Expert Health Articles

Shoulder and Elbow Health Part 2

Craig Hughes, Operations Manager

Julie A. Cole Rehab and Sports Medicine

Preventative measures should be taken before an athlete throws to decrease the chances of arm soreness or damage. It is important to keep the arm and shoulder strong by building muscles through strengthening, stretching and exercising. Keeping the muscles mobile and strong will help prevent injury and soreness from occurring, which in turn can improve performance.

As shoulder/elbow endurance and strength are key components in maintaining the overall health of an athletes’ throwing arm, a few areas that are often overlooked include a preseason throwing program, positions the athlete plays in the day(s) following pitching, pitch counts, inning limitations and long toss programs.

Warmup is important prior to throwing. When practice begins and as positions are being determined, the athletes can be asked to throw or make multiple throws at high velocity with minimal preseason training. This can start the initial inflammatory process within the shoulder and elbow.

Most players play multiple positions that may affect their secondary position. This can place additional stress on the shoulder and elbow due to the increased volume/velocity demands on those joints that are already fatigued from throwing the previous day. For example, a pitcher who is also a catcher or an infielder uses throwing mechanics that can place additional stressors on the shoulder/elbow structures.

The use of pitch counts assists players, coaches and parents in making sure the athlete is not overthrowing while maintaining shoulder/elbow health. Depending on the number of pitches thrown, there is a mandatory rest period once an athlete meets that limit. Many organizations including the Ohio High School Athletic Association (OHSAA), Cal Ripken Baseball, and Pony League have implemented pitch limitations that require a mandatory rest for a set number of days, ranging from zero days of rest for 20 to 30 pitches thrown, to three to four days of rest for 76 to 85 pitches thrown. There are also some limits on the maximum number of pitches that can be thrown on any one day: 50 to 125, depending on the level of play. However, athletes playing multiple contests and/or in multiple leagues make these pitch counts hard to consistently track. The coach, athlete and/or parent should be involved in tracking the number of throws daily and weekly.  

Inning restriction is more common at younger levels with two innings being the most a pitcher can pitch in one day if he or she has not met the pitch limits of his or her league. Inning limits in addition to pitch limits should be taken into consideration if a pitcher is struggling to find the “zone.” When struggling to find the zone, athletes may compromise their proper throwing mechanics in an effort to throw strikes, creating undue stress on the throwing arm while becoming frustrated.

Long toss programs consist of a set number of throws from a specific distance, rest times and percentage of velocity. This type of program then increases in distance thrown over a period of time while increasing the number of throws made with increasing velocities. When beginning to throw, the distance, number of throws, age of the athlete and previous experience should all be considered. There are many types of throws that an athlete can perform when they are mature enough to withstand the forces placed on the shoulder and elbow with the correct instruction.

These programs can be started during preseason training or during the rehabilitation of an injury to increase arm/throwing strength and frequency to avoid future injuries. While these preventative measures can help maintain shoulder and elbow health, growing athletes have special needs related to throwing and the overall health of growth plates. Age-related game and throwing limitations can be discussed with a coach, therapist or orthopedic provider.