NBA and MLB injury crisis points to youth sports

For the past several years, The Athletic has published numerous articles detailing how the crisis in youth sports is increasingly concerning executives in professional sports.  Concern is probably an understatement.  In April of 2024, The Athletic had two articles with “Pitching injury crisis” in the headline. But professional baseball is not unique.  In November 2025, The Athletic published “Many NBA stars are getting injured. Will the league and its partners dive deep for answers?”  

It's not just The Athletic.  As the title of Baxter Holmes’s 2019 ESPN article, “'These kids are ticking time bombs': The threat of youth basketball,” makes clear, many in the professional game point directly at youth sports.  As my book explains, the crisis of injuries in professional sports is a direct result of poor development (discussed in Section One), inappropriate competition (discussed in Section Two), and failed risk management (discussed in Section Three) in our children’s organized youth sports programs. 

Perhaps the greatest existential threat in professional sports is brain injuries to NFL players.  Ironically, football is the exception to the professional sports injury crisis.  While injuries are increasing in most sports, football safety has dramatically improved from the time when deaths from American football were so routine that people kept an annual tally. 

Injury-producing fundamental deficiencies among professional players are a longstanding problem that has only worsened.  One of the primary sources I used to develop a program for my son, Mark, was Vern Gambetta's 2007 book on athletic development.   In it, he wrote, “There is a series decline in base fitness levels and fundamental movement skills at the developmental level.  Even elite athletes do not have the broad base of movement skills that the athletes had when I began coaching in the late 1960s.” 

In addition to failed development and economic incentives to providers that put children in harm's way, we have ineffective risk management.   A good example is the complete ban on heading by children in soccer.  When my boys were between the ages of 4 and 8, one of their favorite games to play was the “crossing game.”  As teens, my boys not only scored more goals with their heads than most players with their feet during the season, but they did so at a lower risk of brain injury.

 At one point in high school, I often headed a soccer ball almost 1000 times per day.  Yet despite not having the slight brain adaptation of a woodpecker, I’m retired and have shown no signs of cognitive decline.   If I ever do, it is far, far more likely to be from the concussion I got in a collision playing baseball or the effects of countless other collisions while playing sports than from properly heading a soccer ball, which is learned through practice. 

A recurring theme in the articles is that current athletes are pushing their bodies harder and with greater volume than ever before.  Baseball has responded by creating a pitch count limit at all levels.  The NBA has responded by reducing the number of consecutive nights on which games are played.   But the view is not unanimous.  The NBA article in The Athletic quoted one general manager stating that “I personally don’t believe it’s because we are running too much, I believe it’s because these guys don’t run enough.”

While the biomechanics of a tennis serve are not the same as throwing a baseball, both put a lot of stress on the arm and shoulder.  Much like pitching, tennis also greatly rewards players who can serve exceptionally hard with significant movement.  Players today hit the ball far faster than those decades ago, and with more spin.  Why isn’t every other professional tennis player suffering a season-ending injury like professional baseball pitchers?

Why is it that players with big serves in tennis can serve 100 or 200 times in a match and remain healthy, despite sprinting back and forth for a couple of hours, smashing the ball back over the net in a variety of other ways?  While Tennis defaults (dropping out of a match due to injury) are not directly comparable to baseball injury statistics, they do provide insight into the health of the tennis players.  The number of defaults in men’s tennis (ATP) reached its peak in the early 2000s and has been significantly lower in subsequent years.

An article in The Athletic, “MLB insiders “pretty worried” by rise in arm injuries to top young starting pitchers” painted a sharp contrast with tennis.  It noted that 263 Ulnar Collateral Ligament surgeries were performed in 2023, a steady increase from 111 procedures in 2011.  Baseball’s biggest star, Shohei Ohtani, has already had two Tommy John surgeries.  The number of top pitchers with arm injuries is far too long to enumerate. 

