The intent of the Baseball Collegian Pitching Project is to inform coaches and players and parents of some of the many theories on being a successful pitcher.
Most every concept has advocates with very strong opinions on either side of the argument. Too often, a theory is chosen based on popularity, conventional wisdom, or because someone famous does it that way, as opposed to one’s own analysis. With so many contradicting theories, it is essential to have an understanding of all of the possible options, before deciding which one to commit to.

These pitching theories are presented without judgment, without confirmation bias, with no preconceptions, and without dogma or commercialism. In turn, the strong hope is that people are inspired to do the work to make up their own mind based on as much information as possible – and in turn, do what makes most sense to them.

This week, the discussion turns to arm injuries.

HEALTH

Q. Why are there more injuries than ever?
General Belief:
High pitch counts
Dr. James Andrews – “Pitching too much in one game, one week or one season is a very high risk factor,” he said. “The problem is the injuries don’t always show up when they pitch too many pitches at age 15. When you see a pitcher at age 22 start developing a problem, you go look at their history and most times you find out they threw too much as a teen.”

Other Philosophies:
Long Toss
Dr. Glenn Fleisig – “While long-toss thrown on a line seems biomechanically sound for rehabilitation and training, the use of long-toss throws for maximum distance may be more harmful than beneficial. This advice against maximum-distance throwing is based upon the high magnitudes of elbow varus torque, shoulder internal rotation torque, and upper trunk tilt, and low magnitude of forward trunk tilt.”

Ligaments & Tendons
Dr. James Andrews – “Ligaments and tendons can’t withstand the high forces caused by the strength gains of modern athletes throwing max effort with high velocity.”

Arm Fitness
Kyle Boddy – “Training to throw harder with no regard for arm fitness is a great way to increase your injury risk. You are layering stress on top of dysfunction.”

Innings
Ron Wolforth – “The key thing to remember, in our opinion, is that pitches-per-inning is more important than total pitches. We like to see pitchers average 15-18 pitches per inning.”

Training
Alan Jaeger – “The pitch count became necessary to compensate for the lack of training,” Jaeger says. “Once the 120 program came into being, guys were undertrained and the pitch count became a necessary evil.”

Low Pitch Counts
Nolan Ryan – “I’m not a doctor and I’m not a scientist. All I am is a guy who threw over 5,000 innings,’’ he said. “I know what pitchers go through and I know what it takes to do that and I really believe we don’t condition our pitchers for what they are asked to do. And because of that, I think we increase our chances of injury on them.
“I believe when an organization puts those kind of random restrictions on their pitching staff, they don’t take advantage and utilize the talent that they have. I think everybody has a pitch limit, but I think also you can tell when a guy’s reached his pitch limit by watching him. That’s what pitching coaches used to do. Now they look at the number of pitches and at around 100, they get somebody up and that pitcher comes out of the game no matter whether he’s having an exceptionally good game or if he struggled. Obviously, they put pitch limits to try to protect people, but I think it’s worked just the opposite.’’

Overuse
American Sports Medicine Institute – “With the rise in elbow and shoulder injuries in adolescent baseball pitchers, the adult community needs to take steps to prevent these injuries. Research points to overuse as the principle risk factor. Poor pitching mechanics also contribute to injury risk. Another suggested risk factor is poor physical fitness.”

Radar Gun
Dr. James Andrews – “I think they should outlaw the radar gun,” he said. “Young pitchers, coaches, scouts and parents put so much emphasis now on throwing hard that these kids are hurting their elbows and their shoulders because they’re trying to throw 90 mph.”

Year-Round Baseball
Dr. James Andrews – “Young pitchers now are throwing hard all year and that is not a good thing,” he said. “There is no rest period. Baseball is a development sport and the ligaments in the elbow need rest to develop.”

Showcases
Dr. James Andrews – “A lot of the times they go to these events not in shape or tired because they maybe pitched the night before,” he said. “They throw them off the mound as hard as they can and damage their arm by doing so.”

Youth Baseball
JJ Conrad – “Youth and travel baseball is where it’s needed. You see there are more injuries with kids between the ages 13-18, but it’s not coming from high school baseball. Kids are being abused at younger ages and most travel coaches are only concerned with winning games. By the time they get to high school, a lot of them already probably have micro-tears and other issues.”

