Base­ball pitcher fa­tigue — learn­ing to rec­og­nize the crit­i­cal signs

The Boyertown Area Times - - LOCAL NEWS - By John R. Mishock, PT, DPT, DC

Most youth base­ball leagues now have pitch count guide­lines to help re­duce shoul­der and el­bow overuse in­juries. Lim­it­ing the amount of pitches thrown has re­duced shoul­der and el­bow in­juries in Lit­tle League Base­ball by as much as 50 per­cent (Lit­tle League, 2011, 2013).

How­ever, pitch lim­its are not the whole story and are of­ten mis­lead­ing.

Each child is dif­fer­ent in their phys­i­cal en­durance, train­ing, body makeup and pitch­ing me­chan­ics. These dif­fer­ences must be taken into con­sid­er­a­tion when coach­ing young pitch­ers. For ex­am­ple, the pitcher who has poor throw­ing me­chan­ics and re­duced phys­i­cal en­durance is at greater risk for in­jury with fewer pitches then the ath­lete who has good pitch me­chan­ics and suf­fi­cient en­durance of the mus­cu­la­ture es­sen­tial for throw­ing. So 25 pitches in an out­ing could be tax­ing and put a young ath­lete at risk, even though it is well be­low most league pitch count guide­lines. Be­cause of this am­bi­gu­ity, pitch counts need to be used in com­ple­ment with signs of arm and body fa­tigue.

Re­cent re­search has shown that the No. 1 risk fac­tor for throw­ing-re­lated in­juries is pitch­ing through arm and body fa­tigue. A pitcher is an as­tound­ing 36 times more likely to sus­tain a shoul­der or el­bow in­jury when pitch­ing through fa­tigue (Amer­i­can Sports Medicine In­sti­tute, 2014). Un­for­tu­nately, most ath­letes, par­ents and coaches have not been trained on the warn­ing signs of arm and body fa­tigue.

First of all, if a pitcher com­plains of be­ing tired or looks tired, it is im­per­a­tive that they stop throw­ing im­me­di­ately and rest. Many pitch­ers will re­sist be­ing taken out of a game, mak­ing it im­por­tant to be able to rec­og­nize key pitch me­chanic changes that are signs of fa­tigue.

Pitch me­chanic warn­ing signs of arm fa­tigue:

1. Up­right trunk at ball re­lease — “stand­ing tall.” As the legs and core (ab­dom­i­nals and hips) mus­cu­la­ture be­gin to tire, there is de­creased knee flex­ion (knee bend­ing) of the land­ing leg and/or de­creased flex­ion (bend­ing) of the torso or trunk. This pat­tern causes less ex­ter­nal ro­ta­tion (back­ward ro­ta­tion of the throw­ing arm) and a high re­lease point, lead­ing to an el­e­vated fast­ball.

2. Change in arm slot or an­gle. As the pitcher’s shoul­der be­gins to fa­tigue, there is less ex­ter­nal ro­ta­tion of the shoul­der, caus­ing the el­bow to drop, chang­ing the arm slot. The change in arm slot puts more strain on the ro­ta­tor cuff mus­cles of the shoul­der.

3. Re­lies less on the lower body and more on the arm. The pitcher be­gins to look like he is throw­ing “all arm.” This is a sign his legs may be tired.

4. Ex­pe­ri­ences a drop in pitch ve­loc­ity. The drop in pitch ve­loc­ity is a sure sign of fa­tigue. A con­sis­tent 3 to 5 mph change in av­er­age ve­loc­ity is a good time to make the pitch­ing change.

5. In­crease time be­tween pitches. When fa­tigued, the pitcher of­ten in­creases his time be­tween pitches, walk­ing around the mound or slow­ing his de­liv­ery.

The com­plete signs of fa­tigue can be found in Dr. Mishock’s book, “The Rub­ber Arm: Us­ing science to in­crease pitch con­trol, im­prove ve­loc­ity and pre­vent el­bow and shoul­der in­juries,” which can be ob­tained at train2­ Learn­ing to ob­serve these sub­tle changes in pitch me­chan­ics may help the par­ent or coach make the crit­i­cal de­ci­sion to re­move a fa­tigued pitcher, po­ten­tially re­duc­ing the in­ci­dence of el­bow and shoul­der in­juries. We can help! If pain is lim­it­ing you from do­ing the ac­tiv­i­ties you en­joy, give Mishock Phys­i­cal Ther­apy a call for a free phone con­sul­ta­tion at 610-327-2600. Email your ques­tions to mishockpt@com­

Visit our web­site at to read more phys­i­cal ther­apy re­lated ar­ti­cles, learn more about our treat­ment phi­los­o­phy, our phys­i­cal ther­apy staff and our six con­ve­nient lo­ca­tions in Gil­bertsville, Skip­pack, Barto, Phoenixville, Lim­er­ick and Pottstown. Our mis­sion is to ex­ceed the ex­pec­ta­tions of our pa­tients by pro­vid­ing ex­cel­lence in care and ser­vice. We are here to serve you!

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