The amount of minor league and major league pitchers who have torn their UCL this season could make up two baseball teams. The MLB has lost more money on UCL surgeries this year than the Houston Astros entire team salary. There is obviously a major health problem for pitchers in this game and it all can be prevented if individual teams set some guidelines and provided some useful information for their high velocity pitchers.
Yes, I believe most of these top level pitchers have no idea what kind of damage they are doing to themselves. Mainly because they are using all of their resources to handle the stress of competing at the top level of this game. If their teams could give them better guidelines and more information to help them protect themselves from themselves then I truly believe this rising problem of arm injuries in Major League Baseball would subside.
I also believe the MLB should consider lowering the mound to help reduce these excessive forces that these upper 90's pitchers are putting on their arms. It would also make pitching even more of a power game which would also make approaches like 3X Pitching more popular. Yes, lowering the mound is my new agenda but it would really weed out a lot of the pitchers with the poor lower half power and make the game more about pure power.
In this article, I will go over the top ten ways to prevent a UCL tear and then set some guidelines that would help pitchers stay out of harms way. I will also list some of the top case studies on elbow injuries for your further research if needed.
Top Ten Ways to Prevent a UCL Tear for Pitchers
The list of ways to prevent a UCL tear here are referenced to the case studies at the bottom of the page. The picture below illustrates the mechanically differences in 1-5 from the list below.
- Do Not Throw Sidearm (1)
- Prevent Early Trunk Rotation (2)
- Lower Your Shoulder Abduction Angle at Front Foot Strike (3)
- Keep the Arm at the Scapular Plane From Arm Cocking into Maximum External Rotation (MER) (4)
- Increase Shoulder Range of Motion While Keeping the Elbow at 90 Degrees During MER (5)
- Stick to Strict Pitch Counts if You Throw Over 85mph Consistently (6,7)
- Throw More Change-ups than Breaking Pitches (8)
- Strengthen the Flexor Mass of the Throwing Forearm (9)
- Do Not Pitch with Arm Pain (10)
- Do Not Pitch All Year Round (10)
Pitching Guidelines to Protect Against UCL Damage
These guidelines are here to help a pitcher apply these top ten ways to prevent a UCL tear to a weekly routine. This would be best practice for pitchers to protect their elbows. Following the 3X Pitching Velocity Program through the off-season, pre-season and in-season programs would also follow these guidelines to help prevent a UCL tear.
- Use a Baseball Specific/Season Specific Strength and Conditioning Program.
- Use a Drill Based Throwing Program to Train the Movements Around an Efficient Set of Pitching Mechanics like the 3X Mechanics.
- Have a Good Flexibility Training Program Post Game or Workout.
- Use Video Analysis on a Weekly Basis to Analyze Your Current Mechanical Movements.
- Stick to Strict Pitch Counts In-Season Similar to ASMI's Youth Position Statement.
- Listen to Your Body and Give it What it Needs at All Times. If it Doesn't Want to Throw or Train for the Day then Don't.
- Avoid Throwing Many Breaking Pitches. Work to Throw Around 80-90% Fastballs and Change-Ups.
- Avoid Using Anti-Inflammatory Drugs. Icing is Better Than these Drugs. Do not Ice More than 12 Minutes On.
- Take a 4 Month Long Off-Season Every Year to Rest, Recover and Rebuild.
Pitching Case Studies on Elbow Injuries
The excerpts here are linked to the top ten ways to prevent a UCL tear for pitchers above. These excerpts reference the entire case studies cited below for further research.
- Fourteen pitchers displayed a sidearm delivery, exhibiting an average elbow valgus torque of 66 ± 24 N?m, which was significantly higher (P = .02) than that of those who threw with the more common over-hand, or “3/4,” slot position (46 ± 29 N·m) (1).
- Thus, subsequent between-group analysis revealed that 34 of the 69 pitchers included in the sample initiated trunk rotation before front-foot contact, whereas 35 did so after- ward. Although there were no significant differences in demographics or ball velocity between groups (P > .10), the pre–foot contact players exhibited significantly more elbow valgus torque (59 ± 27 N?m) than the post–foot contact players did (42 ± 29 N?m, P = .02) (1).
- Elbow valgus was most affected by the shoulder abduction angle at SFC....Mean shoulder abduction at SFC for the 40 pitchers was 109° +- 33°...The magnitude of elbow valgus stress was increased by greater degrees of shoulder abduction at SFC (2).
- Elbow valgus was most affected by maximum horizontal adduction angular velocity...Mean peak shoulder horizontal adduction angular velocity was 933° +- 320°/s...The magnitude of elbow valgus stress was increased by increased horizontal adduction angular velocity (2).
