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Preventing and Evaluating Baseball Pitching Injuries

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What Baseball Pitchers Should Do Between Seasons

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When the school season has ended and summer ball has not yet begun, what should a pitcher be doing? Rest? Throw? Lift weights? Run? Something else?

Angel Borrelli shares her recommendations and the program that her pitchers follow in between seasons in this episode of The Fix.

Show Notes

With high school and college seasons ending and summer or travel ball beginning,what should pitchers be doing in between seasons, if anything?

Watch out for head/neck tilt and learn how it can rob a pitcher of velocity and possibly cause injury.

Pitching injury trends are moving beyond shoulders and elbows and into other parts of the body, such as blood clots and thoracic issues – why?

How Major League Baseball teams are managing injuries — are they on the right track? How can they do a better job of preventing baseball pitching injuries? There is a key missing piece that needs to be included — a qualitative piece that can connect the dots.

MLB pitchers mentioned: Shelby Miller (Tommy John surgery), Aroldis Chapman (rotator cuff inflammation), Wei-Yin Chen (elbow, PRP), Phil Hughes (shoulder), Nate Karns (forearm), Jeurys Familia (arterial clot), Dillon Gee

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This One Exercise Can Help Prevent Elbow Injury

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Elbow joint integrity: protect the inside by training the outside

It is common knowledge that the medial (inside) portion of the elbow joint is where the vulnerability lies in regard to injuries causing epicondylitis, UCL sprains, and UCL tears. In addition to directly maintaining the integrity and strength of the inside of the elbow to offset those injuries, giving the outside of the elbow attention in the gym can provide the elbow with an ally to assist it during challenging times.

The brachioradialis is an elbow flexor that, in studies on muscular activity, has shown itself to be the most active when throwing the fastball. It is located on the lateral (outside) of the elbow joint, and because of its structure, it is a major contributor to elbow stabilization during the moments when the medial side of the elbow is stressed. Training it and making it strong is a huge a protective measure for this vulnerable joint.

The hammer curl is the exercise that shows the greatest activity in the brachioradialis muscle. This is a curling exercise performed with dumbbells and a “hammer” grip (just as you would use when using a hammer) is maintained throughout the performance of the exercise. They can be performed two arms at a time, single-arm, or alternating arms. During the season, my pitchers do this exercise at least twice a week and use either the single-arm or alternating-arms method.

Always remember that by virtue of the nature of pitching, there are many things that can happen to your arm over which you have no control. That is why you must always focus on the one thing that you always have control over — which is your level of strength and conditioning for the skill.

Give hammer curls a try and notice the increase in the integrity of the elbow joint — you’ll likely feel it immediately.

The 3 Body Parts Every Pitcher Should Priority-Train

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Getting through the hard work required in the pre-season and the seasons that follow requires that you know how to train in the gym and what to prioritize for special care. While the entire body is important, make “The Big Three” your priority now and see the difference for yourself. From a complete game to a complete season, get ready for big results.

Number One: the rear deltoid
The rear deltoid’s integrity is so important for so many facets of shoulder health and integrity but its special role in deceleration is where it can take the greatest beating.

Number Two: the elbow extensors (triceps and anconeus)
The triceps are extensors of the elbow and its long head is an extensor of the shoulder. Because of this dual role, it plays a huge role in the health of both joints. The anconeus is a small muscle above the posterior elbow that works with the triceps and plays a special role in rapid elbow extension.

Number Three: the forearm
I can’t say enough about the importance of the forearm and maintaining its integrity throughout the performance of a game as well as throughout the entire season. The effectiveness of its musculature to handle the stresses of the pitching motion can make or break your plan for elbow health. Its strength is the number-one weapon against UCL injuries. Because of the forearm’s complexity, it requires different movements to keep it strong.

