Pitching Mechanics That May Prevent Medial (Inner) Elbow Pain

3.9.2006

It's March of 2006 and in just the past week I've talked to 5 or 6 guys or their parents who are having pain on the medial (or in plain English "inner") portion of their Pitching Arm Side (aka PAS) elbow. While this is probably due to the weather warming up in some parts of the country, it still bothers me.
     Because there are limits to the positive impact that conditioning programs can have on pitchers who are younger than 16 years old (biologically, and not necessarily calendrically, speaking), let me suggest a few mechanical tweaks that pitchers can make that may reduce the medial (inner) elbow pain that you or your child are experiencing and may reduce the likelihood that they will experience this pain in the future.
     Of course, when reading this you should keep in mind that in some cases the root cause of the problem is overuse, which means throwing too much while too young, and the only way to fix the problem (at least until the pitcher gets older) is to not throw so often and/or so hard.

1.A. Don't Show The Ball To CF/2B
The simplest thing that pitchers can do is to not follow the common advice to show the ball to Center Field as they pass through what is variously referred to as the High Cocked Position, the High Guard Position, or the Power Position. The problem with doing this is that it forces you to pronate your forearm too early and then requires that you then supinate your forearm to get your palm around to facing the target. This then focuses the load on the UCL and may irritate it and/or the bones to which it attaches.

1.B. Do Show The Ball To 3B
A better thing to do is for a RHP to show the ball to 3B as you pass through the High Cocked Position, the High Guard Position, or the Power Position. For a LHP, this means that they would show the ball to 1B. The reason to do this is that it supinates your forearm at this moment which then requires you to pronate your forearm in order to get your palm to face the target when you release the ball. This activates the Pronator Teres muscle and takes some of the load off of the UCL. If you were wondering, very few major league pitchers actually show the ball to Center Field. Instead, most show the ball to 3B or at most SS.

2. Do Break Your Hands Early
If you are interested in going a little farther down this road, then another thing you can do is break your hands early. This has three benefits. First, it virtually eliminates the problem of rushing. Second, it reduces the risk that you will experience elbow pain. Third, it reduces the risk that you will experience shoulder pain. If you were wondering, there are a number of major league pitchers who break their hands, and get their pitching arms up, much earlier than most.

3.A. Don't Try To Keep Your Fingers
On Top Of The Ball
A related piece of advice that I think contributes to elbow problems is the advice to always keep the fingers on top of the ball. While well-intentioned (I believe the idea is to keep you from throwing under the ball), I believe this advice causes more problems than it solves. 

3.B.1. Do Break Your Hands With Your Palm
Facing 3B
If, after breaking your hands, you keep your palm facing 3B, or even upwards, then you will have by definition turned your pitching arm side forearm over early. At a minimum, this will put you in a better position to powerfully pronate your forearm as you accelerate your arm toward the plate.

3.B.2. Do Go "Thumbs Up" After Breaking Your Hands
One fairly common piece of advice is that pitchers should keep their thumbs down as they break their hands. I think this is bad advice and can lead to both elbow and shoulder problems. What I teach my guys is to go "thumbs up" after they break their hands. This means that they show the ball to 3B as they raise their PAS arms up into the High Cocked position.

PERFORMANCE IMPLICATIONS
Some people will say that the above advice will hurt your velocity. I'm not convinced that that is the case. For one thing, Freddy Garcia (and others) does what I advocate in point 2 and his velocity is just fine (and he seems more injury-free than others). Also, even if following this advice does cost you some velocity, I think that Greg Maddux proves that this isn't an insurmountable problem and protecting your elbow (and thus your career) is worth it.

MEDICAL AND SCIENTIFIC BASIS FOR THIS ADVICE
The above advice is based on my general knowledge of the physiology of pitching, which I gained from studying the work of Dr. Mike Marshall, and is backed up by articles like "Effect of Pitch Type, Pitch Count, and Pitching Mechanics on Risk of Elbow and Shoulder Pain in Youth Baseball Pitchers" by Stephen Lyman PhD, Glenn S. Fleisig PhD, James R. Andrews MD, and E. David Osinski MA. On page 465 of this article, the authors make the following statement...

"In fact, two mechanical flaws, backward lean in the balance position and early hand separation, correlated with a decreased risk of elbow pain. Two other flaws, a long arm swing and arm ahead of the body at the time of ball release, correlated with a decreased risk of shoulder pain."

When the authors talk about the "arm ahead of the body at the time of ball release" they are talking about pronation (and more importantly something that I call Early Pronation). The only way to have the arm in this position at the Release Point is to be actively pronating at (and more importantly well before) that moment.
   One thing to keep in mind when reading this paragraph (and article) is that the use of the term "mechanical flaw" is unfortunate (if not a bit misleading). I believe that the authors do not mean that doing these four things will hurt your velocity or control. Instead, I believe that they are just saying that these four things differ from what they believe are ideal mechanics.
   Of course, that makes me wonder about the veracity of their model of the ideal pitching motion.
     This article may be located via Google or may be downloaded from here.

GENERAL CONDITIONING PLANS FOR PITCHERS
I am often asked to recommend a conditioning routine for pitchers. I like several. One is a program called The Throwers Ten (.pdf) that is designed to condition a pitcher's entire arm. A second resource is a new book that Steven Ellis just published that is called Tuff Cuff. Third, Tom Seaver's book describes his conditioning routine. Finally, Dr. Mike Marshall has an extensive conditioning program as part of his overall package.

DISCLAIMER
I am neither a doctor nor a medical professional. Instead, I am just a guy who knows a few things about pitching. As a result, before following this, or any of the advice that I give out, you should first run it by your physician.