title: Baseball pitching biomechanics in relation to injury risk and performance.
abstract: BACKGROUND
  Baseball pitching kinematics, kinetics, ball velocity, and injuries at the shoulder and elbow are related.
  
  
  METHODS
  PubMed and Sport Discus were searched for original studies published between 1994 and 2008. Relevant references in these studies were retrieved. Inferential studies that tested relationships between kinematics and kinetics were included, as were studies that tested relationships between kinematics and ball velocity. Descriptive studies that simply quantified kinematics and/or kinetics were excluded.
  
  
  RESULTS
  SEVERAL KINEMATIC PARAMETERS AT THE INSTANT OF FOOT CONTACT WERE ASSOCIATED WITH INCREASED UPPER EXTREMITY KINETICS: front foot position, front foot orientation, shoulder abduction, and shoulder horizontal adduction. The timing of shoulder external rotation, pelvis rotation, and upper trunk rotation was associated with increased kinetics and decreased ball velocity. Low braking force of the lead leg and a short stride were associated with decreased ball velocity. Decreased maximum shoulder external rotation, shoulder abduction, knee extension, and trunk tilt were also associated with decreased ball velocity. As pitchers develop, kinematic values remain similar, their variability reduces, and kinetic values gradually increase. Slight kinematic variations were seen among pitch types, although the kinetics of fastballs and curveballs were relatively the same; changeup kinetics were the lowest. As pitchers fatigued, kinetic values remained constant, but increases in arm pain were reported.
  
  
  CONCLUSIONS
  Several kinematic parameters were related to joint kinetics and ball velocity. To enhance performance and reduce injury risk, pitchers need to learn proper fastball mechanics at an early age. A changeup is recommended as a safe secondary pitch to complement the fastball; the curveball can be added after fastball and changeup mechanics are mastered. Avoiding overuse and pitching while fatigued is necessary to minimize the risk of arm injury.
authors.forename: Dave
authors.initials: D
authors.lastname: Fortenbaugh
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Fleisig
authors.forename: James R
authors.initials: JR
authors.lastname: Andrews