June/July 2022 - 20

BaseBall
PROTECTING THE
YOUNG ELBOW, PART II
By P.J. Gardner, MS, LAT, ATC, CSCS, CES, PES
Contributing Writer
E
..lbow injuries in young baseball pitchers continue
..to rise and reduce participation. Second to the
..shoulder, the elbow is a vulnerable area and prone
to injury in the young throwing arm. Unfortunately, many
young pitchers experience elbow pain - and it should not
be ignored. The elbow is susceptible to injury from the
high valgus forces placed on it from pitching at all levels.
This is the second installment of 'Protecting the Young
Elbow,' which appeared in the May/June 2022 issue of
Training & Conditioning.
2 NEWER RISK FACTORS
In an interesting study of junior level baseball
players (6-12y.o.) by Sakata, J. et. al. in 2016, some
newly discovered risk factors were revealed for medial
elbow injuries. One was the thoracic kyphosis angle as
measured by an inclinometer summation of angles > or =
to 30 degrees over the first, second, and twelfth spinous
processes. This condition can alter scapular dynamics and
increase the valgus forces on the UCL.
Another risk factor revealed in predicting an elbow
injury was an elbow extension deficit > or = to 5 degrees.
These two conditions could easily be evaluated in the
PPE exam prior to each season. Although not found in
the literature, it is this author's belief that one of the risk
factors can be extended to the adolescent (13-18 y.o.)
population, as poor posture (thoracic kyphosis) is often
seen in this age group also.
Another predictive factor for elbow injury was >100
throws per day where all positions practiced in a given
day were included - not just pitches from the mound.
An astonishing fact in this study alone is that the risk of
medial elbow injuries in this age group (6-12 y.o.) may be
reduced by simply improving posture (remember thoracic
kyphosis) and keeping throws under 100 per day.
THROWING MECHANICS
Throwing mechanics are another area of concern at
all levels and are difficult to quantify - and what are
proper pitching mechanics? They are discussed by many
experts in baseball but are difficult to accurately identify.
Video camera analysis is needed to properly evaluate
pitching mechanics - and more importantly - a trained
professional needs to do the evaluation. A " trained
professional " is open for discussion. Most high school,
college, and professional pitching coaches know how to
20 | Training & Conditioning | June/July 2022
evaluate pitching mechanics. Parents especially need to
be careful in deciding who evaluates a young pitcher's
mechanics - as there are several " self-claimed " experts
in the field.
A thorough evaluation of the movements involved
in the throwing motion can reveal abnormal throwing
mechanics possibly leading to injury. Corrective
exercises can then be prescribed to correct any
mechanical deficiencies. Corrective exercises could
include standing external rotation, eccentric ball toss,
scapular strengthening exercises, single leg balance with
perturbations, and hip abductor strengthening.
WARM-UP PITCHES
In the junior level players, the number of warm-up
pitches thrown - which most of us have not considered
being a risk factor for injury in the past - was also
examined suggesting, " there may be an upper limit to the
optimal number of warm-up pitches " for this age group
(6). To my knowledge, no exact number of age-specific
warm-up pitches has been determined. It would make
sense to include warm-up pitches in the total pitch count
but, this is not done and could increase one's pitch count
by at least 15-30 pitches depending on the number of
innings pitched. Even though these pitches are usually
thrown at a lower velocity they still require energy
expenditure and produce valgus forces on the elbow. The
question remains: why aren't warm-up pitches included in
the total pitch count?
SHOWCASES & RADAR GUNS
Showcases are another concern because of the radar
gun being used to clock the speed of various pitches.
The use of radar guns is necessary for scouts to clock
exact velocities of the various pitches but, unfortunately,
it also can cause pitchers of any age to overthrow and
risk arm injury to impress scouts. The higher velocity a
pitcher can throw, the less time a batter has to decide to
swing - so, unfortunately, velocity is of great importance
to pitchers at any age and is one of the metrics scouts
examine closely. This is an ongoing concern for parents
and coaches because the last incident anyone wants is
for a shoulder or elbow injury to occur at a showcase. The
ASMI position statement previously mentioned suggests
not using radar guns. It was also suggested by the USA
Baseball Medical and Safety Advisory committee " young
June/July 2022

Table of Contents for the Digital Edition of June/July 2022
