Table 5. Injury and fatigue.

A summary of findings related to pain and injury resulting from pitching.

Study	Sample size	Fatigue protocol	Data collection process	Findings
Lyman et al. (2001)	298 youth pitchers (aged 9–12 years)	No protocol, collection during season	Conducted over the span of two seasons, pitchers were interviewed via telephone after each game pitched	- Elbow pain was reported in 26% of pitchers, while shoulder pain was reported in 32% of pitchers- Risk factors associated with elbow and shoulder pain included decreased self-satisfaction, increased pitch count, and in-game arm fatigue- Increased age, weight, and lifting weights during the season linked to increased elbow pain
Lyman et al. (2002)	476 youth pitchers (aged 9–14 years)	No protocol, collection during season	Questionnaires were assigned to pitchers before and after the season. Interviews were conducted during the season after each game	- Curveballs were associated with a 52% increased risk of shoulder pain, while the slider was associated with an 86% increased risk of elbow pain- 28% of pitchers reported elbow pain and 35% of pitchers reported shoulder pain at least once during the season- Elbow and shoulder pain increased significantly with pitch count
Freeston et al. (2014)	13 elite pitchers (aged 19.6 ± 2.6 years)	Two test days (minimum of 7 days apart), 5–10 min of moderate intensity running, 5–10 min of stretching, 10–15 min of throwing, throwing or running program	A throwing protocol was assigned to subjects on the first day, a running protocol was assigned on the second day	- Significant increase in velocity following the throwing program (3.5 ± 0.7 vs. 1.4 ± 0.5 km/h, respectively; p ≤ 0.05)- Throwing velocity, a sign of general fatigue, whereas throwing accuracy and arm soreness are indicators of arm fatigue
Yang et al. (2014)	754 youth pitchers (aged 9–18 years)	No protocol, collection during season	A national survey was conducted	- 69.2% of pitchers reported pitching through arm tiredness multiple times throughout the season- 37.9% of pitchers reported multiple incidences of arm pain throughout the season
Makhni et al. (2014)	203 youth pitchers (aged 8–18 years)	No protocol, collection during season	Epidemiological study. Survey.	- 23% of pitchers reported prior overuse injury- 30% of players reported arm pain at decreased level of satisfaction- 46% of players were told on at least one occasion to pitch through arm pain
Sonne & Keir (2016)	73 pitchers	No protocol, collection during season	Retrospective Study. Pitching data retrieved from a public database.	- Reduced effectiveness of the flexor-pronator mass reduces joint rotational stiffness, which in turn increases the strain on the UCL during pitching, therefore increasing risk of injury
Warren, Szymanski & Landers (2015)	21 collegiate pitchers (aged 20.4 ± 1.4 years)	Three simulated, five-inning games (Max 70 pitches per game)	Evaluated the effects of three recovery protocols on range of motion, heart rate, rating of perceived exertion, and blood lactate	- Study looked into injuries in pitching, but did not comment on any related findings