title: Defining the Long-Toss: A Professional Baseball Epidemiological Study.
abstract: BACKGROUND
  Despite widespread use of long-toss throwing in baseball as a component of arm conditioning, interval throwing programs, and rehabilitation, long-toss distance and throwing mechanics remain controversial.
  
  
  OBJECTIVE
  To ascertain the perceived definition of long-toss throwing through a survey of professional pitchers, pitching coaches (PCs), and certified athletic trainers (ATCs) associated with Major League Baseball.
  
  
  METHODS
  Descriptive epidemiology study.
  
  
  METHODS
  Pitchers, PCs, and ATCs associated with 5 Major League Baseball organizations completed an anonymous survey that collected demographic data, personal use of long-toss throwing, and their perception of the distance and throwing mechanics that comprised long-toss.
  
  
  RESULTS
  A total of 321 surveys were completed by 271 pitchers, 19 PCs, and 31 ATCs. For all respondents, the mean distance considered as long-toss was 175 ft (95% CI, 170-181 ft). Respondents categorized the throwing mechanics of long-toss, with 36% reporting throwing "on a line" and 70% reporting long-toss as "not on a line." Of those throwing "on a line," 28% reported using crow-hop footwork while 60% used crow-hop footwork when throwing "not on a line." Interpretation of long-toss distance significantly varied by position: pitchers, 177 ft (95% CI, 171-183 ft); PCs, 177 ft (95% CI, 155-200 ft); and ATCs, 157 ft (95% CI, 144-169 ft) (P= .048). When asked when long-toss throwing is used, pitchers reported using it more frequently in preseason (P= .007), during the season (P= .015), and in the off-season (P= .002) compared with that by ATCs. Functional goals for long-toss throwing demonstrated that pitchers and PCs use long-toss for shoulder stretching more frequently than ATCs (P< .001 andP= .026, respectively). ATCs used long-toss more than pitchers for interval throwing programs (P< .001).
  
  
  CONCLUSIONS
  The definition varies for long-toss throwing distance and throwing mechanics. Pitchers and PCs believe that long-toss comprised longer distances than ATCs and employed long-toss differently for strength conditioning, training, stretching, and rehabilitation. This discrepancy highlights a potential lost opportunity for protecting the shoulder. While long-toss is an important tool, a more scientific definition is warranted to better elucidate its role in enhancing throwing performance and rehabilitation.
authors.affiliation: Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Austin V
authors.initials: AV
authors.lastname: Stone
authors.affiliation: The Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Mannava
authors.affiliation: Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Marquez-Lara
authors.affiliation: Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Freehill
keywords: baseball; long-toss; pitchers; pitching; throwing