Pilates for baseball and softball players: the throwing shoulder and elbow, rotation and the hips, what the evidence shows, and a routine

Load is the biggest risk

Pitching with a tired arm was the strongest risk factor for arm injury in young pitchers, and more than 100 innings a year went with 3.5 times the risk of serious injury. Pitch Smart's limits and rest days come first.

Sources 1, 2, 3

Three tiny Pilates studies, none controlled

In 3 college pitchers, throwing speed rose in two and fell in one after mat Pilates; two Korean studies in teenagers had no comparison group. None counted injuries, and none was in softball.

Sources 4, 5, 6, 7

Core training and throwing speed: small and uncertain

Core training raised standing throw speed in handball and other overhead sports, but not jump or step throws; applying that to pitching is our reading. In one non-randomised study of high school pitchers, read as an abstract, faster throws after hip and trunk training came with more load on the elbow.

Sources 8, 9, 10

Pilates can train the chain

Turning through the trunk both ways, single-leg pelvic control (which went with fewer days missed in professionals) and the lead hip's rotation are what Pilates can add, on both sides.

Sources 11, 12, 13

The throwing shoulder: strength, not more stretch

Too little outward rotation, not inward, went with shoulder injury in professional pitchers, and strength training did at least as well as sleeper stretches in a trial.

Sources 14, 15

Softball has no official pitch limits

Count pitches, share the pitching and plan rest days. The same Pilates suits windmill pitchers, with the shoulder work on both arms.

Sources 16, 17

The throw starts at the feetMixed evidence

Experts describe throwing as a chain: the legs and trunk make the energy and pass it through the shoulder and elbow to the ball. In 90 softball pitchers, body speed, ground forces and pelvic rotation explained 57% of fastball speed. But a review of elbow stress studies found the links between the legs, trunk and elbow load uncertain, with mixed results.

Sources 18, 19, 20

Trunk timing and the armEmerging evidence

In 69 adult pitchers, starting to turn the trunk before the front foot landed went with more load on the inside of the elbow. In 72 high school pitchers, turning the trunk out of order went with more shoulder rotation and force, without a difference in ball speed. These are lab associations.

Sources 21, 22

Pelvic controlEmerging evidence

In 347 professional pitchers, those with the poorest pelvic control on a single-leg test were 3 times as likely as the best to miss 30 days or more. Better control went with fewer walks and hits per inning in Minor League pitchers, and poorer control in single-leg balance went with later arm injury in 49 professionals. Associations in cohorts, not trials.

Sources 11, 23, 24

The hipsMixed evidence

The lead hip's rotation went with ball speed in 19 professional pitchers, but across 17 studies, healthy young players had only 1 to 4 degrees more hip rotation than injured ones, too little for a firm rule.

Sources 12, 25

Load and arm injuriesStrong evidence

Pitching with arm fatigue had pooled odds of 13.3 for injury, and more than 100 innings a year went with 3.5 times the risk of surgery or retiring injured over 10 years. Half of 476 pitchers aged 9 to 14 had elbow or shoulder pain in a season, more with more pitches. In US high schools, rules requiring rest between pitching days went with about two-thirds fewer shoulder and elbow injuries.

Sources 1, 2, 26, 27, 28

The elbow ligamentEmerging evidence

Operations to rebuild the elbow's inner ligament (the ulnar collateral ligament, UCL) rose about 9% a year in 15 to 19 year olds, who had over half of them. Across 83,215 professional injuries, hamstring strains were commonest and UCL injuries cost the most days.

Sources 29, 30

Softball pitchersEmerging evidence

The windmill pitch puts large forces on the shoulder, and no major fast-pitch league uses pitch count limits; as of 2023 there were none in the US or Canada. Little League softball limits innings, not pitches. Shoulder injuries were commoner in college than in high school softball.

Sources 17, 16, 31, 32

What Pilates offers, and what it doesn't

Pilates trains trunk control, rotation both ways, single-leg balance, the hips and the back of the shoulder at low load. It doesn't replace pitch counts, rest, a throwing programme or strength and power training, or treat a sore elbow (our reading).

