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Chen PT, Lin YC, Chang HY, Chiu CH, Chen CY, Chen P, Lin YH. Effects of Shoulder Corrective Training Program on Pitching Loads and Sonographic Morphology in Elbow Joint in Youth Baseball Players. J Strength Cond Res 2024; 38:e440-e447. [PMID: 39072664 DOI: 10.1519/jsc.0000000000004804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
ABSTRACT Chen, P-T, Lin, Y-C, Chang, H-Y, Chiu, C-H, Chen, C-Y, Chen, P, and Lin, Y-H. Effects of shoulder corrective training program on pitching loads and sonographic morphology in elbow joint in youth baseball players. J Strength Cond Res 38(8): e440-e447, 2024-We assessed the effects of a 12-week shoulder corrective training program for shoulder flexibility and strengthening on pitching loads and sonographic morphology of the elbow joints in youth baseball players. Seventeen subjects were recruited and underwent evaluations before and after the training program. We found that following training, subjects demonstrated significantly increased ranges of shoulder internal rotation (38.9 ± 12.9° vs. 69.2 ± 10.8°, p < 0.001), external rotation (91.2 ± 14.6° vs. 107.3 ± 9.5°, p = 0.004), and horizontal adduction (21.5 ± 8.0° vs. 32.7 ± 7.3°, p = 0.002); improved strength in the shoulder internal rotators (8.7 ± 1.6 kg vs. 9.8 ± 2.1 kg, p = 0.04), external rotators (6.5 ± 1.9 kg vs. 7.5 ± 2.8 kg, p = 0.04), middle trapezius (12.7 ± 2.1 kg vs. 14.3 ± 2.4 kg, p = 0.04), and middle deltoid muscles (10.8 ± 3.3 kg vs. 14.8 ± 3.2 kg, p = 0.001); and decreased thickness of the ulnar collateral ligament (6.1 ± 0.6 mm vs. 4.8 ± 0.7 mm, p = 0.002). Although there was no substantial change in elbow torque and arm speed, significantly increased ball speed (51.2 ± 4.6 mph vs. 54.1 ± 4.5 mph, p < 0.001) and decreased arm slot (63.8 ± 11.9° vs. 53.0 ± 12.7°, p = 0.02) were observed. We suggest that adequate corrective training should be performed regularly to minimize or mitigate adverse soft tissue changes at the elbow in youth baseball players. Balanced shoulder strength and flexibility may decrease medial elbow stress during pitching. Future studies should consider the kinetic and kinematic effects of other corrective training programs on the shoulder or elbow joint during pitching.
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Affiliation(s)
- Po-Tsun Chen
- School of Physical Therapy and Graduate Institute of Rehabilitation Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Chun Lin
- School of Physical Therapy and Graduate Institute of Rehabilitation Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Yun Chang
- Department of Athletic Training and Health, National Taiwan Sport University, Taoyuan, Taiwan
| | - Chih-Hao Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Yu Chen
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Poyu Chen
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; and
| | - Yang-Hua Lin
- School of Physical Therapy and Graduate Institute of Rehabilitation Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Physical Therapy, Department of Physical Medicine & Rehabilitaion, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Myers NL, Kennedy SM, Arnold AJ, Gehring ZA, Kruseman KJ, Conway JE, Paine RM, Bailey LB, Garrison JC. A narrative review of little league shoulder: proximal humeral physis widening is only one piece of the puzzle, it is time to consider posterior glenoid dysplasia. JSES Int 2024; 8:724-733. [PMID: 39035657 PMCID: PMC11258838 DOI: 10.1016/j.jseint.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Baseball athletes across all levels of play are at an increased risk for upper extremity injury due to the supraphysiologic demands on the shoulder and elbow during overhead throwing. Little league baseball players present with a unique subset of injuries that can affect the growth plate, commonly at the shoulder or the elbow. Ascertaining a diagnosis and plan of care for little league shoulder (LLS) historically focuses on the proximal humeral physis in skeletally immature throwing athletes presenting with shoulder pain. However, while not a current standard of care, posterior glenoid dysplasia is often present in youth baseball athletes presenting with LLS, warranting a shift in the way clinicians evaluate for and treat the youth baseball athlete's pathologic shoulder. Therefore, purpose of this narrative review is 2-fold: first, to describe the current standard of care as it relates to a diagnosis of LLS, and second, to critically describe a comprehensive evaluation process for youth throwing athletes with shoulder pain that includes screening for evidence of posterior glenoid dysplasia. This paper summarizes the current state of the available evidence for anatomic considerations of LLS in the baseball athletes throwing shoulder. Additionally, we provide a framework for clinical evaluation using a multidisciplinary approach to evaluate the entire kinetic chain of the youth baseball athlete presenting with LLS and posterior glenoid dysplasia. A case study is presented to describe common presentations, clinical and objective examinations, and a plan of care from time of evaluation to return to throwing.