- Elbow valgus was most affected by elbow angle at peak valgus stress and peak shoulder external rotation torque. Elbow angle at peak valgus torque averaged 98° +- 21° and maximum external rotation torque averaged 111 +- 17 Nm for the 40 athletes. The magnitude of elbow valgus stress was increased by increased (ie, more flexed) elbow angle at peak valgus torque and decreased external rotation torque (2).
- There was a statistically significant association between higher pitch velocity and injury (P 5 .0354). The 3 pitchers with the fastest pitches (with speeds of 42.02, 42.02, and 44.25 m/s) were the 3 who had ulnar collateral ligament tears that required reconstruction (3).
- There was a 6% increase in the odds of elbow pain per 10 pitches thrown in a given game; over 75 pitches, odds of elbow pain increased over 50% (4).
- At the shoulder, internal rotation torque, horizontal adduction torque, abduction torque, and proximal force were significantly less in the change-up than in the other 3 pitches (5).
- Exercise and conditioning of the medial elbow musculature, specifically the flexor digitorum superficialis muscle and the flexor carpi ulnaris muscle, may prevent injury or assist in rehabilitation of medial elbow instability, especially in overhand throwing athletes (6).
- The injured group pitched significantly more months per year, games per year, innings per game, pitches per game, pitches per year, and warm-up pitches before a game. These pitchers were more frequently starting pitchers, pitched in more showcases, pitched with higher velocity, and pitched more often with arm pain and fatigue (7).
Pitching Elbow Reference:
- Aguinaldo AL, Chambers H. – Correlation of throwing mechanics with elbow valgus load in adult baseball pitchers. – Am J Sports Med. 2009;37(10):2043–2048.
- Werner SL1, Murray TA, Hawkins RJ, Gill TJ. - Relationship between throwing mechanics and elbow valgus in professional baseball pitchers. - J Shoulder Elbow Surg. 2002 Mar-Apr;11(2):151-5.
- Brandon D Bushnell, Adam W Anz, Thomas J Noonan, Michael R Torry, Richard J Hawkins - Association of maximum pitch velocity and elbow injury in professional baseball pitchers. - Harbin Clinic Orthopaedics and Sports Medicine, Rome, GA 30165, USA. - The American journal of sports medicine (Impact Factor: 3.61). 04/2010; 38(4):728-32.
- Lyman S1, Fleisig GS, Waterbor JW, Funkhouser EM, Pulley L, Andrews JR, Osinski ED, Roseman JM. - Longitudinal study of elbow and shoulder pain in youth baseball pitchers. - Med Sci Sports Exerc. 2001 Nov;33(11):1803-10.
- Fleisig GS1, Kingsley DS, Loftice JW, Dinnen KP, Ranganathan R, Dun S, Escamilla RF, Andrews JR. - Kinetic comparison among the fastball, curveball, change-up, and slider in collegiate baseball pitchers. - Am J Sports Med. 2006 Mar;34(3):423-30. Epub 2005 Oct 31.
- Davidson PA1, Pink M, Perry J, Jobe FW. - Functional anatomy of the flexor pronator muscle group in relation to the medial collateral ligament of the elbow. - Am J Sports Med. 1995 Mar-Apr;23(2):245-50.
- Olsen SJ 2nd1, Fleisig GS, Dun S, Loftice J, Andrews JR. - Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. - Am J Sports Med. 2006 Jun;34(6):905-12. Epub 2006 Feb 1.
