Baseball, as in any sport presents with its own challenges, rewards and risk factors. None of these factors can be more devastating to a player than a throwing injury for a pitcher. Good pitchers are rare in any team, and due to their value often get used more than they should which puts them at high risk for an arm injury. With the repetition required year after year, a good pitcher can be plagued chronic injury which can impair or end an enjoyable career. Good mechanics, avoiding sliders and curveballs in early age, pitch counts and effective treatment intervention can provide this throwing athlete with years of successful and enjoyable participation.
It is well documented that many Major League Baseball pitchers have fallen to throwing injuries. Some examples are, Roger Clemens (potential Hall of Famer), John Smotz (Atlanta Braves retired), Kerry Wood (Chicago Cubs retired 2012), and Stephen Strasburg (Tommy John Surgery 2011 after 92 MLB innings pitched). These are the most talented players in the world on a stage where they have all the resources (team physicians, physical therapists, trainers, immediate access to MRI’s, the latest equipment and treatment methods) to keep their careers healthy and productive.
Proper mechanics are one of the foundations to consistency, velocity and injury avoidance for a pitcher. Improper mechanics to increase the force and torque on the shoulder and elbow and therefore increase the risk of injury. In a study using High-speed motion analysis of 72 healthy college and professional pitchers, correlations were found between improper kinematics and increased elbow and shoulder joint loads. Since these patterns multiply the normal load generated by the throwing arm, they should probably be avoided by the use of good throwing mechanics. John Smoltz and Al Leiter of the MLB Network in 2011 discussed some of the factors that led to Stephen Strasburg’s elbow injury and Tommy John surgery. As well they discussed how they changed their mechanics after receiving Tommy John surgery during their major league career. Good mechanics should be taught from a very early age and be reinforced incessantly. A good coach or rehabilitation professional can provide the pitcher with education and drills to make this a habit during the game.
Throwing breaking balls such as curveballs and sliders provide the pitcher with an advantage to get a batter out. Unfortunately, this places a pitcher at risk for injury if introduced too early. In another study of 476 pitchers, the study evaluated the relationship between the types of pitches thrown (fastball, change-up, curveball, and slider) and shoulder or elbow pain. Pitchers in the 9-14 age bracket reported pain as follows:
- Pitcher who threw sliders were 86% more likely to experience elbow pain during the season.
- Pitchers who threw curveballs were 56% more likely to experience shoulder pain during the season.
- On the other hand, pitchers who threw change-ups were 12% less likely to experience elbow pain and 29% less likely to experience shoulder pain.
- The study also found that as pitch counts increased, the number of cases of shoulder and elbow pain also increased. At the 75-99 pitch count range, the risk of shoulder and elbow pain increased by 52% and 35% respectively.
- The authors recommended that pitchers between the ages of 9 and 12 should limit themselves to throw only fastballs and change-ups, and not throw sliders or curveballs.
An example of a successful Major Leaguer who demonstrated consistency, performance and longevity is Mariano Rivera of the New York Yankees. His dominating pitch is a “Cut Fastball” which is a fastball that moves like a slider. By applying pressure on particular points on the ball and throwing it like a standard fastball, Mariano is able to make his cut fastball break closer to the plate giving the batter less time to react to the ball. Most importantly, Mariano is able to deliver a better than slider quality pitch without the extra stress on his arm. From a batter’s perspective, they cannot recognize the difference between a cutter and a fastball at the release point as both pitches are thrown the same way. Finally, Mariano can locate his pitches anywhere in the strike zone which is his biggest asset. Along with good mechanics and conditioning, Mariano has been a dominant Major Leaguer for over 18 years.
Pitch counts are talked widely during Major League Baseball broadcasts and preached at the youth baseball level. The importance of adhering to a pitch count is often times understated as long as a player is feeling “healthy”. However, the importance for a pitcher to “log” their pitches is of paramount importance to avoid long term injury. In a 2006 study in the American Journal of Sports Medicine, Dr. James Andrews and associates examined 95 adolescent pitchers who had shoulder and elbow surgery, and 45 adolescent pitchers who never had a significant pitching-related injury. When a pitcher regularly threw with arm fatigue, he was 36 times more likely to be in the surgery group as opposed to the non-surgery group. When a pitcher engaged in more than 8 months of competitive pitching during a year, he was 5 times more likely to be in the surgery group. When a pitcher threw more than 80 pitches in a game/appearance, he was 4 times more likely to be in the surgery group. In conclusion, the factors with the strongest association with injury were overuse and fatigue. These guidelines can be found in Ontario Baseball Association or USA Baseball’s website.
Ontario Baseball Association Guidelines
Listed below is the maximum amount of pitches per calendar day:
Minor & Major Mosquito 70pitches
Minor & Major Peewee 80 pitches
Minor & Major Bantam 90 pitches
Minor & Major Midget, Women 100 pitches
Listed below is the maximum amount of pitches per day without requiring two nights rest:
Minor & Major Mosquito 45 pitches
Minor & Major Peewee 55 pitches
Minor & Major Bantam 65 pitches
Minor & Major Midget, Women 75 pitches
Parents, and coaches need to be diligent in recording their child’s amount of pitching especially for the child that may be playing with multiple teams in a season (i.e. high school, club, travel teams).
Finally, if a player is reporting arm pain or discomfort, early evaluation by a regulated health care provider who is familiar with treating throwing injuries is important. Your health care provider as well as the health care team can evaluate and treat your athlete’s arm, develop a training and conditioning program, and determine when your athlete can return to game play. It is always best that an athlete is seen by a sports medicine team for the most comprehensive evaluation and treatment. This team can consist of a physician, physical therapist, chiropractor, massage therapist, orthopaedic surgeon (if needed).
Sports are played on the field and not on the sidelines. If a pitcher ensures that they are keeping in shape, use good throwing mechanics, monitor their pitch count, controlling their pitches and avoiding curveballs and sliders, and getting early intervention for an injury, they can enjoy a healthy, consistent and competitive baseball season.
Pitch Count Questions and Answers. Ontario Baseball Association. http://www.baseballontario.com/Coachs/
USA Baseball Medical & Safety Advisory Committee Guidelines: May 2006. http://www.asmi.org/asmiweb/usabaseball.htm#Conditioning
Lyman S, Fleisig GS, Andres JR, Osinski ED. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. The American Journal of Sports Medicine 30(4):463-468, 2002.
Petty DH, Andrews JR, Fleisig GS, Cain EL. Ulnar collateral ligament reconstruction in high school baseball players: clinical results and injury risk factors. The American Journal of Sports Medicine 32(5):1158-1164, 2004.
Fleisig GS, Kingsley DS, Loftice JW, Dinnen K, Ranganathan R, Dun S, Escamilla RF, Andrews JR. Kinetic comparison among the fastball, curveball, change-up, and slider in collegiate baseball pitchers. The American Journal of Sports Medicine 34(3):423-430, 2006.
James Traub., Mariano Rivera, King of the Closers, New York Times, June 29, 2010. Video link: Magazine: How Mariano Rivera Dominates Hitters http://video.nytimes.com/video/2010/06/30/sports/1247468158551/how-mariano-rivera-dominates-hitters.html.
John Smoltz, Al Leiter. Diamond Demo: Strasburg. MLB Network. September 8, 2011. http://mlb.mlb.com/video/play.jsp?content_id=18966909&c_id=mlb