Note: I recently attended the 2012 American Academy of Orthopaedic Surgeons Annual Meeting in San Francisco, California. In the next few weeks, I will present some of the important studies presented at its Specialty Day, presented by the American Orthopaedic Society for Sports Medicine.

Over the last couple of days pitchers and catchers from all of the Major League Baseball teams have reported to spring training. They will gradually work to prepare themselves for the upcoming season while limiting stress on their shoulders and elbows to avoid injuries.

Youth PitcherOne focus of particular importance at every level of baseball is a pitcher’s mechanics. But does the position of a pitcher’s elbow, long thought by pitching coaches to not only affect ball velocity but also the risk of elbow injury, actually matter?

Authors of a study presented recently at the American Academy of Orthopaedic Surgeons Annual Meeting in San Francisco argue that the answer could be more complicated than just elbow position. Carl W. Nissen, MD et al. used complex motion analysis to determine visual elbow drop and drag and true elbow drop and drag. While I won’t go into exhaustive detail explaining all of the terminology, the results of the analysis are what I consider important.

They found that elbow position alone seems to have little to do with the joint moments on the glenohumeral joint (shoulder) or elbow because many other body positions play a role. Trunk position and rotation and thoracic lean (of the chest) can not only cause an elbow to appear to a coach to be improperly positioned when it isn’t, but the position of the shoulder, elbow, trunk, and chest all work together to generate force with pitching. While elbow position did not affect stress on the elbow joint, the researchers did find that visual elbow drag did affect ball velocity, so elbow position might affect pitching performance.

“The elbow’s position in relation to an injury and enhanced performance in baseball pitchers is highly dependent upon the trunk’s position. Our research showed that the pitching motion is complex and a direct relationship between true elbow position and how much stress is placed on a joint does not appear to exist,” Dr. Nissen noted.

Baseball PitcherNow pitchers, coaches, and parents might wonder how this study affects how they approach pitching and learning proper mechanics, and I will not try at discuss elbow drag or drop or any coaching term. I am not by any means a pitching coach, so I will defer that to people who can explain it much better than I can.

However, it makes sense to me that elbow position alone does not correlate with stress on the elbow joint. And along that line, it probably has little do to with causing shoulder or elbow injury. The pitching motion is complex, and the entire kinetic chain must be considered when evaluating mechanics. Any number of issues, such as posterior capsular tightness of the shoulder, core muscle weakness, improper trunk positioning and rotation, and many others, can alter mechanics and not only cause performance to decrease but also theoretically place unnecessary stress on the shoulder and elbow.

So I would tell pitchers and their parents to learn proper pitching mechanics from a respected pitching coach and work to keep all aspects of the body involved healthy and strong. But even with proper mechanics and shoulder and elbow positioning, remaining injury free is not guaranteed. As we have discussed before, the numbers of innings pitched, types of pitches thrown at certain ages, pitching through pain, and so may other risk factors can all lead to injuries in young arms.

What do you think about this study or this post? What can we do to prevent youth pitching injuries?