Overhead throwing athletes are at a significantly increased risk for injuries involving overuse of the shoulder and elbow. These injuries can range from ulnar collateral ligament tears, labral tears and rotator cuff tears that can affect athletes at any level of their sport.

How Dramatic is the Throwing Injury Problem?

To visualize the prominence of baseball throwing injuries, realize that in Major League Baseball shoulder and elbow injuries account for more missed games than injuries to any other region of the body. Elbow injuries alone result in roughly 8,000 days on the Disabled List each year in the majors. Shoulder injuries account for 3,000 days.

To address this rise in throwing injuries it is imperative to identify their risk factors, which often stem from basic over-use. For instance, due to the extreme amount of stress that pitching places on the entire upper extremity, pitchers are the most susceptible to throwing injuries.

Shoulder torque during pitching can reach as high as 7500-7700 degrees per second! That is just for one pitch!

Throwing injuries are not limited to the highest level of competition

In a survey of 500 injured baseball players from middle school to college-aged, 15% stated that future baseball performance was limited due to injury sustained during youth baseball.

In this same survey, 50% of all injures suffered were from either the elbow or the shoulder. Studies demonstrate that half of pitchers from all levels experience shoulder or elbow pain within a season.

How Do We Prevent Throwing Injuries?

Research has shown that the amount of competitive pitching, and the pressures to pitch while fatigued, are strongly linked to elbow and shoulder injury.

Other risk factors may include pitching on multiple teams, pitching year-round, playing the catcher position (which actually throws more than a pitcher) when not pitching, poor pitching mechanics, and poor physical conditioning.

Train Less

We know that training more than 16 hours per week leads to significantly higher injury risk

Pitch Less

Averaging more than 80 pitches per game may quadruple injury risk, and pitching more than 100 innings per calendar year may triple the risk of serious shoulder or elbow injuries.

Stop Sooner

Pitching with arm fatigue, which can typically be evidenced by a noticeable drop in velocity of pitches) leads to 36 times increased injury risk!

Count Pitches

Coaches, players and parents should track their children’s pitching activity and keep their kids from pitching more than the following:

7-8 year olds: No more than 50 pitches/day

9-10 year olds: 75 pitches/ day

11-12: 85 pitches/day

13-16: 95 pitches/day

17-18: 105 pitches/day

Also, a pitcher who throws more than 41 pitches should not play catcher that day.

Screen Players

Screening can help prevent injuries. Lacking symmetrical shoulder flexion (within 5 degrees on both sides) and total arc of rotation increases injury risk by 2.5-2.8 times.

Increase Total Body Strength

Did you know that 60% of the force of a pitch is generated from the legs?

Pitching is an entire body motion that requires coordination of muscle activity for proper form and injury prevention. Total body strengthening programs can address lower extremity and functional core strength — as well as shoulder strength.

In fact, pitching ability requires a transfer of energy all the way from the lower extremity through the trunk to the arm. The legs provide a stable base for the trunk (core) to rotate and flex.

Summarizing Injury Prevention for Throwers

Pitching is a highly complex and coordinated full body movement that culminates with dynamic motion of the throwing extremity. Proper training and screening of this kinetic chain movement must be appreciated and understood to a greater depth.

Despite update guidelines and precautions (pitch counts, pitch type, rest), many pitchers are still experiencing overuse injuries that can be prevented with better training and understanding of risk factors.