On the way to our first social event as a first-year medical student, I was forever branded as a prude by one of my now best friends, who happens to be a pediatric orthopedic surgeon. My crime: yelling “Slow down you are driving too fast!” While he truly was driving too fast, at that age, I was unable to hold my tongue, and we both were too young and foolish to realize we were young and foolish. It is hard to show restraint with speed, especially when you are convinced that you know everything. Now years later in practice, it seems hard to make the same big statement about teens trying to throw as fast as their heroes in the big leagues. You are trying to throw too fast! Your body is too small and not finished developing! You need to be taller and have bigger muscles to throw that fast! This is what we want to say, but to be effective, we have to be more subtle with our conversations and need ammunition for the conversations.

We all know that we are in the middle of an epidemic with our youth throwers. Too many young athletes have elbow injuries, and it is unnerving at how young surgical indications can present. The sports development machine is partially to blame; it can chew athletes up in its processes. Increased competition has led to increased demands before athletes have reached their full adult size. Adolescents who are half the size of professional pitchers are trying to throw as fast as they see their idols throwing. And weighted baseball “training”dno need to go down that rabbit hole.

In order to win the battle of the minds of our young throwers, we need ammunition, aka evidence, that throwing too hard too soon in their career puts their future at risk. Saito, Okada, Sato, Shibata, Kamada, Namiki, and Terui, in their study, “Increased Medial Elbow Torque Is Associated With Ball Velocity Rather Than a History of Medial Elbow Injuries in Youth Baseball Pitchers,” give us more ammunition for the battle.¹ Higher ball velocity, in athletes with an average age of 10 years, was associated with higher elbow valgus torque.¹ Higher ball velocity, shoulder external rotation angle, and arm speed have been associated with increases in medial elbow torque.^2,3 These facts, combined with higher rates of injury in throwers with higher values of elbow valgus torque and higher ball velocity, are all the ammunition we need for conversations with our patients.^4,5 Limiting ball velocity in the young immature athlete will help us decrease elbow injuries in youth baseball pitchers.