Pitching Mechanics That Prevent Medial (Inner) Elbow Pain


#1

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 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 they are experiencing and may reduce the likelihood that they will experience it in the future. Of course, this is good advice for pitchers of all ages.

1(A). Don’t Show The Ball To Center Field
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). Show The Ball To 3B (Or Even The Target)
A better thing to do is for a RHP to show the ball to 3B (or even 1B) 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 Home Plate (or even 3B). 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 SS or 3B.

2. Break The 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. This includes Freddy Garcia, and he’s no slouch when it comes to velocity.

3(A) Don’t Make The "L"
Another piece of advice that many pitching coaches give that is questionable when it comes to injury prevention is to make an “L” with your upper arm and forearm when you are passing through the High Cocked Position, the High Guard Position, or the Power Position. In other words, they say that the angle between your pitching upper arm and pitching forearm should be 90 degrees. The problem with this advice is that it creates two problems that Dr. Mike Marshall calls Reverse Pitching Forearm Bounce and Pitching Forearm Flyout. Simply put, these two problems put tremendous strain on the bones, muscles, and ligaments of the elbow and directly contribute to the need for Tommy John surgery (among other things).

3(B) Leave The Elbow Extended
A better piece of advice is to have the elbow extended 135 degrees with the forearm leaning back toward Center Field (Dr. Mike Marshall calls this the Ready position). This does not mean, ala Mark Prior, having the elbow extended 45 degrees with the forearm leaning forward toward Home Plate and the ball passing close to the head. Also, as you pass through this Modified High Cocked Position (or Modified Power Position) it is best to have the palm facing upward (or supinated) as you pass through this position. This requires you to then pronate the forearm as you accelerate your arm.

PERFORMANCE IMPLICATIONS
Some people will say that the above advice (especially 2, 3(A), and 3(B). 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). With respect to 3(A) and 3(B), 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 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. 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 term “mechanical flaw” is misleading. The authors do not mean that doing these four things will hurt your velocity or control. Instead, 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…


#2

When the authors talk about the “arm ahead of the body at the time of ball release” they are talking about 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.

I totally agree with this statement. It seems that all effective and healthy pitchers incorporate this into their delivery. So the question becomes how to master these movements? I would encourage people to look at Marshall’s Loading the Sling Shot Drills. I think it is an excellent drill to practice a proper release. Do you use this drill? And, with the thumb pointed down, is that the teaching point that puts the arm in an early pronating position that you are talking about? Also, with the arm weights, has your son done exercises with him on the wrist? If so, how did his arm respond to the actions? Has any of his teammates done the weights on the wrist?

Thanks.


#3

These drills do work. I use them myself.

The problem with having the thumb down after releasing the ball is that, while you are pronated then, it doesn’t say when you started pronating. My concern is that it could be that the more your thumb is down (and the more you are pronated after releasing the ball) the later you are pronating and the less protective effect that pronating is having. Again, you have to pronate early for pronating to have the desired effect.

My son is too young (10.5) for me to feel comfortable with his using weights. I am holding off on this so far.