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Do Pitching Restriction Policies Reduce Shoulder and Elbow Injuries in High School Baseball Players?
Peter K Kriz1, Christy L Collins2, Steven J Staffa3,4
1Division of Sports Medicine, Departments of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA.
Orthopaedic Journal of Sports Medicine
|February 5, 2026
Summary
Pitching restriction policies did not lower overall shoulder and elbow injuries in high school baseball. However, specific rules like pitch limits and rest days significantly reduced injury rates.
Area of Science:
- Sports Medicine
- Epidemiology
- Public Health
Background:
- Shoulder and elbow injuries (SEIs) are common in high school (HS) baseball.
- Pitching restriction (PR) policies were implemented by the NFHS in 2016 to prevent overuse injuries.
- The impact of these PR policies on HS baseball SEIs was previously unknown.
Purpose of the Study:
- To determine if SEI rates decreased after PR policy implementation.
- To identify specific PR policy components associated with reduced SEI rates.
Main Methods:
- A descriptive epidemiological study analyzed NFHS member state PR policies.
- Injury and athlete-exposure (AE) data from 2013-2019 were obtained from the High School Reporting Information Online system.
- Components of PR policies were analyzed for their association with SEI rates.
Main Results:
- No significant changes in overall SEI rates were observed after PR policy mandates.
- Specific components like consecutive pitching day rest rules and a daily maximum of ≤105 pitches showed protective effects.
- Rules differentiating regular vs. postseason and varsity vs. subvarsity pitch counts also demonstrated injury reduction.
Conclusions:
- Specific components of PR policies, not the mandates themselves, are linked to reduced SEIs in HS baseball.
- Consecutive pitching day rest and ≤105 pitches per day are key protective elements against SEIs.
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