| September 15, 2025
As a former collegiate baseball player turned physical therapist, I’ve seen the game from both sides. I’ve felt the thrill of striking out the side, and I’ve experienced the despair of arm pain that threatens to end it all. Now, as a Doctor of Physical Therapy, I spend my days helping young athletes avoid the mistakes that derailed so many careers—including almost my own.
If you’re a baseball parent, this guide is for you. Let’s talk about what’s really happening with your young athlete’s arm and how to keep them healthy for the long haul.
The Youth Baseball Epidemic
The statistics paint a sobering picture of what’s happening to our young baseball players. Half of all youth pitchers now report experiencing arm pain during their season, a number that should alarm every parent and coach. Tommy John surgeries in athletes under 18 have skyrocketed by a staggering 500% in just the last two decades, transforming what was once a rare professional athlete procedure into an increasingly common high school experience. Perhaps most concerning, 40% of youth players who experience arm pain will continue to have recurring issues throughout their careers, creating a cycle of dysfunction that can last for decades. The average age of first UCL reconstruction has dropped to just 16.7 years old, meaning we’re performing major elbow surgery on kids who should be focusing on their junior year of high school.
These aren’t just numbers—they represent dreams deferred and careers cut short. The good news? Most of these injuries are entirely preventable.
Understanding the Growing Athlete
Youth athletes aren’t just small adults. Their bodies are still developing, which creates unique challenges:
Growth Plates
Until around age 16-18, bones are still growing from areas called growth plates. These areas are weaker than mature bone and more susceptible to injury from repetitive stress. That “minor” elbow pain could actually be a growth plate injury that requires immediate attention.
Muscle Development
Young athletes often develop throwing velocity faster than their supporting muscles can handle. A 12-year-old who suddenly gains 5 mph on their fastball needs proportional strength gains to handle that increased force.
Coordination Changes
Growth spurts can throw off mechanics as limbs lengthen at different rates. That smooth delivery can become awkward overnight, increasing injury risk.
The Real Culprits Behind Arm Injuries
Contrary to popular belief, curveballs aren’t the primary villain (though poor mechanics with any pitch are problematic). The real culprits are:
1. Overuse
Overuse manifests in multiple dangerous ways that parents often don’t recognize until it’s too late. Many young athletes now play year-round without adequate rest periods, treating baseball as a 12-month sport when their bodies need seasonal breaks for recovery and development. Pitching for multiple teams simultaneously has become common, but without coordinated pitch counts between coaches, young arms face cumulative stress that no single coach realizes is occurring. Most concerning is the failure to track total throw counts across both practice and game situations, meaning a pitcher might throw 200+ times in a single day between bullpen sessions, practice, and games. Weekend tournaments with unlimited inning requirements compound these issues, creating scenarios where young arms face impossible demands in short time frames.
2. Poor Preparation
Poor preparation creates the perfect setup for injury through several common oversights. Many young players skip proper warm-up routines before throwing, jumping straight into high-intensity throwing without preparing their bodies for the demands ahead. Specific arm care exercises that professional players consider non-negotiable are often neglected entirely at the youth level, leaving supporting muscles weak and unprepared. Insufficient general strength training fails to provide the foundation needed to support throwing mechanics, particularly in the legs and core that generate most throwing power. Perhaps most overlooked is flexibility work that maintains essential shoulder and hip mobility, as tight joints force other areas to compensate in ways that increase injury risk.
3. Mechanical Flaws
Mechanical flaws develop through predictable patterns that increase injury risk significantly. Young pitchers often rush their delivery in an attempt to throw harder, disrupting the timing and sequencing that protect their arms. Many fail to properly involve their lower body in the kinetic chain, forcing their arm to generate power that should come from their legs and hips. Rotating the shoulder too early in the delivery is another common flaw that disrupts proper sequencing and places dangerous stress on the elbow. These mechanical breakdowns often lead to an incorrect arm path that places excessive stress on the elbow joint, setting up conditions for both acute and overuse injuries.
4. Cultural Pressure
Cultural pressure in youth baseball creates some of the most dangerous situations young athletes face. The pervasive “tough it out” mentality teaches kids that admitting pain is weakness, leading them to hide symptoms until injuries become severe. Players develop an intense fear of losing playing time if they admit to any discomfort, creating a culture where honesty about pain is punished rather than rewarded. The modern showcase culture promotes maximum effort at all times, leaving no room for pacing or strategic rest during crucial developmental years. Early specialization pressure eliminates the necessary rest periods that come from playing multiple sports, forcing young arms to handle throwing stress year-round when they should have months of recovery.