Here are my pitchers’ favorite exercises for these body parts:

The rear deltoid: side-lying reverse fly (eccentric emphasis)

The elbow extensors: reverse-grip “w” bar pushdowns and cable kickbacks

The forearms: cable wrist flexions and extensions, forearm pronation and supination, and reverse curls using the EZ-curl bar.

Ask your strength coach for additional ideas for priority training these body parts.

3 Vulnerabilities That Cause Baseball Pitching Injuries

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Aches and pains you are having in the pre-season are signals that something is off; it can be that you don’t have good warm-up habits, that you threw too much too soon, or that your mechanics need adjusting. In any case, your body has only way to get your attention and unfortunately soreness is its loudest voice.

The three areas that are the most vulnerable this time of the year are your biceps, the rear of your shoulder and your forearm. Pain or unusual soreness in any of these areas should be a signal to you to pay attention.

Here are some of the most easily recognizable causes of problems with these sensitive areas of a pitchers arm:

Biceps and or rear shoulder: these two body parts work together in the deceleration phase of the pitching motion. Make sure you well warmed-up in the shoulder and arm musculature before you throw a ball. Make sure you are finishing your pitching. Make sure you are releasing your elbow at the end of the arm path as you complete your follow-through.

Forearm: Make sure you are not introducing pitches other than a fastball too soon. Even though a change-up is easy on the elbow, it is more challenging to the forearm because of the spread-out position of the fingers for most of the popular grips. Having a program that maintains and improves the range-of-motion of the wrist for the different pitches is critical to forearm health. Remember that the forearm muscle is an endurance muscle; if you are not recovering or experiencing tightness in this part of the arm, something is not right as it is designed to endure.

How To Get Game-Ready With Preseason Bullpens

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Are your pre-season bullpens really getting you game-ready?

The challenge of the pre-season is that in your bullpens you have to now be thinking “pitching” while at the same time continuing to work technically on your “pitching motion”. “Pitching” is a combination of the pitching motion, a variety of effective pitches, and pitch/game-strategy. It’s easy to get caught-up in working technically on your motion and forget to get back to the art of pitching.

It is important that every athlete learn how to think technically, let the thinking go, and perform. It is also important that he learn how to self-correct during a performance and get back again to “pitching”. At this stage of your bullpen calendar, your pitch counts should be high enough to where you can practice this type of multi-tasking and keep your progress moving forward as you approach your season.

Construct some of your bullpens like this: take a break after you have thrown what represents your game warm-up pen pitch count and then return to the mound and complete your pitch count for the day in sets of 12 to 15 (taking a break after each set). This prepares you numerically and physically for the timing of a game.

In the above scenario, during the pitches that are thrown in your simulated warm-up pen before your sets, practice thinking technically about some of the adjustments you have been working on and then not thinking technically. Once you get used to thinking and not-thinking, it will become easier to remain present with yourself as well as the task at hand. I watch my highly skilled pitchers practice this way and it is truly a sight to behold.

Another plan is to proceed as above with your warm-up pen number, take a break, and then have your catcher call balls and strikes and take a break after the three outs. Simulating an innings format helps to start to build your confidence and again provides you with the learning environment where you can develop the skill of thinking, self-correcting, letting all that go…and just pitching. When possible, have a hitter stand in. This format gives you great feedback about the effectiveness of each of your pitches.

Embrace this time of the year. Learn to trust the work you have done and put it to the test. Never be afraid to self-evaluate and correct. When the season starts, be ready to trust yourself and your pitching — which is the number-one prerequisite for a solid pitching performance.

How Baseball Pitchers Produce Velocity

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So, you want to throw hard … but, how much do you really understand about the way you produce velocity?

The pitching motion is like any other sport skill in that there are specific physical skills within the skill that need to be developed and practiced. And when it comes to performing the skills that contribute in a large way to velocity, there are three skills that I immediately evaluate when a pitcher comes to me to troubleshoot his loss of, or inability to, produce the velocity he knows he has inside.

