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Pitch Velocity Linked To Elbow Injury Risk, Study Says

Most Talented Pitchers May Be Ones At Greatest Risk

The harder a youth baseball pitcher throws, the greater may be the risk of elbow injury, finds a 2012 study.1  The study suggests adjusting current injury prevention guidelines beyond pitch counts to include how fast a pitcher throws.

Based on tests performed on 26 uninjured high school-aged pitchers, researchers at the Mayo Clinic and the Kerlen-Jobe Orthopedic Clinic in Los Angeles found a very strong link between pitching velocity (PV) and peak stress on the elbow. Young pitcher about to delliver ball to plate

"Our findings suggest that individuals with greater throwing velocities may be more vulnerable to elbow injury, particularly of the ulnar collateral ligament (UCL)," said lead author, Wendy Hurd, PT, PhD, SCS of the Department of Orthopedic Surgery at the Mayo Clinic.

The number of reconstructive surgeries of the UCL (so-called "Tommy John" surgeries) among young pitchers has skyrocketed in recent years.

While not the first study linking pitching speed and risk of injury - a 2006 study2 found that young pitchers who throw over 85 mph have a far greater risk of arm injury - the researchers nevertheless viewed the association between throwing velocity and elbow injury as "alarming," especially since "increasing velocity is the goal of many pitchers."

"A high PV is considered a hallmark of talented young pitchers, suggesting that the best pitchers may be the most vulnerable to injury," said Hurd.

"The finding that the pitchers with greater ball velocity have greater elbow torque or 'moment' (that is, rotational force on the elbow) is consistent with [our] data," says Glenn Fleisig, Ph.D. of the American Sports Medicine Institute (ASMI).  "It makes sense too. I agree that pitchers with greater ball velocity are therefore at greater risk of injury (but also of greater chance of success on the field)."

Slow down, the ball's moving too fast

Another leading expert on pitching injuries, ASMI's Dr. James Andrews, has suggested that there should be a limit on how fast a pitcher should be throwing, and that kids should simply "slow it down."   He thinks one of the reasons kids throw so hard is the radar gun, which he argues, should be outlawed.  "Young pitchers, coaches, scouts and parents put so much emphasis now on throwing hard that these kids are hurting their elbows and their shoulders because they are trying to throw 90 mph," he recently told ESPN.com.

Radar guns, says Hurd, are considered "undesirable by almost all who deal with youth baseball injuries," but are currently commonplace at showcases and most games. "Overthrowing at showcases and for scouts is already a problem. If parents and coaches are sincere about protecting the health of these youth athletes they will stop trying to work around guidelines and do everything they can to promote health," says Hurd.

ASMI's Fleisig, for one, thinks "pitch velocity should be considered if you want to tweak pitch counts for individuals, but so should other factors such as strength & conditioning, history of arm injury, age, height, weight, and pitching history."

"I still think the best approach is to establish pitch count and rest guidelines based upon studies of large samples of pitchers, and then adjust up or down for an individual based upon monitoring his fatigue and performance," Fleisig says.

Although Hurd sees limiting a pitcher's velocity to prevent injury as impracticable, she does suggest the results of the Mayo/Jobe study may nevertheless be useful in enhancing current injury prevention guidelines, which focus on limiting the number of pitches thrown in a game, during a week, and over the course of a season and a year - either in the form of recommendations (USA Baseball) or, in the case of Little League Baseball, mandatory pitch count lmits and rest periods - to include pitch velocity as a factor in setting pitch counts.

"These results emphasize the importance of following existing guidelines, limiting pitch volume and type to minimize the effects of cumulative microtrauma" in youth baseball pitchers, says Hurd.  "Expanding pitch guidelines to include throwing velocity may be necessary to protect [pitchers] from future throwing-arm injury," the study concludes.

A recent study3 shows that, at least with respect to USA Baseball Guidelines, knowledge of and compliance with such guidelines, however, is poor.


1.  Hurd W, Jazayeri R, Mohr K, Limpisvasti O, ElAttrache N, Kaufman K. Pitch Velocity Is A Predictor of Medial Elbow Distraction Forces in the Uninjured High-School Aged Baseball Pitcher. Sports Health: A Multidisciplinary Approach. 2012; DOI:10.1177/1941738112439695 (accessed March 22, 2012)(published online ahead of print). 

2. Olsen SJ 2nd, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors forshoulder and elbow injuries in adolescent baseball pitchers. Am. J Sports Med. 2006;34(6):905-912.

3. Fazalare J, Magnussen R, Pedroza A, Kaeding C.  Knowledge of and Compliance With Pitch Count Recommendations: A Survey of Youth Baseball Coaches.  Sports Health: A Multidisciplinary Approach. published online February 6, 2012. DOI:10.1177/1941738111435632 (accessed February 7, 2012).

Most recently revised March 30, 2012