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Curr Rev Musculoskelet Med. 2021 Jun; 14(3): 224–231.
Published online 2021 Apr 8. doi:10.1007/s12178-021-09706-7
PMCID: PMC8137765
PMID: 33830422
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Abstract
Purpose of Review
Overhead throwing is a particularly violent motion that requires a complex sequence of timed muscle activations to efficiently transfer energy up the kinetic chain to throw a ball. Long-toss has long been utilized as a means of increasing shoulder range of motion, strength, and endurance, as well as an important component of rehabilitation in interval throwing programs. The purpose of this review is to assess the current literature on the science and biomechanics of long-toss.
Recent Findings
While long-toss is ubiquitously utilized in throwing programs for pitchers of all ages, the definition of long-toss, as well as its primary function in a throwing program, is debated. Throwing biomechanics in long-toss differ from that of mound pitching, although much of the variation is determined by the type of long-toss: shorter distance and on a line versus maximum distance and not on a line. Biomechanical factors including the kinematic changes of increased maximum glenohumeral external rotation, increased maximum elbow flexion, decreased trunk forward flexion at front foot contact, kinetic changes of increased shoulder internal rotation torque, increased elbow varus torque, and increased elbow extension velocity can occur with maximum distance long-toss throwing.
Summary
Long-toss is a highly variable training supplement that is used in throwing programs at all levels of baseball competition. Current literature has demonstrated a number of kinetic and kinematic changes in the throwing arm and throwing motion related to increasing long-toss distances. However, the exact benefits of long-toss are difficult to quantify due to the numerous definitions and various utilizations of long-toss.
Keywords: Long-toss, Throwing program, Thrower, Pitching, Overhead athlete
Introduction
Throwing a baseball is a complex and violent motion that involves the entire kinetic chain. As hitters continue to improve and the game of baseball evolves, pitchers too have changed and enhanced their throwing programs and training regimens to throw harder, sustain greater pitch counts, and bounce back quicker between appearances. Since the introduction of the radar gun, pitchers and pitching coaches have put a great deal of focus on increasing velocity. However, this potentially could come at a price. Pitchers have a 34% higher incidence of injury compared to position players in Major League Baseball, two thirds of which occur in the upper extremity [1]. At the high school level, pitchers have a significantly higher injury risk (37%) compared to position players (15%) [2]. Youth pitchers commonly report elbow (26%) and shoulder (32%) pain, often due to overuse and fatigue [3]. Attention and focus have been placed on mitigating this injury epidemic. Now more than ever, pitchers are spending more time in the gym working on core and lower extremity strengthening, utilizing weighted balls, and throwing baseballs ultra-long distances in order to increase their velocity, strengthen their endurance, potentially decrease their injury risk, and improve recovery from injury.
Long-toss has been integrated into throwing programs for years as a means of building arm strength, increasing throwing endurance, improving glenohumeral range of motion, increasing velocity, and decreasing injury risk [4–6]. Specific throwing programs were developed and published in the 1990s and early 2000s, which controlled the quantity and distance of throws [5–8]. Although these programs were originally described as a means of rehabilitation post-surgery or post-injury, long-toss is now being incorporated into preseason, postseason, and even in-season throwing routine programs and regimens to increase and maintain arm strength, and improve shoulder range of motion and condition of the pitcher to handle longer and more frequent outings. Below, we discuss the variable definitions of long-toss currently in the literature, the mechanics of overhead throwing, the biomechanics of long-toss, the limited science behind long-toss, and interval throwing programs, and the future directions of long-toss research.
