Baseball pitch­ing: signs, symp­toms of pitcher fa­tigue to re­duce arm in­jury

The Southern Berks News - - LOCAL NEWS - By John R. Mishock, PT, DPT, DC

Pitch counts in baseball are so com­mon that dur­ing Ma­jor League Baseball tele­casts, the count num­ber can be found next to the score. Most youth leagues now have pitch count guide­lines to help re­duce shoul­der and el­bow overuse in­juries. It is of­ten said that these type of throw­ing-re­lated in­juries are reach­ing epi­demic pro­por­tions through­out our coun­try. While med­i­cal re­search does not iden­tify op­ti­mal pitch counts, pitch count pro­grams have been shown to re­duce the risk of shoul­der and el­bow in­jury in Lit­tle League Baseball by as much as 50 per­cent (Lit­tle League, 2011). How­ever, pitch counts and lim­its are not the whole story. More im­por­tant than pitch counts is con­tin­u­ing to throw as the arm and body be­comes fa­tigued.

If a pitcher con­tin­ues to throw while the arm is tired or fa­tigued, they are 36 times more likely to de­velop a shoul­der or el­bow in­jury (Amer­i­can Sports Medicine In­sti­tute). Arm and body fa­tigue is by far the great­est risk for shoul­der and el­bow in­juries. Un­for­tu­nately, coaches, par­ents and ath­letes have not been trained on the warn­ing signs of arm fa­tigue.

In some cases, the pitch counts can ac­tu­ally in­crease the risk of overuse in­jury. For ex­am­ple, an 11-year-old baseball player pitches for the first time of the sea­son. The coach al­lows the player to make 50 throws (fol­low­ing the league es­tab­lished guide­lines) then takes him out of the game. How­ever, not all ath­letes are the same. This 11-year-old did not per­form a pre-sea­son con­di­tion­ing pro­gram. There­fore, his arm has not de­vel­oped the throw­ing en­durance and tol­er­ance need to make 50 pitches. He also has poor pitch­ing me­chan­ics, caus­ing his body to ex­ert more force on the el­bow and shoul­der with each throw. Be­yond this, he had a shoul­der in­jury last sea­son in which he did not gain full strength of the ro­ta­tor cuff mus­cles of the shoul­der, thereby leav­ing him vul­ner­a­ble for an overuse in­jury. The coach did the right thing from a pitch count per­spec­tive. How­ever, he missed the most im­por­tant as­pect of arm in­jury pre­ven­tion: signs and symp­toms of pitcher fa­tigue.

The warn­ing signs and symp­toms of pitcher fa­tigue should trig­ger a visit to the mound by the coach and po­ten­tial re­moval of the pitcher from the game.

1. Looks tired or fa­tigued: If a pitcher com­plains of be­ing tired or looks phys­i­cally fa­tigued, it is im­per­a­tive to re­move the pitcher from the game and to rest the player at a po­si­tion which re­quires few throws at a short dis­tance (i.e., first base).

2. Get­ting wild: As the body fa­tigues, there will be com­pen­satory move­ments and a lack of me­chan­i­cal efficiency lead­ing to poor ball con­trol and an in­abil­ity to throw strikes.

3. De­creased throw­ing ve­loc­ity: As the body fa­tigues, the ve­loc­ity of the fast­ball will be re­duced.

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

5. Dropped el­bow: The arm slot is the mo­tion which the arm fol­lows when throw­ing. Each player’s arm slot is spe­cific to the ath­lete, based on ge­net­ics and anatomic struc­ture. As the scapu­lar sta­bi­lizer mus­cles (mus­cles which sup­port the shoul­der blade) fa­tigue, there is poor po­si­tion­ing of the shoul­der blade (lack of up­ward ro­ta­tion). The “dropped el­bow” leads to a higher re­lease point and poor ball con­trol (high pitches).

6. Throw­ing all arm: As the legs, hips and torso po­ten­tially fa­tigue, the pitcher will com­pen­sate with greater arm ef­fort.

7. Re­duced stride length: Stride length is mea­sured be­tween the stance foot at the pitch­ing rub­ber and the stride foot con­tact point at foot strike. As the pitcher’s stance leg gets tired, there is less abil­ity to push off of the rub­ber, lead­ing to a less­ened stride length.

8. Stand­ing tall: At foot plant in the stride leg thigh, there is a high de­gree of mus­cle ac­ti­va­tion to ex­tend and sta­bi­lize the knee in or­der to ac­cel­er­ate or cat­a­pult the hip and pelvis over that sta­ble base. As the pitcher fa­tigues, it is dif­fi­cult for that pitcher to main­tain the front knee po­si­tion (flex­ing and then ex­tend­ing), caus­ing a change in me­chan­ics and de­creas­ing ball ve­loc­ity.

9. De­creased bend: In a sim­i­lar process to “stand- ing tall,” the ab­dom­i­nals, hips and back ex­ten­sors fa­tigue, caus­ing the pitcher to limit the bend­ing of the torso and trunk.

Many of these signs of pitcher fa­tigue may be dif­fi­cult to see with the un­trained “naked” eye. It may be nec­es­sary to video record (eas­ily done us­ing a smart­phone) the player in slow mo­tion to de­ter­mine these sub­tle changes in pitch me­chan­ics. The above men­tioned signs and symp­toms of pitcher fa­tigue should be used as a guide to iden­tify the pitcher who has reached his lim­its in throw­ing in hopes of pre­vent­ing the arm in­juries seen in my phys­i­cal ther­apy clin­ics.

Dr. Mishock’s new book, “The Rub­ber Arm: Us­ing Sci­ence to In­crease Pitch Con­trol, Im­prove Ve­loc­ity and Prevent El­bow and Shoul­der In­juries,” has been re­leased. This book can be found at

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 or email your ques­tions to mishockpt@ com­ Also, visit our web­site 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 Stow at 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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