INDICATORS OF THROWING ARM FATIGUE IN ELITE
ADOLESCENT MALE BASEBALL PLAYERS: A
RANDOMIZED CROSSOVER TRIAL
JONATHAN FREESTON,1 ROGER ADAMS,2 RENÉ E.D. FERDINANDS,1
1
Clinical and Rehabilitation Sciences Faculty Research Group, The University of Sydney, New South Wales, Australia; and
2
Exercise, Health and Performance Faculty Research Group, The University of Sydney, New South Wales, Australia
ABSTRACT
Freeston, J, Adams, R, Ferdinands, RED, and Rooney, K.
Indicators of throwing arm fatigue in elite adolescent male
baseball players: A randomized crossover trial. J Strength
Cond Res 28(8): 2115–2120, 2014—Throwing carries an
inherent risk of injury that worsens in the presence of arm
fatigue. The purpose of this study was to identify markers that
could facilitate the early detection of this type of fatigue, by
comparing the response to bouts of throwing-specific and
running-based exercise. Thirteen elite junior male baseball play-
ers were tested twice, 7 days apart with a randomized cross-
over design. They were assessed for shoulder proprioception,
maximal throwing velocity, and throwing accuracy before and
after a 10-minute bout of either throwing-specific (THROW) or
general (RUN) exercise. Maximal throwing velocity was
reduced similarly after both THROW and RUN bouts (21.0
6 0.4 vs. 20.6 6 0.2 m$s21, respectively; p # 0.05); however,
accuracy was only reduced after THROW (7.6 6 3.4 cm; p #
0.05). Arm soreness increased significantly more after
THROW than RUN (3.5 6 0.7 vs. 1.4 6 0.5 km$h21, respec-
tively; p # 0.05). Shoulder proprioception did not change after
either exercise bout. The results suggest that throwing velocity
is an indicator of general fatigue, whereas throwing accuracy
and arm soreness are markers of arm fatigue. Shoulder pro-
prioception does not seem to be a sensitive marker of either
type of fatigue. Throwing velocity should be monitored to
gauge overall fatigue levels, whereas accuracy and arm sore-
ness should be closely monitored to gauge arm fatigue and
throwing-induced injury risk.
KEY WORDS overhead, precision, speed, pitching
Address correspondence to Jonathan Freeston, jonathan.freeston@
sydney.edu.au.
28(8)/2115–2120
Journal of Strength and Conditioning Research
Ó 2014 National Strength and Conditioning Association
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
AND KIERON ROONEY1
INTRODUCTION
T
hrowing is critical for success in many sports, yet it
carries an inherent risk of injury (10,18,23). This
risk increases with the volume of throws per-
formed per game and per year (15). Fatigue that
occurs during a bout of repetitive throwing is thought to
exacerbate this injury risk, with an increased prevalence of
shoulder pain evident in pitchers who continue to throw in
the presence of “arm fatigue” (10).
Consequently, the ability of coaching staff to determine
when an athlete is fatigued during the course of a bout of
repeated throwing is critical for injury prevention within this
population. The early detection of arm fatigue would allow
for enhanced clinical decision making to take place, pro-
viding an evidence base for an individual’s pitching volumes
and restrictions, as well as informing decisions as to when an
athlete should be removed from the game.
As a result, much research has sought to identify specific
parameters that may be indicative of arm fatigue. Throwing
velocity (4), arm soreness (16,25), shoulder muscle strength
(11,25), throwing arm proprioception (20,21), muscle dam-
age (16), and throwing kinematics (12) have been shown to
be affected by a single bout of repeated throwing. Problem-
atically, however, these studies did not use a randomized
control design, raising doubts as to whether throwing was
the actual cause of the observed changes, or merely a result
of taking repeated measures over time. To accurately gauge
the level of arm fatigue experienced by a throwing athlete,
support staff should closely monitor only those parameters
that are negatively affected by repeated throwing itself.
Currently, it remains unclear as to which variables are
indicative of arm fatigue and should be monitored during
bouts of throwing. Consequently, the aim of this study was
to determine key markers that are indicative of arm fatigue,
to guide monitoring practices of staff working with throw-
ing athletes who could benefit from the early detection of
arm fatigue.
We conducted the study with the following hypothesis: That
throwing velocity and accuracy as well as shoulder proprio-
ception and soreness in the throwing arm would be signifi-
cantly and negatively affected by throwing-specific exercise and
VOLUME 28 | NUMBER 8 | AUGUST 2014 | 2115
 Indicators of Throwing Arm Fatigue
therefore be presented as key indicators of arm fatigue that
should be monitored closely during bouts of repeated throwing.
METHODS
Experimental Approach to the Problem
To determine the key indicators of arm fatigue, this study used
