Young Athletes

Tourney Time: Keys to Keeping Your Ballplayer Injury-Free During Playoff Season


With summer baseball/softball leagues as well as Little League and Cal Ripken League tournaments going on, many youth ball players have shifted from league play to tournament play. Tournament play presents unique challenges to keeping athletes healthy as it is a format many players are not accustomed too. Coaches and players often feel more pressure to win.  Having a child involved in tournament play myself and seeing some of the situations these kids are put in, I thought I would provide, based on the latest research, some things to watch out for that can lead to increased risk for injury.

Pitch Counts for Youth Baseball

These guidelines are based on extensive research and are widely considered the standard for youth baseball. You would think that these guidelines would be adopted in all youth tournament play, but unfortunately this is not the case. For example, see the pitch count regulations for Cal Ripken Baseball Tournament play below.

  • As you can see from the 9-12 year old regulations, a pitcher is allowed up to 40 pitches with no rest days required and 75 pitches with only 2 days rest required.  These tournaments often can go on for a week or more so you could be in a situation where your child is allowed to pitch up to 40 pitches on back-to-back-to- back-to-back days. This would never happen in the Major Leagues. How can it be permissible in youth baseball? A study in the American Journal of Sports Medicine in 2016 that looked at risk factors for “Tommy John” injury found that proper rest between pitching appearances can be just as important as following pitch counts. It is essential that parents and coaches are aware of this and make the right decisions for athletes.

Factors that Affect Pitch Counts

Though the pitch count guidelines above are helpful, there are factors that may reduce the number of pitches that should be thrown.

  • Stressful Innings: not all innings are created equal. There is definitely a difference in stress on a pitcher's arm between times when they are cruising along and throwing free and easily, and when they are having tough innings when they have runners on base and are throwing 20 pitches or more in an inning.  
  • Hot Days: on particularly hot or humid days, pitchers are more likely to become fatigued (more on fatigue later) which can cause their mechanics to break down and leave them at increased risk for injury.
  • Pitchers’ Physical Make Up: a pitcher’s size can relate to increased risk for injury in a way that may be counterintuitive to what you may think. A study in the medical journal Arthroscopy in 2015 showed that taller kids who throw harder are at increased risk for injury. It is recommended that coaches and parents are more careful with taller kids who throw harder.

Preventing Injury for Catchers and Fielders

  • Pitching and Then Playing in the Field: Particularly in the younger levels of youth baseball, the pitcher tends to be one of the best athletes on the field. You will often see coaches take kids from the mound when they are done pitching and put them at shortstop, 3rd base or, worst of all, catcher. Be careful with this practice, as you have to take into account the overall volume of throws the athlete is making. The safest practice if you are going to keep the pitcher in the game when they are done on the mound is to move him to the right side of the field, 1st base, 2nd base or right field.

  • Catcher: Though pitchers get much of the attention, catchers also are making a tremendous number of throws. Often catchers make many more throws than pitchers do in a given game and catchers may be asked to play multiple days in a row or even multiple games on one day. Care should taken as to the number of throws catchers are making and proper rest should be taken if catchers are starting to show signs of fatigue.

  • Middle of the Field:  A similar idea holds true with middle infielders and center fielders.  Most of the action in the game is in the middle of the field so care should be taken, especially if playing multiple games in a day and multiple days in a row. Attention should be paid not only to throws made during play, but also warm up throws between innings.


  • Fatigue and overuse have shown to be the two greatest factors for injury in youth baseball and softball players. A study by the American Sports Medicine Institute in 2006 found that pitching while fatigued increased likelihood for injury by 36x. I just want to repeat that: If a kid pitches while tired, he or she is 36x more likely to be injured!

  • A nice study came out in the Journal of Strength and Conditioning Research in 2014 finding that the best indicators for fatigue are velocity and accuracy. A drop in velocity or loss of control is the best way to tell if a pitcher is fatigued. It’s crucial that a coach not only keep a close eye on the pitcher, but is also in close communication with the catcher about how the pitcher is looking.


I understand how tournament play can lead to increased emphasis on winning. It is imperative, however, that coaches and parents keep things in perspective and don’t let a “in it to win it” attitude place players at risk. Following proper pitch count guidelines, paying attention to overall volume of throws in the field, and monitoring for signs of fatigue are a few ways that coaches and parents can help protect their players and help ensure that these athletes will enjoy the game for years to come.

