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For Pitchers: Fractures and Prevention

by Herb McReynolds, M.D.
Tucson MSBL

More about spontaneous stress fractures, and workout tips

(This article appeared in the Fall 1992 Issue of HardBall Magazine)

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In the Spring 1992 issue we reviewed Dr. Clyde Partin's research on pitching related stress fractures of the upper arm in men over thirty. All the reported cases involved men who pitched infrequently and had no regular off-season throwing regimen. The type of pitch seemed to matter little, and pain prior to the event was not always a symptom.

This summer, layers from Clovis, California and Richmond, Virginia have written us about their own, probably preventable, spontaneous fractures.

The 31-year-old man from Richmond was warming up to pitch in an MSBL game on September 7, 1991, throwing fastballs with no hint of pain, when he heard a loud pop in his arm. His only pertinent history was a month of elbow pain in August after pitching all summer. He rested a few weeks, then worked out painlessly the first week of September, lifting weights and throwing three or four times—about 200 pitches per session. He has now made a full recovery, but does not plan to pitcher again.

One is Plenty

The first-year MSBL pitcher from Clovis was not so lucky. On May 10, 1992, he was pitching in the second inning when he heard a sickening snap. X-rays revealed the now-familiar spiral fracture of the humerus, complicated by nerve and tendon damage, requiring the placement of a metal rod for stabilization. The contusion of the radial nerve should heal within six months, but the rod will be permanent. This report makes it clear that injuries in these cases can be more complex and severe than previously imagined.

Although these fractures are rare, one case is plenty if it happens to you. There is no perfect method of prevention, but pitchers with a regular throwing routine almost never report this type of injury, while a prominent identifier among the fracture group in the lack of a year-round conditioning program.

Get on a Program

You don't need to compete to stay fit in the off-season. Long toss two or three times a week is sufficient. Stretch properly (see HardBall, Spring 1991). Start throwing at 40 feet and work your way up to 200-250 feet. Fifteen minutes is enough to keep your muscles toned and stretched.

"A pitcher is only as good as his legs.” The off-season routine should include some running, a minimum of ten 75-yard sprints. Nolan Ryan's career demonstrates the value of a great aerobic-routine-and-weight program, involving a lot of leg work.

After the workout, stretch again. The posterior cuff stretch is critical. Lift the throwing arm to shoulder height, grab the elbow with the other hand and pull the throwing arm across the body until you feel the tension in the back of your shoulder. Then stretch the other muscle groups, especially the legs.

Year-round training should include some weight-lifting to promote conditioning and endurance and reduce the chances of injury. Throwing does not require great strength, but the muscles must be trained to repeatedly perform this stressful motion. This can be done at home with dumbbells, starting with as little as two pounds and progressing. Three to five times a week, perform sets for the rotator cuff and shoulder muscles, the biceps and triceps (which help protect the humerus), and the muscles of the forearm and wrist. Do not lift to gain bulk, but for tone and endurance.

We strongly recommend Dr. Frank Jobe's pamphlet, "Shoulder and Arm Exercises for Athletes.” Dr. Jobe, orthopedist for the Dodgers, has done much of the original research on pitching injuries, their repair and rehabilitation.

Stay on the Program

Preseason training should build upon the off-season routine. The stretching program should continue before and after workouts.

The short-toss/long-toss routine should be performed at least four times per week. For the first ten minutes, use the fastball grip; for the last five, use the curveball grip. Then start pitching to a catcher, at first for five minutes, working up to fifteen. In a week, you should be able to throw fifteen minutes of batting practice. In ten days, you will be ready to throw in game situations. Work on your mechanics from both windup and set positions, but don't throw too hard at first.

Continue your leg work, adding more sprints if you can. Aerobic exercise is helpful for all muscle groups. Strong legs are the key to a strong arm, if you use proper mechanics.

For hand strength, squeeze a rubber ball up to a thousand times daily. Practice snapping curve balls a hundred times per day.

Keep two sets of sleeves so you can stay dry. Pitching in tee-shirts or with no baseball undershirt is courting disaster. After pitching cool down by walking five to ten minutes wearing a warm-up jacket.

This program is designed to keep you and your arm in top shape all year. Derived from a major league team manual, it has been revised with the amateur athlete in mind. If you want to design your own workout, remember: stretch, tone, condition, strengthen and stretch again. A program that balances these components will work. But no program will work unless it is practiced diligently. An older athlete who neglects conditioning may be due for a painful surprise.



Dr. Herb McReynolds founded the Tucson MSBL and served as its president from 1989 to 1991. He is a former member of the MSBL National Board of Directors and was inducted into the MSBL World Series Hall of Fame in 2009.





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