a randomized crossover design comparing the effects of
throwing-specific and running-based exercise on potential
markers previously identified in the literature. The assumption
was that factors, which are negatively affected by throwing
exercise specifically (rather than general exercise), would be
the most sensitive markers of arm fatigue and therefore ought
to be the variables monitored by coaches of throwing athletes.
Subjects
Thirteen junior elite baseball players participated in the
study (19.6 6 2.6 years, 17–23 years, 1.80 6 0.05 m, and 75.5
6 7.4 kg), subject to the condition that they had played
baseball at the state level within the past 18 months and
were currently selected in a state-level high-performance
baseball program. Appropriate consent was obtained pur-
suant to law because all participants were informed of the
experimental procedures involved before providing written
consent to participate in the study. Parental or guardian
consent was also obtained in the event the participant was
younger than 18 years of age. They also completed a ques-
tionnaire regarding injury and playing history. All research
was in compliance with the ethical guidelines for human
research laid down by the Australian NHMRC, and institu-
tional board approval was provided by the University of
Sydney Human Research Ethics Committee.
Procedures
Testing took place during the off-season phase of competi-
tion. The participants were required to attend the facility on
2 occasions separated by a minimum of 7 days. Testing was
conducted within an indoor laboratory, and each session
took place at the same time of the day. The participants were
instructed to maintain a high level of hydration and to refrain
from eating within 2 hours of the testing session.
Shoulder Proprioception Assessment. On arriving at the facility,
the participants were assessed bilaterally for active shoulder
proprioceptive acuity using a method previously developed
(24). Briefly, we used a specifically designed Active Move-
ment Extent Discriminating Apparatus (AMEDA) (13), con-
sisting of a computer-controlled motor mounted on an
adjustable hoist, driving a geared shaft with a circular
wooden disc at its end (RS Components Pty. Ltd., Silver-
water, Australia). Standing in 908 of shoulder abduction,
elbow flexion, and shoulder external rotation, the partici-
pant’s arm was rested on a padded rest. This position was
defined as position 0. The motor could move the disc ante-
riorly from this position to 1 of 5 different locations. Addi-
tional random movements of the shaft were made during
the TM
2116 Journal of Strength and Conditioning Research
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
repositioning to prevent any use of auditory cues as to the
end location of the disc. Each position was approximately
1.5 cm apart and elicited 748 of external rotation at position 5
and 858 at position 1. The left and right arms were tested and
the order was randomized. After the nature of the test was
explained to the participant, 21 practice trials were per-
formed with 3 trials to each of the 5 locations and a further
3 trials to the 2 terminal locations. The participants then
performed a randomized sequence of 50 trials under test
conditions comprising of 10 trials for each of the 5 positions.
During each practice and test trial, the participants were
instructed to face forwards, with the elbow in full extension.
When the disc was in its final position, the participants were
required to flex the elbow to 908 then externally rotate the
shoulder until the hand contacted the disc. The participants
estimated the position of the disc (from 1 to 5) immediately
after hand contact with the disc. The examiner, seated
behind the participant to ensure correct movement, entered
each response without the knowledge of the actual position.
Testing took approximately 30 minutes. The intraclass corre-
lation (ICC) and the SEM for test-retest reliability for the
proprioception measure were 0.86 (95% CI, 0.52–0.96) and
0.03 receiver operator characteristic (ROC) units, respectively.
Throwing Velocity and Accuracy Assessment. The participants
then performed a general warm-up routine consisting of
5–10 minutes of moderate intensity running followed by
5–10 minutes of general stretching of the major muscle
groups. This was followed by 10–15 minutes of throwing,
which began at light intensity before progressing to high
intensity at completion (5,6).
After the warm-up procedure, the participants performed
a total of 10 throws from the set position (1 forward stride
permitted before release) toward a target located 20 m from
Figure 1. Freeston and Rooney throwing target (version II), consisting
of a calibration frame of known distance (calibration frame) and throwing
target (target). This figure is typical of a still frame used to determine of
the ball’s location (ball) relative to the target.
 the TM

