reported incidences of concussion and how parents, athletes and coaches should be more careful about making informed decisions about play and return to play. They added that orthopedic physicians have a responsibility to share information regarding the risks of contact sports.


There has been increased awareness of sports-related concussions and risks associated with head trauma. The reported rates of concussions have doubled during the past decade, especially among youth and high school athletes. Much of the increase is attributable to greater recognition and diagnosis, as well as more media attention.

Among youth and high school athletes, American football has the highest risk of concussions, accounting for almost half of sport-related concussions in United States and the highest rate of concussions per player. Male athletes have more concussions overall due to greater participation in contact sports, however, female athletes are diagnosed with almost twice the rate of concussions compared with males in comparable sports, such as soccer. Younger athletes may have greater susceptibility to concussions, risk of recurrence, chance of second impact syndrome, as well as prolonged symptoms and recovery.

Risks of concussions

Treatment of concussions in young athletes consists of cognitive and physical rest along with symptom management. Short-term concussion risks include prolonged symptoms consistent with post-concussive syndrome and rare, but potentially fatal, second impact syndrome if the athlete sustains a second head injury too soon after the first. Patients with prior concussions are also at two- to five-times greater risk of sustaining another concussion. Long-term concerns include reported increased rates of dementia and depression potentially related to chronic traumatic encephalopathy (CTE).

In a published study, researchers analyzed the brains of 202 deceased football players. They found an overall 87% rate of CTE on neuropathology. Former high school players had a 21% rate of mild CTE, and the rates of CTE increased based on highest level of play to 99% of former National Football League (NFL) players who had predominantly severe CTE on pathology.

The study had limitations, but it was proposed that CTE may be related to repeated blows to the head in football and the severity may increase as athletes reach high levels of play. Many questions remain about the impact of early exposure to head impacts from youth football and of hits sufficient to result in clinical diagnosis of concussion vs. clinically silent subconcussive hits.

Due to these concerns, football leagues of all levels, as well as those of other sports, have made rule changes designed to reduce head injuries. Many of the interventions have had success in reducing the rate of concussions, although the effect on potential long-term cognitive effects of repeated head trauma and rates of CTE remain unknown. Some rule changes have been shown to have paradoxical increases in rates of concussions, which more likely reflect simultaneously increasing awareness of concussions among players, coaches, trainers and team physicians, rather than a causative relationship of the rule changes and increased concussions. Equipment changes, such as improved helmets and increased use of mouth guards have been made, but show mixed data on their impact on concussion rates.

Counseling patients, parents

As orthopedic sports medicine physicians, we should have a low threshold to suspect and diagnose concussions in athletes in conjunction with trainers and other health care providers. Patients should be removed from play to prevent further injury and allowed to undergo appropriate concussion treatment prior to consideration of return to play. A multidisciplinary team approach can be valuable, particularly in patients with prolonged or recurrent concussion symptoms.

Athletes recovering from concussions along with their parents, in the case of youth athletes, should be advised that certain contact sports are associated with elevated risk of concussion. This risk is inherent to contact sports despite attempts to reduce risks with rule changes, equipment modifications and coaching. Once an athlete is symptom-free and completes a concussion protocol, return to play may be considered as a shared decision with patients and parents.

Counseling patients and families on the long-term risks of single or repeated concussions is more challenging, including risks for cognitive, behavioral and mood disorders and neurodegenerative changes of CTE. Patients should be informed that the growing evidence connects CTE and its associated symptoms to football, particularly prolonged and high-level play.

Existing data make it impossible to project these risks for an individual athlete with a concussion or repeated subconcussive hits to the head. Furthermore, it is unclear how early participation in football and concussions sustained in youth and high school football influence long-term cognitive function. However, we owe it to our patients to discuss the potential risks although we cannot provide firm guidelines about number of concussions or head impacts after which they should consider not returning to play.

Despite uncertainty about long-term and patient-specific risks, the decision to participate in contact sports comes down to an informed decision by patients and parents. Orthopedic sports medicine physicians should provide information about the current understanding of the risks, which patients and parents can use to make decisions about what short- and potential long-term risks are acceptable.                       

Billy Garrett Jr. thrives in defiance of Sickle Cell Disease; Transform your Health with the Toxin Take-down Course

Episode 17.20 with Hosts Steve Kashul and Dr. Brian Cole. Broadcasting on ESPN Chicago 1000 WMVP-AM Radio, Saturdays from 8:30 to 9:00 AM/c.

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Segment One (01:33): Billy Garrett Jr. talks with Steve and Dr. Cole about his Sickle Cell condition, how he trains and has played at the highest level at DePaul University and now currently with the NY Knicks G League. The 6-foot-5 Chicago native has the “SC” form of sickle cell disease, statistically milder than the “SS” form. It is different from sickle cell trait, which can cause muscle breakdown during intense exercise.

Billy Garrett Jr.

Garrett Jr.’s condition, in short: Red blood cells mutate into a “sickle” shape to clog vessels and limit blood flow. This can cause extreme pain emanating from joints or, worse, damage to organs. Each of these episodes is called a crisis. Triggers include stress, a lack of rest, cold temperatures (that constrict blood vessels) and dehydration — all of which describe the daily working conditions of an athlete playing high-level basketball.


Segment Two (15:20): Karen Malkin from Karen Malkin Health Counseling talks about the various program levels and resources available to improve your health, your life and improve the environment.

The 14 Day Transformation Program, the Foundation Program, Master Your Metabolism Program and announcing her new Toxic Takedown Course to be launched in October.

The new program educates you on how to reduce the toxic load in your food and environment and eliminate damage from free radicals. Karen encourages all of us to visit ewg.org which provides a wealth of resources to help us live better and protect the environment.

The Environmental Working Group’s mission is to empower people to live healthier lives in a healthier environment. With breakthrough research and education, we drive consumer choice and civic action.