Baseball Injury Prevention: The Strasburg Limit Is Not the Only Way

Stephen Strasburg burst onto the MLB scene and dominated batters with his 100+ mph fastball. Unfortunately, it quickly led to Tommy John surgery. Two years after the surgery, his general manager has limited him to 160 innings during the 2012 season to avoid re-injury. Is limiting total innings to prevent injury the best option for Strasburg and other pitchers, or are there other factors involved? Read on to find out.

The Art of Pitching

Pitching is a craft (Check out STACK's Guide to Pitching to hone your craft). Like any artist, a pitcher develops his skills over time and after many failed attempts to achieve perfection. The goal is to be able to repeat the same motion over and over, which increases pitching speed and accuracy. However, if you do anything over and over again, hundreds or thousands of times, your body begins to wear down.

Pitchers who throw the hardest have the most mobility. The upper arm bone rotates in the shoulder joint at an extremely high velocity. Small muscles around the shoulder blade and connected to the arm work together to slow the arm down, to keep it from flying forward and following the ball when it is released. The repetitive extreme forces and stress begin to add up and can lead to an injury of either the shoulder or the elbow.

How Pitchers Get Hurt

• A recent study found that simply throwing harder correlates to greater risk of injury (Olsen, Fleisig, et al.)
• Pitchers now throw for more than six months of the year during their primary season and summer ball, limiting time for post-season recovery
• Pitchers often perform in pain and mask it by taking non-steroidal anti-inflammatory medicine, like ibuprofen.
• Several studies indicate that even some MLB pitchers have a weak supraspinatus (one of four rotator cuff muscles) on their throwing arm. Lack of strength in this eternal rotator, combined with high strength on the internal rotators (lats, pecs and subscapularis), puts a pitcher at a high risk of injury (Magnusson, Mullaney and Bryam, et al.).

Strasburg's Inning Limit

On The Scott Van Pelt Show on ESPN Radio, renowned surgeon Dr. James Andrews recently talked about exercising caution with a player within two years after undergoing Tommy John surgery. During this timeframe, a player has the greatest chance of reinjury. In the same interview Dr. Andrews noted that it was impossible to know whether the inning limit set for Strasburg will be sufficient to prevent reinjury over the course of his career.

One downside of Strasburg's 160-inning limit is that not all innings are created equal. An inning is always three outs, but it can involve anywhere from three pitches to more than 40; and the amount of rest between innings can range from five minutes to more than 20 minutes. So, an inning limit does not effectively determine whether a pitcher has been throwing too much. It is more appropriate to limit the number of pitches.

Best Strategies for Preventing Injury

• Avoid jogging in season as this has proven to cause a drop in power (Rhea et al.)
• Sprint in season to maintain power and mobility in the hips
• Maintain elbow extension and shoulder internal rotation mobility by stretching rotator cuff and elbow muscles after each outing
• Avoid stretching the shoulder in external rotation. This is naturally increased by throwing, and too much of it can lead to injury
• Focus on long tossing in-season to maintain arm strength
• Stretch the hips after each outing to maintain mobility (Ellenbacker et al.)
• Do not throw if you are in pain

Photo: mlbfanpost.com