Journal of Strength and Conditioning Research | www.nsca.com

the participant’s back foot. The target consisted of a white

circle measuring 7.0 cm in diameter, painted onto a black

†Errors are expressed in cm 6 SEM. Peak and mean maximal throwing velocity (peak MTV and mean MTV) are expressed in m$s21 6 SEM. Velocity variability is expressed in
Exercise effect
rubber mat that was suspended on a specifically designed
metal frame (Figure 1). The center of the target circle was

0.00§

0.00§
0.01§
0.34
0.29
0.64

0.47

0.11
p at a height of 0.70 m from the ground. Using a regulation size
(approximately 6.7 cm diameter) and weight (142 g) base-
ball, 10 throws were performed at 100% of maximal throw-
ing velocity (MTV), measured with a Cordless Speed Radar
Gun (Jugs Corporation, Tualatin, OR, USA) positioned
0.01z
0.00z

0.00z

0.05z
0.12

0.10
0.15

0.38
behind the participant. Ten seconds separated each throw
p

to minimize the fatigue effect. A video camera (SONY Cor-

Time effect

poration, Tokyo, Japan) recording at 50 Hz was used to

20.6 6 0.2
20.7 6 0.1
0.4 6 0.2

3.0
3.0
2.4
2.7
2.9
determine the point of ball contact relative to the target.
Change

The ICC and the SEM for test-retest reliability for the
6
6
6
6
6

MTV test were 0.98 (95% CI, 0.93–0.98) and 0.4 m$s21,
25.4
4.7
217.7
2.5
26.5

respectively, and for the accuracy test were 0.87 (95% CI,
0.54–0.97) and 6.7 cm, respectively.
SD 6 SEM. Total, variable (VE), absolute constant (ACE), horizontal (X), and vertical (Y) errors are expressed in cm 6 SEM.
32.1 6 0.8
31.3 6 0.8
2.0 6 0.2

3.4
2.7
4.4
2.5
3.1

Exercise Protocol. After the throwing accuracy test, the

TABLE 1. Changes to velocity and accuracy after throwing-specific (THROW) and general (RUN) exercise.*†

Post

6
6
6
6
6

participants were randomly allocated to perform either

56.6
47.1
31.5
31.7
39.4

a throwing-specific (THROW) or running exercise (RUN)

protocol. A crossover design was used such that the
RUN

participants completed the alternate exercise protocol during

32.6 6 0.8
32.0 6 0.8
1.6 6 0.2

4.5
3.0
5.3
3.3
4.4

the second testing session. THROW consisted of 60 near

Pre

6
6
6
6
6

maximal effort throws (.95% MTV as determined by a cord-

62.0
42.4
49.2
34.3
46.0

less radar gun) over a distance of 20 m toward no specific

target, each throw being separated by 10 seconds. The total
time for this protocol was 10 minutes. RUN consisted of one
0.03z
0.01z

0.05z

0.05z
0.01z

20-m shuttle run test (beep test) to exhaustion (9). The total
0.40

0.19

0.80
p

time for this protocol was dependent on the fitness level of

Time effect

the individual and ranged between 9 and 12 minutes.