Patient of the Month: Kyle

Because we love what we do and who we work with, at Complete Game PT we’ve decided to feature a Patient of the Month each month. June’s Patient of the Month is Kyle.

Kyle came to Complete Game several months ago after suffering a back injury that occurred while he was swinging in baseball. Since working with Greg, Kyle has found his discomfort significantly decreased.

“It’s going great,” said Kyle. “I strained my nerve while swinging and couldn’t throw, couldn’t hit – I couldn’t do anything involving baseball. Even sometimes while I was driving or sleeping – everything hurt. But now I’m doing great.”

Kyle is even back to playing baseball now, which he is thrilled about. “I’m playing baseball all the time. This past season went great, and now I’m starting up my summer team, so it’s going great.” Kyle remarked.

A typical physical therapy session for Kyle at Complete Game starts off with a massage. “Then,” Kyle said, “I’d work on strengthening with bands and different balls and weights to strengthen the muscles around my back.”

Kyle would “definitely” recommend Complete Game Physical Therapy to anyone suffering an injury or living with pain. “Every single time I came here, it didn’t feel like a chore. I came here to get stronger. You’ll feel better, too.”

If you or your athlete are recovering from an injury or experiencing any discomfort or pain, give Complete Game Physical Therapy a call at 978-710-7204, email Greg at, or browse our website. Also check us out on Facebook and Twitter for more tips on staying injury-free.

Patient of the Month: Thomas

Complete Game Patient of the Month Pic.jpeg

Because we have so many amazing patients with unique stories, at Complete Game PT we’ve decided to feature a Patient of the Month each month. April’s Patient of the Month is Thomas. Thomas is a 12 year old baseball player who came to us last fall after suffering his 2nd incidence of “little league elbow” in the past year. He worked with us not just to rehabilitate his elbow, but also to strengthen his shoulder and core muscles to help him reach his goals and return to his favorite sport, baseball.

Thomas was ecstatic to get back to baseball, thanks to Complete Game. “My experience at Complete Game Physical Therapy was great. They not only helped me with my injury but gave me exercises for my elbow and shoulder to make sure it doesn’t happen again. I was given a home exercise program of bands and stretching that I had to complete every day,” says Thomas. “This really helped with my recovery.”

Thomas is so excited that it’s finally baseball season - and that he’s back and better than ever. “I am not only back to playing baseball but now throw harder and hit the ball farther than before!”

Thomas’s mom, Heather, also was thrilled with Thomas’s recovery, and their experience at Complete Game. “Our experience at Complete Game was fabulous. The atmosphere was warm and inviting and helped make the rehabilitation process fun for Thomas.” Heather drove over 45 minutes each way to come see Greg at Complete Game and “would never even consider going anywhere else. Because of the care Thomas received at Complete Game he was able to return to baseball months before anyone thought he would. Thank you!”

Thomas’s amazing recovery is due to his hard work and to the fact that Complete Game PT utilizes state of the art rehabilitation methods and clinical expertise to help him meet his goals. We were also able to work directly with his baseball coaches and instructors to make sure he was fully ready to return to baseball and make sure he uses proper mechanics so the injury won’t occur again. This has also lead to improved performance (4 home runs already this spring!).  Great job, Thomas!

At Complete Game Physical Therapy, we specialize in the treatment of youth baseball and softball players. If you or your athlete is experiencing shoulder or elbow pain, or you want more info on how you can prevent it call us at 978-710-7204, email me at, or browse our website. Also check us out on Facebook and Twitter for more tips on keeping yourself and your athlete injury-free.

3 Ways to Prevent Injury During Baseball/Softball Tryouts

With high school baseball and softball tryouts starting this week in Massachusetts, it’s a good time to talk about injury prevention strategies. Research has shown that preseason injury rates are more than three times higher than in-season or post-season rates. Inevitably I see athletes every spring who hurt their arm or pull a muscle during tryouts. This can be a minor annoyance for some causing them to miss a few weeks, or can be devastating for others, causing them to miss a season or more. Here are a few strategies to help reduce the likelihood of injury.

