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Preventing Throwing Related Injuries

Baseball season at the major league and high school levels is in full swing even though it is snowing as I am writing this. Our opportunity to implement comprehensive injury prevention strategies has passed since that should have begun in November. That doesn’t mean we cannot continue to prevent some throwing related shoulder and elbow injuries. The strategies available at this stage of the season require players, parents, and coaches to be educated about the current available science regarding throwing injuries in the high school baseball player. It also requires them to utilize this available science.


In the last 10+ years there has been a strong focus on pitch-counts as a method to reduce arm injuries in Little League players. While some states and high school leagues have implemented pitch counts, others have lagged behind and continue to allow the overuse of high school aged throwing arms. When pitch-counts are adhered to they can and have reduced the number and severity of throwing related injuries. What pitch-counts do not take into account, are bullpen pitches, warm-up pitches between innings, and multi-league play.


A recent research study published in the Journal of Orthopedic Sports Medicine looked at the idea of unaccounted workload factor including bullpen pitches and between-inning warm-up pitches. While it did not look into multi-league play, it did shed light on the role that bullpen warm-up pitches, between-inning warm-up pitches, and acute spike in pitching volume play in throwing fatigue and subsequent injury. It also outlined the threshold for throwing-related fatigue and its role in throwing-related injuries.


This study of 34 high schools in North Central Florida in 2017 showed that bullpen and between-inning warm-up pitches can add a minimum of 60 pitches to the in-game pitch count. If you are a 15-year-old high school pitcher allowed to throw 95 pitches (the USA Baseball game allowance) and you throw a total of 60 warm-up pitches, your total workload factor is really 155 pitches, not the 95 counted. One of the questions raised in the study was whether or not the average pitcher trains at the same volume at which they compete. The answer is that most of the time a high school baseball pitcher trains at a volume lower than that of competition. The guidelines also allow the 95 pitches to be thrown in 7 innings, not 9. Therefore the total workload intensity is much higher at the high school level than it is at levels playing 9 innings.


Workload spikes such as a “big inning” (throwing greater than 25 pitches in one inning), will predispose the pitcher to injury if they continue to pitch to the allowed pitch count. This type of situation creates early fatigue and is therefore a contributing factor to shoulder and elbow injuries in high school baseball pitchers.


This study continued to reinforce that throwing-related fatigue, kinetic chain defects, hip strength deficits, reduced shoulder range of motion, altered throwing mechanics, rotator cuff weakness and fatigue, forearm fatigue, alteration of scapular and arm position, and reduced joint position sense will have a negative effect of the pitcher’s arm slot.


In 2018 we have incredible scientific data and information to help reduce the number and seriousness of throwing related injuries. But all of this information does us no good when coaches, players, and parents refuse to educate themselves and become current on this wealth of information. Instead of utilizing the expertise of those available, they rely on the arrogance of archaic coaching principles.


Here are some simple things to keep in mind when trying to prevent throwing related shoulder and elbow injuries: You can’t prevent throwing injuries unless you have good pitching mechanics. You can’t have good pitching mechanics without strong hips and the ability to balance on one leg. You can’t reduce arm strain without a consistent arm slot. And you can’t have a consistent arm slot without a strong rotator cuff. You can’t do any of this unless you have a pre-season program that specifically addresses these common areas of breakdown. If all of these aspects of mechanical fault are addressed, the concept of pitch-counts, pitch monitoring, and proper rest can now be more effective at reducing arm injuries.


With all of the information available to us and with the variety of programs that have been developed, the number of “Tommy John” surgeries to repair the torn ulnar collateral ligament of the throwing elbow has risen six-fold. With everything we know, how could this be?  The simple answer is that coaches, players, and parents continue to ignore the science and rely on training gimmicks. Keep this in mind: a regulation baseball weighs 5 ounces, so being able to bench press a house won’t help you throw it faster. Pitching is about strategic strengthening and efficiency.

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