Does Fatigue Alter Pitching Mechanics?

OBJECTIVES: Background: Injuries of the adolescent shoulder and elbow are common in baseball pitchers. Fatigue has been demonstrated to be a risk factor for injury. Purpose: To determine if shoulder and elbow kinematics, pitching velocity, accuracy, and pain change during a simulated full baseball game in adolescent pitchers. METHODS: Methods: Adolescent pitchers between the ages of 13-16 were recruited to throw a 90 pitch simulated game. Shoulder range of motion was assessed before and after the game. Velocity and accuracy were measured for every pitch and every 15th pitch was videotaped from two orthogonal views in high definition at 240 Hz. Quantitative and qualitative mechanics were measured from these videos. Perceived fatigue and pain were assessed after each inning using the visual analog scale. Data was statistically analyzed using a repeated-measures analysis of variance. RESULTS: Results: Twenty-eight elite adolescent pitchers were included. These pitchers, on average, were 14.6±0.9 years old (mean ± standard deviation), had been pitching for 6.3±1.7 years, and threw 94±58 pitches per week. Our experimental model functioned as expected in that pitchers became progressively more fatigued and painful and pitched with a lower velocity as pitch number increased (p<0.001, 0.001, and <0.001 respectively). Knee flexion at ball release progressively increased with pitch number (p=0.008). Hip and shoulder separation significantly decreased as pitch number increased, from 90%±40% at pitch 15 to 40%±50% at pitch 90 (p0.271 in all cases, 91% power for elbow flexion at ball release). External rotation and total range of motion in the pitching shoulder significantly increased post-pitching (p=0.007 and 0.047 respectively). CONCLUSION: Conclusion: As pitchers progress through a simulated game they throw lower velocity pitches and become fatigued and painful. Core and leg musculature becomes fatigued before upper extremity kinematics change. Based upon these results, the authors hypothesize that core and leg strengthening may be valuable adjuncts to prevent upper extremity injury.