Source 33

Three Pilates studies, none controlledMixed evidence

Our searches found three Pilates studies in baseball players and none in softball. In the only one with a throwing outcome, 3 college pitchers did mat Pilates 2 or 3 times a week for about 10 weeks: two threw faster (by 3.6% and 5.3%) and one slower (by 2.3%), and their trunk and balance tests improved. The tester wasn't blinded.

Sources 4, 5

Korean teenagersMixed evidence

In 11 middle-school players, 8 weeks of classical mat Pilates 3 times a week went with slightly more lean mass and stronger left knees, but trunk flexor strength fell; in 8 players aged 15, knee, trunk and shoulder strength rose. Both came from the same group, had no comparison group and studied growing teenagers, so the changes can't be put down to Pilates.

Sources 6, 7

Core training and throwing speedMixed evidence

In 10 trials in overhead athletes, core training raised standing throw speed, but not step or jump throws. In 8 trials in 226 mostly teenage handball players, it added about 3.8 km/h to a standing throw and nothing to a jump throw. Across sports, the effect on throwing or hitting speed was small and uncertain, and in 30 handball trials resistance training, especially barbell lifts, raised throwing speed more consistently. Applying any of this to pitching is our reading.

Sources 9, 8, 34, 35, 36

In baseball and softball playersMixed evidence

In 46 college players, power-stability core training raised throwing speed more than endurance core training. Adding medicine ball training to lifting raised trunk rotation strength in 49 high school players, with no pitching outcome, and 6 weeks of mixed exercises made no difference in 19 college players.

Sources 37, 38, 39

Two cautionsMixed evidence

In 54 high school pitchers, 8 weeks of hip and trunk strength training raised ball speed and also the load on the elbow; this is one non-randomised study, read as an abstract, and its authors suggest fewer pitches or longer rest as ball speed rises. In 71 high school players, movement screen training improved screen scores and balance while pitching speed fell.

Sources 10, 40

A warm-up that cut arm injuries in childrenEmerging evidence

Sixteen Japanese youth teams (237 players aged 9 to 11) were randomised to a 10-minute warm-up of stretches, mobility and balance at least once a week for a year: shoulder and elbow injuries were 1.7 against 3.1 per 1,000 practices and games. A non-randomised programme went with fewer inner-elbow injuries, and better turning of the non-throwing hip went with fewer injuries. It wasn't Pilates, but the moves overlap.

Sources 41, 13

Strength at least as good as stretchingEmerging evidence

In 113 high school pitchers, 9.8% of those doing nightly outward-rotation strength work were injured over 150 days, against 22.6% doing sleeper stretches. The trial showed strength was at least as good, not better.

Sources 15, 42

Strength and balance prevent injuries; stretching doesn'tStrong evidence

Across 25 trials, strength and balance training cut sports injuries and stretching didn't. The evidence linking core stability with arm injuries in throwers is limited.

Sources 43, 44

Which range mattersMixed evidence

In 296 professional pitchers, too little outward rotation in the throwing shoulder went with 2.2 times the risk of shoulder injury and 4 times the risk of surgery, while lost inward rotation didn't predict shoulder injury. Deficits of 5 degrees or more in total rotation or raising the arm went with elbow injury. An earlier study's link with lost inward rotation wasn't statistically significant.

Sources 14, 45, 46

Strength first, stretch a measured loss

Our reading, as on our baseball page: outward-rotation and shoulder-blade strength on both arms, and the cross-body stretch only on a side a physiotherapist has measured as tight. Leave the sleeper stretch out unless they've found a clear loss on one side.

Source 15

Loose shoulders

If you're hypermobile, don't use mobility work to push further: the NHS says "do not overextend your joints just because you can". See a GP if you think you have joint hypermobility syndrome: for example, your joints keep dislocating, or you keep getting sprains, strains, pain or stiffness.

Stop an exercise, or shrink its range, if you get the feeling the shoulder is about to slip out (editorial).

Sources 47, 48

Pilates and a sore throwing arm

With a tired or sore throwing arm, keep to the hips, legs, trunk and breathing until it has been checked, and take weight off the arm (the leg pull front and back, push-up and side bend). Pilates never counts as rest for the arm if it loads it (our suggestion).

