Assessment and rehabilitation of chronic low back pain in baseball: part II

Impact of low back pain experience on future occurrence of shoulder pain in adolescent baseball players: A 1-year prospective cohort study

BACKGROUND

Low back pain can affect musculoskeletal problems of the upper limb in adolescent overhead athletes. However, few epidemiological studies have examined this causal relationship. This prospective cohort study aimed to investigate the relationship between baseline low back pain experience and the occurrence of future shoulder and elbow pain among high school baseball players.

METHODS

Participants comprised 383 high school baseball players from 43 high school baseball teams who had undergone baseline medical evaluations (a self-completed questionnaire and physical examination). The occurrence of shoulder and elbow pain during a 1-year follow-up and associations with baseline low back pain (positive subjective symptom during the last year at baseline) adjusted for flexibility of the scapulo-thoracic region, shoulder, and lower extremities, such as straight-leg raise angle (hamstring tightness), Thomas test (iliopsoas tightness), heel-buttock-distance (quadriceps tightness) and passive range of motion of the hip were investigated using multivariable analysis.

RESULTS

A total of 307 players (80.2%) participated in the 1-year follow-up survey, with shoulder and elbow pain reported in 75 players (24.4%) and 119 players (38.8%), respectively, during follow-up. After adjusting for factors associated with shoulder pain using logistic regression modeling, significant associations between LBP experienced during the last year at baseline (odds ratio, 2.18; 95% confidence interval, 1.23-3.87; P = 0.0078) and new-onset of shoulder pain were noted.

CONCLUSIONS

Baseline low back pain impacted future shoulder pain in high school baseball players during the 1-year follow-up. Management of shoulder pain warrants careful attention to low back pain.

The Burden of Back and Neck Strains and Sprains in Professional Baseball Players

STUDY DESIGN

A retrospective case series study.

OBJECTIVE

To analyze the epidemiology of diagnoses of back and neck strains and sprains among Major League (MLB) and Minor League (MiLB) Baseball players.

BACKGROUND

Baseball players perform unique sets of repetitive movements that may predispose to neck and back strains and sprains. Data are lacking concerning the epidemiology of these diagnoses in this population.

MATERIALS AND METHODS

De-identified data on neck/back strains and sprains were collected from all MLB and MiLB teams from 2011 to 2016 using the MLB-commissioned Health and Injury Tracking System database. Diagnosis rates of conditions related to cervical, thoracic, and lumbar musculature and their impact on days missed due to injury, player participation, and season or career-ending status were assessed. Injury rates were reported as injuries per 1000 athlete exposures (AEs).

RESULTS

There were 3447 cases of neck/back strains and sprains in professional baseball players from 2011 to 2016. Seven hundred twenty-one of these occurred in MLB versus 2726 in MiLB. Of injuries 136 were season-ending (26 in MLB, 110 in MiLB); 22 were career-ending (2 in MLB, 20 in MiLB). The total days missed were 39,118 (8838 from MLB and 30,280 from MiLB). Excluding season or career-ending injuries, the mean days missed were 11.8 (12.7 and 11.6 in MLB and MiLB, respectively). The median days missed were 4 (3 and 5 in MLB and MiLB, respectively). Combining MLB and MiLB, the pitcher injury rate was 1.893 per 1000 AEs versus 0.743 per 1000 Aes for other position players (P < 0.0001).

CONCLUSION

There was a high incidence of neck/back strains and sprains in MLB and MiLB players, with nearly 40,000 aggregate days missed in our 6-year study period. The median days missed were lower than the mean days missed, indicating rightward outliers. Pitchers had over double the rates of injuries compared with other position players.

LEVEL OF EVIDENCE

Level III.

Factors affecting chronic low back pain among high school baseball players in Japan: A pilot study

The prevalence of chronic lower back pain (CLBP) among baseball players is high. CLBP is associated with reduced participation in practice and games. This pilot study examined the factors associated with CLBP among high school baseball players in Fukui, Japan. The participants underwent two health examinations in high school: (1) as first-grade baseball players (baseline) and (2) as second-grade baseball players (follow-up); a total of 59 players who could be followed-up a year later were included in the study. Players were divided into three groups based on whether they had no lower back pain (LBP) (n = 30), improved LBP (n = 17), or CLBP (n = 12) after 1 year of follow-up. Players were evaluated on the physical and cognitive aspects of pain. The Number Rating System, Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Central Sensitization Inventory (CSI), body characteristics (age, height, weight, body mass index, and skeletal mass index), and a medical history questionnaire regarding spondylolysis and baseball loads were used to evaluate the players. Inventory scores were highest in the CLBP group, which indicated that this group had significant pain that affected their willingness to engage in baseball-related activities. The TSK scores in the CLBP group were worse on follow-up. High school baseball players with CLBP were more likely to have lumbar spondylolysis and kinesiophobia, which are also factors related to pain chronicity. Kinesiophobia and the presence of lumbar spondylolysis should be considered when creating an exercise program for high school baseball players with CLBP.