Weighted Baseballs
Mike Reinold – “Scientifically, this gain in external rotation is not from a muscle stretching or the bone adapting. It wouldn’t happen that fast. What is likely happening is that the static stabilizers that are supposed to prevent excessive external rotation are being damaged. This could be the capsule, labrum, or even rotator cuff. These are not injuries that you want. Plus, as layback increases, so does stress on the Tommy John ligament.
This is why many people do not get hurt during a weighted ball program, but end up getting hurt down the road. They’ve pushed past their normal anatomy to increase pitching velocity.
So weighted ball programs have two potential concerns:
1. Overweight balls may be causing damage to the tissue of the shoulder to allow more layback. This gain in layback may also increase the strain on the Tommy John ligament.
2. Underweight balls increase the amount of peak strain on the arm.
We still don’t know how safe these programs are and, more importantly, what the effective “dose” should be to increase pitching velocity. What I mean by this is, how heavy, how light, how many throws, how often per week, and how much during the year among other questions. Selecting the right dose is important, and it should start with the minimum viable dose to achieve a training effect.
Let me be clear and get this out of the way. I am a believer of performing weighted baseball and long toss programs. I incorporate them into my programs and think you should too. (No one will remember those last two sentences, by the way). It’s not the program that is the problem, it’s how these programs are being implemented. It all comes down to ‘dosage.’”

Specialization
Eric Cressey – “Not surprisingly, the rise in specialization (as evidenced by the growth in popularity of fall ball teams, showcases, and opportunities to play for multiple teams during the “normal” baseball season) has paralleled the rise in velocity and injuries.”

Getting Injured previously
Russell Carleton – “…previous DL trip makes a pitcher about eight times more likely to land on the DL this season. But even at that, the rate at which previous disabled list visitors go back on is lower than 50 percent. A pitcher with an injury history is not a certainty to get injured, just a much higher risk.
The take-home message is one that is probably not very shocking to anyone. An injured body part is more likely to get hurt again. A pitcher who has thrown a lot of pitches is more likely to have a lot of wear and tear on that arm. It’s not rocket science, although I do wonder if people understand the magnitude of the effect size.
According to the Verducci Effect, teams needed only to avoid extending their young pitchers to maximize their odds of staying healthy. My model doesn’t offer as much comfort. Once a pitcher is damaged, he’s damaged goods. And it’s not like you can tell a pitcher not to throw another pitch; that’s what pitchers do. And sometimes they get hurt. That’s life.”

Mechanics
Don Cooper – “There is no doubt in my mind that the majority of arm injuries, shoulder injuries, come from having poor mechanics.”

Biomechanical Efficiency
Tom House – “Biomechanical efficiency is a function of three things (in order of importance): timing, kinematic sequencing, and the mechanical variables pitching coaches have been trying to teach for a hundred years. He continues, “I think most of the issues that take place with mechanics are because they are not timed properly.”

Elbow above the Shoulder line/Inverted W
Chris O’Leary – “In the Inverted W the pitcher…
1. Lifts their elbows to the point where they are at, or even above, the level of their shoulders.
2. While, and more importantly, their forearms are flat or, worse yet, pointing downwards.
3. Into, or in the worst case at, Foot Plant and/or the start of shoulder rotation.
The Inverted W isn’t (necessarily) a problem in and of itself. Rather, the Inverted W contributes to injuries in pitchers by creating a timing problem, and timing problems are what tend to hurt pitchers’ arms.
The Inverted W increases the likelihood that a pitcher’s arm will not be in the proper position when their front foot plants and their shoulders start to rotate. That will increase the load on the elbow and the shoulder, providing a short-term velocity boost but, in the long run, significantly increasing the risk of injury to the pitching arm.”

Inverted W/Arm Action
Brad Mills – “Elbow lifting, along with poor lower and upper body timing, causes the elbow to lift up above the throwing shoulder. Then upon landing with the elbow above the shoulder, the elbow must quickly snap into a position to begin arm acceleration. This is very, very stressful and is the cause of many elbow and shoulder injuries in pitchers.
One of the reasons that some pitchers are being taught to “elbow lift” is because of what has been referred to as “scapula loading,” which is emphasizing the pinching of the shoulder blades as a way to improve velocity. This is wrong and will only produce more arm injuries.”

Excessive Horizontal Adduction
Brent Pourciau – “Casting the arm or throwing with poor hip to shoulder separation puts the elbow out in front of the face during external rotation which puts a significant amount of stress on the elbow. This along with increased speeds of horizontal abduction to adduction is the number one cause of UCL tears.
Fleisig (1994) found the maximum horizontal adduction range displayed to be proportional to the maximum elbow medial force during arm cocking phase at a rate of 2.4 N/°. Since the total amount of elbow medial force during the arm cocking phase was 270N in Fleisig’s study, an increase of 7° horizontal adduction would be associated with an 18N or 7% increase in this force.”

Not Striding Straight
Guy Hansen – “Once a pitcher lands two shoe-sizes width closed, he is dealing in the “red zone,” where I think lousy, harmful stuff happens. It takes additional torque to work across the body and get the same finish on your pitches, especially on breaking balls for three-quarter delivery pitchers – which most pitchers are. These pitchers just don’t have the built-in angle of “correct side” pitchers who throw in a direct line home. I haven’t seen the injuries attributed to their positioning, but I’m convinced it plays an impact. There is just no question this leads to pitchers throwing all arm with a misdirected stride. That’s a recipe for trouble.”