Pitching Injury Prevention
The hum of each pitch as it cuts through the crisp October air and the pop of the ball in the back of the catcher’s mitt are just a few of the hallmark sounds of post season baseball. Amidst all of the excitement, however, what often isn’t heard are the conversations between clubhouse managers, pitchers, and medical staff. They spend hours weighing the benefits and risks of injury as pitch count and inning accumulation begin to take a toll.
Baseball is a beloved sport across all age groups, but the repetitive and high-intensity motion of pitching can place significant strain on a pitcher’s body, leading to various injuries over the years. For pitchers, avoiding injury is critical to maintaining performance and longevity in the sport.
In this blog, we’ll explore the most common baseball injuries affecting pitchers, ways to prevent them, and key tips for maintaining a healthy pitching arm.
What Are Some Common Baseball Injuries in Pitchers?
Fortunately for most of us, our career doesn’t depend on striking out Mookie Betts in game 7 of the World Series. In fact, the majority of athletes seen at a physical therapy clinic like Agile PT, are either weekend warriors or young athletes who aren’t pitching exclusively. Here are some of the most common injuries seen in pitchers:
Rotator cuff injuries
The rotator cuff, a group of muscles and tendons in the shoulder, plays a vital role in pitching mechanics. Overuse and repetitive throwing motions can lead to inflammation or tears in the rotator cuff, causing shoulder pain and reduced range of motion. Proper conditioning and avoiding overuse are essential to preventing this injury.
Ulnar collateral ligament (UCL) injuries
The UCL, located in the elbow, is often damaged in pitchers due to repetitive stress. This injury commonly results in the need for Tommy John surgery, where the ligament is replaced with a tendon from another part of the body. Maintaining proper pitching mechanics and adhering to pitch count limits can significantly reduce the risk of UCL injuries.
Labral tears
The labrum, a ring of cartilage in the shoulder, helps stabilize the joint. Repetitive throwing can cause labral tears, leading to instability and pain. Symptoms often include a “dead arm” feeling or loss of velocity. Early detection and proper rest can prevent this injury from worsening.
Muscle strains
Pitchers frequently experience strains in their forearm, shoulder, or oblique muscles. These injuries occur due to the explosive movements involved in pitching. Strengthening these muscle groups and ensuring proper warm-ups can reduce the likelihood of strain.
Shoulder and elbow instability
Instability in the shoulder or elbow can occur when repetitive throwing causes the joint to become loose. This condition is common in pitchers of all levels and may lead to pain, reduced strength, and limited range of motion. Early intervention through physical therapy and proper mechanics is critical.
The Role of Pitching Mechanics in Injury Prevention
In recent years, we've had some disturbing facts coming out about young players experiencing injuries and pain. According to this report, an estimated 20-30% of players aged 8-12 report elbow pain, with this number rising to an astonishing 50% and above for high school, college, and professional athletes.
Proper pitching mechanics are critical to reducing the strain placed on the shoulder and elbow. Some common mechanical flaws that increase injury risk include an overextended stride, poor arm positioning, and lack of balance during delivery. Working with a pitching coach to refine your mechanics can make a substantial difference. Incorporating biomechanical analysis tools can also help identify potential issues.
Additionally, focusing on shoulder rotation, elbow alignment, and follow-through motion can prevent injuries by distributing the physical stress evenly across the arm and body. Regular assessment of mechanics ensures continuous improvement and injury prevention.
Implementing Effective Warm-Up and Conditioning Routines
Warm-up exercises
A proper warm-up is non-negotiable for injury prevention. Dynamic stretches, resistance band exercises, and light throwing are excellent ways to prepare the shoulder and elbow. These exercises help improve blood flow, increase flexibility, and reduce the risk of injury.
Specific exercises such as arm circles, cross-body stretches, and scapular retractions target key muscles and joints used during pitching. Incorporating these into a pre-game routine can optimize performance and minimize injury risk.
Warm up and Pre-Season Pitching: The first rule of thumb when the season begins is to start slow!
- First, high school pitchers should begin with warm up toss from 90 feet (the distance between each base) followed by
- 3 sets of 15 throws at 60 feet (roughly the distance between the pitcher’s mound and home plate)
- 9 minute rest after the first and second set
- End with 20 long toss throws at 90 ft once again
- Second, initial pitching effort should be at just 50% of their full effort progressing in pitch count, intensity, and distance daily up to 160ft for long toss and full speed by 15 foot increments each day
- Thirdly, initial pitching work should be focused solely on fastballs
- Lastly, offspeed pitches (curveball, slider, etc.) should be worked on only after a solid two weeks of pre-season training without incident
Strength and conditioning
Strengthening the rotator cuff, core, and lower body can enhance pitching performance and reduce injury risk. Exercises such as shoulder external rotations, planks, and squats should be included in any conditioning routine. Additionally, incorporating plyometric exercises can improve explosiveness and velocity.
Training should also include exercises targeting the ulnar collateral ligament and tendons in the elbow, as these areas are highly susceptible to stress during pitching. Regular strength assessments and gradual progression in training intensity are recommended.
Understanding and managing pitch counts
Adhering to pitch count guidelines is essential for pitchers, especially for youth and amateur players. Overuse injuries often stem from exceeding safe pitching limits.
The USA Baseball Medical and Safety Advisory Committee have established pitch count limits by age for day, week, season, and year. The chart below details these recommendations for each age group.
| Age Group | Pitches Per Game | Pitches Per Week | Rest Days After 1 Game |
| 8-10 years | 50 | 75 | 2 |
| 11-12 years | 75 | 100 | 2-3 |
| 13-16 years | 95 | 125 | 3-4 |
| 17-18 years | 105 | 140 | 4 |
Monitoring pitch counts and recognizing signs of fatigue, such as decreased velocity or control, is crucial for preventing overuse injuries.
