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Baseball and softball players are busy during the summer season, but many play year-round on club and travel teams. That can take a toll, and the increase in shoulder and elbow injuries proves it.

UR Medicine Sports Medicine surgeon Dr. Mike Maloney has even had young athletes and their parents asking him for Tommy John surgery—designed to repair a torn elbow ligament—before they’re injured, in the mistaken belief that it can make them throw harder.

Maloney and Conner Lorenzo, director of operations at UR Medicine Fitness Science, talk about sports injuries from overuse in throwing athletes and what they and their parents can do to help prevent injuries and health issues later in life.

You’re seeing more young athletes come to you with shoulder injuries and elbow injuries. Why is this happening?

So much of it stems from overuse. Young throwing athletes have growth plates that have not fully formed in their elbows and shoulders; these are under a great deal of stress from powerful forces involved in throwing baseballs or softballs. Athletes face pressure to throw the ball harder and harder to boost their pitch speeds. And they are playing much more often and more intensely than their parents’ generation did.

Do pitch count limits help prevent injury?

Lorenzo: Yes, those are important safeguards—as long as athletes follow them. Throwing creates micro-trauma to the entire shoulder area. Many young athletes are over-training: in addition to practices and games, many go to a pitching coach to focus on throwing faster and harder. Then they practice pitching on their own. Add all that to the practices and games they play throughout the week, and they’re overdoing it.

Do you really have athletes and their parents ask you for Tommy John surgery when they aren’t even injured?

Maloney: Yes, it happens. Some as young as middle schoolers have asked for the surgery because they’ve heard it will help them throw harder. That’s a misconception.

When pitchers throw repeatedly, they stretch out that ulnar collateral ligament; Tommy John surgery tightens the ligament back to normal and, after rehab, pitchers regain throwing strength. But the surgery can’t give you more power than you had to begin with. It’s just not realistic to put a young athlete through that surgery when sensible steps can protect their health and make them better athletes in the long run.

What’s the answer to preventing these shoulder and elbow injuries?

Maloney: Appropriate conditioning, nutrition, and rest are the best tools to keep athletes playing their best, and to keep them healthy for many seasons to come. For young athletes, especially those with open growth plates in their elbows and shoulders, they need to have a period where they refrain from throwing, probably for three months every season.

Does a rest period interfere with an athlete's progress in their sport?

Maloney: That’s the pressure they are under—chasing the short-term goal of making a team and getting play time. Many athletes aim to play at the collegiate level and feel they can’t slow down.

However, they have to realize that by playing with high intensity all year long, from age 8 to 18, they’re putting themselves at high risk of injury. And they need to remember that an injury can keep them out of athletics for months or prematurely end their competitive career.

How should an ambitious young athlete approach this, then?

Lorenzo: Younger athletes can focus on strength and conditioning as their foundation, rather than simply working to throw harder and faster. Too often, we hear about athletes throwing weighted balls or doing a crushing workout regimen without supervision. It’s better to build your body strength appropriately for your age and learn proper form to maximize the speed and accuracy of your throws.

Can shoulder exercises and elbow exercises help prevent injury?

Lorenzo: At Fitness Science, for throwing athletes, we focus on conditioning the shoulder, elbow, and lower body. We want to make sure the muscles and connective tissues throughout the shoulder and arm are sufficiently strong and flexible to withstand the stress they take. And for the lower body, we make sure they have strong legs to translate to their throwing power and not just rely on their arm.

What other advice do you have for players and parents?

Maloney: In addition to resting from your primary sport, it’s also beneficial to play a different sport so you’re cross-conditioning. That improves your overall athleticism and your mindset as you learn new skills and make new friends and teammates.

How does sports psychology fit into this?

Mindset is very important; I’ve seen many cases of athletes burnout from year after year of rigorous focus on just one sport.

More information on the Fitness Science program can be found here.