Top 9 Reasons for Pitching Injuries

It’s no secret that the numbers of youth injuries in baseball are staggering. Even with the implementation of pitch counts, youth pitching injuries not only continue to rise but account for many of the injuries ball players eventually suffer later in their careers.  Here we go, with my top 9 reasons for pitching injuries…

1. 1. Previous / Lingering Injury
   2. Early Age Overuse
   3. Inadequate Strength
   4. Lack of Mobility/Stability
   5. Poor Pitching Mechanics
   6. Inadequate Rest between Outings
   7. Insufficient Shutdown Period
   8. Insufficient Pre-season Ramp-up
   9. Poorly Designed Strength Training Programs

1. Previous / Lingering Injury

Let’s start with what I believe to be the “numero uno”. Common knowledge in the industry tells us that the #1 predictor of injury is a previous injury. A good example is an athlete who has had a lingering elbow issue from a prior year (or years) and is hoping that a shut down in the off-season will help.

This usually isn’t the case with overuse injuries. Once throwing begins the symptoms return, and voila!, another season on the bench. This is also a key reason why pitching injuries are at their highest early on, in the season.

2. Early Age Overuse

This is probably the most prevalent issue as well as the one that I believe has the biggest carry-over to some of the other reasons we’ll look at. We are starting to see the results of what these kids did to themselves beginning 10 years ago. The excessive pitch counts in youth and high school baseball is starting to rear its ugly head. Granted we all realize that baseball is part of being a kid. What most people don’t realize is that we have a lifespan on our ligaments. When starting to throw at an early age (7-11), there are permanent structural changes to the growth plates in the arm, shoulder and elbow that change the kinematics of the joint. This is called humeral retroversion. While this acquired increase in ER allows for greater layback, it also comes with a higher risk for pitching injuries associated with “little league elbow “such as:

• • Epicondylitis and physeal plate (growth) fractures
  • Osseous (bony) changes in the humeral head
  • Calcification of the UCL and acromion

Many young athletes are injuring themselves as kids and don’t even know it. This is why playing multiple sports and monitoring pitch counts is of the utmost importance at an early age.

3. Inadequate Strength

If quality weight room work, which is needed to maintain strength, mobility and stability, trails off, so will power on the mound. Pitchers are throwing harder earlier, so much so that they’re writing checks that their bodies can’t cash due to a lack of strength.

It will likely leave an athlete vulnerable to a cavalcade of maladies including a gradual drop in velocity (have I got your attention now?), control, and worst of all injury as the season moves onward. When a young athlete gets to a certain age, strength training is no longer an option, nor is it something thing you do only in the off-season. Remember, throwing too much, too little or with bad mechanics are the primary causes of pitching injuries… not weight lifting.

4. Lack of Mobility/Stability

We need to help the body achieve more athletic positions in the delivery with mobility work. Mobility is “the ability to move freely into a desired position” and is definitely something that is lost fairly quickly. In fact, many athletes don’t even realize they’re losing it until they’re injured. If you combine a loss of shoulder and hip mobility with the speed of the pitching movement, and for many repetitions you can get a recipe for disaster. On the other hand, not all athletes need extensive mobility work. Those with laxity (excessive joint range of motion) need more stability to help them get into more athletic positions. For these guys some foam rolling, scapular stability work and good ‘ol fashioned strength training may be just what the doctor ordered.

(Mobility – Quadruped T-spine Mobility)

5. Poor Pitching Mechanics

Does the following scenario sound familiar?

• • Pitcher’s arm hurts
  • He goes to Physical Therapist (PT)
  • PT shuts him down for 6 weeks
  • Pain goes away
  • Pitcher starts throwing again
  • Pitcher’s arm hurts again…

The question is “are we really fixing the problem or just relieving the symptoms”.  I mean, obviously if we stop throwing, the pain will go away but if it returns once throwing begins again it’s generally a clear sign that something is awry in the pitching delivery. For example, sequencing issues of the lower half can cause the athlete to overuse the arm to generate a higher velocity ceiling. This can cause pain in the anterior shoulder and medial elbow. Giving this athlete specific throwing correctives to help engage the lower half, and teaching him to create a more “hip dominant” back leg, will allow him to put more force into the ground while coming down the mound.  The net result of all this will create lower half leverage in the delivery and take much of the stress off of the anterior shoulder by lowering the work load of the upper body and arm.

