Author's Accepted Manuscript

The Biomechanics of Throwing

Brandon J. Erickson MD, Robert J. Thorsness MD,
Jason T. Hamamoto B.S., Nikhil N. Verma MD

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PII: S1060-1872(16)30002-8
DOI: http://dx.doi.org/10.1053/j.otsm.2016.04.002
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Oper Tech Sports Med

Cite this article as: Brandon J. Erickson MD, Robert J. Thorsness MD, Jason T. Hamamoto
B.S., Nikhil N. Verma MD, The Biomechanics of Throwing,
Oper Tech Sports Med , http://dx.doi.org/10.1053/j.otsm.2016.04.002

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Title: The Biomechanics of Throwing

Running Title: Throwing Mechanics

AUTHORS:

Brandon J. Erickson, MD1

Robert J. Thorsness, MD1

Jason T. Hamamoto, B.S.1

Nikhil N. Verma, MD1

INSTITUTION:
1
Midwest Orthopaedics at Rush
Rush University Medical Center
1611 West Harrison Street, Suite 300
Chicago, IL 60612
Phone: 312-243-4244
Fax: 312-942-1517

CORRESPONDING AUTHOR:

Brandon J Erickson, MD
Midwest Orthopaedics at Rush
Rush University Medical Center
1611 West Harrison Street, Suite 300
Chicago, IL 60612
Phone 312-243-4244
Fax: 312-942-1517
Email: berickso.24@gmail.com

Conflict of interest: Brandon J. Erickson, Robert J. Thorsness, and Jason Hamamoto have
no conflicts of interest to declare. Nikhil N. Verma has the following conflicts of interest:
Arthrex, Inc: Research support; Arthroscopy: Editorial or governing board; Publishing
royalties, financial or material support; Arthroscopy Association Learning Center
Committee: Board or committee member; Arthrosurface: Research support; Cymedica:
Stock or stock Options; DJ Orthopaedics: Research support; Journal of Knee Surgery:
Editorial or governing board; Minivasive: Paid consultant; Stock or stock Options;
Omeros: Stock or stock Options; SLACK Incorporated: Editorial or governing board;
Smith & Nephew: IP royalties; Paid consultant; Smith & Nephew, Athletico, ConMed
Linvatec, Miomed, Mitek: Research support; Vindico Medical-Orthopedics Hyperguide,:
Publishing royalties, financial or material support

Acknowledgements: None

Title: The Biomechanics of Throwing

Running Title: Throwing Mechanics

Abstract

The shoulder is a complex joint that affords the most degrees of freedom of any joint in

the body. As such, there are several static and dynamic structures that act on the shoulder

with every shoulder motion to maintain the humeral head in proper position. The

overhead athlete, specifically the baseball pitcher, faces a multitude of forces about the

shoulder with each athletic encounter. These forces can often lead to chronic, attritional

injuries that manifest as decreases in both velocity and accuracy over several months, or

less frequently, as acute, traumatic injuries. In order to understand how to manage the

different pathology that arises in the shoulder of the overhead athlete, it is first imperative

to understand the biomechanical forces that act on the athlete’s shoulder with varying

shoulder motions, specifically the baseball pitch. The baseball pitch, commonly divided

into six distinct phases, is a classic example of the shoulder forces experienced by an

overhead athlete, and serves as a basis for understanding shoulder biomechanics in these

players. Football quarterbacks, javelin throwers, swimmers, and other athletes also
experience similar significant forces about the shoulder. With a complete understanding

of shoulder kinetics and kinematics in the overhead athlete, one can improve diagnostic

accuracy and treatment of subtle pathologies seen in this patient population.

Keywords: Biomechanics; Shoulder; Overhead Athlete; Pitcher; Baseball

Introduction

The shoulder is a complex joint that affords the most degrees of freedom of any joint in

the body. As such, there are several static and dynamic structures that act on the shoulder

with every shoulder motion including the labrum, glenohumeral joint capsule,

glenohumeral ligaments (superior, middle, and inferior), coracohumeral ligament,

articular cartilage, long head of the biceps tendon, rotator cuff, and multiple other

muscles surrounding the glenohumeral joint.(1-5) The baseball pitch generates more

angular velocity about the shoulder than any other movement in sports.(6-8) As such, the

shoulder is at greatest risk for injury during the baseball pitch. Significant time and

energy has been put into studying the baseball pitch to better understand the parts of the

shoulder that are at risk during various parts of the pitching cycle in an effort to prevent

injury.(8)

Pitching Cycle

While the baseball pitch is one continuous, fluid motion, it can be broken down into six

distinct phases. These segments include the: wind-up (variably present as this will be

absent if the athlete is pitching from the stretch), early cocking, late cocking,
acceleration, deceleration, and follow-through (Figure 1).(6, 8-16) While the position of

the shoulder may vary slightly between different pitch types, player age, etc., the same

basic six phases are present in every baseball pitch. The pitching cycle will be discussed

in detail to allow understanding of the shoulder biomechanics involved in each specific

phase.

