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May 3, 2022

Throwing Limits and Rest Days Important For Young Pitchers

ThedaCare Physical Therapist Explains how to Help Prevent Muscle Weakness and Overuse Injuries  

With recent health studies indicating that more than 50% of youth sports injuries are related to muscle overuse, it’s important that parents and coaches are aware of how much pitching and throwing activity young softball and baseball players engage in. 

“Overuse and muscle weakness are the primary cause of many injuries we treat in young athletes,” said Aaron Nelson, PT, DPT, CMTPT, a physical therapist with ThedaCare Orthopedic Care. “Many injuries occur from weakness in the shoulder girdle/shoulder blade muscles and not having enough stability in muscles near the spine to support the high-level task of dynamic overhand or underhand throwing.”   

He noted that many body parts are involved with throwing and pitching, including the athlete’s arm, shoulder, spine-supporting muscles, neck, hips and knees.  

According to the National Institutes of Health (NIH), the prevalence of injuries (in youth) may be attributed to the combination of an underdeveloped musculoskeletal system, increased participation in competitive sports at a younger age, and increased duration and intensity of training. 

Some of the most common injuries affecting young players include: 

  • Growth plate injuries 
  • Shoulder pain or “Little League Shoulder” 
  • Rotator cuff problems 
  • Ulnar collateral ligament injuries (Little League elbow) 

Nelson observed that many kids play multiple sports, while others may focus on one specific activity.  

“Those who play multiple sports may not have the opportunity to participate in open gyms or other activities to get their arms ready for throwing,” said Nelson. “While athletes who focus on one sport like baseball or softball, may need some overall body toning in addition to getting their arms ready for throwing.” 

He noted that it’s not just pitchers who may suffer throwing injuries.  

“Any and all throwing an athlete does should be considered as part of ‘pitch counts,’” he said. “What is helpful is the development of wearable technology that is now available that keeps track of throwing activity. Those are being used more often.”  

Nelson recommended the Pitch Smart program ( as a guideline for how often and how long youth of various ages should throw pitches. If kids play on multiple teams, their parents/guardians should keep track of their overall throwing activity.  

Nelson also cautioned that it’s important to consider all of the throwing a player may do.  

“Especially in Little League games, kids may play all over the field,” he explained. “They may pitch for a while, then play in the infield or outfield. Even the throwing they do pre-game or in different drills during practices should be considered as part of the pitch count to determine when they need a day of rest.” 

Preventing Injury 

As with most sport activities, a proper warm up prior to a game is essential, and Nelson advises a full-body warm-up for softball and baseball.  

“A pre-game warm-up should include light jogging, side shuffles, a high knee run, trunk rotation and upper extremity strengthening to get blood flowing to all the muscles,” he said. “There are also programs to help kids prepare their arms for pitching. The exercises address the muscle groups in the shoulders and arms that tend to be weak, including the smaller muscles that otherwise might not get a good workout.” 

He added that improving throwing also requires strengthening activities.  

“We have started adding weighted balls to our exercise program for throwers, starting small with 100 grams (100g), working up to 1,000g for youth, 2,000g for high school to college, adding weight as their strength increases,” he said. “We want to make sure kids are focusing on the smaller muscles in their arms and shoulders. If we add weight too quickly, the larger muscle groups tend to take over, and the smaller muscles don’t get the workout they need.” 

Nelson also stressed the importance of rest and proper nutrition, including drinking plenty of fluids, for young athletes. He noted the recommendation that young athletes rest at least one day per week with no games or practices. 

Time to See a Doctor 

If an athlete is having trouble with his or her mechanics, they may seek help from a physical therapist specializing in sports training, making them good resources. Anytime an athlete experiences sharp pain while throwing, it’s time to consult a doctor. 

“There should not be pain with throwing, whether it’s in the neck, shoulder, elbow, forearm or back,” he said. “Pain is not normal; muscle soreness is normal, but pain should be checked out.” 

Next, he advised if parents and coaches notice changes in a kid’s throwing mechanics they should talk with them about what they are experiencing.   

“Maybe they are not making throws across the infield like they did, or are having a harder time making pitches they can normally make or it looks like they’re changing up their mechanics for no known reason,” he said. “That’s an indication there may be a problem. Oftentimes kids don’t want to admit there’s a problem for fear they won’t be able to keep playing. As parents, we tend to know our kids best, so when we see different behavior or mechanics, we should ask why.” 

Nelson said ignoring a problem generally only makes it worse and often ends up involving other areas of the body.  

“Maybe the issue started as elbow pain because the shoulder had some weakness, but now their neck and back are involved because they’ve been compensating on how they’ve been throwing,” he explained. “If we take care of the original problem early, we may be able to address their problem and keep them playing while having improvement in their symptoms at the same time. It’s likely that the longer we wait to address a problem, the longer the treatment plan will be because there’s more involved.”  

Looking Ahead: ThedaCare Medical Center–Orthopedic, Spine and Pain  

Nelson is looking forward to the new ThedaCare Medical Center–Orthopedic, Spine and Pain, which is expected to open soon. This will be the region’s only comprehensive health center specializing in orthopedic, spine and pain care. The 230,000 sq. ft. Center includes a medical office building, specialty surgery center, and orthopedic and spine hospital with 25 in-patient beds, as well as support services, such as imaging, lab, retail pharmacy and dining, for total patient care at a single destination.  

The services offered will enhance access to specialized experts, where care teams understand each person’s unique medical background, lifestyle and personal goals, getting patients back to living their best life, sooner – including youth who might be experiencing a pitching injury. 

“At the new Center, our therapy facilities will include a regulation pitcher’s mound, a turf area and extended netting so we can focus on pitching and batting mechanics,” he said. “We can create videos of an athlete’s technique, which we can slow down, and then discuss areas of opportunity for improvement. The new technology will help us provide better care for our athletes and our patients.”  

Among the many unique features at ThedaCare Medical Center–Orthopedic, Spine and Pain, our patients will benefit from surgery suites with the latest technology, private recovery rooms and state-of-the-art physical therapy equipment and facilities. The new facility will allow patients to access even greater integrated care. From the initial consultation to surgery, recovery and rehabilitation – it will all be available at the new location, which will make treatment even more comprehensive and convenient for patients 

ThedaCare Medical Center–Orthopedic, Spine and Pain is expected to open in summer 2022. 

About ThedaCare 

For more than 110 years, ThedaCare® has been committed to improving the health of the communities it serves in northeast and central Wisconsin. The organization delivers care to more than 600,000 residents in 18 counties and employs approximately 7,000 health care professionals. ThedaCare has 180 points of care, including seven hospitals. As an organization committed to being a leader in Population Health, team members are dedicated to empowering people to live their best lives through easy access to individualized care, supporting each person’s own health and wellbeing. ThedaCare also partners with communities to understand unique needs, finding solutions together, and encouraging health awareness and action. ThedaCare is the first in Wisconsin to be a Mayo Clinic Care 

Network Member, giving specialists the ability to consult with Mayo Clinic experts on a patient’s care. ThedaCare is a not-for-profit health system with a level II trauma center, comprehensive cancer treatment, stroke and cardiac programs, as well as primary care.