The ulnar nerveMixed evidence

In 50 healthy college players, ultrasound showed the ulnar nerve slipping out of its groove at the elbow in 16%, without symptoms, often with a pop when throwing that can be mistaken for a ligament injury. Tingling into the ring and little fingers needs checking.

Sources 49, 50

Young throwers

For children, Pitch Smart's limits and rest days matter most. Inner-elbow pain from throwing in a child or young teenager means stop throwing and get it checked, not stretch it.

Source 3

What we'd work on

Our reading: turning the upper back both ways, the lead hip's inward turn and the back hip's front, single-leg pelvic control for the stride, and trunk endurance, on both sides, not only the throwing side.

Sources 13, 11

Back pain in young pitchersMixed evidence

In 812 Japanese high school players, reduced core stability had no link with back pain overall, but pitchers with pain on bending backwards were more likely to have reduced core stability.

Back pain that is worse arching back and has lasted more than a couple of weeks can be a stress fracture of the spine (spondylolysis): get it checked.

Source 51

Pitch Smart's limitsStrong evidence

Major League Baseball (MLB) and USA Baseball's Pitch Smart sets daily limits from 50 pitches at ages 7 and 8 to 105 at 17 and 18, rest days by the number thrown, no pitching on 3 days in a row and months off throwing every year. Our baseball page gives the full table.

Source 3

Where Pilates goes

Our suggestion: once or twice a week on non-throwing days or after practice, for at least 6 to 8 weeks before you judge it. Before throwing, use the arm care warm-up on our baseball page.

The sleeper stretch

Leave it out unless a physiotherapist has measured a clear loss of inward rotation on one side; use the cross-body stretch first.

Sources 14, 15

A sore throwing shoulder or elbow

Keep weight off the arm (the leg pull front and back, push-up and side bend) and do only the hips, legs, trunk and breathing until it has been checked (our suggestion).

A young player whose back hurts when arching

Leave out the swan, double-leg kick and rocking, and get it checked.

After a shoulder dislocation

No moves that load the arm near the end of its range until a physiotherapist clears them.

A pop or sudden pain in the elbow

Same day (NHS 111, or your team doctor): a pop on the inside of the elbow while throwing, with sudden pain, especially if you can't carry on throwing or the elbow feels loose. Stop throwing and get it checked.

Same day (A&E or an urgent treatment centre): a sudden pop or sharp pain on the inside of the elbow during a throw, followed by pain, swelling or bruising, or an elbow that won't straighten. The growth plate bump can pull away (an avulsion fracture), and an X-ray shows how far it has moved.

Sources 52, 50

An arm injury

Go to A&E or call 999 if you've injured your arm and it is numb, tingling or has pins and needles; a bone is sticking out or a bad cut is bleeding heavily; or the arm or elbow has changed colour or shape, or is at an odd angle. Don't drive yourself.

Urgent treatment centre or A&E: severe pain in your arm and it's difficult to move; you've injured your arm and heard a snap, or your arm has changed shape; or your arm tingles or feels numb.

Source 52

Elbow pain or tingling when you throw

• Inner-elbow pain when you throw, or a feeling that the elbow gives way, especially if your throws have lost speed or accuracy and don't recover after a short break from throwing: get it assessed by a GP, a physiotherapist or a sports medicine clinic.
• A child or young teenager with inner-elbow pain from throwing: stop throwing and get it checked. The growth plate there usually closes by about 15, and our Little League elbow guide covers it.
• Tingling or numbness into the ring and little fingers when throwing: the ulnar nerve may be irritated, so get it assessed.

Source 50

A shoulder that comes out

Call 999 or go to A&E: after a fall or injury, your shoulder looks out of place or has changed shape, you cannot move your arm, or your shoulder is painful, bruised or swollen. Do not drive yourself, and do not try to put it back in yourself.

Same day (GP or NHS 111): sudden weakness lifting the arm after an injury or fall. A rotator cuff tear caused by an injury needs urgent referral to a shoulder specialist. After a dislocation in anyone over 40, the rotator cuff should be checked: about 40% have a tear.

Your shoulder has partly or fully come out of joint, or you worry it might.