Wind-Up

The baseball pitch begins with the wind-up in which the pitcher achieves a starting

position that will allow them to generate an accurate, forceful pitch. The phase begins as

the pitcher flexes their lead hip and knee (left leg in a right handed pitcher) to bring the

knee to its maximum height. Bringing the knee up generates the potential energy present

in this phase. This allows a balanced position in which there is no significant force

exerted on the shoulder, which is held in slight flexion and abduction. It should be noted

that the lead leg should only move up towards the chest and should not move toward

home plate. If the leg moves towards home plate as it is brought up, this will cause the

pitch to be rushed, leading to improper coordination between the lower and upper body.

If the upper and lower body become discordant, the potential energy from the legs may

not be properly transferred to the arm, causing the pitcher to place a higher demand on

the shoulder to generate velocity on the ball. This can lead to an increased risk for

injury.(8) This improper motion is more commonly seen in younger or less experienced

pitchers indicating a need for proper instruction of pitch mechanics. The phase ends with

the pitcher achieving a balanced state with the lead hip and knee maximally flexed prior

to moving towards home plate.

Early Cocking

The early cocking phase begins when the lead leg, which was previously held at maximal

height, begins to move towards home plate. At this point the pitcher’s hands begin to

separate. Through external rotation of the lead hip and internal rotation of the stance hip,

energy is created which will be used to bring the upper body towards home plate.

Although the pitching shoulder moves into approximately 90° of abduction, 20° of

horizontal abduction, and 60° of external rotation by the conclusion of this phase, no

significant force is imparted on the shoulder.(8, 17, 18) This phase ends when the lead

foot contacts the ground (front foot contact).

Late Cocking

At front foot contact the late cocking phase begins and lasts until the shoulder reaches

maximal external rotation (typically between 160°-180°). This significant increase in

external rotation can be seen in the setting of adaptive humeral retroversion, which occurs

in pitchers secondary to deformation through the proximal humeral epiphyseal cartilage

from pitching.(12, 19, 20) As a result, overhead throwing athletes develop a shift in their

total arc of motion favoring external rotation. During this phase the shoulder experiences

a significant amount of force.(8) Energy is transferred up the kinetic chain as the pelvis

and then torso rotate towards home plate while the upper extremity lags behind, creating

a significant distraction force at the shoulder of over 750N.(8) This distraction force is

primarily countered by the rotator cuff. However, to decelerate the shoulder external

rotation, the shoulder internal rotators are eccentrically loaded. This lag places the
shoulder in maximal external rotation at 90° of abduction. Simultaneously, as the

shoulder externally rotates, it also horizontally adducts to 15°. In order to allow the

shoulder to move towards home plate with the trunk and prevent posterior translation of

the upper extremity, both significant anterior shear force and horizontal adduction torque

is generated.

Internal impingement, or abnormal contact between the articular side of the rotator cuff

and posterior-superior glenoid rim, also occurs in the late cocking/early acceleration

phase. Pitchers will often complain of posterior shoulder pain during this part of the

pitching cycle. This can be due to a tight posterior band of the inferior glenohumeral

ligament and anterior microinstability.(21) Patients should be evaluated for this by

checking shoulder range of motion (ROM), specifically internal and external rotation, as

internal impingement can lead to undersurface tearing of the infraspinatus and

supraspinatus as well as posterosuperior labral abnormalities.(22)

Acceleration

The acceleration begins when the shoulder has reached maximal external rotation and

ends with ball release. Although this is the shortest phase from a time standpoint,

significant shoulder forces are generated during this phase. The shoulder maintains

abduction of approximately 90° during this phase which may minimize the chance of

injury, specifically from impingement, and allow the greatest amount of force generation.

