Safety of Heavy Ball Training and Max Effort Long Toss for Pitchers Under 12 Years Old

Introduction:
The safety of heavy ball training and max effort long toss for young pitchers under 12 years old is a topic of concern due to the potential risk of injury to the shoulder and elbow. Research on this subject has provided insights into the biomechanics, risks, and guidelines for safely training youth baseball pitchers.

Evidence:

1. Heavy Ball Training:

• An increase in ball weight correlates with greater medial elbow torque, decreased pitch velocity, and decreased arm speed among youth pitchers aged 9-14 years (Okoroha et al., 2019).
• Using lighter baseballs (e.g., 3 to 4 ounces) instead of heavier weighted balls can increase pitch velocity without increasing the injury risk to the shoulder or elbow (Erickson et al., 2020).
• Training programs with lighter baseballs did not report any injuries, suggesting a safer alternative to heavy ball training (Erickson et al., 2020).

1. Max Effort Long Toss:

• Maximum-distance long-toss throws produce increased torques and changes in kinematics, particularly at the shoulder and elbow, which may increase injury risk (Fleisig et al., 2011).
• When players throw at reduced perceived effort, their actual throwing metrics do not decrease at the same rate, leading to potentially higher elbow stress than intended during rehabilitation and training (Melugin et al., 2019).
• A gradual increase in throwing distance with controlled effort is recommended to minimize injury risk (Slenker et al., 2014).

1. General Injury Risk for Youth Pitchers:

• Youth pitchers who exceed 100 innings per year or engage in more strenuous throwing activities (e.g., max effort long toss) have a higher risk of serious shoulder and elbow injuries (Fleisig et al., 2011).

Conclusion:
Heavy ball training, especially with increased weights, and max effort long toss both carry an increased risk of injury for pitchers under 15 years old. Safer alternatives include using lighter baseballs and adopting controlled, gradual throwing programs. Coaches and trainers should focus on pitch count limits, proper mechanics, and avoiding maximum effort throws in young athletes to reduce the risk of overuse injuries.

Introduction:
The safety of heavy ball training and max-effort long toss for pitchers 13- 18 years old is a debated topic in sports medicine. While these training methods may offer performance benefits (controversial), they also carry potential injury risks, particularly to the shoulder and elbow joints of young athletes.

Evidence:

1. Risk of Increased Elbow and Shoulder Stress:
   Max-effort long toss and heavy ball training have been associated with increased shoulder internal rotation torque and elbow varus torque, which could elevate the risk of injury. A study by Fleisig et al. (2011) found that maximum-distance long-toss throws increased torques and changes in kinematics, suggesting caution when using these throws in rehabilitation and training (Fleisig et al., 2011).
2. Heavy Ball Training and Injury Rates:
   Weighted ball velocity (WBV) programs, which involve heavy ball training, have shown a 24% increase in injury rates among 13-18-year-old baseball pitchers, despite improved throwing velocity. This finding indicates a trade-off between performance gains and safety risks (Zaremski, 2020).
3. Throwing Effort and Elbow Torque:
   Studies show that perceived reduced effort does not match actual reductions in elbow torque and ball velocity, meaning young athletes may unknowingly place excessive stress on their arms even when attempting to throw at less than maximum effort (Melugin et al., 2019).
4. Medial Elbow Torque with Heavy Balls:
   Research on youth pitchers demonstrated that increasing the ball weight led to higher medial elbow torque, which can contribute to overuse injuries (Okoroha et al., 2019).
5. Safe Training Recommendations:
   Studies recommend structured interval throwing programs that avoid maximum effort in early stages and emphasize gradual progression. The "throw to the target, not through the target" approach is suggested to reduce stress on the shoulder and elbow during throwing programs (Slenker et al., 2014).

Conclusion:
While heavy ball training and max-effort long toss may enhance performance metrics such as throwing velocity (through the artificial increase in shoulder external rotation), they also significantly increase the risk of shoulder and elbow injuries in youth pitchers. Caution, structured programs, and gradual progression with careful monitoring of mechanics and intensity are critical to ensure safety for athletes under 18 years old.