6. Inadequate Rest between Outings

Fatigue is the enemy of motor learning

– Nick Winkelman

After each outing on the mound, there can be up to a 10 degree loss of gleno-humeral IR, losses in hip mobility and ankle stability, just to name a few. It goes without saying, that if you don’t perform proper maintenance religiously (see #4 above), and you don’t rest adequately between outings, you will, sooner or later, experience a gradual loss in total range of motion. This not only compromises movement patterns but also increases the risk of pitching injuries as well.

Note: Many times there are no warning signs of fatigue but if you know what to look for, fatigue can present itself in a variety of ways including by the way mechanical issues on the mound (such as a decrease in stride length, lack of trunk flexion or releasing the ball high and arm side to name a few).

7. Insufficient Shutdown Period

am going to spend a minute on this one as it hits close to home. While there are many reasons (too many to list in this blog!!) why an 4-8 week shut down is paramount, I’ll just list a couple big ones that pertain to what we do here at RPP in the off-season:

• • Give “lay-back” a break – Pitchers should intentionally lose a few degrees of external rotation each off-season, this allows them to improve their stability on the anterior side of the shoulder and gain back some much needed IR.
  • Allows time to get in some manual resistance cuff exercises – Manual resistance exercises are the single-best option for improving rotator cuff strength. We incorporate them when appropriate all season long in our programming. This allows us to emphasize eccentric strength. Bands are ok, but no where near as powerful.

(Half Kneeling Band Stab. w/ Perturbations)

Here at RPP, cuff strength and scap stability work, as well as mobility work, are included in every program we write. Throwing year-round without a break works against many of these qualities we work so hard to achieve. This is especially problematic in younger populations, as they are generally weaker and skeletally immature.

This is why we advocate an 8-10 week shut down annually. Sure, you’ll be a bit rusty in the first few weeks of starting up but don’t worry you’ll “figure it out” during the ramp-up of your throwing program.

8. Insufficient Pre-season Ramp-up

Sometimes too little of a good thing can be detrimental as well. Many older, more experienced players especially the guys that already have commitments to schools may be trying to save some bullets and start throwing a little later, and ramp up a little slower. Players go from a casual off-season progression to an excessive amount of high intensity pitches in a short amount of time. In the northeast, this is especially taxing due to the fact that the season usually begins in 40 degree weather. It is a grind.  So, make sure you ramp-up properly for the spring load.

9. Poorly Designed Strength Training Programs

This one hits close to home as well. Most traditional baseball strength training programs either involve:

• • Excessive coddling (no heavy lifting), or
  • Going to the extremes and doing the football team’s workout

I read a great quote by Eric Cressey once where he stated…

Baseball players can and should be pushed incredibly hard as long as the exercise selection is appropriate.

I agree 100%.  Including a thorough assessment is a must to ensure individualized programming as well as coaching proper movement patterns to ensure that we’re not allowing athletes to get really good at moving poorly.

(Lateral KB Lunge)

In addition, programming should reflect where the athlete is in their season and as always, avoiding things such as Olympic lifting (hard on the shoulders and wrists).  Not placing heavy weights in unstable OH shoulder positions will also go a long way in reducing wear and tear on the joints in the weight room.

Having said all this, pitching injuries continue to rise despite the greater focus on injury prevention. Many times this unjustly falls into the lap of physical therapists and/or strength coaches. I don’t believe either are to blame, pitchers’ arms don’t hurt from weight lifting or physical therapy.  They more thank likely hurt from mismanagement of one or more of the topics above. So for the over-zealous helicopter dads who are looking for someone to blame for their kids arm injury they may not have to look any further than the bathroom mirror.

I have assembled below what we consider to be our Pitchers Doctrine, I hope it’s helpful.

1. 1. Avoid early age overuse (7 – 14)
   2. Improve overall strength
   3. Improve and maintain mobility / stability year-round
   4. Maintain an optimum weight level (lean muscle mass)
   5. Identify and correct pitching mechanics for disconnects and stress
   6. Get adequate sleep
   7. Observe a minimum 6-week shutdown period during the year
   8. Participate in a thorough pre-season ramp-up program
   9. Avoid year-round baseball
   10. Follow a proper nutrition program

See ya’ in the gym…

Note: This article was published in the March/April 2018 issue of Inside Pitch Magazine (ABCA).  By Nunzio Signore (BA, CSCS, CPT, NASM, FMS)

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