The Great Pitching Paradox (part 1)

Pitchers and paradox go hand-in-hand. Here I'd like to deal with the mother of #pitcherproblems which I've written as a haiku just for flare.

They need to throw fast.
And keep their arm in good health.
Or else there's no K.

In other words - pitchers need to throw with high velocity over the long-term, but high arm speed happens to be highly correlated with injury. Of many potential variables that have been identified, injury risk is most highly correlated with , uh, more throwing, less time off from throwing, and more velocity (see all the biomechanical indicators of high throwing velocity.

Guys, really, we can quit blaming the curveball. In fact, breaking pitches are thought to carry less risk of injury due to the fact that they typically occur with less velocity relative to throwing a fastball. With less arm speed there is less strain imposed on the shoulder and elbow.

So let's revise our perspective and expectations from the get-go. Pitching is awesome and rewarding and, in my opinion, worth it. But don't pretend that it's ever going to be healthy.  Instead of reporting how many pitchers get injured, we should see reports of the "staggering number" of high level pitchers who actually do NOT get injured.

And so we naturally arrive at the question as to what athletes can do to enable them to throw hard and remain injury free. While I fear there is no escape from the paradox, I do think that a thorough mechanical analysis and specific training is the absolute best we can do.

I will first speak briefly on pitching mechanics.

All serious pitchers should study what's happening under high speed video. All pitchers and their coaches, PTs, and trainers should work with their own unique rhythm of throwing. We should avoid any of the typical simplistic and over-confident advice on "the way" to pitch, because there really is no one way. But at the same time it is important to realize that there are clear biomechanical red flags to watch out for, especially if the pitchers is experiencing pain.

These should not be a foreign language to your coach, trainer, or PT:

-Maximum knee height (absolute and relative to height)
-Degrees of shoulder abduction at foot contact
-Degrees of lead knee angle at foot contact
-Stride length at foot contact (absolute and relative to height)
-Degrees of maximum external rotation (MER)
-Degrees of lead hip flexion at ball release

*Having awareness of these values does not demand highly sophisticated and precise technology. Someone with a little know-how can easily catch potential problems areas without need of a fifty thousand dollar motion analysis lab.

**Red flags are not guaranteed predictors of injuries or performance, but identified outliers as compared to a population of healthy high level pitchers.

When we analyze things mechanically and say something like "there's too much shoulder abduction at foot contact" or "he's opening the hips too early," most coaches are all too eager to jump in and fix it. Sometimes that works, and sometimes not.

As a physical therapist, I'm eager to ask more questions. Why are the hips opening up early? Is there a reason why stride length is only 70% of height? What, if anything, can the athlete do about it?

Part 2 to come: On the Inadequacy of the Throwers Ten

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