I agree with most of these points. I think it is important to understand as well that a good majority of the injuries that are occurring at the professional level, can be attributed to what has occurred before the players ever got to that level. Most experts such as James Andrews agree with that last statement. I read an article on this site that said most youth pitchers have the same mechanics as professional pitcher’s, just not the same strength, speed, and flexibility. This was based on some study that was done. If that is the case, why do any bio-mechanical analysis? What would be the reason for teaching mechanics if most youth players already have professional grade mechanics? Kids arms, and this is including the kid’s buying your program, and every other program out there, are not developed like an adult arm. Could it be that the kid’s whose parents are buying these programs, and who are following these programs, are suffering to some degree from things within these programs? At what point do the coaches, instructors, and fitness guru’s look at themselves and ask if their program is contributing to the epidemic of arm issues? The arm injuries are becoming epidemic for a myriad of reason’s. Tommy John surgery was unheard of in kids just 10-15 years ago, now it is becoming a common problem. Kid’s are training longer, harder, and more intensely than they ever have before. They are doing workout’s meant for older players at a very young age. How many times have you seen any program say “Don’t buy my program if you are under 17”, or “Consult a Physician about the specifics of my program before ever doing anything within it”? There is an elite performce sport’s academy in every town. These academy’s are marketed to parents for their kid’s. There are atleast a handful of these where I live. A common factor in all of them is money. I wonder how many parents, coaches, instructors, and fitness guru’s have observed the differences in a kid’s arm that has been x-rayed, as opposed to an adults? I wonder how many have observed the differences between a kid’s MRI and an adult’s. Maybe, just maybe, trying to build kid’s into super human athlete’s is contributing to the problem. My son walked into High School throwing 83 just before his 15th birthday. He is 19 now and top’s out at 95. He has yet to have an arm issue because I have done all I can to make sure to not buy into all of the hype that is out there, and have done all I can to protect his health and well being. I have never taken the “Let’s build a super human athlete” approach with him. He also was born with some God given gifts that no program will ever be able to sell you. He strength trains, but has never, and I mean never lifted a free weight. Also, he is currently 6 foot 2 inches and weighs 160 pounds. His hands are enormous, with long fingers, disproportionately enormous. His wingsspan is also disproportionately big. His arms and hands are bigger, and longer than guy’s who are 6-10 inches taller than him. He has a thin, athletic build, but for anyone to say that more weight equals better velocity, that is ludicrous, that rule obviously does not apply to him.
Travis, so basically if we took your advice instead of these “velocity programs” we should never train in the weight room, never use a guru’s program and never go to an elite academy. We should just somehow become your child so we have your genetics which is obviously designed to produce “natural” high velocity pitchers who throw 95mph. I would be glad to promote your gene pool if you could tell us how to get into it. I guess the best part is that you obviously are not going to charge us for this because of the money factor that you made a point to address. Is this what you are proposing?
Interesting dialogue and points from each side. I am curious about one thing? If Travis has stayed away from all the “guru” stuff then why was he here? Just wondering what he was seeking?
I am also a coach, former player, and most importantly a fan of the game. I believe in people within the industry sharing ideas. I believe that you can never know it all about the game, and thus I read, and talk with alot of people in the industry. Hopefully that answers your question. It is not that everything on this site is bad. I never stated that and in fact stated that I agreed with alot of what was in the article. With that said, I also know that there are a ton of people out there making tons of money off of parents, and kids, who have a dream. Many of those people only care about the dollar, and are ill prepared to address this particular problem with honesty.
I think you got whatever it is you were looking for from what I said. I agreed on some of the points with this article, but not all of them. Genetics do play a role in elite level talent. To say otherwise is flat out lieing to people. Professional hitter’s generally have much better eyesight alone than your average person. There is a reason such a very small percentage of players ever reach the collegiate level, even less reach the minor league level, and even less reach the Major League level. The odds of making the Major League level are so astronomically against players that you have better odds of being struck by a bolt of lightening. Genetics play a huge roll in that. I am not saying players should not work to get better, but players, coaches, and parents, need to have those players train and play smarter. Also, I never stated my son did not strength train, he does, but he does functional strength training that is geared towards strengthening the movements he does as a pitcher. None of it consists of using free weights. Velocity was never put at the top of the list with his development. The velocity just came naturally and got better and better as he grew. That velocity was off the charts compared to other kids from the first day he picked up a ball. At 5 year’s old, he threw harder than every other 5 and 6 year old I had seen. With each year the same thing could be said because genetics do play a big role. Aroldis Chapman is a incredible physical speciman in every way. It is no coincidence that he can go out and throw 103, 104, 105 for one inning. His genetics are a huge part of that.
Brent, did the greats of the game, Cobb, Ruth, Walter Johnson, Bob Gibson, Nolan Ryan, Hank Aaron, Mel Ott, Greenberg, Mantle, Williams etc. etc. etc., need you or any other guru charging money for their system? Did any of the pitcher’s listed need TJ surgery? Did they need bio-mechanical analysis? And if that bio-mechanical analysis is so great, why the massive problem with arm injuries?
I am not reaching out to help guys like Cobb, Ruth, Walter Johnson, Bob Gibson, Nolan Ryan, Hank Aaron, Mel Ott, Greenberg, Mantle, and Williams. I am reaching out to help those guys who don’t have the genetics or who are at the end of what their genetics can produce and want more like I did for myself, David Aardsma, Bob Wheatley and the 35 other testimonials on my site.
We have a problem with arm injuries because the averages play to much, have poor physical fitness and poor mechanics. This is why they need gurus that actually can help them reduce the risk of injury while peaking performance. I will admit you are correct, not many of these gurus out there.
are you going to do an article on the arm in relation to the scap plane? that really interests me.
Got a bunch of camps coming up but yes, just remind me!
Correlation of pitching mound height on pitcher’s arm injuries?