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Affiliation(s)
- Natalie L. Myers
- Memorial Hermann’s Rockets Sports Medicine Institute, Houston, TX, USA
| | - Sean M. Kennedy
- Memorial Hermann’s Rockets Sports Medicine Institute, Houston, TX, USA
| | - Amanda J. Arnold
- Texas Woman’s University, School of Physical Therapy, Houston, TX, USA
| | - Zachary A. Gehring
- UTHealth Houston McGovern, Medical School Orthopedic Surgery, Houston, TX, USA
| | | | - John E. Conway
- UTHealth Houston McGovern, Medical School Orthopedic Surgery, Houston, TX, USA
| | - Russ M. Paine
- UT Ortho Physical Therapy, Department of Orthopedic Surgery, Houston, TX, USA
| | - Lane B. Bailey
- Memorial Hermann’s Rockets Sports Medicine Institute, Houston, TX, USA
| | - J Craig Garrison
- Memorial Hermann’s Rockets Sports Medicine Institute, Houston, TX, USA
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Slowik JS, Diffendaffer AZ, Crotin RL, Stewart MS, Hart K, Fleisig GS. Biomechanical effects of foot placement during pitching. Sports Biomech 2024; 23:860-869. [PMID: 33821767 DOI: 10.1080/14763141.2021.1898668] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
Baseball coaches often focus on the landing position of a pitcher's front foot as a key aspect of mechanics. Furthermore, controversy persists regarding positioning the rear foot on the first base or third base end of the rubber. The purpose of this study was to determine the effect of rear and front foot placement on pitching biomechanics. Our hypotheses were that there would be significant kinematic and kinetic differences associated with foot placement. This was a retrospective review including 144 healthy right-handed adult baseball pitchers divided into groups based on their rear and front foot placements: first base open (1B-Open), first base closed (1B-Closed), third base open (3B-Open), and third base closed (3B-Closed). Two-way ANOVAs detected no statistically significant main effects for kinetic variables but several for kinematic variables. Open pitchers had less shoulder abduction at the time of ball release and greater maximum shoulder internal rotation velocity in comparison with closed pitchers. They also had less forearm pronation at the time of ball release and greater maximum elbow extension velocity. Additional statistically significant results were found; however, low effect sizes may lessen the clinical significance of many of the results.
