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BACKGROUND: There are a number of studies showing that fastball pitches place greater loads on the shoulder and elbow than the curveball; however, the results of these studies are inconsistent, especially in collegiate-level pitchers. There is also discussion that sliders may produce substantially greater loads than other breaking pitches, but there is little scientific evidence to support this claim. HYPOTHESIS: The curveball and slider/cutter produce greater moments on the shoulder and elbow compared with the fastball and change-up. STUDY DESIGN: Descriptive laboratory study. METHODS: Thirty-six collegiate pitchers were evaluated using motion analysis techniques. All subjects pitched a fastball and a change-up, 29 pitched a curveball, and 20 pitched a slider/cutter. Kinematic data were collected, and kinetic (joint moment) data were computed using standard protocols. A random-intercept, mixed-model regression analysis was used to assess differences in joint moments between pitch types. RESULTS: The greatest glenohumeral and elbow moments were found when pitchers were pitching the fastball (mean ± standard deviation: 80.8 ± 15.5 and 79.2 ± 16.9 N·m, respectively) and the lowest when pitching the change-up (73.2 ± 14.5 and 71.6 ± 15.0 N·m, respectively). The moments produced by the slider/cutter and curveball were similar (74.9 ± 16.4 and 75.6 ± 15.5 N·m at the elbow, respectively) and significantly lower than the moments produced by the fastball (P < .0001). Results also indicate that the change-up produced the lowest joint moments compared with other pitch types. CONCLUSION: This study shows that the fastball and not the curveball or slider/cutter produced the greatest moments on the college pitcher's glenohumeral and elbow joints, as previously believed. The study also shows that the change-up may be the safest of the 4 pitch types analyzed. CLINICAL RELEVANCE: There is a long-held belief that throwing breaking pitches, specifically the slider and curveball, places additional stresses on the shoulder and elbow of skeletally mature pitchers. However, these results show that pitching breaking pitches may not be as detrimental to a college-aged pitcher as currently believed.
Solomito et al. (Tue,) studied this question.