Ultimately the goal with pitchers of all levels is to prevent injury to the arm. Elite Sports Medicine and Orthopaedic Center’s Dr. Burton Elrod explains that with high level athletes (amateur or professional) there is a fine line between maximum performance and injury. The goal is to maximize your ability and potential while at the same time taking the necessary precautions to avoid injury. The American Sports Medicine Institute has come with recommendations for both professional pitchers and youth baseball pitchers to reduce the risk of Tommy John injury.

The following recommendations are taken directly from the American Sports Medicine Institute’s (ASMI) position paper for youth baseball pitchers:

•    Watch and respond to signs of fatigue (such as decreased ball velocity, decreased accuracy, upright trunk during pitching, dropped elbow during pitching, or increased time between pitches). If a youth pitcher complains of fatigue or looks fatigued, let him rest from pitching and other throwing.
•    No overhead throwing of any kind for at least 2-3 months per year (4 months is preferred). No competitive baseball pitching for at least 4 months per year.
•    Do not pitch more than 100 innings in games in any calendar year.
•    Follow limits for pitch counts and days rest. (See Below)
•    Avoid pitching on multiple teams with overlapping seasons.
•    Learn good throwing mechanics as soon as possible. The first steps should be to learn, in order: 1) basic throwing, 2) fastball pitching, 3) change-up pitching.
•    Avoid using radar guns.
•    A pitcher should not also be a catcher for his team. The pitcher-catcher combination results in many throws and may increase the risk of injury.
•    If a pitcher complains of pain in his elbow or shoulder, discontinue pitching until evaluated by a sports medicine physician. Inspire youth pitchers to have fun playing baseball and other sports. Participation and enjoyment of various physical activities will increase the youth’s athleticism and interest in sports.

I find the recommendation to avoid radar guns particularly interesting. As a culture we tend to like statistics in sports. We often ask about athletes- how much can they lift, how fast are they, how far than they hit it, how hard can they throw, etc…I am guilty of this too. Often when an athlete comes to our office I ask how hard they can throw. I really just ask because it is a conversation starter. The answer to that question will likely not affect the course of treatment or my evaluation of that player. However, by asking the question I have placed an emphasis on velocity. Velocity should not be a pitcher’s (or my as a medical provider) number one priority. The number one priority should be placed on getting batters out. Chris Heston of the San Francisco Giants recently threw a no hitter against the New York Mets while never topping 91 mph on the radar gun, proving you do not have to throw in the upper 90 mph’s to be an effective pitcher.

Below is a table with recommended guidelines for limiting the number of pitches thrown in games. This is taken directly from the American Sports Medicine Institute’s position paper for youth baseball pitchers:


In addition there is a very helpful smart phone app available. Throw Like a Pro: Throw Faster, Stronger, and Safer (by Abracadabra Health) is a $10 app designed by Dr. James Andrews and physical therapist Kevin Wilk. The app includes in season and off season strength work, pitch counters, and long toss programs that are in line with the ASMI’s recommendations.
It is my hope that over this three part Tommy John series you more informed about what exactly a Tommy John injury is, why we have seen an increase among Major League players, common myths associated with this injury, and ways to help prevent this injury.

One last thing – Let us help! I know that people generally get anxious about going to see a doctor. There is always a fear that the physician may give you bad news or recommend that you to stop doing something you really enjoy. That is not our goal at Elite Sports Medicine and Orthoapedic Center. Our mission is to provide unsurpassed orthopaedic care to our patients so that they may pursue and maintain more active and healthy lifestyles. Ourgoal is always for you or your child to continue participating in the sports and activities you enjoy, but we want that participation to be as safe and injury free as possible.

If you have any orthopaedic need please contact our office at 615.324.1600 and schedule an appointment with us today!

Stephen Hasselbring, PA-C
Physician Assistant to Dr. Burton Elrod.