It’s no secret that the numbers of youth injuries in baseball are staggering. Even with the implementation of pitch counts, youth injuries not only continue to rise but account for many of the injuries ball players eventually suffer later in their careers. An awful lot has been written about overuse among young pitchers that ultimately leads to injury. But I believe there are many other contributing factors that are often overlooked. Below is a summary of my top 9 leading causes of pitching injuries.
- 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 has fixed the problem. 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 injuries are at their highest early on in the season.
- Poor Pitching Mechanics
The question is “are we really fixing the problem or just relieving the symptoms?” 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…
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 isn’t right 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 workload of the upper body and arm.
- 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 at an earlier age, and many are writing checks that their bodies can’t cash due to a lack of strength. Even with lower pitch counts, some young athletes are not strong enough to throw even 40 pitches let alone 60 or 70. It will likely leave an athlete vulnerable to a cavalcade of maladies including a gradual drop in velocity, 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 you should only do in the off-season.
- Early Age Overuse
This is probably the most prevalent issue as well as the one that I believe has the biggest carryover 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 some 10 years ago. The excessive pitch counts in youth and high school baseball is starting to rear its ugly head. We all realize that baseball is part of being a kid, but 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 external rotation allows for greater layback, it also comes with a higher risk for 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.
- 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 glenohumeral internal rotation, losses in hip mobility and ankle stability, just to name a few. It goes without saying that if you don’t perform proper maintenance and don’t rest adequately between outings, you will experience a loss in total range of motion. This not only compromises movement patterns but also increases the risk of injury 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 mechanical issues on the mound (decrease in stride length, lack of trunk flexion or releasing the ball high and arm side). Here’s a great chart (courtesy of Pitch Smart) to let you know where you stand:
- 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 can be 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 violence of the pitching movement, 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 old-fashioned strength training may be just what the doctor ordered.
- Insufficient Shutdown Period
I am going to spend a minute on this one as it hits close to home. While there are many reasons why a 10-12 week shut down is paramount, I’ll just list a couple big ones:
- 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 internal rotation.
- Allow 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 nowhere near as powerful. Cuff strength and scap stability work as well as mobility work should be included in every off-season training program.
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 a 10-12 week shut down annually. Sure, you’ll be a bit rusty in the first few weeks but don’t worry—you’ll “figure it out” during the ramp-up of your throwing program.
- 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 since the season usually begins in 40-degree weather. It is a grind. If you are a high-level pitcher and you aren’t familiar with Davis’s Law, you should be: "Ligaments, or any soft tissue, when put under even a moderate degree of tension, if that tension is unremitting, will elongate by the addition of new material; on the contrary, when ligaments, or rather soft tissue, remain interruptedly in a loose or lax state, they will gradually shorten, as the effete material is removed, until they come to maintain the same relation to the bony structures with which they are united that they did before their shortening.”
So, make sure you ramp-up properly for the spring load.
- 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. 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 overhead shoulder positions will also go a long way in reducing wear and tear on the joints in the weight room.
Injuries continue to rise despite the greater focus on injury prevention. So, I have assembled below what I consider to be a Pitcher’s Doctrine, I hope it’s helpful:
- Avoid early age overuse (7-14)
- Improve overall strength
- Improve and maintain mobility/stability year-round
- Maintain an optimum weight level (lean muscle mass)
- Identify and correct pitching mechanics for disconnects and stress
- Get adequate sleep
- Observe a minimum 10-weeks of shutdown during the year
- Participate in a thorough pre-season ramp-up program
- Avoid year-round baseball
- Follow a proper nutrition program
Nunzio Signore is the owner and operator of Rockland Pitching Performance, author of the book Pitchers Arm Care, and Co-Director of the Pitching Lab. He has spoken at clinics like Be the Best and Inside Baseball as well as college exercise science majors at schools such as Springfield College, Cortland University and Montclair State. Nunzio is also a performance enhancement specialist certified through the National Academy of Sports Medicine, is certified in the Functional Movement Screen, and has done work with Cressey Sports Performance and Mike Boyle (Olympic Men’s Ice Hockey, Boston Red Sox).