Defining Long-Toss
What exactly is long-toss? Despite the widespread use of the term “long-toss” to describe components of various throwing programs or routines, what actually constitutes long-toss remains controversial. Defining long-toss is important to understand and study its utility and the effect it has on the thrower. Depending on who is being asked, there are significant variabilities in the reported length, trajectory, mechanics, and purpose of the long-toss throw (Table (Table1).1). Fleisig et al. examined the effects of long-toss throwing and included multiple distances: 120 ft, 180 ft, and a maximal distance that averaged 260 ft [9]. Slenker et al. utilized a distance of 180 ft in their evaluation of the biomechanics of an interval throwing program and baseball pitching [10]. Melugin et al. used 120 ft as the distance for their long-toss throwing program[11••], while Leafblad et al. utilized 90 ft, 120 ft, 150 ft, and 180 ft as their long-toss distances in their study of high school and college pitchers [12•] In their data-based interval throwing programs for baseball players, Axe et al. use 160 ft as their maximum long-toss distance for the age group 13 to 14 years old, as well as the high school, college, and professional athletes [4]. Stone et al. queried professional pitchers, pitching coaches, and certified athletic trainers in their epidemiologic study to determine what constitutes long-toss [13]. They found that pitchers and pitching coaches more commonly described long-toss distance as 177 ft and a “not on a line” style of throwing, with a primary functional goal of shoulder stretching, while athletic trainers listed a shorter distance of 157 ft and an “on the line” style of throwing for the primary purpose of arm rehabilitation. Thus, there is no universal agreement in the definition of long-toss as it pertains to distance of the throw, technique, and the primary goal.
Table 1
Examples of variation in long-toss definitions
| Manuscript | Subjects | Distance (ft) | Trajectory | Footwork | Purpose |
|---|---|---|---|---|---|
| Fleisig et al.[9] | Collegiate pitchers | 120, 180, 260 | On a line (120 ft, 180 ft), not on a line (260 ft) | Crow-hop optional | Rehabilitation and training |
| Slenker et al.[10] | Collegiate pitchers | 121, 180 | On a line | Crow-hop optional | Rehabilitation |
| Melugin et al.[11] | High school and collegiate pitchers | 120 | On a line | Stand-still | Rehabilitation |
| Leafblad et al.[12] | High school and collegiate pitchers | 90, 120, 150, 180 | On a line | Stand-still | Rehabilitation |
| Stone et al.[13] | Professional pitchers, pitching coaches | 177 | Not on a line | Stand-still | Shoulder stretching |
| Athletic trainers | 157 | On a line | Crow-hop | Rehabilitation | |
| Axe et al.[4] | 13–14 years old, high school, collegiate, and professional pitchers | 160 | Not specified | Crow-hop | Rehabilitation, training, and conditioning |
Biomechanics of the Throwing Motion
In order to understand the variations in the biomechanics between long-toss and pitching from a mound, we must understand the kinetic chain and the six phases of the overhead throwing motion. Overhead throwing, and baseball pitching in particular, is a violent motion that requires a complex sequence of muscle activations as the kinetic chain is activated and energy is transferred from the lower extremities to the arm as the ball is delivered [14–17]. This complex sequence of muscle activations that results in the ball being thrown involves a synchronization of movements and balanced mechanics that decrease injury risk [14].
Power generation begins in the legs, then moves up through the hips, pelvis, core, and trunk[16] to the shoulder, elbow, and, ultimately, the ball. A breakdown in the kinetic chain, either unintentionally due to decreased mobility, injury, or fatigue, or intentionally through a different style of throw such as long-toss, can lead to abnormal stresses placed on the soft tissues and subsequent injury to the shoulder and elbow [18–22].
The overhead throwing motion in pitching is traditionally broken down into six phases: (1) wind-up, (2) stride/early co*cking, (3) late co*cking, (4) acceleration, (5) deceleration, and (6) follow-through (Fig. (Fig.1)1) [20, 23–26]. There is a specific transfer of energy in each phase of the throwing process, and each phase can be defined by this energy transfer. Below, we will give a brief overview of each phase of the traditional pitching throwing motion and reveal areas where the traditional throwing motion breaks down or changes in the long-toss throwing motion (Table (Table22).
The six phases of overhead throwing: wind-up, stride/early co*cking, late co*cking, acceleration, deceleration, and follow-through. (Reproduced with permission from Fleisig et al. [26])
Table 2
Changes in overhead pitching motion biomechanics during long-toss compared to standard mound pitching
| Throwing phase | Changes in long-toss |
|---|---|
| Wind-up | Requires more coordination with crow-hop but no significant change |
| Stride/early co*cking | ⬇Knee flexion on landing |
| ⬆Torques in the shoulder and elbow | |
| Late co*cking | ⬆Maximum elbow flexion |
| ⬆Elbow extension arc | |
| Acceleration | ⬆Knee extension |
| ⬇Forward flexion | |
| Deceleration | ⬆Deceleration forces required |
| Follow-through | No significant change |
Wind-Up
This phase focuses on the generation of power by the legs and trunk, ultimately putting the pitcher in a balanced position to deliver the ball to home plate. This balanced position serves as a checkpoint in the delivery as the pitcher establishes control of the throwing motion [23]. If the pitcher is throwing with “crow-hop footwork,” their body’s forward momentum is used to generate power. The “crow-hop” is a sequence of steps where the thrower’s front and back feet shuffle and cross-over each other as linear momentum is created by the body moving toward the target (Fig. (Fig.2)2) [9, 13]. This motion requires more coordination than the wind-up from a stand-still, so there are inherently more ways in which the mechanics could break down and injury results if not performed in a controlled manner.
