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Pitching a baseball is a complicated sequence of motions that occur in very rapid succession. Over the last 30 years that sequence, known as the "kinetic chain" has been studied in over two thousand pitchers using high speed cameras and computer analysis. The components of effective pitching biomechanics are now well understood. In addition, flaws in the pitching delivery that predispose to shoulder and elbow injuries are also well understood.

The common shoulder and elbow injuries that occur in pitchers are "injuries of attrition", the result of repetitive high forces acting over and over on the supporting tissues of these joints. While high velocity pitching itself requires large forces, the forces are magnified when poor delivery biomechanics are in play. Strength from the large muscles of the legs, hips, and torso is necessary both to generate acceleration in the pitching arm as well as to absorb forces as the arm decelerates. Weakness, stiffness, or poor mechanics of the trunk and lower body are the "villains", the shoulder and elbow are the "victims".

Injury prevention in pitchers has several components:

  • teaching effective biomechanics in youth baseball
  • developing overall agility and athleticism
  • pitch counts appropriate to age
  • pitch types appropriate to age
  • limiting innings pitched through the year
  • off season non-pitching conditioning
  • adequate time for warm-up
  • recognizing fatigue as the game progresses
  • allowing adequate rest between appearances
  • recognizing and addressing minor arm injuries before they progress
  • frank and honest communication between coaches and players

The windmill delivery in softball is also stressful on shoulders and elbows, however due to the different motions the exact tissues effected are different. Back and neck injuries are more common as these areas play a larger role in decelerating the arm. Nevertheless, the same principles of injury prevention apply.