By Dev K. Mishra, M.D.,?President, Sideline Sports Doc,?Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • A recently presented study from orthopedic surgeons at Midwest Orthopaedics at Rush sheds further light on the risk factors for injury in elite adolescent pitchers
  • The study strongly supports the idea that fatigue is a contributing factor in poor pitching mechanics, which ultimately increases the risk for arm injury
  • The legs and core tend to fatigue and weaken before the shoulder and arm, suggesting that focus on core and leg strength would be helpful in reducing pitching injury risk

It?s that time of year- time to start thinking about baseball and young pitchers. Much has baseball pitcherbeen written about the effects of over-pitching on the potential for shoulder and elbow injuries, but this week I want to highlight a unique study performed by the physicians at Midwest Orthopaedics at Rush, in Chicago, Illinois.

The researchers simulated a 90-pitch game for 28 elite, adolescent pitchers and then investigated how their shoulder and elbow motions affected pitching speed, accuracy, pain, and pitching mechanics. As expected, the boys became progressively more fatigued and painful with additional pitches. They also found that their pitching mechanics changed, which may ultimately contribute to injury.

The pitchers ranged in age from 13 to16 years of age, had been pitching for approximately 6 years and pitched an average of 94 pitches per week. Shoulder range of motion was assessed before and after the game. Speed and accuracy were measured for every pitch and every 15th pitch was videotaped. Perceived fatigue and pain were assessed after each inning.

The interesting thing the study authors noted was that core and leg strength may be a key component of fatigue and ultimately injury in pitchers. As pitchers became fatigued, trunk rotation timing began to falter and pain increased.?The key finding is that fatigue lead first to changes in the core and leg mechanics, and secondly to alterations in arm mechanics.

One of the study authors, Dr. Nikhil Verma, orthopaedic surgeon at Midwest Orthopaedics at Rush, said that ?As adolescent pitchers became more fatigued, they lost the proper timing of sequential rotation of the hips and then the shoulders. The core musculature thus lost the ability to contribute to pitch velocity. We hypothesize that this change occurs because the core and leg musculature fatigues before the upper extremity and thus core kinematics change before upper extremity kinematics as adolescent pitchers fatigue. We thus hypothesize that core and leg strengthening may be key adjuvants to prevent fatigue and potentially prevent injury in youth pitchers.?

SideLineSportsDoc?The most surprising finding was that trunk/core kinematics change before upper extremity kinematics as pitchers become fatigued. This supports the concept of the ?kinetic chain? meaning that the large lower extremity and core muscles are the true power generators for the baseball pitch. Many young players fail to appreciate the importance of trunk, core and lower extremity strength. Early fatigue in these areas may lead to increased stress in the arm and shoulder and potentially increased risk of injury.?

You can listen to a podcast of Dr. Anthony Romeo discussing the study key findings here.?Bottom line for young pitchers: to improve your pitching and decrease chances of injury, you must pay close attention to your leg and core strength.

Click here for full podcast playlist.