Pitching Mechanics and Injury: Are We Forgetting Something?

By Dr. Stephen Osterer

How Most View Pitching Injury:

Ask most pitching coaches at the amateur or even collegiate and professional levels about injury prevention and you’ll find the conversation default to mechanics. Where the elbow needs to be, how long their stride length should be compared to their height, or having their head in ‘XYZ’ position at late-cocking.

Indeed, biomechanics provides us with a large pool of information. So large, in fact, that sometimes we blind ourselves to the rest of the pitching paradigm. The complexity of the biological system cannot be dwindled down to biomechanical analysis, as it is just one component of athletic performance. So let’s step back from this narrowed viewpoint and consider what we are gaining from breaking down pitching mechanics and what other pertinent information we may be skipping over.

The most significant information that has been deduced from biomechanical research is the amount of stress and/or strain placed on biological tissues while undergoing certain movements. By throwing with X kinetic and kinematic factors, scientific researchers are able to calculate the amount of force being placed on Y.

This information is subsequently used to make mechanical tweaks in an effort to decrease the physiological burden on a specific anatomical region/structure/tissue/cell and so forth. Being up to date on current information is incredibly important when dealing with injury prevention and performance in baseball; pitching is violent in nature and players are increasingly getting injured. (As pitching coaches, we have a responsibility to help prevent this).

Here’s an example: a pitcher has a long history of shoulder pain and shows excessive contralateral tilt while throwing. According to the research, it would be prudent to alter this ‘mechanical flaw’ in order to decrease the load on the shoulder.

So What Are We Missing?

Biomechanical insight provides us with parameters that assist in understanding which mechanics CORRELATE to POTENTIAL injury. Notice that I did not say LEAD to DEFINITE INJURY. Though somewhat minute in stature, this small difference is sometimes painstakingly neglected in the dogma of baseball culture.

“You’re going to injure yourself if your elbow/shoulder/wrist/head/trunk/pelvis/knee/foot/belt/shoelace/hair is in that position!!!” No. The literature does not claim that universally. In fact, it simply provides us with information regarding demand on tissue. Different demand for different kinetics and kinematics. That’s it.

Interpretation of a demands contribution to overall injury is, actually, fairly simple.

Essentially it all comes down to the following:

Demand >> capacity => Injury

Demand > capacity => Adaptation

Capacity = demand => No injury

In other words, in order for an injury to occur, the demand on a tissue must greatly outweigh it’s capacity to handle said demand. Lessen the demand, and you get an adaptation over time.

As you can see, biomechanical information is not the be all, end all, of injury.

The demand side of the equation is just one piece, and includes more than just biomechanics. Making a change how a pitcher delivers a baseball can decrease this tissue burden. But so can increasing rest between outings, decreasing how many pitches are thrown per game, and altering the intensity of throwing between starts. This list can go on forever, as I’m sure everyone could continue to provide numerous other factors. And that is exactly the point. It’s NEVER one thing that leads to injury. Biomechanics alone is not the answer.

So how much attention are we really paying to the capacity side of the equation?

How many pitching coaches approach the months leading up to the season as a time to progressively build their pitchers’ tissue load bearing capacity? If we know that a pitcher is prone to shoulder pain from excessive contralateral tilt, then why not also focus on building the affected tissues’ strength? How about a pitcher who always had medial elbow pain?

The question, in my opinion, becomes: over time, can we gradually increase the strength of the ‘ligaments, tendons and bones’? The answer: Absolutely!

In the manual therapy world, it is recognized that function dictates anatomy. Our body has an incredible ability to adapt to the demands that we place on it, and that most definitely includes the functionality of bones, ligaments, tendons and muscles.

What happens when we do the opposite and stop physical activity and, therefore, loading of our tissues? Sarcopenia. Osteopenia. ATROPHY. Why is it so common for overhead throwers to have humeral retroversion? As previously mentioned, function dictates anatomy. Our body will adapt to the demands placed on it.

So while we are in the off-season we must be more cognizant of the fact that we can alter the load bearing capacity of the tissue while simultaneously preparing it for future demands.

But doesn’t throwing, with progressive overload, just accomplish this for us?

Sort of. Throwing a baseball does produce demand, but it’s placed on numerous locations with varying quantity that is difficult to determine. It is much less specific than if done by manual means. Moreover, not everyone has the ability to throw indoors year round. Our off-season programming should be mindful of the process of building capacity and use whatever tools available. We need to go beyond the thinking that throwing once a week indoors during the winter months will prepare us for throwing 5 days a week in the summer.

Adaptation is a constant biological process that cannot be trivialized. Rather, in baseball it demands respect! Demand – adapt – demand – adapt – demand – adapt.

We have a pretty good idea what type of mechanics lead to increased strain and stress on various aspects of our system. Although important, we must remember that this is but one aspect of the injury equation and not forget about capacity.

Note: There is always great debate around sport science and specific applications to sport. We are not necessarily supporting the opinion of the authors but certainly respect them both as wiser than the editor.