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Review
. 2017 May/Jun;9(3):216-221.
doi: 10.1177/1941738116686545. Epub 2017 Jan 1.

The Relationship Between Pitching Mechanics and Injury: A Review of Current Concepts

Peter N Chalmers, Markus A Wimmer, Nikhil N Verma, Brian J Cole, Anthony A Romeo, Gregory L Cvetanovich, Michael L Pearl
Review

The Relationship Between Pitching Mechanics and Injury: A Review of Current Concepts

Peter N Chalmers et al. Sports Health. 2017 May/Jun.

Abstract

Context: The overhand pitch is one of the fastest known human motions and places enormous forces and torques on the upper extremity. Shoulder and elbow pain and injury are common in high-level pitchers. A large body of research has been conducted to understand the pitching motion.

Evidence acquisition: A comprehensive review of the literature was performed to gain a full understanding of all currently available biomechanical and clinical evidence surrounding pitching motion analysis. These motion analysis studies use video motion analysis, electromyography, electromagnetic sensors, and markered motion analysis. This review includes studies performed between 1983 and 2016.

Study design: Clinical review.

Level of evidence: Level 5.

Results: The pitching motion is a kinetic chain, in which the force generated by the large muscles of the lower extremity and trunk during the wind-up and stride phases are transferred to the ball through the shoulder and elbow during the cocking and acceleration phases. Numerous kinematic factors have been identified that increase shoulder and elbow torques, which are linked to increased risk for injury.

Conclusion: Altered knee flexion at ball release, early trunk rotation, loss of shoulder rotational range of motion, increased elbow flexion at ball release, high pitch velocity, and increased pitcher fatigue may increase shoulder and elbow torques and risk for injury.

Keywords: baseball/softball; biceps tendon; glenoid labrum; motion analysis/kinesiology; superior labral anterior posterior (SLAP) tear.

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Conflict of interest statement

The following authors declared potential conflicts of interest: Markus A. Wimmer, PhD, has grants/grants pending from Biomet, Ceramtec, and Zimmer. Nikhil N. Verma, MD, is a paid consultant for Smith and Nephew; receives royalties from Arthroscopy, Vindico, and Smith and Nephew; and has stock/stock options in Cymedica, Minivasive, and Omeros. Brian J. Cole, MD, MBA, is a paid consultant for Arthrex, Regentis, and Zimmer; receives royalties from Arthrex, DJ Orthopaedics, Elsevier, Saunders, and SLACK; and has stock/stock options in Carticept and Regentis. Anthony A. Romeo, MD, is a paid consultant for, and received payment for lectures from, Arthrex, and also receives royalties from Arthrex and Saunders.

Figures

Figure 1.
Figure 1.
Phases of the pitch for a left-handed pitcher: (a) wind-up, (b) stride, (c) cocking, (d) acceleration, (e) deceleration, (f) follow-through, and (g) end of the pitch.
Figure 2.
Figure 2.
The 3 kinetic factors shown to correlate with injury: elbow valgus torque (a), shoulder external rotation torque (b), and pitch velocity (c).
Figure 3.
Figure 3.
Two pitchers each at the moment of front foot contact. Marked differences can be seen in thoracic rotation, between (a) rotation 30° toward the pitchers and (b) rotation 45° toward second base. The axes for the environment are shown in red (x), blue (y), and yellow (z).
See this image and copyright information in PMC

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