Throwing Injury Prevention Strategies with a Whole Kinetic Chain-Focused Approach

Purpose of Review

This review examines the relationship between the baseball pitching motion and the kinetic chain. The goal was to determine the underlying causes of a deficiency in throwing mechanics throughout a throwing motion, and to provide an evidence-based approach on how to prevent injuries caused by a lack of proper mechanics. In doing so, we sought to provide a warm-up strategy that can be added to every baseball player’s daily on-field routine that is tailored to each phase of the throwing motion.

Recent Findings

To help minimize the risk of injury to overhead throwing athletes, a thorough understanding of the throwing motion is critical. Throwing a ball places extreme stress on the body, notably the shoulder and elbow joints. With a clear understanding of the biomechanics of throwing, we can develop an injury prevention routine to minimize unnecessary stresses throughout the kinetic chain.

Summary

The throwing cycle is a complex motion that places various stresses throughout the thrower’s body, from the ankle to the core, and from the back to the shoulder and elbow. A thorough understanding of the mechanics of this motion, along with specific exercises to target the specific actions of each phase, may allow for throwers, regardless of their age and experience, to minimize injury risk.

Epidemiology of Spine-Related Neurologic Injuries in Professional Baseball Players

STUDY DESIGN

A retrospective case series study.

OBJECTIVE

To analyze the epidemiology of diagnoses of degenerative cervical and lumbar spinal conditions among Major League Baseball (MLB) and Minor League Baseball (MiLB) players.

SUMMARY OF BACKGROUND DATA

Repetitive high-energy forces in professional baseball players may predispose them to degenerative cervical and lumbar spinal conditions. There is a lack of data concerning the epidemiology of these injuries in professional baseball.

METHODS

Deidentified data on spine injuries were collected from all MLB and MiLB teams from 2011 to 2016 from the MLB-commissioned Health and Injury Tracking System database. Rates of diagnoses of common degenerative spinal conditions as well as their impact on days missed due to injury, necessitation of surgery, and player participation and career-ending status were assessed. Injury rates were reported as injuries per 1000 athlete-exposures in concordance with prior studies.

RESULTS

Over 2011 to 2016, 4246 days of play were missed due to 172 spine-related injuries. 73.3% were related to the lumbar spine and 26.7% to the cervical spine. There were similar rates of surgery required for these injuries (18.3% of lumbar injuries vs. 13.0% of cervical injuries, P = 0.2164). Mean age of players with cervical injuries was higher compared with the lumbar group (27.5 vs. 25.4, P = 0.0119). Average number of days missed due to lumbar injuries was significantly higher than those due to cervical injuries (34.1 vs. 21.6 d, P = 0.0468). Spine injury rates for pitchers were significantly higher than those of other position players (0.086 per 1000 athlete-exposures vs. 0.037, P < 0.0001).

CONCLUSION

Neurologic diagnoses relating to the cervical and lumbar spine lead to substantial disability among MLB and MiLB players as well as days missed from play. Pitchers have over double the rates of injury compared with other position players. Lumbar conditions were associated with significantly higher numbers of days missed from play.Level of Evidence: 4.

[Function-based tests to determine the return-to-activity state in patients with non-specific low back pain]

BACKGROUND

 Most people with back pain suffer from non-specific low back pain, for which no specific reasons can be found. Two out of three have recurrent pain episodes. To reduce the likelihood of recurrence and long-lasting pain, functional tests are increasingly used to determine the current functional status. This literature study evaluates evidence of functional tests in patients with non-specific low back pain and their validity related to the return-to-activity (RTA) status. The objective of this analysis is to give recommendations for specific activities and to assess the risk of chronification and recurrent pain.

METHODS

 PubMed-based literature search. Narrative review focusing on data from the past ten years.

RESULTS

 A total of twelve studies were included in the analysis. Overall, 33 different tests were identified for which positive statements regarding reliability, validity and relevance for the assessment of the RTA status in non-specific back pain could be made. The tests identified may be able to provide useful information when assessing the RTA status and to recognise yellow and blue flags in patients with non-specific low back pain. The ability to walk, the behaviour when lifting and carrying objects, motor control, muscle strength and mobility play a particular role.

CONCLUSION

 The determination of the RTA status in patients with non-specific low back pain should be patient-specific and based on biopsychosocial aspects rather than relying exclusively on movement-related tests. Exact statements regarding the point in time when patients can resume everyday activities and work without an increased risk of recurrence or chronicity do not seem possible with functional tests alone. The major influence of psychological and social factors on disease development, course and prognosis are limiting factors. Movement and strain-related tests can still be used to evaluate activities related to everyday life, to design therapy programs and to give patients confidence.

