Home Baseball Content Ulnar Collateral Ligament Injuries in Quarterbacks vs. Pitchers

Ulnar Collateral Ligament Injuries in Quarterbacks vs. Pitchers

Written on July 26, 2010 at 5:39 am, by Eric Cressey

Here’s an interesting study on the incidence of ulnar collateral ligament (UCL) injuries in professional football quarterbacks.  With only ten reported cases between 1994 and 2008, it’s obviously (and not surprisingly) much lower than the rates we see in professional baseball players.  This is right in line with what I discussed in Weighted Baseballs: Safe and Effective or Stupid and Dangerous?

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However, what is very interesting to me is that 9/10 cases were treated non-operatively; in other words, Tommy John surgery is much less prescribed in football quarterbacks than baseball pitchers – meaning that the quarterbacks respond better to conservative treatment.

What’s up with that?  They are the same injuries – and presumably the same rehabilitation programs.

In my eyes, it’s due to the sheer nature of the stress we see in a baseball pitch in comparison to a football throw.  As a quarterback, you can probably “get by” with a slightly insufficient UCL if you have adequate muscular strength, flexibility, and tissue quality.  While this is still the case in some baseball pitchers, the stresses on the passive structure (UCL) are still markedly higher on each throw, meaning that your chances of getting by conservatively are probably slightly poorer.


I’m sure that the nature of the sporting year plays into this as well.  Football quarterbacks never attempt to throw year-round, so there isn’t a rush to return to throwing.  There are, however, a lot of stupid baseball pitchers who think that they can pitch year-round, so kids often “jump the gun” on their throwing programs and make things worse before they can heal completely.

That said, we’ve still worked with a lot of pitchers who have been able to come back and throw completely pain-free after being diagnosed with a partial UCL tear and undergoing conservative treatment (physical therapy).  It’s an individual thing.

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8 Responses to “Ulnar Collateral Ligament Injuries in Quarterbacks vs. Pitchers”

  1. chris Says:

    I think the biggest and most obvious difference between pitchers and quarterbacks, which this article completely overlooks, is the huge difference in volume of throws between the two jobs. An NFL quarterback plays a maximum of 20 games (if they make it all the way to the Super Bowl and don’t get a first round by) in a season, plus 4 pre-season games in which they’ll hardly play, and rarely attempt more than 30 passes a game. A starting MLB pitcher can have up to 35 starts in the course of a season, plus 3-5 preason starts and up to 10 post season starts (that’s a total of up to 50 starts a year), in which they can average over 100 pitches per game. That’s a difference of 600 throws for the quarterback versus up to 5000 for the starting pitcher.

  2. john jacobson Says:

    I think the article overlooks it because it is so obvious–and your comment overlooks how often quarterbacks throw in practice vs a pitcher’s practice session. Counting just the throws you see on tv doesn’t really give a full picture. Not so clear cut, which why the article focused on a couple aspects. Great stuff!! Thanks.

  3. Eric Cressey Says:

    Chris, it’s a good point, but don’t overlook the frequency side of things. My experience has been that while quarterbacks may not have as many throws in an outing, they do tend to make more throws between outings than pitchers. In my experience, throwing frequency is just as much of a causative factor with respect to lost ROM as is number of throws. We still see big shoulder internal rotation and elbow extension deficits in QBs.

    Thanks for your comment.

  4. Kyle Ridgeway, DPT Says:

    Great post Eric. I think a couple of things to consider are the mechanics of a MLB baseball throw and an NFL QB throw. I am thinking how the arm is cocked pre-throwing, forearm/hand positioning, and follow through. Intuitively, I would think that the forces and stress on the medial elbow are higher in a pitcher considering the positioning of the arm/shoulder/elbow during throwing. For example, you do not see the lunged stance with body in front of arm and shoulder in hyper ER in the cocking phase of a QB throw. And of course you need to take into account arm speed (angles per second of IR) and ball size.

    Further, while frequency is DEFINITELY an important factor (as you address in your comment) I also think the time between throws (relative rest period) may also play a roll. Another way to define this would be “density” of throws. A QB (in a game) isn’t throwing as many throws per unit time [think about the time between plays and the breakdown of run plays vs. pass plays and the length of a series] whereas a pitcher will be throwing consistently during his half of each inning.

    Just some other thoughts. Anyone else agree or disagree/have other insights??

  5. Ron Wolforth Says:

    One thing to also consider in this discussion is because of the 5oz-15 oz difference in ball weight…and its effect on the speed of the arm/ball into launch…is that the demands of the deceleration are much more acute in a baseball pitcher…in other words…all things being equal… he must be considerably more efficient at deceleration/pronation than his QB counterpart. I don’t see many Qb’s banging their olecr. process into their fossa…in baseball its the rule rather than the exception.
    In my experience…the more inefficient your deceleration…the more likely the pitching athlete is to become a reliever. Now its true that MANY things shape and influence the body’s ability to decelerate your arm…such as the scapula…alignment…hip and hamstring flexibility etc.etc
    but one can not underestimate the value of considering ALL the influences/variables of deceleration in protecting the elbow & shoulder. therefore IMO we are well advised to keep pronation, its specific timing in the sequence and it’s specific characteristics in mind when ever considering elbow and shoulder issues

  6. Kevin Brower Says:

    All very good points. The throw a QB makes, although a different motion in regards to biomechanics as a whole, can be measured in a similar way (torque, ext. to int. rotation, etc), but the situation is very different. Granted a QB may not throw every pass at 100% intensity (John Elway excluded) being hurried in the pocket, or making throws off the left foot would seem to put more stress on the elbow. Also, the ball being stripped as the arm begins to accelerate forward is a significant stress that is tough to measure. My UCL was a slight tear the first week of the season, and bearable enough to pitch through until it finally gave out and fully tore about 50 games in. It makes you wonder if their original injury was from the resistance of a defender’s hand and not the continual throwing. Similar to the thoughts Eric has on the weighted baseball, but only for a fraction of a second with greater resistance. The weighted baseballs do have a usefull purpose, but I don’t like them for throwing.

  7. N. T. Wakelyn Says:

    My grandson will be in the 9th grade this year. He had a very good year as a baseball pitcher this summer and is supposed to be talented. He is playing football this season as a quarterback. Should a young teenager being doing both sports?

  8. Eric Cressey Says:

    That’s quite a bit of stress to take on for a young arm, but I feel like it can be done. Just make sure that he has ten weeks of the year where he is not throwing. I’d end summer baseball at the end of July and get two weeks off before ever picking up a baseball. Then, when football season ends, take time off from throwing anything until January 1.

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