Stride/Early co*cking
In the stride phase, also known as the early co*cking phase, the potential energy generated during the wind-up is transferred into kinetic energy as the pitcher drives their lead leg toward home plate [24, 25] This motion creates a linear acceleration of the body toward the target [20]. While stride length is an important factor in power generation, longer strides have been reported to increase fatigue, [27] which could increase the risk for shoulder and elbow injury [28–30]. A properly flexed lead knee of approximately 38 to 50° at the time of front foot contact allows the leg to better absorb the impact and transfer the forces up the kinetic chain, affecting shoulder and elbow torques [31–33]. Fleisig et al. demonstrated that during long-toss, pitchers land with less knee flexion,[9] thus forcing the shoulder and elbow to experience higher torques. Though concerns have been reported, front leg stiffness versus certain amounts of flexion is debated regarding effectiveness of pitching. If a crow-hop is utilized in the long-toss throw, momentum is generated in the direction of the target and merges the wind-up and stride phases, thus producing the energy required to throw the long distance [8].
Late co*cking
At the end of the stride phase, the lead foot makes contact with the ground, the hip and knee flex upon impact, and the throwing arm is further co*cked into position in maximum external rotation. This step is known as the late co*cking phase. The pelvis, core, and trunk sequentially rotate to face the target, while the trunk begins to forward flex to further aid in energy transfer [23]. Lumbopelvic stability, core control, and proper timing of the sequential muscle activations are imperative in this step.
As the pelvis and core rotate forward, the humerus abducts and externally rotates into the co*cked position. Maximum glenohumeral external rotation is achieved at this point in the throwing motion. Increased external rotation of the humerus allows for a greater internal rotation torque, through an increased arc of motion, to be placed on the arm and, thus, greater velocity on the throw [23, 34, 35]. Pitchers commonly develop greater external rotation in their throwing shoulder to allow for maximum generated torque [36]. Maximizing external rotation is one component of a long-toss program, as the throwing arm demonstrates significantly more external rotation with progressively increasing long-toss distances [9]. The amount of external rotation which is advantageous versus when it could become pathologic is also a subject of interest and scrutiny.
As the co*cking phase completes, the elbow begins to extend as it moves toward the acceleration phase, creating a longer lever arm and generating greater centripetal force as the shoulder internally rotates [23]. Fleisig et al. also demonstrated increased maximum elbow flexion during arm co*cking in long-toss throwing, which allows for an increased elbow extension arc as the arms move through the subsequent phases to ball release [9].
Acceleration
The acceleration phase begins with the arm in maximum external rotation. The arm then goes through humeral internal rotation and elbow varus torques as the ball begins to accelerate forward. The elbow moves from a flexed position at late co*cking to an extended position at the end of the acceleration phase and time of ball release, while the humerus internally rotates at approximately 90° of abduction [23]. The stride leg knee extends as the trunk forward flexes and rotates. The lead leg serves as a stable base for the rapidly forward flexing torso [23]. During long-toss, the knee is more extended and the trunk goes through less forward flexion; thus, the thrower is more upright at the time of ball release, sending the ball in a more arched trajectory for longer distance throwing [9].
Deceleration
Once the ball is released, the pitcher begins the deceleration phase. In this phase, the trunk and hips are flexed and the lead knee and throwing elbow are extended [23]. After the ball is released, the rotator cuff, teres major, latissimus dorsi, and posterior deltoid stabilize the glenohumeral joint as the throwing arm decelerates by adducting across the body and internally rotating [20, 37–39]. A longer, slower deceleration may help to decrease the risk of injury to the shoulder and elbow as this allows the energy from the motion of the arm to be absorbed by the larger legs and trunk [23]. Dowling et al. reported an increase in arm speed as throwing distance increases when throwing on a line, [40••] thus greater deceleration forces are required to slow the arm during certain types of long-toss, which puts increased stress on the shoulder girdle musculature.