Sources 53, 54

A throwing shoulder that isn't right

• Pain at the top or outside of the upper arm when throwing, or throws that are slower or less accurate: stop throwing and see a GP or a sports physiotherapist. X-rays of both shoulders may be needed, and stopping straight away gives the best early results.
• Losing throwing speed or control, needing a much longer warm-up, a dead arm, or pain that comes back each time you build up your throwing: see a physiotherapist or sports doctor.
• A throwing arm that tires easily, with a hand that feels cold or turns blue, grey or pale, or pins and needles: see a GP. Rarely, a blood vessel or nerve near the top of the ribs or in the armpit is being squeezed (thoracic outlet syndrome).

Sources 62, 63, 64, 65, 66

A knock to the head

Call 999 if someone has hit their head and has been knocked out and hasn't woken up, can't stay awake or keep their eyes open, has a fit, has fallen from a height of more than 1 metre or 5 stairs, has problems with their vision or hearing, has clear fluid coming from their ears or nose, has new numbness or weakness, has problems with walking, balance, understanding, speaking or writing, hit their head at high speed, or their behaviour has changed. Get help from NHS 111 if they're being sick, feel dizzy or take medicine that thins the blood. If you're told to go to A&E (accident and emergency), don't drive yourself there if you have hit your head.

With a suspected concussion, if in doubt, sit them out. The UK's grassroots guidelines say no sport for at least 24 hours, get checked by a healthcare professional or NHS 111 within 24 hours, follow a staged return, and no competition before day 21; if symptoms last beyond 28 days, stay out of sport and see a doctor. Pilates waits too: gentle breathing and mobility fit the early, light-activity stages; bodyweight strength work can start in the light aerobic exercise stage, which allows "low intensity, body weight resistance training"; and springs, weights and harder trunk work come later (our reading). Our concussion guide has the stages.

Sources 55, 56

A collapse after a ball to the chest

If a player collapses and isn't breathing normally: call 999, start CPR straight away and send someone for a defibrillator.

Sources 67, 68

Chest pain or fainting: call 999

Call 999 if:

• You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
• The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
• You have chest pain and feel sweaty, sick, light-headed or short of breath.
• Someone faints while exercising, can't be woken within 1 minute, or has chest pain or a pounding, fluttering or irregular heartbeat.

Sources 57, 58

Unusual breathlessness

Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.

Source 59

A young player's back

Back pain that is worse arching back and has lasted more than a couple of weeks can be a stress fracture of the spine (spondylolysis): get it checked.

Source 69

Stop the session if

You feel any pain or become unwell, as the NHS advises for its Pilates videos, and especially for chest pain or pressure, unusual breathlessness, dizziness or fainting. If you have a health problem, an injury or any symptoms, get advice from a healthcare professional, such as a GP, before you start.

Source 60

Before you start

The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.

Source 60

"Core work prevents pitching elbow injuries"Emerging evidence

No trial shows it. Faster throws after hip and trunk training came with more elbow load in one study, and the elbow's biggest risks are pitch counts, fatigue and too little rest. The warm-up that cut arm injuries in children mixed stretches, mobility and balance.

Sources 10, 1, 2, 28, 41

"Pilates will add miles per hour"Mixed evidence

One study in 3 pitchers found two faster and one slower. Core training raised standing throws in other overhead sports, not step or jump throws.

Sources 5, 9, 8

"Every pitcher needs sleeper stretches"Mixed evidence

Lost inward rotation alone didn't predict shoulder injury in professionals, and strength did at least as well as sleeper stretches in a trial.

Sources 14, 15

"Softball pitching is natural, so it doesn't need limits"Emerging evidence

The windmill pitch loads the shoulder hard, and one study linked more than 85 pitches in a game with injury. Softball has no official pitch counts, so plan rest days yourself.

Sources 16, 17

"A strong core prevents all injuries"Strong evidence

Definitive evidence linking a weak core with injury is lacking; the programmes that cut injuries trained strength and balance.

Sources 61, 43

"You need a reformer for real Pilates"Mixed evidence

The pitchers' study used mat Pilates, and the Korean study that mentions equipment lists mat moves. Use what you can get to.

Sources 5, 7