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Affiliation(s)
| | | | - Ryan L Crotin
- The Los Angeles Angels, Anaheim, CA, USA
- Sport Performance Research Institute, Auckland University of Technology, Auckland, New Zealand
| | | | - Karen Hart
- The American Sports Medicine Institute, Birmingham, AL, USA
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Koseki H, Kajiyama S, Shida T, Tomonaga I, Nishiyama Y, Yoshida D, Mizukami S, Yamaguchi K, Imai C. Characteristics and Clinical Assessment of Elbow Pain in Youth Baseball Players. Sports (Basel) 2024; 12:161. [PMID: 38921855 PMCID: PMC11209444 DOI: 10.3390/sports12060161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/27/2024] Open
Abstract
Elbow injuries related to the throwing motion in baseball during the growth period present difficulties for early detection and may cause serious future disabilities. This study aimed to comprehensively determine the characteristics and clinical assessment of elbow pain in youth baseball players. Two hundred and sixteen young baseball players underwent elbow medical examination. Basic information and physical examination, clinical assessment, and ultrasonography results were examined. Univariate analyses were statistically performed between the pain-free (98 participants) and elbow pain (118 participants) groups. The mean age was 11.6 years, and ultrasonographic abnormalities were found on the medial side of the elbow in 37.5%. In total, 118 (54.6%) participants experienced elbow pain, with 64.4% of them complaining of elbow pain on the medial side. Players with multiple positions (≥2 positions) had a significantly higher prevalence of elbow pain. Height, weight, length of baseball experience, and positive rates of horizontal flexion and moving valgus stress tests were higher in the elbow pain group than in the pain-free group. The risk factors and clinical assessment for elbow pain are useful for the prevention and early detection of throwing elbow injuries in youth baseball players.
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Affiliation(s)
- Hironobu Koseki
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8520, Japan
| | - Shiro Kajiyama
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Takayuki Shida
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Iku Tomonaga
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Yuta Nishiyama
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8520, Japan
| | - Daisuke Yoshida
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8520, Japan
| | - Satoshi Mizukami
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan
| | - Kazuhiro Yamaguchi
- Department of Orthopedic Surgery, Yamaguchi Orthopedic Clinic, Nagasaki 850-0013, Japan
| | - Chieko Imai
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
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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.
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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
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Yoshida K, Nyland J, Krupp R. History of Ulnar Collateral Ligament Injury and College Pitcher Fastball Profiles: A Retrospective, Observational, Live Pitching Analysis. J Hand Surg Am 2024; 49:614.e1-614.e8. [PMID: 36280555 DOI: 10.1016/j.jhsa.2022.08.030] [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: 12/16/2021] [Revised: 08/02/2022] [Accepted: 08/31/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to retrospectively compare the fastball profiles of pitchers who had previously sustained grade I or II ulnar collateral ligament (UCL) injuries, were rehabilitated, and released back for competition with those of pitchers with no history of elbow injury. METHODS Eighteen pitchers from the pitching staff of 1 National Collegiate Athletic Association Division III team participated in this study. Group 1 had a history of grade I or II UCL injury (n = 8), and group 2 (n = 10) did not. A computerized pitch tracking device was used to analyze ball movement and pitching mechanics. The hypothesis was that the pitchers with a history of injury (group 1) would display differing fastball velocity-ball movement relationships compared to those without (group 2). RESULTS The groups had similar heights, weights, pitching experiences, and arm slot positions at ball release. The pitching coach-determined preinjury arm slot position and the postinjury computerized pitch tracking device measurements after return to competition displayed strong agreement (r = 0.83), suggesting comparable pre and postinjury pitching techniques. The groups had comparable glenohumeral joint range of motion and fastball profiles, except that group 1 released the ball at a 2.5 times lesser horizontal distance away from the pitching rubber center. Group 2 also displayed consistently more robust and more frequent fastball movement relationships with velocity, horizontal break, and vertical break than group 1. CONCLUSIONS Reduced horizontal ball release distances at comparable vertical ball release heights without changes in the arm slot position suggest that pitchers with a history of grade I or II UCL injury have greater contralateral trunk tilt and elbow flexion at ball release. Increased contralateral trunk tilt may occur to increase pitch velocity at the expense of ball movement while placing the pitching elbow in a potentially injurious position. Computerized fastball profile analysis using a computerized pitch tracking device, in conjunction with coach pitching technique observation, and team medical staff clinical examination may help better identify pitchers with an increased risk of UCL injury. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
- Kei Yoshida
- Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY
| | - John Nyland
- Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY.
