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Injury Management in Baseball

Happy winter everyone! The cold is setting in around Melbourne and winter has officially come. I thought I might publish a blog post about baseball as I have a special interest in this area and have been seeing a number of baseball players in the clinic.

Baseball is becoming quite a popular sport in Victoria and there are some amazing players who are rising through the ranks. One such talent is Genevieve Beacom who made baseball history recently by becoming the first woman to pitch for a professional baseball team in Australia at the age of seventeen! Truly incredible. So whilst baseball has always been a dominant sport in the United States, the sport is a lot more popular than you think.

For those who don’t know how baseball is played, here is a quick summary. Baseball is a game played with two teams of nine players, the game is divided into nine innings, each divided into halves. One team will bat and the other team will field for the first half and then they swap. The team who scores more runs at the end of the nine innings is the winner.

It is usually played on a diamond field with four bases. The pitcher will throw from the pitcher’s mound to the batter (a distance of 60 feet 6 inches or 18.39 metres) and the batter will attempt to hit the ball into the field away from fielders. Once the ball has been hit, the batter needs to run to all four bases to successfully score a run.

If I have lost you by now, I apologise. It can be quite a boring sport to watch. However, it is a fascinating sport. Unlike most other sports, baseball exists outside of time – there is no clock to control game play or judge a player’s performance. However, it is a game that has an overwhelming amount of statistics. Players, coaches, team managers and fans spend endless hours comparing the performance of players and where there is statistics there is information. 

As with any sport, injuries follow close behind. Arm injuries among baseball players are highly prevalent in all levels of the sport. In Major League Baseball (MLB) it accounts for nearly 50% of all injuries(Conte, Camp & Dines, 2016) These are primarily in the upper limb extremity and are normally seen in pitchers. And if you have a look at the image below, you might see why!

It is the age of the pitchers at the moment. In 2018, the MLB had more strikeouts than hits for the first time ever in the history of the sport (Sheinin, 2019). The median pitch has become almost one mile per hour faster over the last 10 years and there are more pitchers that are hitting 100 miles per hour (Sheinin, 2019). Just to comprehend that, 100 miles per hour is 160 kilometres per hour. Vicroads would have a field day with those speeds on the freeway! 

Just as the game is being driven by pitchers, it is pitchers that have been reported to experience a greater proportion of shoulder and elbow pain as compared with other positions due to the greater physical demands of the upper limb. So with more velocity, comes more problems. As the speed increases, batters get better and there is an emphasis on maintaining these speeds throughout the game. I will speak only about the risk factors in this blog post and show some of the current research on the matter.

The MLB has devised a Pitch Smart protocol to give players and coaches some guidance on how to best manage pitching numbers and guidelines to follow. You can find them here on

The image below shows the recommendations for pitchers in the 19-22 year old group. There is no guidance beyond that age of 22 however there are further guidelines for younger age groups. There is no distinction between males and females currently. 

So what does the research say on this matter?
Here is the current research, there is evidence supporting the following (Agresta, Krieg & Freehill, 2019).

  • Increased mechanical load (measured by pitch count or training hours)
  • Higher pitching velocity (Chalmers et al., 2017)
    • Higher pitch velocity can lead to higher elbow valgus torque and higher loads through the shoulder
  • Decreased shoulder range of motion especially in flexion, internal rotation and horizontal adduction with kinematics of the throw (Kibler & Thomas, 2012).
    • The bottom image describes the total motion concept. The combination of the external rotation and internal rotation equals total motion of the shoulder. The pathological loss of internal rotation will result in total loss of motion.

There is limited evidence currently regarding these risk factors (Agresta, Krieg & Freehill, 2019):

  • Higher percentage of curveballs compared with the fast balls DO NOT lead to a higher risk of shoulder injuries 
  • Scapular dysfunction is NOT associated with subsequent upper extremity injuries in baseball 
  • Lower limb strength, trunk function and related kinematics HAS NOT been shown to prevent the risk of shoulder injuries

There is no evidence regarding the following risk factors (Agresta, Krieg & Freehill, 2019):

  • Playing multiple teams at the same time
  • Throwing curveballs and sliders at a young age
  • Pitching on consecutive days

Now it is important to consider that there is a massive gap in the research with certain aspects of baseball. Table 6 shows that there is still not enough research to show the link between:

  • Trunk kinematics
  • Shoulder/Elbow kinematics
  • Scapular kinematics
  • Shoulder/Elbow laxity
  • Scapular alignment 
  • Lower limb muscle strength
  • Trunk strength/endurance
  • Arm anthropometry
  • Grip strength 

(Mine et al., 2021)

So what does this mean? If you are a new baseball player or a young baseball player, it is crucial to work on your throwing mechanics and focus on developing the necessary strength to withstand these forces. From a young age, it is important to pay attention to pitching loads and keeping to the MLB guidelines. 

If you want to throw faster, then it comes from a combination of rotator cuff strength, trunk rotation mechanics and lower limb strength. It is important to build a good foundation of strength first and then learn to transfer that strength into power. 

As shown in the above image, there are modifiable factors that can be changed and there are non-modifable factors that cannot be changed. The bottom line is that there are a lot of factors that can affect a pitcher and it is important to focus on the things that we can control. 

If you have any questions, please feel free to reach out! 

As always, keep moving!



Agresta, C. E., Krieg, K., & Freehill, M. T. (2019). Risk factors for baseball-related arm injuries: a systematic review. Orthopaedic journal of sports medicine, 7(2), 2325967119825557.

Chalmers, P. N., Wimmer, M. A., Verma, N. N., Cole, B. J., Romeo, A. A., Cvetanovich, G. L., & Pearl, M. L. (2017). The relationship between pitching mechanics and injury: a review of current concepts. Sports Health, 9(3), 216-221.

Conte, S., Camp, C. L., & Dines, J. S. (2016). Injury trends in Major League Baseball over 18 seasons: 1998-2015. Am J Orthop, 45(3), 116-123.

Kibler, W. B., & Thomas, S. J. (2012). Pathomechanics of the throwing shoulder. Sports medicine and arthroscopy review, 20(1), 22-29.

Mine, K., Milanese, S., Jones, M. A., Saunders, S., & Onofrio, B. (2021). Risk factors of shoulder and elbow injuries in baseball: a scoping review of 3 types of evidence. Orthopaedic journal of sports medicine, 9(12), 23259671211064645.

Sheinin, D., 2019. Velocity is strangling baseball – and its grip keeps tightening. [online] Available at: <> [Accessed 8 June 2022].


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