  1. Show up in shape. Tryouts are not a time to get yourself in shape, as you will be doing everything you can to show your skills to the coaches to get a spot on the team. If you haven’t been exercising prior to tryouts, you will probably have a tough time. Playing other sports to stay in shape, working out in the gym or with a trainer, as well as taking some swings and fielding some balls are all important to get ready for the upcoming season. And no, playing MLB The Show on PlayStation 4 doesn’t count!

  2. Get your arm ready. Every year I have players come in for physical therapy, especially baseball players, with shoulder or elbow problems after tryouts. You need to get your arm ready before tryouts. Start out just playing catch, progress to a long toss program, then gradually start pitching if you’re a pitcher (start with flat ground pitching then build up to pitching off the mound). I know many high school coaches will use a radar gun during tryouts and I see many kids who try to throw as hard as they can for the gun.  They often end up hurt and this to me is criminal. If you are not ready to pitch during tryouts, don’t - you will get hurt.

  3. Cold weather concerns. Especially here in the northeast early in the season (and sometimes even through a good part of the season) it can be quite cold. Be sure to perform a good, dynamic warm up prior to tryouts, games, or practice. Also dress appropriately, wearing layers that you can remove as you get going.

These are just a few ways you can help reduce the likelihood of injury during baseball/softball tryouts this year. As the great Bill Belichick likes to say, “you can’t make the club from the tub,” which means it doesn’t do any good to just go out and get hurt. For more info on preventing injury for the upcoming baseball/softball season stay tuned for my new ebook 7 Arm Care Strategies for Youth Baseball/Softball.

Good luck and have a great season!

Greg, Complete Game Physical Therapy

3 Keys to Proper Cool Down

I was recently approached by a local youth basketball coach who asked “I have heard so much about the importance of proper warm up before practice and games, but what about cool down?” What a great question. Though I often inform my patients and athletes about the importance of proper stretching and cooling down after working out, I had never been asked by a coach how to properly cool down his or her team. Here are the 3 keys to proper cool down.

1.)  Injury Prevention

At the end of practice or following games is the perfect time to do a few exercises to help reduce the likelihood for injury.  Most non contact injuries, be it ankle sprains or ACL tears, occur when athletes are fatigued. Performing some simple balance exercises can help improve control and reduce the likelihood for injury.

Single Leg Balance:

Simply standing on one leg will help with balance and neuromuscular control.  Focus should be on proper alignment, keeping knee in line with the foot and maintaining an athletic position. 

Balance and Reach:

balance and reach.jpg

Balancing while reaching out with the other leg challenges balance and control even further.  Focus should continue to be on maintaining proper alignment and control with the balance leg.

2.)  Light Static Stretching

Doing some light static stretching is a key part of proper cool down, particularly with youth athletes.  Youth athletes are often going through “growth spurts” where the athlete’s muscle length doesn’t always keep up with bone growth.  This often leads to problems such as Sever’s disease (heel pain) or Osgood-schlatter’s (knee pain).  Here are a couple of stretches that can help with this.

Quad Stretch:

Calf Stretch:

3.)  Breathing

The third key to proper cool down is performing some deep breathing.  During practice and games athlete’s sympathetic nervous system gets fired up.  This is the fight or flight response of the nervous system that can is helpful when in stressful or competitive situations, but can leave the athlete feeling anxious or stressed after.  Taking 10-15 deep breaths will help athletes “wind down” and get in a more relaxed state of mind.  This is also a great opportunity for the coach to talk about the positive things that happened during the practice or game.

This is by no means a comprehensive list of everything that should be included in a cool down, but a few items that can be easily implemented.  For more information on this subject please refer to Mike Robertson at He does a great job of getting really in depth about this subject.  For more info on breathing, which is helpful both in training and daily life, Brett Jones does a great job reviewing it in the video that can be found here:


If you are interested in having Complete Game Physical Therapy perform a youth injury risk screening on your athletes, or are interested in any of our services, contact us at 978-710-7204. 

Let's Help Reduce Injuries in Youth Athletes

Sports Injury Risk Screening:  What is it and why does my child need it?

Sports medicine for the youth athlete is all too often, a vicious cycle; 

·      The athlete gets injured and sees his or her physician. 