| | - Ryan Krupp
- Norton Sports Performance, Louisville, KY
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Kenyon C, Beebe A, Easley K, Jayanthi N, Bowers R. Feasibility of the pitch efficiency rating: A novel tool for systematic assessment of pitching mechanics in developing throwing athletes. PM R 2024; 16:339-346. [PMID: 38551303 DOI: 10.1002/pmrj.13178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Injuries in younger baseball athletes continue to increase despite work characterizing risk factors. Three-dimensional (3D) motion capture may identify suboptimal pitching mechanics that predispose an athlete to injury, but 3D-motion analysis is often inaccessible. Thus, there is a gap between the current biomechanics literature and its practical application in young athletes. The current study aims to assess the reliability of the pitch efficiency rating (PER) as a systematic tool to evaluate throwing mechanics in developing baseball pitchers. OBJECTIVE To determine the feasibility of application and reliability of a novel, scientifically informed tool (PER) for the assessment of pitching mechanics. DESIGN Reliability study using Bland-Altman methods for assessing agreement between two raters. SETTING Academic medical center through community outreach. PARTICIPANTS Pitching mechanics were assessed and rated with the PER for 40 athletes (26 high school, 14 Division III), average age 19.0 years old (range 15.3-23.7 years old). INTERVENTIONS N/A. MAIN OUTCOME MEASURES Interrater and intrarater reliability as calculated by intraclass correlation coefficient (ICC). RESULTS For initial readings comparing interrater reliability between Rater 1 and Rater 2, the ICC was calculated at 0.80 (95% confidence interval [CI] 0.66-0.89) and 0.76 (95% CI 0.60-0.86) for the second set of ratings. Regarding intrarater reliability across reads, ICC was found to be 0.63 (95% CI 0.43-0.79) for Rater 1, and 0.91 for Rater 2 (95% CI 0.85-0.95). CONCLUSIONS The present study introduces the PER as a potential tool for evaluating pitching mechanics. However, the intrarater reliability of the PER did not meet preestablished criteria in one of the two pilot raters. Further study is needed to continue to assess the reliability of the tool across diverse demographics.
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Affiliation(s)
- Charles Kenyon
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Alex Beebe
- Diamond Performance and Rehab, Atlanta, Georgia, USA
| | - Kirk Easley
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Neeru Jayanthi
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
| | - Robert Bowers
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory Sports Medicine Center, Atlanta, Georgia, USA
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Lu Y, Chen P, Chou WY, Yang CP, Sheu H, Tang HC, Weng CJ, Chiu JCH. Relationship between shoulder and elbow range of motion and ultrasonographic structural abnormalities in the elbow of Taiwanese high school baseball players. BMC Sports Sci Med Rehabil 2024; 16:44. [PMID: 38347601 PMCID: PMC10860268 DOI: 10.1186/s13102-024-00839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/04/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Ultrasonographic structural abnormalities are regarded as one of the risk factors of elbow injuries. Elbow injuries are commonly associated with decreased shoulder/elbow range of motion (ROM). The purpose of this study is to determine the relationship between shoulder/elbow ROM and elbow ultrasonographic structural abnormalities in Taiwan high school baseball players. METHODS A total of 533 Taiwan high school baseball players were enrolled. Physical examinations including measurements on shoulder/elbow ROM and elbow sonographic examinations were performed and recorded by professional physicians. The analyses were conducted in three subgroups according to their defensive position because the training programs were different. All players pooled, pitchers-only, and fielders-only, due to several demographic differences among these subgroups. In all the subgroups, univariate analyses were conducted separately for participants with and those without elbow ultrasonographic structural abnormalities, and then multivariate analyses were conducted to identify factors significantly related. The odds ratios (ORs) were used to estimate the risk of elbow ultrasonographic structural abnormalities. RESULTS Demographic data showed that pitchers had taller body height (P < 0.001) and greater elbow flexion/extension ROM (P < 0.001). When all players were pooled, significant risk factors included started playing baseball at an younger age (OR = 1.202; 95% CI = 1.064-1.357; P = 0.003), longer experience of official baseball (OR = 1.154; 95% CI = 1.038-1.283; P = 0.008), lower total shoulder rotation angle (OR = 1.007; 95% CI = 1.000-1.014; P = 0.050), and less total elbow arm angle (OR = 1.052; 95% CI = 1.017-1.088; P = 0.003) For pitchers, significant risk factors included longer experience of official baseball (OR = 1.342; 95% CI = 1.098-1.640; P = 0.004), lower total shoulder rotation angle (OR = 1.016; 95% CI = 1.004-1.027; P = 0.006), and lower total elbow arm angle (OR = 1.075; 95% CI = 1.024-1.129; P = 0.004) (Table 5). There were no significant risk factors for elbow structural abnormalities in fielders. CONCLUSION For Taiwan high school pitchers, longer official baseball experience, decreased shoulder total rotational angle, and decreased elbow total flexion/extension angle, were related to ultrasonographic structural abnormalities in elbows.