As the shoulder begins to move forward from maximal external rotation, the elbow

extends followed by internal rotation of the shoulder. The shoulder internally rotates to
generate an internal rotation velocity between 6000 to 8000 degrees/second just prior to

ball release.(8, 23) Of note the shoulder moves from approximately 15°-20° of horizontal

adduction at maximal external rotation to 10° of horizontal adduction at ball release.(8)

Deceleration

The deceleration phase begins at ball release and ends when the shoulder reaches

maximal internal rotation (which is 0°). Eccentric contraction of several muscles,

including the rotator cuff muscles and long head of the biceps, allows the shoulder to

quickly decelerate.(6, 10, 12) It is believed the rotator cuff tears can occur during this

phase secondary to the tensile forces experienced by these muscles during arm

deceleration as these muscles attempt to resist distraction.(1, 8, 16) Furthermore, superior

labral tears have also been postulated to occur during this phase secondary to a traction

injury which the long head of the biceps tendon pulls the labrum away from the glenoid

as it attempts to decelerate the arm and prevent anterior subluxation of the humeral head

during this phase.(3) Other mechanisms including the peel back mechanism described by

Burkhart and Morgan have been postulated as the cause of SLAP tears, although this

typically occurs during the late cocking/early acceleration phase of the pitching

cycle.(24) Currently the exact mechanism causing a SLAP tear is unknown and multiple

pathologic mechanisms are possible. The shoulder experiences a multitude of forces

during the deceleration phase including posterior shear force, inferior shear force,

proximal force (equal to the pitcher’s body weight of over 1000N), adduction torque, and

horizontal adduction torque.(8) The shoulder must generate opposite forces to

counterbalance the forces it experiences. The posterior shoulder muscles are crucial in

preventing anterior humeral subluxation.

Follow-Through

Finally, the follow-through phase begins with maximal shoulder internal rotation and

ends when the pitcher assumes a fielding position. The energy used to accelerate the pitch

continues to dissipate during this phase, with the aid of the trunk and legs, causing the

force about the shoulder to be less than the acceleration and deceleration phases. The

posterior shoulder muscles are still active eccentrically during this phase in order to

decelerate shoulder rotation.

Factors Effecting Pitch Biomechanics

Varying Pitch Types

As the game of baseball continues to evolve, pitchers continually look for new and

effective ways to get outs in games. As very few pitchers have been successful in

throwing only one type of pitch, the majority of pitchers vary the types of pitches they

throw to keep batters guessing. Some of the more common pitch types include: fastball,

curveball, change-up, slider while less common pitch types include the knuckleball,

gyroball, etc. (Figure 2). Fleisig et al conducted a biomechanical study in 21 collegiate

baseball pitchers to compare shoulder and elbow torques the four most common pitches

(fastball, curveball, change-up, slider). (25) The results showed that the change-up had

significantly lower shoulder internal rotation torque, horizontal adduction torque,

abduction torque, and proximal force than all three other pitches. Furthermore, shoulder
proximal force was greater in the slider than the curveball and shoulder horizontal

abduction torque was higher in the fastball than both the curveball and slider. Finally, the

change-up showed different shoulder kinematics than the other pitches; the change-up

had lower angular velocities and lower joint kinetics than the other three pitches. Hence,

given that the change-up has the lowest kinetics of the four most common pitches, it

places the least amount of force across the shoulder, and therefore likely carries the

lowest risk for injury.

Level of Competition

Given the difference in stages of skeletal development among pitchers of varying ages, it

is important to understand the differences that exist in regards to pitching kinetics and

kinematics in these varying populations. Fleisig et al analyzed 23 youth, 33 high school,

115 college, and 60 professional baseball pitchers using multiple kinetic, kinematic, and

temporal parameters to evaluate for differences between groups.(18) While no

differences were seen in the temporal parameters and only one difference was seen in

kinematic position parameter (significantly less maximum internal rotation velocity

during the acceleration phase in high school compared to collegiate pitchers), all of the

measured kinetic parameters increased with increasing level of competition. This

translates into a higher risk for injury in older pitchers at higher levels of competition

secondary to higher joint forces and torques from an increase in muscle mass (as velocity

parameters increased but temporal parameters remained constant) compared to younger

pitchers at lower levels of competition. In summary, this data suggests that as velocity

increases, shoulder force and torque increases, which may increase injury risk.
Mound vs. Flat Ground

While in competition pitchers are required to throw from a mound, in many warm-up and

rehabilitation protocols pitchers begin by throwing from a flat surface (Figure 3). This is

because it is thought that throwing from a mound is more harmful to the shoulder than

throwing from a flat surface. Often, pitchers throwing from a mound will have a longer

stride length during their pitch, leading to more external rotation at the shoulder in the

early and late cocking phases (Figure 4). Furthermore, the amount of distraction force

that is placed through the elbow when throwing short toss from flat ground is less than

when throwing from the mound, leading to more activation of the posterior rotator cuff

muscles when throwing from the mound.(8, 26) Interestingly, although throwing short

toss from the ground is less stressful than throwing from the mound, studies have shown

that throwing long toss from flat ground places as much stress on the shoulder and elbow

as throwing from the mound

Other Sports

While the biomechanics surrounding the baseball pitch have been extensively studied,

there are several other sports in which overhead athletes impart a significant amount of

force on the shoulder. These include the football throw, javelin toss, windmill throw, and

others. The windmill throw, although different from the baseball pitch in delivery, has

been shown to produce kinetic and kinematic variables that are similar to a baseball pitch

during delivery phase.(27) Studies have shown that several kinetic and kinematic

differences exist between the baseball pitch and football pass, with quarterbacks showing
more external rotation at front foot contact and more horizontal adduction at ball release

than pitchers.(28)

