Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

OBJECTIVES: To investigate the relationship between baseball pitching biomechanics and pain, injury, or surgery, in pitchers of all ages and competition levels. DESIGN: Systematic review. METHODS: This study was registered on Prospero (CRD42019137462). Four online databases (MEDLINE, SPORTDiscus, CINAHL, and Embase) from inception to June 13, 2019 were systematically searched. Risk of bias was assessed through the modified Downs and Black. RESULTS: 967 titles/abstracts were screened with 11 studies (1376 pitchers) included. Four studies used 3D biomechanical analyses, five studies video analysis, and two studies evaluated EMG activity. Level 1b evidence suggests that injured pitchers had greater elbow valgus torque at late arm cocking (injured: 91.6Nm, non-injured: 74.7Nm, p=0.013) and early trunk rotation was predictive of increased upper extremity surgical risk (Hazard Ratio: 1.69 (95% CI 1.02-2.80)). Level 3b evidence observed pitchers with upper extremity surgical history had greater lateral trunk tilt at release (surgery: 29.3°, controls: 23.4°, p=0.035), and flexor carpi ulnaris EMG activity was decreased (injured: 68% MMT, controls: 103% MMT) in pitchers with elbow injury. CONCLUSIONS: Increased elbow valgus torque and early trunk rotation were injury risk factors, and elbow injured pitchers displayed diminished forearm muscle activity. Due to the low power of many of these studies, and the lack of prospective 3D biomechanical studies, other pitching biomechanical variables cannot be ascertained as injury risk factors. Future studies are needed to prospectively assess pitching injury risk through 3D biomechanical methods.

Original publication




Journal article


J Sci Med Sport

Publication Date





13 - 20


Elbow valgus torque, Pelvis rotation velocity, Trunk rotation, Trunk tilt, Adolescent, Adult, Arthralgia, Baseball, Bias, Biomechanical Phenomena, Child, Elbow Joint, Electromyography, Humans, Risk Factors, Rotation, Torque, Torso, Upper Extremity, Video Recording, Young Adult