Changes in flexor wad, subjective fatigue suggest pitch counts for adolescent pitchers
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Results showed between 50 and 75 pitches is likely appropriate for 10-year-old pitchers, with changes in flexor wad fatigue and an increase in subjective fatigue throughout the pitching session.
Michael T. Freehill, MD, FAOA, and colleagues evaluated medial elbow laxity, muscle energy changes in the forearm flexor-pronator mass and changes in grip strength, shoulder strength and range of motion, subjective fatigue, pitching velocity and accuracy among 22 male adolescent pitchers.
“They threw 75 pitches, but we divided them into sets of 25 pitches,” Freehill said in his presentation at the American Shoulder and Elbow Surgeons Annual Meeting. “This would more closely resemble a normal pitching outing for many of these pitchers.”
Throughout the study period, Freehill noted no significant differences with medial elbow laxity between arms. The flexor carpi radialis demonstrated a significant change from baseline to 75 pitches with regard to flexor wad, according to Freehill. He noted no significant differences in flexor digitorum superficialis and flexor carpi ulnaris across time points.
“Grip strength significantly decreased in the throwing arm after 75 pitches compared to after 25 pitches,” Freehill said. “Subjective fatigue statistically increased in the throwing arm across all time points compared to the non-throwing arm once pitching began.”
Freehill added no statistically significant changes in velocity, accuracy, shoulder strength and range of motion were found.
“We’re hoping this provides a foundation for further objective testing of physiologic changes with increasing pitch count to better hone in on the most appropriate number,” Freehill said.
Editor’s Note: On Jan. 11, 2021, we removed the photo originally included in the article as it was incorrect. The Editors regret this error.
Perspective
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Given the increased incidence of UCL injuries in young throwers, identifying any preventable risk factors that may prevent injury is critically important. An evidence-based approach to define pitch counts and lower risk is important. While the impact of changes in grip strength on UCL in unknown, it is a first step to look at performance and injury in this population.
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Freehill MT, et al. Adolescent pitcher fatigue: Ulnar collateral ligament stress, flexor0pronator mass energy depletion, and correlation to pitch count. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 2-3, 2020 (virtual meeting).
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