It is theorized that “improper” pitching technique leads to injury by placing added stress on the shoulder and elbow joints, and creating shoulder and elbow pain and pitching-related upper extremity injuries.27, 29, 30, 33, 48, 49, 50 and 51 However, evidence that directly links pitching technique to pitching-related upper extremity injuries is limited. In 1978, Albright et al.32 investigated the association between arm position (i.e., angle of humerus) during delivery and reports of shoulder and elbow symptoms at the end

of the baseball season in youth and collegiate pitchers. The study reported that 73% of the pitchers who exhibited a more horizontal arm delivery reported shoulder or elbow symptoms compared to 21% among the pitchers who exhibited a more vertical arm delivery, and that the reported elbow symptoms were more severe in pitchers BKM120 with a more horizontal arm delivery. The

limitations of this study, however, were that the study did not take pitch volume over the season into account and that the study used crude and subjective assessments of “arm angle” and symptoms. In another study, Huang et al.52 demonstrated differences in throwing kinematics between youth baseball players with and without a history of medial elbow pain. This study demonstrated that youth baseball players with a history of elbow pain threw with a more extended elbow at maximum shoulder external rotation and greater lateral trunk tilt at ball release. However, Selleck CAL 101 a retrospective nature of the analysis precludes us from determining whether the Resminostat pitchers with an injury history demonstrated the error prior to the time of injury, or if the error developed after the injury. To this date, these are the only studies that directly link pitching technique to upper extremity pain and injury. Lyman et al.6 attempted to link quality of the pitching technique to risk of shoulder and elbow pain in youth baseball

pitchers. However, the study failed to demonstrate a significant relationship between pitching technique and complaints of shoulder or elbow pain. While evidence directly linking pitching technique to injury is limited, there is evidence to support that increased joint loading during pitching is associated with upper extremity injuries, and there are separate sets of evidence demonstrating the effects of pitching technique on joint loading. These sets of evidence will be discussed next. Evidence linking increased joint loading and injuries comes from studies that describe pitching biomechanics and anatomy. Traditionally, pitching is described in six phases: wind up, stride, arm cocking, acceleration, deceleration, and follow through.53 and 54 Of these phases, the arm-cocking, acceleration, and deceleration phases are the phases when high magnitudes of forces and moments are experienced at the shoulder and elbow joints.