Overuse-Related Injuries of the Musculoskeletal System: Systematic Review and Quantitative Synthesis of Injuries, Locations, Risk Factors and Assessment Techniques

Overuse-related musculoskeletal injuries mostly affect athletes, especially if involved in preseason conditioning, and military populations; they may also occur, however, when pathological or biological conditions render the musculoskeletal system inadequate to cope with a mechanical load, even if moderate. Within the MOVIDA (Motor function and Vitamin D: toolkit for risk Assessment and prediction) Project, funded by the Italian Ministry of Defence, a systematic review of the literature was conducted to support the development of a transportable toolkit (instrumentation, protocols and reference/risk thresholds) to help characterize the risk of overuse-related musculoskeletal injury. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach was used to analyze Review papers indexed in PubMed and published in the period 2010 to 2020. The search focused on stress (overuse) fracture or injuries, and muscle fatigue in the lower limbs in association with functional (biomechanical) or biological biomarkers. A total of 225 Review papers were retrieved: 115 were found eligible for full text analysis and led to another 141 research papers derived from a second-level search. A total of 183 papers were finally chosen for analysis: 74 were classified as introductory to the topics, 109 were analyzed in depth. Qualitative and, wherever possible, quantitative syntheses were carried out with respect to the literature review process and quality, injury epidemiology (type and location of injuries, and investigated populations), risk factors, assessment techniques and assessment protocols.

Epidemiology and pain in elementary school-aged players: a survey of Japanese badminton players participating in the national tournament

Pain is common in athletes which should be well managed. To identify risk factors for shoulder pain, and the association between shoulder pain, lower back pain and knee pain among elementary school-aged badminton players, we conducted a cross-sectional study to collect data of the past year among 611 elementary school age (7-12 years old) badminton players belonging to the Japan Schoolchildren Badminton Federation using a questionnaire. Odds ratio (OR) and 95% confidence interval (CI) were estimated by multivariate logistic regression analysis. The overall incidence rate of shoulder injuries, lower back injuries and knee injuries was 0.38 injuries per 1000 h of badminton training. Players with training time per day > 2.5 h were 2.64 times (95% CI 1.03-6.78, p = 0.043) more likely to sustain shoulder pain than those with training time per day ≤ 2.5 h. A significant association was revealed between shoulder pain and knee pain as well as between lower back pain and knee pain as training hours per day > 2.5 h. Moreover, lower back pain was significantly associated with shoulder pain independent of training hours per day (≤ 2.5 h: p = 0.001; > 2.5 h: p < 0.001). These findings indicate that training time per day is risk factor, and shoulder pain, lower back pain and knee pain were associated with each other in elementary school-aged badminton players.

Back injuries in Major League Baseball

BACKGROUND

There is a scarcity of epidemiological studies on back injuries in Major League Baseball (MLB). In our study, we explore all back related injuries in the MLB from 2010 to 2016 (inclusive) in an aim to help better understand these injuries, assess their risks, and improve their prevention policies.

METHODS

The transaction lists from the MLB website were screened for back injuries from 2010 THROUGH 2016. Only players who were placed on the disabled list (DL) for one or more days due to back-related injury were included in our study. Our database included the player's position, team, injury location, injury type, days spent on the DL and month of injury occurrence.

RESULTS

254 back injuries, an equivalent of 7% of all injuries, were recorded between 2010 and 2016 (inclusive). These injuries increased from 2010 to 2016. Back related injuries were found to place players on the disabled list for around 54 days. Injuries were recorded mostly during April, and strain was significantly greater than any other type of injury (P value <0.001).

CONCLUSIONS

Back injuries are prevalent in the MLB. Better understanding of the trends and patterns of these injuries will help in establishing better prevention policies.

Tuck Jump Assessment as an Indicator for Upper Extremity Injury

The purpose of this study was to determine if tuck jumps can be used as a dynamic movement assessment to ascertain a previous history of upper extremity injury in an overhead throwing sport. Seventy-one youth baseball and softball athletes (28 baseball/43 softball; 12.41±2.22 yrs.; 161.98±13.65 cm; 59.17 ± 14.90 kg) were recruited to participate and were placed in either the previous injury (N=18) or no previous injury (N=53) groups. Kinematic data were collected from jumps 4 through 8 during a trial of 10 tuck jumps performed at 100 Hz using an electromagnetic tracking system (trakSTAR ^TM , Ascension Technologies, Inc., Burlington, VT, USA) synced with the MotionMonitor ^® (Innovative Sports Training, Chicago, IL, USA). A logistic regression showed no significance in trunk flexion or upper leg elevation in the ability to determine upper extremity injury ( χ ² (1, N =71)=3.55, p =0.315). In conclusion, examining only trunk flexion and upper leg elevation during the tuck jump assessment (TJA) is not enough for clinicians to recognize previous upper extremity injury. Even though the body behaves as a kinetic chain, simplifying the dynamic movement assessment while not specifying the type of upper extremity injury is not favorable for the clinician to identify previous injury.