Immediately before and after exercise, the participants
21.0 6 0.4
21.1 6 0.3
0.3 6 0.3

3.4
3.0
4.4
3.2
3.4
Change

were required to subjectively rate from 0 to 10 their level of

6
6
6
6
6

soreness located specifically in the throwing arm using the

7.6
4.2
9.7
11.5
20.9

universal pain assessment tool (1). They were also asked to

subjectively rate their level of perceived exertion using the
Borg 6–20 scale (2).
31.8 6 0.5
30.8 6 0.6
2.5 6 0.3

3.0
2.7
5.7
3.7
2.9

After the exercise protocol, the participants rested for

Post

6
6
6
6
6

a period of 3 minutes and were then reassessed for throwing

66.0
51.6
42.7
39.3
44.8

accuracy and shoulder proprioception acuity as described

THROW

above.
§Denotes significant exercise type effect.
32.8 6 0.8
31.8 6 2.8
2.2 6 0.8

4.5
4.4
5.0
2.8
4.3

*MTV = maximal throwing velocity.

Data Processing. Footage of each throw was filmed and

zDenotes significant time effect.
Pre

6
6
6
6
6

imported into a measurement analysis software package

58.4
47.4
33.0
27.9
45.7

(Swinger Pro; Webbsoft, Scoresby, Australia). A still frame

of the time of contact between the ball and target was
generated. The distance between the center of the ball and the
Velocity variability

target center was then calculated by measuring the number of

pixels between the ball and target before converting this to
Variable

Mean MTV

a length in meters using the calibration frame (Figure 1).

Total error
Peak MTV

Throwing accuracy was determined by assessment of

Accuracy
Velocity

ACE

specific parameters defined previously (7) including total

VE

X
Y

error (E), absolute constant error (ACE), variable error

(VE), vertical error (Y), and horizontal error (X). The
E was calculated as the average distance between each

VOLUME 28 | NUMBER 8 | AUGUST 2014 | 2117

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 Indicators of Throwing Arm Fatigue

TABLE 2. Changes to rating of perceived exertion (RPE), throwing arm soreness (arm soreness), and shoulder
proprioception after throwing-specific (THROW) and general (RUN) exercise.*†

THROW Time effect RUN Time effect Exercise

effect
Variable Pre Post Change p Pre Post Change p p
RPE 6.6 6 0.3 12.2 6 0.6 5.5 6 0.5 0.00z 6.5 6 0.2 17.5 6 0.3 11.0 6 0.4 0.00z 0.00§
Arm soreness 0.3 6 0.1 3.7 6 0.7 3.5 6 0.7 0.00z 0.2 6 0.1 1.4 6 0.5 1.2 6 0.4 0.02z 0.01§
Proprioception
Throw arm 0.59 6 0.02 0.59 6 0.02 0.00 6 0.02 0.86 0.60 6 0.01 0.60 6 0.02 0.00 6 0.02 0.84 0.51
Nonthrow 0.58 6 0.02 0.61 6 0.02 0.03 6 0.02 0.86 0.59 6 0.01 0.62 6 0.02 0.03 6 0.02 0.10 0.89
arm

*RPE = rating of perceived exertion.

