Comparison of Elbow Varus Torque During Interval Throwing Programs and Gameday Pitching in High School Baseball Pitchers (125)

Objectives: Completion of an interval throwing program (ITP) is a common benchmark for return to full competition following an injury to the dominant extremity of an overhead throwing athlete. While workload management for overhead athletes has evolved, the general structure of the ITP remains relatively unexamined. Furthermore, the daily and cumulative workload of ITPs is generally unknown. An ideal ITP would allow for a gradual increase in workload that eventually approximates, but does not exceed, workload measurements attained during competition. It is currently unknown if ITPs achieve this critically important objective. Therefore, the current study sought to 1) determine the daily and cumulative workload for common ITPs using elbow varus torque (EVT), and 2) compare EVT experienced during completion of ITPs to game pitching EVT values. Methods: A retrospective review identified high school pitchers with at least 50 throws at distances of 90, 120, 150, and 180 feet plus game pitches while wearing a MotusBASEBALL sensor. Averages for EVT per throw and torque per minute were calculated at each distance. Three throwing programs were created using a template of one phase at each distance with two steps per phase (Table 1). Programs varied only by number of throws per set (20, 25, and 30 throws for Programs A, B, and C, respectively). Total EVT for each step, phase, and program were calculated using average EVT values for each distance. Total torque for each step and program was converted to an average inning pitched equivalent (IPE) and maximum pitch count equivalent (MPE), respectively, using pitching EVT values and expected average pitch counts (16 pitches/inning and maximum 105 pitches/game). Results: 3,447 throws were analyzed from 7 pitchers with an average age of 16.7 yrs (0.8 yrs SD). EVT progressively increased with distance (range 36.9-45.5 N·m), comparable to game pitching (45.7 N·m). Average torque per minute was highest for 90 ft throws (193.4 N·m/min) and lowest for game pitches (125.0 N·m/min). Program A demonstrated the lowest range of IPE per step (2.0-3.7), and Program C had the highest range (3.0-5.6) (Figure 1). The phases of Program A never exceeded 1MPE. Program B exceeded this threshold after phase 1, and Program C exceeded 1MPE at every phase (Figure 2). Total program MPE ranged from 3.5 (Program A) to 5.2 (Program C). Conclusions: Performing long-toss throwing led to greater torque per minute compared to gameday pitching. Additionally, ITPs requiring 25 or more throws per set led to increased cumulative EVT, especially at distances greater than 150 ft, which can exceed typical values from gameday pitching. ITPs should be adjusted accordingly to encourage a slower pace of long-toss throws and less than 25 throws per set, especially at distances greater than 120 ft. Most ITPs currently recommend one rest day between steps. However, cumulative EVT at longer distances can exceed 5 IPE. Most pitch count rules require more than one rest day after a pitching outing that exceeds multiple innings pitched. Therefore, days off between steps and phases of an ITP should reflect these demands. We advocate for multiple days off between steps that require more than 3 IPE. Table 2 presents a novel ITP based on the findings of the current study.