·      The physician refers to physical therapy, recommends rest, or-in the worst cases-refers for surgical consult. 

·      The athlete recovers and returns to sports.

·      The cycle repeats; injury, doctor’s office, recovery, return to sport.

 But there is a better way forward.

 Youth Sports Injury Prevention:

Some of these injuries are difficult to avoid; contact injuries or falls for example.  But many of these injuries to youth athletes are overuse or non-contact injuries.   Overuse injuries account for nearly half of all sports injuries to middle and high school aged athletes.  Non-contact injuries have been reported as high as 36% in college athletes, many of these being ankle injuries and ACL injuries.  When you consider that over 5.5 million kids play sports in the US each year these numbers are staggering. 

The good news is that the likelihood of overuse or non-contact injury can be significantly reduced with proper assessment and training.  Deficits with balance and lack ability to properly perform fundamental movements has shown to accurately predict injuries in youth and college athletes.  Training with proper exercises to address these deficits has shown to improve evaluation, scores in soccer and football players thereby reducing their likelihood for injury.

What Have We Been Doing to Prevent Sports Injuries?

For years athletes have received pre-participation exams (PPEs) by their doctor prior to participating in sports.  High school’s require a physical or they will not let the athlete play.  There are baseline standards for cardiac health and neurologic function to allow for athletes to participate in sports, why do we not do the same for the musculoskeletal system?  Musculoskeletal problems are the 2nd leading cause of disability in the world yet all that typically goes into the musculoskeletal portion of a PPE are quick screens of joint range of motion and pain. 

The two options we have had for youth athletes are to take what we get during the PPE or extensive injury risk screening programs.  These can take up to 4 hours to complete and can cost hundreds of dollars making them prohibitive for most from a time and money standpoint.  What about a quick and cost effective option to musculoskeletal screening that has shown to reduce the likelihood for injury?

A New Approach to Sports Injury Prevention

Physical therapists are experts in assessment and treatment of the musculoskeletal system.  Testing programs such as move2perform provide us with an objective, reliable testing system that can be completed in a timely and cost effective manner.  This program looks at dynamic balance with the y-balance testing system and fundamental movement capacity with the Functional Movement Screen to help identify and address deficits prior to injury.  Proper assessment and adherence to neuromuscular training programs has shown to decrease injury in youth athletes.

Despite these findings injury risk screening is often met with skepticism by both coaches and parents.  Parents are willing to spend whatever it takes in time and money after their child is injured to ensure full recovery, but are unwilling to spend the roughly 20 minutes and minimal cost of testing to help prevent injury.  The biggest predictor of future injury is previous injury; once the athlete is injured it is too late.




At Complete Game Physical Therapy we are working to educate parents and coaches as to the importance of injury risk screening and help break the vicious cycle for youth athletes.  We offer injury risk screening, provide seminars on injury prevention and will use this blog to provide readers with practical ways to reduce likelihood of injury.   With our injury risk screening program we look to help reduce the likelihood of youth sports injury for schools, youth sports organizations and individuals.  Contact us for more information on how you can get your athlete screened. 


For more information on youth sports statistics please visit and for more information on the research that has gone into move2perform please visit


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Low Back Pain in the Youth Athlete

At Complete Game Physical Therapy, we have performed injury risk screens over the last two weekends for Storm Club Lacrosse, a local girls lacrosse program.  During the screening, we identified several athletes who required further evaluation for lower back pain.  This screening, along with a couple baseball players who see me due to lower back problems, made me think about the prevalence of lower back pain in youth athletes.

Though low back pain is more often associated with an older, sedentary population, it is actually quite common in youth athletes.  An estimated 10-15% of young athletes will experience low back problems.  With over 30 million kids participating in sports, this is no small number.  Here is a brief review of common causes of lower back problems in youth athletes and some prevention strategies to help reduce the likelihood of low back pain occurring.


Though the exact role of posture in relation to lower back pain has been debated, it is certain that poor posture will lead to problems.  A good way to think about posture is through a comparison to the alignment of your car.  You may be able to get away with your car being out of alignment for a while, but eventually misalignment will cause problems. 

