Sideline Consult

A Radical Proposal for Reducing Baseball Pitching Injuries

Bert R. Mandelbaum, MD, DHL (Hon)

Disclosures

August 20, 2015

The Problem With All-Season Pitching

When I was pitching for my 13-year-old Little League all-star team in New York, I never had problems with my elbow. But I can't take the credit for protecting myself with any special conditioning or throwing technique. I probably owed my good luck to geography. Because of the weather, we couldn't pitch past October or before April, so I was forced to rest for most of the year.

The benefit of this limitation is no secret. It's well known that Major League scouts generally don't look for pitchers in California or Florida because all-season pitching wears these athletes down.

But it's not only California and Florida pitchers who are getting injured. Ulnar collateral ligament injuries are increasing at all levels of the sport.[1]

It's time for baseball players, coaches, and managers at all levels to pay more attention to this problem.

Risk Factors for Pitching Too Often

The first step is to understand risk factors. Major League Baseball is working with the players on a large, multiyear, prospective study to examine the problem in detail. They're following players as they come into the league, doing physical examinations, and measuring a variety of metrics over time in relation to the ulnar collateral ligaments. I'm looking forward to the results.

In the meantime, epidemiologic studies suggest that individuals who are bigger and stronger and who throw with the greatest amount of speed and kinetic injury are at greatest risk of injuring their elbows.[2]

Of course these are the players who coaches want to play the most. One of my patients told me that he has a 16-year-old son who throws 92 mph. I said, "Fantastic, but you have to sit on this kid." They do become today's victims of success.

So, what's the solution? All competitive baseball teams, be they high school or college, non-40-man roster, 40-man roster, or Major League Baseball, need more fast pitchers so that each one can pitch less.

If you want to have your best pitchers pitch the most, then you should have them pitch less time per week and less time over a year. That way they can have a longer number of years pitching. It's all a question of dosing, and less certainly is more. I think that's going to be the challenge in baseball going forward.

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