Shoulder Biomechanics Following Surgery

Ulnar Collateral Ligament Reconstruction:

There has been a recent significant increase in the number of primary, as well as revision

ulnar collateral ligament reconstruction (UCLR) procedures performed in pitchers of high

school, collegiate, and professional levels.(29-31) Unfortunately, this upward trend in the

number of UCLR does not seem to be slowing. With this increase, it is important to

understand the changes, if any, that occur to the mechanics of pitchers following this

surgery to allow injury prevention as well as monitoring for fatigue upon return to sports

(RTS). In 2015 Fleisig et al recently performed a biomechanical analysis in which 40

minor league pitchers with a history of UCLR were compared to 40 matched controls (no

prior shoulder or elbow surgery) using 23 reflective markers to obtain various

biomechanical data points.(32) The UCLR were performed an average of 30.5 months

prior to the biomechanical testing. Shoulder and elbow range of motion (ROM) testing

was initially performed and then, following warm-up pitches, the pitchers threw 10

fastballs from a pitching mound that were used for the analysis. The results showed no

significant difference in shoulder or elbow passive ROM and no significant difference in

shoulder and elbow biomechanics. As the pitchers were an average of 30.5 months out

from their UCLR, this may have given them time to normalize their throw. It is possible

that had the time period from UCLR to testing been significantly shorter, prior to the
pitchers having completed rehab, the differences in shoulder and elbow biomechanics

would have been seen. Further study is needed in this regard.

Superior Labral Repair:

With the increasing number of superior labrum anterior posterior (SLAP) tears that are

diagnosed, and, according to recent studies, repaired, it is important to understand what

effect a SLAP repair has on shoulder throwing mechanics.(33, 34) Laughlin et al

evaluated 13 collegiate and professional pitchers who had a history of a SLAP repair, and

compared these players to 52 matched controls (1:4 matching for age, height, and pitch

velocity) with no history of surgery using three dimensional motion analysis with

reflective markers.(35) Following warm-up pitches the pitchers threw 10 fastballs from

the wind-up on a pitching mound, and multiple biomechanical parameters of the

shoulder, elbow, and body were compared between the two groups. The study found that

pitchers who had a history of a SLAP repair had less horizontal abduction at front foot

contact (p=.013) and less maximum external rotation (p=0.16) without a significant

difference in internal rotation torque. The only difference in body biomechanics was that

pitchers who had a prior SLAP repair threw the ball more upright (less forward trunk tilt

at ball release) while there were no significant differences in elbow biomechanics

between the two groups.

Hence, when comparing the results of pitching biomechanics following SLAP repair to

those following UCLR, it seems that pitchers are better able to replicate normal

biomechanics following UCLR than following a SLAP repair.(32, 35) It should be noted
that the biomechanics of these pitchers were compared to control groups of pitchers and

not to pre-injury data from the individual pitcher who underwent surgery, so some

personal variation could have existed that accounted for these differences. These findings

suggest that subtle loss of rotation after SLAP repair may have negative impacts on

pitching mechanics which may influence functional recovery and return to play following

surgery. Further studies are needed to identify kinematic patterns that may predict injury

and changes that occur following surgery and recovery.

Conclusion

The baseball pitch is one of the most studied athletic motions to date. The biomechanics

behind the baseball pitch provide insight into injury patterns and at-risk structures.

Knowledge of changes in biomechanics following injuries and at different levels of

competition can help the surgeon diagnose and treat problems early on before they

require operative intervention.

Figures/Tables

Figure 1: Diagram of the pitching cycle demonstrating the six phases. The wind-up phase
is variably present depending on if the pitcher is throwing from the stretch.

Figure 2: Common hand grips used in pitching including the four-seam fastball, two seam
fastball, splitter, cutter, slider, change up, and curveball.

Figure 3: Diagram showing a pitcher throwing from a flat surface. Notice the relatively
short stride length.

Figure 4: Diagram showing a pitcher throwing from a mound. Notice the relatively long
stride length.
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