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Collegiate Pitchers' Attitudes Toward Fastball Velocity and Ulnar Collateral Ligament Injury Risk: A Cross-Sectional
Benjamin W King1, Evan P Bailey1, Jesse Seilern Und Aspang1
1Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA.
Background:
Throwing velocity is among the most consistently implicated and controversial risk factors for ulnar collateral ligament (UCL) injury. Collegiate pitchers' perceptions of the importance of fastball velocity for competitive success along with the relationship between velocity and injury risk has yet to be evaluated.
Purpose/Hypothesis:
The purpose of this study was to describe collegiate pitchers' attitudes toward fastball velocity and its relationship with UCL injury risk. It was hypothesized that pitchers would place substantial importance on velocity and that a significant proportion would be aware of, and willing to accept, greater UCL injury risk in exchange for increased fastball velocity.
Study Design:
Cross-sectional study.
Methods:
An anonymous online survey was distributed to National Collegiate Athletic Association (NCAA) baseball pitchers from August to October 2025. The final survey instrument consisted of 30 questions divided into 4 sections: (1) demographics and injury history; (2) perceived pitching effectiveness; (3) opinions on the importance of fastball velocity; and (4) relationship between fastball velocity and UCL injury risk. Categorical variables were reported as frequencies and percentages and continuous variables as means with standard deviations. Chi-square tests compared attitude responses across NCAA division levels, history of prior UCL injury, and fastball velocity groups.
Results:
A total of 169 collegiate pitchers completed the survey. Most agreed that velocity is critical for in-game success (89.1%), college recruitment (66.9%), and advancement to professional baseball (91.8%), while also acknowledging its association with increased UCL injury risk (67.6%). On average, pitchers were willing to accept a 10.0% ± 10.9% increase in UCL injury risk for a 1-mph gain in velocity. High-velocity pitchers were more likely to play in Division I (69.2% vs 17.6%; P < .001), be starters (63.8% vs 40.2%; P = .002), and perceive themselves as effective (98.8% vs 89.7%; P = .02). Low-velocity pitchers more often agreed they would have been recruited by a better college program had they thrown harder in high school (90.8% vs 66.3%; P < .001). Pitchers with a UCL injury history more often agreed that sustaining earlier UCL surgery was preferable (63.6% vs 36.7%; P = .001).
Conclusion:
This study showed that collegiate pitchers view fastball velocity as vital for competitive success and career advancement. Despite acknowledging the link between velocity and UCL injury risk, many are willing to accept added risk in exchange for enhanced performance.
