1
|
Hoenecke H, Fiske JW, Tamayo AE, D'Lima DD. Evolution of the throwing shoulder: why apes don't throw well and how that applies to throwing athletes. J Shoulder Elbow Surg 2024; 33:1404-1417. [PMID: 38316235 DOI: 10.1016/j.jse.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/04/2023] [Accepted: 12/17/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Humans have unique characteristics making us the only primate that can throw well while most other primates throw predominately underhand with poor speed and accuracy. The purpose of this study is to illuminate the uniquely human characteristics that allow us to throw so well. When treating an injury such as a labral tear or capsule tear, this study hopes the reader can gain a better understanding of the issues that lead to the tear and those that may determine the success of treatment besides the actual repair. METHODS In addition to a review of scientific and medical literature, information was obtained from interviews and experience with primate veterinarians, anthropologists, archeologists, and professional baseball players. These sources were used to study the connection between evolutionary throwing activities and current sports medicine issues. RESULTS Arm acceleration requires a functional kinetic chain, rapid motor sequences, and the ability to absorb elastic energy in the shoulder. Successful treatment of the throwing shoulder requires awareness of the shoulder's position in the kinetic chain and correction of defects in the ability to execute the kinetic chain. Some problems in the shoulder could reflect regression to a more primitive anatomy or dyskinesis. Return of performance requires regaining the elasticity in the tissues of the shoulder to temporarily store kinetic energy. For example, tissue remodeling after rotator cuff repair continues for months to years; however, the newly formed tissue lacks the same elasticity of the native tendon. This suggests why throwing performance typically does not return for 7 or more months after repair even though there may be structural integrity at 3-4 months. CONCLUSION The shoulder has developed uniquely in modern man for the act of throwing. The anatomic deficiencies in primates for throwing provide an illustration of the more subtle changes that a throwing athlete might have that are detrimental to throwing. Nonhuman primates have been unable to demonstrate the kinetic chain sequence for throwing secondary to the lack of neurologic pathways required. Humans are more sophisticated and precise in their movements but lack robusticity in their bone and muscle architecture, seen especially in the human rotator cuff. Successful treatment of a throwing injury requires familiarity with the conditions that cause the injury or affect the rehabilitation process. The return of performance following injury or surgery requires regaining the elasticity in the tissues of the shoulder to temporarily store kinetic energy from the kinetic chain.
Collapse
Affiliation(s)
- Heinz Hoenecke
- Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA; Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA.
| | | | | | - Darryl D D'Lima
- Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA; Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA
| |
Collapse
|
2
|
Manzi JE, Dowling B, Wang Z, Cecere R, Sudah SY, Fu MC, Gulotta LV, Dines JS, Carr JB. An Analysis of Intrapitch Variation in Joint and Segment Velocities With Throwing Arm Kinetics in High School and Professional Baseball Pitchers. Am J Sports Med 2024; 52:1676-1684. [PMID: 38767156 DOI: 10.1177/03635465241247546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Improper sequencing order of maximal joint and segment velocities has been identified as an important predictor for both throwing arm kinetics and ball velocity. PURPOSE To investigate the intrapitcher variation of maximal segment velocities and the relationship to throwing arm kinetics and ball velocity in high school (HS) and professional (PRO) pitchers. STUDY DESIGN Descriptive laboratory study. METHODS HS (n = 59) and PRO (n = 338) pitchers, instructed to throw 8 to 12 fastball pitches, were evaluated with 3-dimensional motion capture (480 Hz). Maximal joint and segment velocities were calculated for each pitch, and the standard deviation of the maxima was calculated per pitcher. These standard deviations were used to classify pitchers as "low variance" or "high variance" for each segmental velocity subgroup, "overall low variance" or "overall high variance" based on cumulative segment velocity variation, or "population," with any pitcher eligible to be included in multiple subcategories. Maximal velocities and throwing arm kinetics were compared among the various subgroups. RESULTS The HS low-variance shoulder internal rotation velocity subgroup (4949 ± 642 deg/s) had significantly lower maximal shoulder internal rotation velocity compared with HS population (5774 ± 1057 deg/s) (P < .001); similar findings were observed for PROs (5269 ± 835 vs 5824 ± 1076 deg/s; P < .001), as well as lower shoulder superior force compared with the PRO population (14.8% ± 8.8% vs 17.8% ± 8.8% body weight; P = .001). The PRO low-variance lead knee extension velocity subgroup had significantly lower maximal lead knee extension velocity (216 ± 135 vs 258 ± 125 deg/s; P = .001) and shoulder distractive force (111.5% ± 14.4% vs 115.6% ± 15.9% body weight; P = .003) compared with the PRO population. The PRO overall low-variance subgroup had significantly lower shoulder distractive force (111.8% ± 14.1% vs 119.6% ± 15.5% body weight; P = .008) and elbow anterior force (40.6% ± 5.0% vs 43.6% ± 6.2% body weight; P = .008) compared with the PRO overall high-variance subgroup. CONCLUSION HS and PRO pitchers with low variance for joint and segment velocities achieved significantly lower maximal velocities in the subgroup of interest, while preserving ball velocity. PRO pitchers with overall low variance among multiple maximal joint and segment velocities demonstrated decreased shoulder distractive and elbow anterior force. CLINICAL RELEVANCE PRO pitchers with low intrapitch variation in maximal joint and segment velocities may be viewed as kinetically conservative throwers. These pitchers with similarly maintained mechanics between pitches may have an increasingly regimented form that preserves kinetic forces about the throwing arm. The opposite may be true for PRO pitchers with increased variability in segmental velocities during their pitching motion, as they showed increased throwing arm kinetics including shoulder distractive and elbow anterior force compared with the overall low-variance group, theoretically increasing their risk of injury.