Warning Signs Every Parent Should Know
Your child may not tell you they’re hurting. Watch for these signs:
Physical Signs:
Physical warning signs are often subtle but telltale indicators of developing problems. Watch for decreased velocity or control that persists beyond normal day-to-day fluctuations, as consistent performance drops often indicate underlying issues. Notice if your child starts rubbing or shaking their arm between pitches, a subconscious response to discomfort they might not even verbalize. Pay attention to noticeable changes in arm slot or mechanics, as the body often compensates for pain by altering movement patterns. Be concerned if they begin actively avoiding throwing activities during practice, especially casual catch play they previously enjoyed. Finally, increasing reliance on ice or heat packs after throwing often signals that recovery is becoming more difficult and inflammation is increasing.
Behavioral Signs:
Behavioral warning signs can be even more telling than physical symptoms, as young athletes often hide pain but can’t hide changes in behavior. Watch for reluctance to engage in casual catch play, something that should be effortless and enjoyable for any baseball player. Notice mood changes that occur specifically around game time, as anticipatory anxiety about pain can manifest as irritability or withdrawal. Be alert when they start making excuses to avoid pitching responsibilities, especially if they previously sought out those opportunities. Pay attention if they suddenly ask to play other positions without a clear developmental reason, as this often indicates they’re trying to avoid throwing stress. Most concerning is general withdrawal from a sport they previously loved, as this often signals that pain is affecting their enjoyment and relationship with the game.
The “Magic Words” to Listen For:
Young athletes have learned to use specific phrases that minimize their symptoms, and parents need to recognize the real meaning behind these common expressions. When they say “My arm is tired,” this almost always means they’re experiencing pain but don’t want to admit it or worry you. “It’s just tight” is rarely just tightness—tightness that affects performance or persists usually indicates underlying dysfunction. “It only hurts when I first start” is actually a classic early injury sign, as stiffness and pain upon initiating activity often precede more serious problems. Perhaps most deceptive is “It goes away once I warm up,” because the pain doesn’t actually disappear—they simply adapt to it and learn to play through it, masking symptoms while the underlying problem continues to worsen.
The Arm Care Non-Negotiables
Every baseball player needs these five components:
1. Dynamic Warm-Up (10-15 minutes)
Every throwing session, whether practice or game, requires a comprehensive dynamic warm-up that should never be rushed or skipped. This begins with general body movement to increase blood flow and core temperature throughout the entire system, not just the throwing arm. Arm circles and swings help mobilize the shoulder joint through its full range of motion, preparing it for the extreme ranges required in pitching. Band exercises specifically activate the rotator cuff muscles that stabilize the shoulder throughout the throwing motion, ensuring these small but crucial muscles are ready to do their job. Finally, a progressive throwing program gradually increases intensity and distance, allowing the arm to adapt to increasing demands rather than jumping straight into maximum effort throws.
2. Strength Training (2-3x per week)
Strength training for young baseball players should focus on the entire body rather than just the throwing arm, as throwing is a total-body athletic movement. Special emphasis should be placed on back and rotator cuff strengthening, as these areas support the shoulder throughout the throwing motion and are often underdeveloped in young athletes. Never forget that the legs and core provide the foundation for all throwing power—a strong lower body generates the force that the arm simply transfers to the ball. Always use age-appropriate resistance that prioritizes proper movement patterns and form over impressive weight numbers, as developing correct motor patterns is far more important than raw strength in growing athletes.
3. Flexibility Work (Daily)
Daily flexibility work is non-negotiable for baseball players and must address the specific demands of the throwing motion. Shoulder internal rotation stretches are essential to maintain healthy range of motion, as the throwing motion tends to create tightness that can lead to impingement and pain. Hip mobility exercises support lower body mechanics and ensure proper sequencing through the kinetic chain, as tight hips force compensation patterns that increase arm stress. Thoracic spine rotation stretches maintain proper trunk function, allowing the spine to rotate efficiently during the throwing motion. A general stretching routine targeting all major muscle groups ensures overall flexibility and helps prevent compensation patterns from developing anywhere in the system.
4. Recovery Protocols
Establishing proper recovery protocols is just as important as the training itself and should be treated with equal seriousness. Post-throwing routines should include ice application for 15-20 minutes after significant pitching sessions to manage inflammation and promote recovery. Rest days must be treated as absolutely mandatory rather than optional, as this is when the body adapts and strengthens from training stress. Adequate sleep of 8-9 hours nightly is crucial for young athletes, as growth hormone release peaks during deep sleep phases, making sleep one of the most important recovery tools available to growing bodies.