Follow-Through
The throw is completed in the follow-through phase, which balances the thrower with the arm, trunk, and legs at rest as the residual kinetic energy dissipates. The glenohumeral and scapular stabilizers continue to work to maintain the humeral head centrally on the glenoid.
Biomechanics of Long-Toss
The biomechanics specific to long-toss depend on the style and purpose of the particular long-toss throw. There is significant variation between hard, on a line, flat ground throwing to an increased distance and maximum distance throwing, on an arc, with the use of a crow-hop.
Fleisig et al. studied the biomechanics between standard pitching and long-toss in healthy college baseball pitchers [9]. The pitchers were instructed to throw from increasing distances, starting on the mound at 90 ft to reproduce and compare to the normal pitching motion, then increasing to “long-toss” distances. The pitchers were instructed to throw hard, on a line for the shorter distances of 120 ft and 180 ft, while for the maximum distance (average of 260 ft) there were no constraints on the pitcher’s biomechanics. They found that for the shorter distances, where the pitcher threw hard and on a line, the biomechanics were similar to that of normal pitching from the mound. However, when the constraints were removed and the pitcher was instructed to throw as far as possible, the pitcher’s maximum shoulder external rotation, elbow flexion, shoulder internal rotation torque, elbow varus torque, and elbow extension velocity were all increased compared to that of normal pitching. The greater stress placed on the throwing arm with maximum distance throwing puts the arm at increased risk for injury and thus the authors recommend that this style of throwing should be incorporated into throwing programs with caution.
In a similar study involving high school pitchers, Dowling et al. examined the effect that increasing distance has on the biomechanics of throwing [40••]. They found an increase in shoulder external rotation, elbow varus torque, and overall arm speed with increasing throwing distance up to 150 ft. Furthermore, increasing distance resulted in a decrease in arm slot, the angle between the forearm and the ground. Once again, the authors note that increasing distance throwing programs help increase arm speed and shoulder range of motion, but recommend that proper precautions should be taken during long-toss throwing programs to avoid injury to the throwing shoulder and elbow.
An important characteristic of long-toss programs is that the pitcher throws the longer distances with a lower effort. Therefore, if throwing hard at longer distances results in higher torques and stresses on the arm, a pitcher can counteract this by throwing with less effort. By throwing with less effort, the pitcher can theoretically gain the benefits of long-toss, such as stretching out the posterior shoulder musculature, without exposing the arm to dangerous consequences of throwing long distances with high effort. However, in a study of high school and collegiate baseball pitchers, Melugin et al. revealed a disconnect between a pitcher’s perceived effort and their actual measured effort during a structured long-toss program [11••] Specifically, when asked to throw at certain levels of decreasing effort (maximum effort, then 25% less each round) from 120 ft, the pitcher’s actual decreased effort (7% less elbow varus torque and 11% less velocity) did not match that of the perceived decrease in effort.
The Science Behind Long-Toss
Long-toss is incorporated into many throwing programs as a means of improving arm strength and endurance while also achieving greater shoulder range of motion. But how does it work? The mechanics and demands of long-toss may not be meant to mimic those of pitching. Instead, long-toss can be considered a training activity to increase shoulder range of motion, stretch out the arm after competitive pitching, build arm strength and throwing endurance, while decreasing the risk of injury. Thus, long-toss is comparable to sprinters utilizing long-distance runs to supplement low-intensity, long-duration exercises into their training in order to stress their bodies in a different way, resulting in improved performance and a reduced risk of injury [4, 5].