Collapse
Affiliation(s)
- Joseph E Manzi
- Department of Orthopedic Surgery, Lenox Hill Hospital, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Brittany Dowling
- Sports Performance Center, Midwest Orthopaedics at Rush, Chicago Illinois, USA
| | | | | | - Suleiman Y Sudah
- Department of Orthopedic Surgery, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Michael C Fu
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Lawrence V Gulotta
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Joshua S Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - James B Carr
- Sports Medicine Institute, Hospital for Special Surgery Florida, West Palm Beach, Florida, USA
| |
Collapse
|
3
|
Dowling B, Hodakowski A, Olmanson BA, Cohn MR, Pauley PJ, Verma NN, Nicholson GP, Garrigues GE. Relationship Between Arm Path, Ball Velocity, and Elbow Varus Torque in Professional Baseball Pitchers. Orthop J Sports Med 2023; 11:23259671231202524. [PMID: 38045766 PMCID: PMC10693215 DOI: 10.1177/23259671231202524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 12/05/2023] Open
Abstract
Background Currently, most pitching instructors suggest a shorter arm path-the total distance the arm travels during pitching. Theoretically, this combination allows for better body segment sequencing, a more efficient energy transfer through the kinetic chain, and increased ball velocity, while limiting elbow varus torque. Hypothesis Shorter arm paths would be associated with increased ball velocity and decreased elbow varus torque. Study Design Descriptive laboratory study. Methods A total of 182 professional pitchers threw 8 to 12 fastball pitches while evaluated by 3-dimensional motion capture (480 Hz). The arm path was calculated as the total distance the hand marker traveled during the pitch. The pitch was divided into early, late, and total arm paths. A linear regression model assessed the interpitcher relationship between arm path, elbow varus torque, and ball velocity. A linear mixed-effects model with random intercepts assessed intrapitcher relationships. Results Interpitcher comparison showed that total arm path weakly correlated with greater elbow varus torque (P = .025). Strong correlations were found between ball velocity and early (R2 = 0.788; P < .001), late (R2 = 0.787; P = .024), and total arm paths (R2 = 0.792; P < .001). Strong positive intrapitcher correlations were found between elbow varus torque and early (R2 = 0.962; P < .001) and total arm path (R2 = 0.964; P < .001). For individual pitchers, there was a large variation in the early (30.1 ± 15.7 cm) and late (21.4 ± 12.1 cm) arm path. For every 30-cm (11.8-inch) increase in early arm path (the mean range for an individual pitcher), there was a 1.29-N (β = 0.0429) increase in elbow varus torque and a 0.354 m/s (0.79 mph) (β = 0.0118) increase in ball velocity. Conclusion A shorter arm path correlated with decreased elbow varus torque and decreased ball velocity in intrapitcher comparisons. Determining the individual mechanics that decrease elbow varus torque may help coaches and trainers correct these patterns. Clinical Significance A shorter arm path during the pitch can decrease elbow varus torque, which limits the load on the medial elbow but also has a detrimental effect on ball velocity. An improved understanding of the impact of shortening arm paths on stresses on the throwing arm may help minimize injury risk.