Nolan Ryan threw the ball far harder than his peers.  He pitched in the high 90s until his mid-40s and threw a no-hitter at age 43.  Few pitchers today can last the nine innings that are required to pitch a no-hitter.  Ryan struck out almost 1000 more batters than the next closest pitcher and started more games than every pitcher by Cy Young, who began his career in 1890.  

 The Society for American Baseball Research (SABR) reported that by the time he reached junior high, Ryan had the arm strength to stand on the goal line of a football field and throw a softball over 100 yards — 30 yards farther than any other boy in the area.  In the pre-radar gun era, the article quoted a scout stating, “The night before, I had seen the two fastest pitchers in the National League at that time, Jim Maloney and Turk Farrell. Nolan Ryan was already faster than both of them by far.”

While many consider him to be a genetic freak, his childhood suggests an alternative theory.  By pure coincidence (sarcastic emphasis mine), between the ages of 8 and 16, Ryan spent every morning from 1 to 4 a.m. with his father delivering the Houston Post to homes in the Alvin area.  For those unfamiliar with physical newspaper delivery, kids (and some parents) would roll up newspapers and toss them onto the front porch.  The farther and more accurate your throw, the faster you can get the job done. 

While Ryan clearly spent considerable time throwing objects, he did not specialize in baseball as a young child.  “In the ninth grade, he became even more focused on baseball after abandoning his short-lived football career in the aftermath of a head-on collision with future NFL running back Norm Bulaich; the impact produced a dazed and embarrassed Alvin cornerback and a La Marque Junior High touchdown.”  Also, since “Little League baseball had only recently come to Alvin,” Ryan “started playing on a nearby vacant lot, where neighborhood kids built a diamond.”

The contrasts in how children in Ryan’s era and those playing today are stark.  Previously, children who performed high-speed arm movements grew up in environments with high repetition, where they determined how their arms would move.  If their arm hurt, they would stop.  In contrast, children today pitching in baseball have strict restrictions on how much they can throw. They perform low-volume, maximum intensity movements under an adult's direction.  Every weekend, they must win a new tournament for their team. Anyone familiar with athletic training knows this is a recipe for injury. I might also note that coaching is not permitted during a tennis match.

This recipe for harm has worked incredibly well.  In a study of high school athletes, the percentage of baseball players who lost 3 or more weeks due to an injury is higher than that for football, and the rate of injuries requiring surgery is almost identical.  This is even though people often describe each play in football as a car crash, whereas most plays in baseball involve just the pitcher, batter, and catcher, with everyone else watching. 

My younger son’s favorite position in youth sports was catcher.  He was plenty good enough.  His coaches called him a “5 tool player” because he had a cannon for an arm, hit for average and power, could field, and had pretty good speed for a baseball player.  However, he stopped playing at age 13, despite being in good health, shortly after purchasing his first set of catching gear. 

His travel baseball coach gave him an ultimatum that if Mark didn’t agree to specialize in baseball, he wouldn’t let Mark play catcher.  If Mark had been able to catch up physically and become a dominant hitter, the coach probably wouldn’t have risked losing Mark by forcing him to choose.  Since Mark was comparatively young and his body was less mature, the only reasonable alternative was to play recreational baseball, which Mark found miserable. 

The ironic part was that the coach's son quit baseball a year or two later to focus on golf, a sport he would later play in college.  Michael Jordon also liked golf.   The ESPN article quoted Wally Blase, a Bulls athletic trainer saying, “When the season ended, Michael left and played golf and didn't pick up a basketball again until probably a little bit before training camp” and “There were days (during the season) when Michael would show up, put ice on his knees, go smoke a cigar and then go play 18 holes of golf."  Jordan even took a few seasons off to play some professional baseball.  Perhaps that is why he was still playing in the NBA at age 40. 

In contrast, we have travel team coaches pushing kids to specialize and rack up ranking points in tournaments.  Sometimes it is for their egos, but often it is to make their teams more attractive to parents and generate more income.  Ultimately, Mark had alternatives, so things worked out well.    His quitting baseball is a small drop in a swimming pool of issues created by our broken youth sports programs.