How to Recognize Signs of Fatigue and Injury
Pitchers must learn to listen to their bodies. Common signs of fatigue or injury include:
- Persistent shoulder or elbow pain
- Decreased velocity
- Difficulty controlling pitches
- A “dead arm” sensation
These symptoms often indicate underlying issues such as ligament strain, tendonitis, or joint instability. If these symptoms occur, it’s important to rest and consult with a sports medicine professional. Ignoring early signs can lead to more serious issues.
The Importance of Rest and Recovery to Avoid Pitching Injuries
Rest is just as important as training. Overuse is one of the leading causes of pitching injuries. Resting the arm between games, combined with proper recovery techniques like stretching, foam rolling, and icing, can help maintain a pitcher’s health. For youth pitchers, taking breaks during the year from throwing altogether can allow their bodies to recover fully.
Post-game recovery should also include hydration, nutrition, and light stretching to promote muscle repair and reduce soreness. Advanced recovery techniques such as cryotherapy and massage therapy can provide additional benefits.
Advancements in Sports Medicine for Pitchers
Sports medicine has made significant strides in preventing and treating pitching injuries. Techniques such as biomechanical analysis, platelet-rich plasma (PRP) injections, and advanced physical therapy methods have become instrumental in helping pitchers avoid surgery. Consulting an orthopedic surgeon or sports medicine specialist can provide tailored advice and treatment options.
Recent research has also led to the development of wearable technology that monitors a pitcher’s biomechanics and workload. These devices provide real-time data, allowing for immediate adjustments and reducing injury risks.
Find a Good Physical Therapist for Your Pitching Injury Prevention!
Despite careful adherence to the safety protocols listed above, injuries can still occur from a repetitive sport like baseball. Finding a physical therapist who has the knowledge of the stage and tissues involved with your injury is key. They will collaborate with you to create a tailored training program to get you back on the field faster and better.
Fortunately, most pitching injuries can be treated conservatively with a good training program from a physical therapist and activity modification. In conclusion, if you’re a casual baseball player, a young athlete, or even a college or professional pitcher, the Agile staff is here to help you with your pitching injury prevention. 68% of Agile PTs have board certifications, versus the national average of 12.5%, giving Agile the uniquely qualified edge to get you back to the ballfield as soon and as safely as possible!
Most Common Pitching Injuries
Some of the most common shoulder injuries include rotator cuff strains and tears, bicep tears or tendonosis, and labral injuries. Some of the most common elbow injuries are forearm tendinosis or ligamentous injuries. The most popular being a tear in the ulnar collateral ligament which has been made famous by a major league pitcher called“Tommy John” surgery. The good news is that there is now evidence and a protocol for the recreational and young pitchers to prevent injury.
Pitch Count (Volume) and Injury Prevention: Baseball can be a highly repetitive sport with a long season. The stress on the body has to be able sustain the cumulative toll not through just a single game or series, but often an entire season. In a repetitive sport like baseball, the stress on the body tissue is not only present in the moment, but has a cumulative effect over the course of days, weeks, and years of play. Education and protection are two key components to injury prevention. A number of research studies have linked throwing volume to elbow and shoulder injuries.
| Age Group | Pitches |
| 9-10 year olds | 50 per game
75 per week 1000 per season 2000 per year |
| 11-12 year olds | 75 per game
100 per week 1000 per season 3000 per year |
| 13-14 year olds | 75 per game
125 per week 1000 per season 3000 per year |
Pitching Injury Prevention: Just because an athlete throws fast does not mean that their body tissues are also stronger and have adapted to this increased velocity. Particularly in younger athletes, an increase in pitching velocity has the potential to translate to a greater risk of injury. For this reason, The USA Baseball Medical and Safety Advisory Committee recommend that if an athlete is 3-5 standard deviations above his or her peers in either speed or distance than 2 years should be subtracted from his or her actual age when following the pitch count numbers above.
Soreness Rules While Following a Pitching Program: Following the above guidelines is a great way to prevent pitching injury. However, listening to one's body is equally important in assessing whether or not it is safe to proceed in pitch count or competition. The following soreness rules have demonstrated to help stop a mild injury from becoming a bigger problem.
- If no soreness from pitching the previous day, advance the number of throws everyday or every other throwing day. Only if there's no soreness.
- If sore during warm-up but soreness is gone within the first 15 throws, repeat the previous workout. If the shoulder or elbow becomes sore during this workout, stop and take 2 days off. Upon return to throwing, decrease the number of throws from the prior day.
- If sore more than 1 hour after pitching, or the next day, take 1 day off and repeat the most recent throwing program workout.
- If sore during warm-up and soreness continues through the first 15 throws, stop throwing and take 2 days off. Upon return to pitching, decrease the number of throws.
It can be tempting to fall into the mantra of “practice makes perfect” to help young athletes reach their potential but sometimes less is more. In fact, current evidence indicates that early specialization (before puberty) can lead to greater injury and burnout. In addition, specializing early fails to give young athletes motor skills from other sports that may crossover to benefit to their eventual sport of choice. The exact amount of time dedicated to one sport in order to deem it a specialization is not established. One study of high school athletes showed increased injury risk if training volume exceeded 16 hours/week. Another determined that specialization was a risk factor for injury and that athletes who participated in organized sports compared with free play time in a ratio of 2:1 had an increased risk of an overuse injury. The same study showed that if they participated in an organized sport more hours/week than their age in years their risk of overuse injury was greater.
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Written By: Trevor Hopkins PT, DPT, OCS