The skill of sequencing and separating the rotation between the hips, lower trunk, and upper trunk is necessary to accumulate the angular velocity derived from the rotation phase of the pitching motion. The stretch-factor derived from separating the levels of rotation is actually the pre-stretch that will convert to the contraction that produces the transfer of power to the ball. Troubleshoot your rotation to be sure that your hips and trunk are not moving in one piece and/or that your upper trunk is getting ahead of the lower trunk rotation.

The skill of trunk tilt (flexing at the level of the hip joint of the landing leg) toward the plate (not to be confused with lateral trunk tilt, which is a sideways tilt away from the pitching arm at ball release) is necessary to release the ball as close to the plate as possible. The more efficient the trunk tilt, the greater your ability to get over your front leg. Troubleshoot your trunk tilt by making sure that you are not “sitting back in a chair-like position” at ball release. Your shoulders should be moving ahead of your feet, not staying behind them as you tilt forward. A stable front leg (not sinking) and proper use of the rear leg for stability are two requirements for producing a great trunk tilt.

The skill of internally rotating the shoulder and simultaneously extending the elbow at acceleration is essential to maximizing the enormous power of shoulder rotation that is obtained through the pre-stretch of the shoulder accelerators. A delay or change in the position of the shoulder musculature due to faulty arm mechanics can rob you of your velocity. Remember, force production during contraction is based on how well you pre-stretch a muscle — and couple that pre-stretch with the contraction. Knowing how to do this requires understanding the skill and practicing it. Troubleshooting this skill can start with making sure that the stretch you begin to feel around the shoulder joint as you start to rotate your hips toward the plate is not lost during the following moments of rotating the trunk as you square your body prior to acceleration.

Three Pitching Flaws that Rob Velocity

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Man holding radar gun to track speed and velocity of a baseball pitcher

When pitchers tell me they can’t figure out why they are not throwing harder, the first thing I do is to look at their motion from a perspective of what they might be doing that is blocking or interfering with the velocity capability that already resides within them.

It is common these days to feel like you have to search for some new thing “to do” to throw harder. While there are always ways to improve on the specific skills required for your maximal velocity, looking first at eliminating interfering movements is critical. Without first eliminating possible culprits that may be getting in your way, you run the risk of “adding” something to a motion that may have some basic flaws, thus leading to more frustration and failure — not to mention injury.

These are the three most common motion flaws I see that can interfere with the pitcher’s capability of improving his velocity:

  1. Speeding down the hill
  2. Incomplete hip rotation
  3. Leading with the elbow

Pitching Mechanical Flaw #1: Speeding Down the Hill

Speeding down the hill creates a situation of so much power at the beginning of the motion that the body has to jar itself to stop once the front foot lands. This excessive deceleration can create problems for the rotational phase of the motion which is where the accumulation of rotational forces actually begins. The stride is a delicate balance of direction/control/and intensity.

Pitching Mechanical Flaw #2: Incomplete Hip Rotation

Incomplete hip rotation causes a problem for the sequencing and separation of the rotation that occurs through your hips, lower trunk, and upper trunk, essential characteristics of an efficient motion and top velocity production. This error is seen when the lower body is not square-to-the plate prior to accelerating the ball into ball release. Some common causes of this are improper use of the rear leg, pulling the rear foot off too soon, or landing in a location that prevents full hip rotation.

Pitching Mechanical Flaw #3: Leading with the Elbow

Proper acceleration of the ball requires using the shoulder correctly and its capacity for fast rotational forces. When the shoulder and elbow mechanics are off, the elbow will get in front of the shoulder before the shoulder internally rotates (leading with the elbow). This creates a different action at the shoulder and thereby diminishes its vast capacity for acceleration forces. Common causes of this are improper hip rotation (the upper trunk arrives before the hips), a lack of knowledge of proper arm mechanics, and an unstable base (faulty stride position) that disallows proper sequencing during the rotation phase.

It is so important to unleash the velocity potential that is already in you. The first step is to get out of your own way. The second step is to work on the skills required.