†RPE data are expressed as a rating from Borg’s 6–20 scale 6 SEM. Arm soreness data are expressed as a rating of 1–10 6
SEM. Proprioception data are expressed as the area under the curve of the receiver operator characteristic 6 SEM.
zDenotes significant time effect.
§Denotes significant exercise type effect.

throw and the target. The ACE, a measure of bias, was
calculated as the distance between the typical throw (cen-
troid) and the target, with the typical throw defined as the
centroid calculated by averaging the X and Y values of each
throw in a set. Variable error, a measure of consistency, was
calculated as the average distance between each throw and
the typical throw. The X and the Y errors were calculated as
the average distance between each throw and the target in
the X and Y directions, respectively.
For each subject, ROC graphs were generated for the
shoulder proprioception data obtained for the dominant
arm. The area under the curve (AUC) gives an accuracy
of discrimination measure (19). An AUC of 1.0 represents
perfect accuracy, whereas a score of 0.5 represents chance
performance. The AUC was calculated from positions 1 and
5 of the AMEDA.
Statistical Analyses
The hypothesis was tested by comparing the effect caused
by throwing-specific exercise to that caused by running-
based exercise on each of the factors of interest. To do this,
the data set was subjected to ANCOVA (22), where the
dependent variable was the change score, calculated as the
postscore minus the prescore. The independent variable was
the type of exercise (THROW vs. RUN), and the covariate
was the score at baseline. The assumptions for ANCOVA
were met. Outcomes were grouped into velocity (n = 3),
accuracy (n = 5), subjective measures (n = 2), and proprio-
ception (n = 2) variables, with the Holm-Bonferroni adjust-
ment applied. T-tests were also conducted on each
dependent variable to determine time effects for each of
the exercise conditions. Pearson’s correlation coefficients
were calculated on baseline and change scores to determine
the relationship between shoulder proprioceptive acuity,
MTV, and throwing accuracy. Statistical significance was
set at p # 0.05.
the TM
RESULTS
Throwing Velocity
Mean and peak MTV were significantly reduced after
THROW and RUN protocols to a similar degree (p #
0.05). Velocity variability was not significantly different after
either exercise bout (Table 1).
Throwing Accuracy
Total error and X were significantly increased after THROW
(p # 0.05), but unchanged after RUN, leading to a significant
exercise effect, (p # 0.05). Absolute constant error was signif-
icantly increased after THROW (p # 0.05) and significantly
reduced after RUN (p # 0.05) leading to a significant exercise
effect (p # 0.05). Variable and Y errors were not affected by
the THROW or RUN protocol (Table 1).
Subjective Measures
Rating of perceived exertion and throwing arm soreness
increased significantly after RUN and THROW (p # 0.05).
The increase in RPE was significantly greater after RUN
compared with THROW (p # 0.05), whereas the increase
in arm soreness was significantly greater after THROW
compared with RUN (p # 0.05). Proprioception was not
significantly affected by RUN or THROW. No significant
correlations were found between proprioception and throw-
ing velocity or accuracy (Table 2).
DISCUSSION
This is the first study to compare the effects of throwing-
specific and general exercise on potential markers of arm
fatigue in throwing athletes. As hypothesized, the results
confirmed previous findings (4,17,25) and demonstrated that
throwing velocity, throwing accuracy, and throwing arm
soreness were negatively affected by throwing exercise.
Interestingly, throwing velocity was reduced to a similar
degree after both throwing and general exercise bouts,

2118 Journal of Strength and Conditioning Research

Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.

