Baseball: Two-out Drill Reduces Risk of Shoulder Injury

Performing a two-out drill after pitching may improve shoulder and elbow range of motion and reduce the risk of injury in baseball pitchers, according to new research published in the March issue of The American Journal of Sports Medicine.

Rafael F. Escamilla, Ph.D., PT, CSC, FACSM, professor of physical therapy and co-director of the Biomechanics Laboratory at the California State University in Sacramento, California, and colleagues investigated whether performing a short-duration stretching/calisthenics drill after pitching would increase glenohumeral internal rotation (IR), external rotation (ER), total rotational motion, and elbow extension in 20 male professional baseball pitchers.

Each participant engaged in the following sequence of activities:

• a 5-to-10-minute warm-up
• elbow extension and IR and ER patient-reported outcome measures (PROM) were taken before each pitching session began
• 40 full-effort pitches off the pitching mound
• 8 minutes of rest
• elbow extension and IR and ER PROM measurements taken after pitching
• a short-duration stretching/calisthenics drill (two-out drill)
• elbow extension and IR and ER PROM measurements taken after the drill.

According to results, there wasn’t a significant difference in elbow extension between pre-pitching, post pitching and post drill, but ER was greater during pre-pitching and post drill than post-pitching (p = 0.010 and 0.005, respectively). In addition, IR was greater during pre-pitching and post drill than post-pitching (p = 0.034 and 0.043, respectively), and total rotational motion was greater during pre-pitching and post drill than post-pitching (p = 0.034 and 0.004, respectively).

Escamilla told OTW, “To lose a significant amount of shoulder motion in less than 30 minutes secondary to pitching, and then to re-gain it all back in just one minute from doing the two-out drill, was surprising.”

He said the findings “will assist clinicians to better understand the positive effects of performing a short duration stretching/calisthenics drill on shoulder internal and external rotation range of motion between innings while pitching during a baseball game.”

He added, “The next steps in research should be to assess how often these drills need to be done to achieve optimal shoulder range of motion, thus an optimal dose-response relationship. Also, to further assess how the two-out drill mayincrease pitching performance and decrease the risk of shoulder and elbow injuries.”