Pitchers and elbows

The elbow is the most common injury in youth pitchers. I've always felt helpless when a pitcher points to his elbow and says it hurts here - pointing to the inside of his elbow. Well, I'm still not an expert but I feel I've researched this enough to speak intelligently about it. Here goes.

Elbow injuries occur when the arm gets in a vulnerable position during the pitching delivery. Imagine arm wrestling someone. The strongest position possible is one where the body is near the arm. A vulnerable position is when the arm works away from the arm. As a pitcher, wanting the arm in a strong position near the body is critical. How do we do this?

Dr. James Andrews and Dr. Glenn Fleisig have diagnosed the two primary times in a pitchers motion where injuries occur. These times are at the initial acceleration phase of the delivery and at release point. The initial acceleration phase is when the arm actually starts to work forward. The ball instantly and violently turns in the direction of home plate. The release point is easier to understand. It is when the ball literally exits the pitchers hand. So, if this is when injuries occur, how do we prevent injuries?

Lets go back to that arm wrestling analogy. When you begin to win an arm wrestling match your arm pronates as it takes your opponent to defeat. When you lose, your arm suppinates as your opponent takes you to the table. The idea for a pitcher is to maintain pronation in favor of suppination during these two moments in time.

When the pitcher begins his initial acceleration phase it is absolutely critical that his torso be back and in a strong position. If the torso begins to drift away from the rubber the arm will attempt to catch up and will suppinate early to do so. The torso must remain back as the hips and legs begin their drive to the plate. This "staying back" allows the arm to stay connected to the torso and pronate at initial acceleration phase.

What does pronate at initial acceleration look like? When the shoulders start to turn the elbow should drop under the shoulder and the palm of the hand should marry the direction of the chest. If the palm starts to open to home plate faster than the chest- thats early suppination and big trouble.

The second time in the delivery where the pitcher is vulnerable is at release. Every pitcher pronates at release. However, some pitches allow the elbow to pronate easier than others. The fastball, change up and the curveball make for easy pronation. Whereas the slider and the cutter put the elbow in a precarious spot.

Doctors refer to this stress on the elbow as valgus stress. Valgus stress directly relates to suppination of the elbow. Keeping an eye on these stresses is critical to maintaining proper perspective.