whereas accuracy and arm soreness were affected to a far
greater degree by throwing exercise. Although throwing
velocity may prove to be a useful indicator of general fatigue,
these results do not suggest that it is a sensitive marker of
arm fatigue because the true cause of the observed reduction
in velocity cannot be confidently attributed to the throwing
activity itself. Alternatively, changes in throwing accuracy
and arm soreness are attributable to throwing-specific exer-
cise because accuracy was only reduced after throwing exer-
cise, and the increase in arm soreness was significantly
greater after THROW than after RUN. As a result, these 2
measures present themselves as key indicators of arm fatigue
with the potential to act as early detectors of throwing-
induced injury risk.
Although no studies have described accuracy changes
after throwing-specific exercise, the results of this study
confirm anecdotal evidence from the baseball coaching
community which views accuracy as a sensitive predictor
of arm fatigue. Interestingly, however, within this commonly
held belief, vertical accuracy is thought to be the variable of
interest, with throws that miss high in the strike zone
suggested to be more indicative of fatigue. In this study,
horizontal rather than vertical accuracy worsened over the
course of the throwing bout, with the participants less able
to hit the target in the left to right plane. The specific cause
of this finding remains unclear. Previous investigations have
shown repeated throwing to result in significant changes
to a number of kinematic and kinetic parameters such as
lateral trunk tilt (4), maximal external shoulder rotation,
knee angle at release, maximal shoulder and elbow distrac-
tion force as well as horizontal shoulder adduction torque
(12). Although repeated throwing potentially reduces
throwing accuracy by creating deviations away from typical
kinematic and kinetic sequences (8), such a conclusion is
beyond the scope of this study and provides stimulus for
future investigation.
Interestingly, and in contrast with previous research, this
study does not support the monitoring of shoulder pro-
prioception as an indicator of arm fatigue. Although previous
investigations have shown reduced shoulder proprioception
after throwing-specific exercise (20,21), this study found no
such relationship. We attribute this to differences in the com-
plexity of the tasks used. This study involved 3-dimensional
unconstrained throwing, a highly complex and coordinated
skill, whereas previous investigations into proprioception
used constrained throwing in which the lower limbs were
physically restrained or minimally involved in the throwing
motion. Although the role of shoulder proprioception in
throwing performance and injury risk cannot be ruled out,
there is little evidence to suggest that the shoulder proprio-
ception of throwing athletes should be routinely monitored
at this time. This position is reinforced by the complex
and time-consuming nature of this type of assessment. Given
the poor feasibility of proprioception measurement, com-
bined with its lack of sensitivity to detect changes in arm
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
the TM
Journal of Strength and Conditioning Research | www.nsca.com
fatigue, this monitoring practice ought not to be adopted at
this time.
In addition to monitoring practices, the current results
have significant implications for the training of throwing
athletes. The demands of throwing-specific exercise were
demonstrated to place unique stresses on the body, signif-
icantly increasing arm soreness and reducing performance in
terms of throwing velocity and accuracy. These data
highlight the need for throwing athletes to engage in
throwing-specific conditioning and prehabilitative exercises
(3,6,14) to build their resilience to throwing-induced arm
fatigue and attenuate the performance decrements that result
from this type of activity.
PRACTICAL APPLICATIONS
Overall, this study identified a number of key variables that
are indicative of fatigue during a single bout of repeated
throwing. Throwing velocity, throwing accuracy, and the
degree of soreness in the throwing arm may provide insight
into the level of overall fatigue and, therefore, injury risk
within this population. More specifically, however, throwing
accuracy and arm soreness are presented as indicators of arm
fatigue, whereas velocity may be more indicative of general
fatigue. Consequently, the routine monitoring of these
particular variables is warranted and may provide a greater
evidence base upon which clinical decisions can be made.
Coaches should routinely ask their pitchers to rate their level
of arm soreness using a scale similar to that used in this
study. When available, coaches should measure the ability of
their pitchers to throw accurately using ball-tracking sys-
tems. In lieu of this technology, coaches should observe the
accuracy of the pitcher, as well as obtain subjective ratings of
accuracy from the catcher and pitcher between innings.
Information regarding throwing velocity, throwing accuracy,
and arm soreness should be used to make decisions about
what pitching restrictions an individual should be placed on
and when they should be removed from the game. Greater
weighting should be placed on arm soreness and throwing
accuracy during this decision-making process, as velocity
may be more indicative of general rather than arm fatigue.
Interestingly, this study does not support the practice of
shoulder proprioception monitoring as a marker of injury
risk at this time.
ACKNOWLEDGMENTS
The results of this study do not constitute endorsement of
the product by the authors of the National Strength and
Conditioning Association. No external funding was received
for this study. There are no conflicts of interest to declare.
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