Collapse
Affiliation(s)
- Brittany Dowling
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | | | | | - Matthew R. Cohn
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Patrick J. Pauley
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Nikhil N. Verma
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory P. Nicholson
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Grant E. Garrigues
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
4
|
Wasserberger KW, Giordano KA. Ground reaction forces in baseball pitching: temporal associations with pitch velocity among high-velocity pitchers. Sports Biomech 2023:1-15. [PMID: 37991012 DOI: 10.1080/14763141.2023.2284828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/03/2023] [Indexed: 11/23/2023]
Abstract
How baseball pitchers interact with the ground is an important aspect of pitching technique and performance. Previous studies on ground reaction forces in baseball pitching have largely been limited to pitchers at the youth or adolescent level, with only a few studies examining higher velocity pitchers. Additionally, previous studies have limited their analyses to only peak kinetic values, neglecting any temporal importance of when these peak values occur. Therefore, our purpose was to provide normative ground reaction force values and examine the associations between pitch velocity and ground reaction forces in high-velocity pitchers. We retrospectively extracted pitch velocities as well as rear and lead leg ground reaction force data from internal databases for 105 high-velocity pitchers. We analysed the associations between the full ground reaction force time series and pitch velocity using statistical parametric mapping regression. Regression analysis revealed pitch velocity significantly predicted lead leg braking ground reaction force from approximately 27% to 35% of the period between front foot contact and ball release. These data reinforce the importance of effective braking forces for achieving maximal pitch velocities. Additionally, our observed peak ground reaction force values were considerably higher than those previously reported.
Collapse
Affiliation(s)
| | - Kevin A Giordano
- Department of Physical Therapy, Creighton University, Phoenix, AZ, USA
- Institute of Sports Performance and Orthopedic Therapy, Holy Cross Health, Fort Lauderdale, FL, USA
| |
Collapse
|
5
|
Manzi JE, Dowling B, Wang Z, Sudah SY, Quan T, Moran J, McElheny KL, Carr JB, Gulotta LV, Dines JS. Forearm Pronation at Foot Contact: A Biomechanical Motion-Capture Analysis in High School and Professional Pitchers. Orthop J Sports Med 2023; 11:23259671221145233. [PMID: 37123995 PMCID: PMC10134138 DOI: 10.1177/23259671221145233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/26/2022] [Indexed: 05/02/2023] Open
Abstract
Background It has previously been speculated that baseball pitchers who display excessive forearm pronation at foot contact (FC) have a higher propensity toward ulnar collateral ligament injury and subsequent surgery. Purpose To evaluate the association between degree of forearm pronation/supination at FC and throwing arm kinetics in high school and professional pitchers, at both the individual (intrapitcher) and the group (interpitcher) level. Study Design Descriptive laboratory study. Methods High school (n = 41) and professional (n = 196) pitchers threw 8 to 12 fastballs while being assessed with a 3-dimensional motion-capture system (480 Hz). Pitchers at each playing level were divided into a supination or pronation subgroup depending on degree of forearm pronation at FC. Regression models were built to observe the relationship between forearm pronation at FC and kinetic and kinematic parameters of interest. Results At both the individual and the group level of high school and professional pitchers, there was no significant correlation between forearm pronation at FC and elbow varus torque (P min = .21). For every 10° increase in forearm pronation at FC in the individual high school pitcher, elbow flexion at FC decreased by 5°, whereas maximum elbow extension velocity was achieved 0.6% later in the pitch. In addition, elbow medial force increased by 4.1 N and elbow varus torque increased by 0.8 N·m for every 10° increase in forearm supination at FC. For every 10° increase in forearm supination in the individual professional pitcher, ball velocity increased by 0.5 m/s, shoulder external rotation at FC decreased by 11°, and elbow medial force decreased by 5.5 N. Conclusion Supination- or pronation-predominant forearm motion during the pitch did not significantly differ between playing levels. Excessive forearm pronation at FC was not a significant risk factor for increased throwing arm kinetics for high school or professional pitchers. There was a weak positive association between forearm supination at FC and elbow varus torque in the individual high school pitcher. Ultimately, coaches and pitchers may be better served by redirecting their focus to other mechanical aspects of the pitch that may have stronger associations with injury risk implications as well as performance.
Collapse
Affiliation(s)
| | - Brittany Dowling
- Sports Performance Center, Midwest Orthopaedics at Rush, Oak Brook, Illinois, USA
| | | | - Suleiman Y. Sudah
- Department of Orthopedics, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Theodore Quan
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Jay Moran
- The George Washington School of Medicine and Health Sciences, Washington DC, USA
| | - Kathryn L. McElheny
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - James B. Carr
- Sports Medicine Institute, Hospital for Special Surgery Florida, West Palm Beach, Florida, USA
| | - Lawrence V. Gulotta
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Joshua S. Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
- Joshua S. Dines, MD, Hospital for Special Surgery, HSS Sports Medicine Institute West Side, 610 West 58th Street, New York, NY 10019, USA ()
| |
Collapse
|