5. Pitch Count Guidelines
Follow USA Baseball recommendations, which have been developed based on extensive research into youth arm safety and development. For players aged 7-8 years, limit pitching to 50 pitches per game with a maximum of 2 games per week, allowing their developing arms to adapt gradually to pitching stress. Players aged 9-10 years can handle 75 pitches per game with up to 3 games per week, reflecting their increased development and strength. The 11-12 year age group can pitch up to 85 pitches per game with 3 games per week maximum, maintaining appropriate limits during crucial developmental years. Players aged 13-14 years can handle 95 pitches per game with up to 4 games per week, but these limits become even more important as throwing velocity and stress increase significantly.
Creating a Culture of Arm Health
As parents, you have more influence than you might think:
At Home:
Creating a culture of arm health starts at home with how you approach and discuss your child’s baseball participation. Make arm care exercises as routine and non-negotiable as brushing teeth, establishing them as part of daily life rather than something extra to fit in when convenient. Celebrate rest days as essential components of getting stronger, helping your child understand that recovery is when adaptation and improvement actually occur. Meticulously track pitches and throws across all activities, not just games, as practice throws and bullpen sessions contribute to cumulative stress just as much as game pitches. Focus your conversations on effort and improvement rather than just results and outcomes, reinforcing that development is a process that requires patience and consistency.
With Coaches:
Building positive relationships with coaches around arm health requires proactive communication and shared commitment to long-term development. Engage coaches by asking specific questions about their approach to arm health, pitch counts, and injury prevention, demonstrating that these topics are important to your family. Share your child’s complete throwing history including any previous issues, giving coaches the information they need to make appropriate decisions. Don’t be afraid to set protective limits when necessary, as you are ultimately responsible for your child’s long-term health and development. Actively support coaches who clearly prioritize long-term development over short-term wins, as these are the coaches who will help your child have a long, successful baseball career.
With Your Athlete:
Developing the right mindset in your young athlete is crucial for long-term success and health. Encourage completely honest communication about any pain or discomfort, creating an environment where admitting problems is rewarded rather than punished. Regularly remind them that professional athletes prioritize arm care as a fundamental part of their training, not as something extra or optional. Make physical therapy visits and assessments as normal and routine as batting practice, removing any stigma around getting professional help for their body. Consistently reinforce that baseball careers are marathons rather than sprints, helping them understand that longevity and development take time and patience.
When to Seek Help
The key to preventing serious injuries is acting quickly when warning signs appear, rather than waiting for severe pain to develop. Seek professional evaluation immediately if any pain persists more than 3 days despite appropriate rest and care, as persistent pain usually indicates an underlying issue that won’t resolve on its own. A velocity drop of more than 5 mph without clear explanation often signals mechanical problems or developing injury that needs attention. Notice if your child’s mechanics change noticeably in ways that seem designed to avoid discomfort, as compensation patterns often precede more serious problems. Most importantly, trust your parental instinct—if something doesn’t seem right about how your child is moving or performing, seek professional evaluation even if you can’t pinpoint exactly what’s wrong.
Early intervention typically means 2-3 weeks of modification. Waiting often means 2-3 months on the shelf.
The Insurance Advantage
Good news for parents concerned about costs: most insurance plans provide excellent coverage for physical therapy related to youth sports injuries and prevention. At Evo PT Group, we accept most major insurance plans and Medicare, making professional care accessible for families. Many modern insurance plans don’t require a physician referral for physical therapy access, allowing you to seek help directly when concerns arise. Preventive care is increasingly covered by insurance providers who recognize that early intervention costs far less than treating established injuries. Most importantly, early intervention saves significant money long-term compared to surgical treatment, making professional guidance both medically and financially wise.
Don’t let cost concerns delay getting help. We’ll verify your benefits and explain your coverage options.
The Long Game
Here’s what I tell every parent: The goal isn’t to be the best 12-year-old player—it’s to still be playing at 18, 22, or beyond. The players who make it aren’t always the ones who threw the hardest at 12; they’re the ones who stayed healthy.
Your child has thousands of throws in their arm. Our job—as parents, coaches, and healthcare providers—is to make sure they get to use them all.
A Personal Note
I almost lost baseball forever due to preventable injuries from poor training. Now, I’ve made it my mission to ensure no young athlete goes through what I did. Arm care isn’t optional—it’s essential. And it’s never too early or too late to start.
Take Action Today
Does your young athlete need an arm care program? Don’t wait for pain to start. Prevention is always better (and cheaper) than treatment.
Schedule an evaluation at Evo PT Group and let’s build a plan to keep them playing the game they love. We accept insurance, making professional care accessible for your young athlete.