Learn effective strategies to reduce the risk of common baseball arm injuries for pitchers and position players

Last week we discussed how to prevent the most common injuries in baseball. For more on that, read part 1 here. Here were the foundational takeaways from a sports physical therapist’s perspective:

1. Sleep at least 8 hours a night.

2. Eat a balanced diet with enough protein (1.5 - 2 grams of protein per kilo of body weight).

3. Gauge your mental load outside of just ball and talk to a professional if needed.

4. Do not ignore abnormal tightness/soreness. Talk to an athletic trainer or give us a call for free at (720) 248-7515.

This week we’ll discuss workloads and how to structure throwing/training in order to reduce your risk of arm injuries. Then in part 3 we’ll finally get into specific mobility and strength drills within a proper arm care routine to further protect against baseball injuries. 

Here’s part 2 of how to prevent the most common baseball injuries:

For reference, when I say “common injuries in baseball” here’s the data to validate the claim. A whopping 49% of injuries to big leaguers were to the arm! Here are the most common arm injuries in baseball according to one source:

• Shoulder - 35%
  
  
• Elbow - 31%
  
  
• Hand - 14%

This data is a physical therapist’s nightmare. So let’s get into how your training structure and workload management can reduce your injury risk.

Managing Workloads

You only get one workload “bucket”. Everything that you do on a daily basis from walking to the car to high intensity sprints that day goes into your bucket. That’s why just working hard is not the recipe to prevent arm injuries in baseball. You’ll burn yourself out and eventually get injured. That’s the reality.

What else goes into that bucket?

You guessed it. Pitch counts.

Welp, the digital friendship was good while it lasted. Hope to see ya around!

Pitch Counts

The science isn’t new. Throwing too much - especially as a young baseball player - leads to bad things. Pitchers who throw more than 100 pitches in a game are more likely to sustain shoulder and elbow injuries. 

That’s why 25% of 12 to 16 year old baseball players sustain some sort of arm injury.  You don’t want to end up in a physical therapist’s office, right?

Here at PRO Athlete Physical Therapy, we support pitch counts in 98% of cases. Why? Because in most instances not only are pitchers blowing past pitch counts, they’re also spending the rest of the weekend playing catcher throwing even more. 

Here’s what MLB recommends. Keep in mind they know the most common baseball injuries and are trying to help:

Here’s a list of things the research has told us about what causes arm injuries in baseball other than violating pitch counts. As a physical therapist, these are things I want to manage right away when athletes come into my office:

• History of injury
  
  
• Training > 16 hours per week (in youth athletes)
  
  
• High pitch velocity
  
  
• Bad shoulder range of motion
  
  
• Bad shoulder strength
  
  
• Bad throwing mechanics

Work Harder and Smarter

Listen, I get it. You want to outwork the competition but the bottom line is that one more bullpen or one more set of plyos or one more cage session is probably doing more harm than good. Especially if you’re already fatigued and especially if you already have physical limitations like bad shoulder/elbow strength and mobility.

Sidebar: Want a customized maintenance plan to prevent injuries in the first place? Call us to set up an injury prevention program designed jus for you.

Now, does that mean you should never work hard? Of course not. 

Research shows that tolerating extremely high workloads - uncomfortable levels of hard work - for a brief period can be a good thing. But your training program should be designed in a way that exposes you to hard work safely. 

How?

Physical therapist, Dr. Mike Reinold, and his team created this throwing program for MLB pitchers with arm injuries. They did so by following the 0.7 to 1.3 principle. These numbers come from years of workload-related research in many other sports. Long story short, big swings in workloads can lead to nearly double the injury risk among athletes.

This study is hot off the presses by a baseball physical therapist and thought leader Mike Reinold:

These graphs show daily throw count and overall workloads over time. You’ll notice that the trend is smooth and never takes a sharp turn in either direction. This is the most logical way to attempt to prevent common baseball injuries in baseball players.

Example

A professional reliever is rehabbing from a shoulder injury and is now in week 1 of his mound progression. In the first week on the mound, he’s scheduled to throw 2 bullpens for a total of 44 pitches.

By Week 5, that means, ideally, he doesn’t surpass ~58 total pitches from the bump (AKA no more than 30% of the volume from week 1).

And,

By Week 5, that means, ideally, he doesn’t throw any less than ~35 total pitches from the mound (AKA at least 70% of the volume from week 1).

Now, there are approximately one million considerations here that this mini example doesn’t take into account. Here are a few:

• Athlete age
• Warmup throws/rehab work
• Injury history
• In-game max velocity
• Perceived effort
• Elbow torque
• Build up volume to bullpen
• Self recovery reports
• Objective strength/mobility data
• Diet/hydration
• Sleep quality
• Outside stressors
• Player goals
• Team goals
• Alternative pitches
• Time of year
• Strength and conditioning program and goals

As you can guess, this is a very, very watered down version of a complex topic but athletes with minimal to no resources should follow these general workload rules:

1. Don’t do too much too soon (no more than 30% of the previous 4 weeks)

2. Don’t let activity dip below a baseline level (at least 70% of the previous 4 weeks)

3. Ramp up at a pace that gradually increases your work

Structure and Routine

Another area of concern for sports physical therapists when it comes to an athlete’s structure and routine is the athlete not having any at all. While I was a PT with the Twins, I saw this issue arise consistently. Guys had no idea how many throws/swings they would rack up in a day or week. What’s worse, they had no concept of relative intensity. The result? 

Spoiler: they’d spend a chunk of the season in rehab with me treating some of the most common baseball injuries. 

But what does relative intensity even mean? Relative intensity means alternating the amount of stress/work in any given training day. The scientific term for this is undulation. 

Example

Imagine a professional pitcher building up for the season. Instead of throwing a max effort bullpen every day, many professional relievers structure their week like this:

• “Day before” (a light day in preparation for the heavy day)
  
  
• “Day of” (bullpen or heavy day)
  
  
• “Day after” (a medium intensity recovery day)

Below is a very basic template of how a pro reliever structures his work week coming back from an arm injury. This obviously depends on several factors - especially the rotation - but the idea is to separate work days into light/medium/heavy intensity. As with everything there are caveats and exceptions. However this is generally how to get the most out of training and prevent the most common injuries in baseball:

This applies to position players, too. You should not be long-tossing and taking 300 swings on one day, lifting heavy the next day, then playing in a double-header on the third day. 

Undulation prevents injury and improves performance because it allows for your tissues to heal and for your brain to process new skills. Your training should be like a predictable roller coaster - not a never ending NASCAR race. 

What’s the Point?

You may be thinking “Edwin, all of this research is based on injured guys. I’m healthy.”

Exactly.

When a baseball player is injured, physical therapists and athletic trainers follow all of these concepts to get them back on the field. Why wait until you’re injured to take advantage of all this knowledge?

Here’s what you’ve learned so far to prevent shoulder and elbow pain as a baseball player:

• Get at least 8 hours of sleep
  
  
• Dial in your diet and hydration
  
  
• Find good mental headspace
  
  
• Don’t red-line your workouts every day
  
  
• Create a predictable roller coaster-like routine

Now it’s time to start thinking about a specific shoulder/arm care routine to prevent common baseball injuries. Remember these 3 risk factors from earlier?

• Bad shoulder range of motion
  
  
• Bad shoulder strength
  
  
• Bad throwing mechanics

Turns out that’s our wheelhouse as physical therapists! In the final installment of this 3 part series on preventing common baseball injuries, I’ll get into my process of assessing a baseball player as a physical therapist. That process leads to an individualized arm care routine. 

We’ll talk soon.