We know from Fleisig et al. that during the long-toss throwing motion, when the ball is thrown hard and on a line up to 180 ft, the biomechanics are similar to that of pitching from a mound, but at maximum distance the mechanics changed significantly [9]. This deviation from the normal mechanics is adaptive, as the requirements for maximum distance throwing are very different from that of pitching from a mound, much in the same way long-distance running mechanics are different to those of sprinting. In order to minimize injury risk, long-toss programs should be closely monitored and arguably performed at a lower intensity. Despite throwing a longer distance, the pitcher is throwing with a decrease in effort—in other words, they are not trying to throw their hardest fastball, but they are using the kinetic chain in a slightly different manner to achieve a longer distance throw. However, we learned that one of the major challenges of incorporating long-toss into throwing programs is that the perceived decreases in effort with long-distance throwing does not appear to match actual decreases in effort [11••]
It is worthwhile to note that Stone et al. in their study of the definition of long-toss revealed the difference in the approach to long-toss between athletic trainers and the pitchers and pitching coaches [13]. Athletic trainers, who primarily focus on the health of the pitcher, define long toss as shorter in distance and more commonly on a line (with a similar motion to that of pitching) as part of an interval throwing program, while pitchers define long-toss as longer in distance and not on a line, as a means of shoulder stretching.
According to Stone et al., a majority of pitchers throw long-toss to stretch out their throwing arm [13]. A recent study by Luo et al. examining the effects of straight-line long-toss (SLT) versus ultra-long-toss (ULT) throwing on shoulder range of motion post-pitching in 24 National College Athletic Association Division I baseball pitchers revealed a significant increase in passive external rotation, but no significant improvement in passive internal rotation [41•]. While each group had significantly greater external rotation after long-toss, there was not a significant difference between the SLT and ULT groups. Internal rotation loss is often a target of post-pitching stretching programs; however, Luo et al. demonstrated there is no significant change in internal rotation before and after either SLT or ULT.
Previous biomechanical studies show that long-toss results in decreased arm slot, increased arm speed, and greater arm rotation [9, 40••]. Camp et al. examined the contributing biomechanical factors that are associated with elevated elbow varus torque, which include decreased arm slot, increased arm speed, and greater arm rotation, [36] thus revealing the potential dangers of long-toss through its direct relationship with elbow varus torque. It should be noted the torque was measured with a one-sensor methodology and more work is needed in this area.
At the current time, despite its widespread use in baseball at all levels, we do not entirely understand the science behind long-toss, due in part to the variation in the definition of long-toss as well as the intra-thrower variability. Further work needs to be done to clarify the definition of long-toss in order to establish more consistent, science-based throwing programs.
Interval Throwing Programs and Future Directions
The use of progressive, interval throwing programs during the rehabilitation period post-injury is well established [4–8]. While many throwing programs have a primary focus on rehabilitation,[4–8, 12•, 42] interval throwing programs have been implemented not just for recovery from injury but also to train, condition, stretch, and strengthen the arm for the taxing activity of overhead throwing [4]. In addition, more recent publications have stressed the importance of individualizing throwing programs for each thrower depending on their particular age, position, situation, and needs [4, 12•, 43]. Regardless of the specific interval throwing program, there is commonly some component of long-toss incorporated into the program.
However, the mere definition of long-toss is a debated subject with a great amount of variability depending on who is being asked. Thus, it is understandable that there is variability in when and how often long-toss is utilized, what the goals are of long-toss programs, and who should be incorporating long-toss into their routine. These questions are not clearly answered in the current literature, but what we do know is that their answers likely vary depending on exactly for whom the long-toss program is intended.
Hence, it may be prudent to stress individualization of long-toss programs depending on a number of variables: level of competition, starter versus reliever, preseason versus in-season versus post-season, and strengthening versus stretching versus rehabilitation. In addition, these programs should be closely monitored by athletic trainers and pitching coaches to ensure the pitcher is properly adhering to the program and that necessary adjustments to the program are made to accommodate the individual pitcher and their current needs.
Summary
Long-toss is a highly variable training activity with global use at all levels of baseball despite the little consensus on its precise definition, who should be doing it, when they should be doing it, and why it should be incorporated into throwing programs. However, long-toss does provide benefits to a thrower when done in a safe, monitored environment including increased glenohumeral range of motion and increased arm strength and endurance. Other goals of long-toss are potential increased velocity and decreased injury risk when later pitching from a mound. While sprinters supplement their training with longer distance runs, so too should pitchers supplement mound pitching with long-toss, but we must work to provide a clearer consensus on long-toss and its utilization.
Declarations
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Footnotes
This article is part of the Topical Collection on Injuries in Overhead Athletes
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References
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