March 9, 2017 • BaseballSports Medicine

Preventing baseball injuries with specific exercises

Baseball remains an extremely popular sport among youths and adolescents and will likely experience an even greater resurgence following the dramatic 2016 World Series. Baseball, however, also remains a sport that gravitates toward early specialization, and with it, increased risks of injury.

Several methods have been proposed to counter overuse injuries in baseball, including recent regulatory changes focused on pitch counts. This passive approach from the athlete’s point of view is important, but four easy strength and conditioning exercises can aid an athlete in staying healthy, decreasing risk of injury and improving performance. These four exercises focus on areas often neglected in traditional strengthening programs but are of vital importance as athletes progress in their careers.

1. Cross-body stretch with good posture.

Posterior shoulder capsule tightness has been linked to a multitude of problems in throwing athletes, including injuries to the rotator cuff, glenoid labrum, ulnar collateral ligament, ulnar nerve and the biceps tendon.¹Tightness in this area leads to the shoulder blade moving improperly and usually not being in the right position at the right time, affecting the tissues that move underneath the top of your shoulder. This disrupts the kinetic chain of throwers, since a kink now exists between the energy being transferred up the body and through the arm until ball release.

Traditionally, work in this area has focused on long duration static stretches like the “sleeper stretch,” deep tissue massage with tools or rolling balls like lacrosse balls, or dynamic warmup exercises. A recent review of four studies shows that the sleeper stretch alone is ineffective on posterior capsule tightness with cross body motion. The authors show support for cross-body stretching in terms of immediate and short-term effects.²

Another recent group studied the effectiveness of stretching the arm across the chest with and without stabilizing the shoulder blade in place. Using ultrasound machines to look at the muscle’s stiffness, they found that stabilizing the shoulder blade in place while performing the stretch significantly improves the flexibility of the tissues being examined, while stretching without stabilization did not produce any tissue changes.³

2. Hip flexor stretch.

When done correctly, this can provide significant benefits to injury prevention and performance. To ensure proper technique, one should kneel on a padded mat with their front foot out beyond the front knee. Initially, you can place your hands on your front knees, but eventually the hands can be placed on the hips. Next, perform a pelvic tilt by squeezing your glutes underneath you, helping to stabilize the hips and isolate the effects of the stretch to the hip flexor. To perform the stretch, you should focus on bending the front knee until the shin is vertical and your knee is directly over your toes. If you don’t feel a stretch in this position, ensure you have contracted the glute muscles and start with the foot further out in front of the knee.

This stretch is crucial for pitchers to improve stride length as they come down the mound. Longer stride lengths improve velocity and place the release point closer to the plate.

More flexible hip flexors allow the trunk to remain upright for a little longer around max shoulder external rotation, which allows for greater transfer of energy up through the kinetic chain. This stretch should be performed daily, especially during periods of rapid growth, for maximal injury prevention and performance improvement effect.

3. Single-leg balance.

Balance for baseball players is crucial, whether they are pitchers or position players. Movements of less than a quarter-inch can make a significant difference for batters and pitchers. There are a multitude of balance apparatuses out there but simple single-leg balance with and without eyes open on a flat or cushioned ground can be incredibly taxing to the individual.

Photo: Kevin Hoffman

Balancing exercise should be functional for a player. For instance, if an athlete is only a position player, it doesn’t make sense to emphasize balancing with your knee as high as possible. Similarly, it’s less effective to focus on balance positions where the pitcher is in a batting stance with a bat in hand.

For pitchers, one of my favorite exercises is to slowly go through the throwing motion, emphasizing ankle, hip and postural control throughout the entire range of motion. I would begin by watching the athlete simulate the throwing motion at normal speed before slowing down in a stepping manner, usually 25 percent increments to find a player’s level of stability. If the athlete is having some trouble at 50-percent effort, focus at this speed for a few sessions before slowing down to 25 percent. If we try to make large adjustments initially — starting at 25 percent and moving to 50 percent — the pitcher does not have the neurological control to make the necessary adjustments and often develops additional compensatory changes.

4. Standing hip abduction with toes inward.

Another overlooked area is the gluteus medius, the fan-shaped muscle on the side of the hip responsible for lifting the leg to the side and steadying the hip while standing on that leg. This is another muscle that has big implications for hitters and pitchers alike.

Hitters with a weaker gluteus medius can have the stance hip drop down with some knee collapse, affecting their ability to make contact and drive the ball with power. A 2015 study demonstrated the importance of hip stability in pitchers, particularly as they come down on the mound, in which the gluteus medius and several scapular stabilizers showed significant activity between foot strike and ball release on the throwing side.

An easy way to strengthen this muscle is to stand tall and raise the leg out to the side with the toes turned inward. It’s important to keep the toes turned inward throughout the entire motion because it helps to isolate the gluteus medius better than with the foot turned out. Progression often includes an increased number of sets and repetitions and adding resistance bands around the knees or ankles.

Baseball and its related training are very time-intensive. Maximizing the effects of these four simple exercises can significantly decrease the risk of injury while drastically improving performance.

Corey Dawkins is the practice administration manager at The Micheli Center for Sports Injury Prevention in Massachusetts. Learn more at


1. Muraki T, Yamamoto N, Zhao KD, Sperling JW, Steinmann SP, Cofield RH, An KN. Effect of posteroinferior capsule tightness on contact pressure and area beneath the coracoacromial arch during pitching motion. Am J Sports Med. 2010 Mar;38(3):600-7.

2. Mine K, Nakayama T, Milanese S, Grimmer K. Effectiveness of stretching on posterior shoulder tightness and glenohumeral internal rotation deficit: a systematic review of randomized controlled trials. J Sport Rehabil. 2016 Aug 24: 1-28 [Epub ahead of print].

3. Umehara J, Hasegawa S, Nakamura M, Nishishita S, Umegaki H, Tanaka H, Fujita K, Kusano K, Ichihashi N. Effect of scapular stabilization during cross-body stretch on the hardness of infraspinatus, teres minor, and deltoid muscles: An ultrasonic shear wave elastography study. Man Ther. 2016 Oct 12 [Epub ahead of print]

4. Sgroi T, Chalmers PN, Riff AJ, Lesniak M, Sayegh ET, Wimmer MA, Verma NN, Cole BJ, Romeo AA. Predictors of throwing velocity in youth and adolescent pitchers. J Shoulder Elbow Surg. 2015 Sep; 24(9):1339-45.

5. Oliver GD, Weimer WH, Plummer HA. Gluteus medius and scapula muscle activations in youth baseball pitchers. J Strength Cond Res. 2015 Jun; 29(6):1494-9.

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