Posture problems can generally be simplified to either overly extended or rounded.  Over extended (or lordotic posture) is often associated with athletes and, in particular, gymnasts, figure skaters and cheerleaders.  Rounded posture is what we commonly think of as slouched posture.  It is especially common in kids who spend a great deal of time playing video games, on computers/phones or watching television.  Either way, I like to simplify posture and tell my patients to just think of keeping your ear, shoulder and hip in line when standing and sitting.  You can also do some gentle shoulder blade pinches to help remind you to maintain good posture, especially when sitting for long periods.


Flexibility can certainly be an issue with youth athletes.  Combine the sitting we mentioned above with the possibility of recent growth spurts where muscle length may not keep up with bone growth and you end up with muscle tightness.  It is particularly common in two muscle groups: the hip flexors and the hamstrings.  

Hip Flexor Stretch

This can be particularly helpful with an athlete with more extended posture.

Hamstring Stretch

This can be helpful with an athlete with rounded posture.


Strengthening is also important, as many athletes with back pain tend to have weak core musculature.  I will review two exercises:  the pelvic tilt and back bridge

Pelvic Tilt

This exercise is accomplished by gently pressing the lower back down into the floor as you lay on your back.  The pelvic tilt has fallen out of favor with some who prefer to teach more of a neutral isometric exercise.  The pelvic tilt can, however, be very useful, especially with the athlete with extended posture.

Back Bridge

This is a great exercise to strengthen the core and glutes which can help take pressure off your lower back.

The exercises and stretches listed above may be helpful in reducing the likelihood of experiencing lower back pain and keep an athlete on the field.  This information is by no means, however, a complete review of lower back pain.  If you (or your athlete) are having lower back pain, you should be evaluated by a medical professional.

Thank you for reading.  Please sign up for my newsletter to receive more injury prevention tips.

3 Strategies to Reduce Likelihood of Injury in Baseball/Softball

With the baseball season winding down (rather abruptly for my poor Red Sox) now is a good time to discuss injury prevention ideas for youth baseball players.  Proper rest and limiting pitch counts have been talked about frequently in the baseball community and I will refer you to the following resources for more in depth discussion on those two injury prevention strategies ( and  Here I want to review three injury prevention strategies that youth athletes can start working on in the off season to help reduce the likelihood of injury and help improve performance for the upcoming season.

1.)  Proper throwing mechanics- improper throwing mechanics have shown to be a major factor in both shoulder and elbow injury in the overhead throwing athlete.  One of the common mechanical faults we often see in youth athletes is them relying too much on their arm and not using their legs and lower body effectively with their throwing.  85% of force should be generated before the shoulder.  Working with a pitching coach, catching coach or fielding coach who is well versed in proper throwing mechanics is a great way to help improve throwing mechanics and reduce stress on the athlete’s arm.   Keep in mind though that throwing a ball is a complex motor pattern meaning that the body needs many, many repetitions with proper form to groove this motor pattern.  Do not wait until one week before the season to start working on this.  Also encourage your athlete to use proper mechanics as often as possible even when playing catch in the back yard, playing with friends or warming up before practice.

2.)  Proper warm up- the offseason is a great time for each athlete to figure out exactly what they need to do to get their body ready for practice or competition.  Improper warm up has show to increase the likelihood for injury.  Most programs will have a team stretch or warm up they use, if not you may want to see a strength and conditioning coach who can help your athlete develop their own dynamic warm up.  I know how difficult it can be getting kids to practice on time but you should be sure that your athlete is never rushed and is always given time to warm up properly.

3.)  Preseason injury risk screening- much research has gone into finding indicators for increased injury risk in the overhead athlete.  Limitations with fundamental movement patterns have shown to increase the likelihood of injury.  Strength or mobility restrictions can relate directly to poor throwing, swinging or running mechanics.  Balance deficits have shown to lead to increased incidence of UCL or Tommy John injury in baseball players.  Being screened for and addressing any deficits found in screen will greatly help reduce the likelihood for injury.

There is no way to prevent injury but there are definitely steps we can take to help reduce the likelihood of injury.  Working on proper throwing mechanics, proper warm up and getting a preseason injury risk screen are great ways to help reduce the likelihood of injury in your youth athlete and help improve their performance.