We often chase the usual suspects when diagnosing pitching injuries — shoulder IR deficits, hip mobility restrictions, or elbow valgus torque. But this new study turns our attention somewhere else entirely: the neck.

Researchers tracked 88 professional pitchers across a full season after assessing their cervical range of motion during spring training. The question was simple: can neck asymmetry predict arm injury risk? The answer was unequivocal — and the implications are far-reaching.

What the Study Found

• Pitchers with greater side-to-side asymmetry in cervical rotation were significantly more likely to get injured.
  
  
• For every 1° increase in rotational asymmetry, the risk of arm injury increased by nearly 4x.
  
  
• Injured pitchers had an average asymmetry of -5°, while uninjured pitchers averaged -1°.
  
  
• Dominant-side cervical rotation averaged 74° in injured pitchers versus 78° in uninjured pitchers.
  
  
• Other metrics — including lateral flexion, flexion/extension, and even the Cervical Flexion-Rotation Test (CFRT) — showed no predictive power.
  
  
• Shoulder internal rotation was slightly lower in injured pitchers but did not account for the same variance.
  
  
• Arm injury incidence was 23%, with a combined injury rate of 1.3 per 1000 exposure days.
  
  

This wasn’t a lab test. These were real pro pitchers, tracked across an entire competitive season. Injuries included both shoulder and elbow pathologies, and exposure time was meticulously logged — making this one of the more practically relevant predictive studies we’ve seen in recent years.

Why This Matters

Neck rotation is rarely discussed in baseball injury prevention — but it might be one of the most important and under-evaluated factors in overhead athletes.

The neck plays a key role in:

• Visual tracking and gaze stability
  
  
• Timing of trunk rotation
  
  
• Proprioceptive feedback
  
  
• Head-trunk dissociation during sequencing
  
  

If a pitcher can’t rotate symmetrically, especially toward their glove side, it may affect how they time trunk rotation, perceive pitch location, or compensate elsewhere in the chain.

This study showed that even a few degrees of rotational deficit had a massive effect on injury risk. That should raise eyebrows.

Notably, commonly used screens like the CFRT didn’t predict injury — it was the raw asymmetry in rotation that mattered most. This suggests that screening protocols may need to shift, prioritizing simple, high-resolution measures of active cervical rotation.

How We Apply This at VeloU

At VeloU, we already evaluate neck ROM in all new assessments — and this research strengthens our commitment to it.

We use a laser-guided inclinometer and head rotation tests to identify asymmetries. When we see more than 3-4° difference side-to-side, we intervene immediately. Depending on the case, this might include:

• Soft tissue therapy and cervical mobilization
  
  
• Gaze training and visual vestibular drills
  
  
• Postural interventions during throwing warmups
  
  
• Integration with scapular and trunk mobility work
  
  

What this study emphasizes is the need to look above the shoulder. Many athletes present with “clean” shoulder IR numbers, yet something in their sequencing feels off. This research may explain why: if the neck isn’t rotating well, the entire kinetic chain downstream may compensate.

And those compensations don’t just cost command — they may cost time lost to injury.

This article is part of Applied Baseball Science by Dr. Nicholas Serio, where we break down the biomechanics, performance science, and injury research shaping the modern game. Powered by VeloU (Velo University) — where research meets real-world baseball.

Reference

Pizzari, T., LaScala, F., Mott, T., Heinlein, C., Feeley, B. T., & Dines, J. S. (2024). Cervical rotation asymmetry predicts arm injuries in professional baseball pitchers: A prospective cohort study. Orthopaedic Journal of Sports Medicine, 12(4), 23259671241247480. https://doi.org/10.1177/23259671241247480