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Affiliation(s)
- Yi Lu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Comprehensive Sports Medicine Center (CSMC), Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Poyu Chen
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Yi Chou
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Comprehensive Sports Medicine Center (CSMC), Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huan Sheu
- Department of Orthopedic Surgery, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hao-Che Tang
- Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chun-Jui Weng
- Department of Orthopedic Surgery, Kaohsiung Municipal Feng-Shan Hospital, Kaohsiung, Taiwan
| | - Joe Chih-Hao Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Comprehensive Sports Medicine Center (CSMC), Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- School of Medicine, Chang Gung University, No. 5, Fusing St., Gueishan District, Taoyuan City, 333, Taiwan.
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9
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Sciascia AD. Rehabilitation of the painful elbow. J Shoulder Elbow Surg 2024; 33:466-473. [PMID: 37648014 DOI: 10.1016/j.jse.2023.07.034] [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: 04/10/2023] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023]
Abstract
Although lateral elbow pain and medial ulnar collateral ligament injury are common musculoskeletal pathologies in overhead athletes, the evidence supporting specific interventions for managing these conditions is scarce. Management of these conditions has been guided mostly by expert opinion rather than empirical evidence, yet the lack of comparative data in the literature has not negatively affected return-to-play rates following surgery. However, an understanding of what is known regarding unimodal and multimodal treatments for lateral elbow pain and medial ulnar collateral ligament injury is needed for clinicians to select evidence-based treatment pathways and highlight what is not known to develop future high-quality investigations.
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Affiliation(s)
- Aaron D Sciascia
- Institute for Clinical Outcomes and Research, Lexington Clinic, Lexington, KY, USA.
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10
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Kuhn JE. Adaptive pathology: new insights into the physical examination and imaging of the thrower's shoulder and elbow. J Shoulder Elbow Surg 2024; 33:474-493. [PMID: 37652215 DOI: 10.1016/j.jse.2023.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023]
Abstract
Throwing with high velocity requires extremes of glenohumeral external rotation of the abducted arm where particularly high forces in the shoulder and elbow are endured. Repeated throwing leads to dominant-arm bony remodeling of the humerus, glenoid, and elbow, and multiple soft tissue changes that would be considered abnormal. Many of these features are thought to be adaptive and protective. The purpose of this work is to (1) define the concept of adaptive pathology; (2) review the mechanics of the throwing motion; (3) review pertinent physical examination and imaging findings seen in asymptomatic throwers' shoulders and elbows and describe how these changes develop and may be adaptive-allowing the thrower to perform at high levels; and then (4) review the principles of surgical treatment in the throwing athletes, which should focus on reducing symptoms, but not necessarily restoring the thrower's anatomy to normal.
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Affiliation(s)
- John E Kuhn
- Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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Yoshimoto M, Kawabata M, Miyata T, Sato Y, Naoi D, Ashihara M, Suzuki N, Ikoma C, Tatsuki H, Kuratsubo R, Watanabe H, Kusaba Y, Watanabe D. Association of Head-Neck Rotation With History of Pitching-Related Elbow Pain in Youth Baseball Players. Orthop J Sports Med 2024; 12:23259671241229079. [PMID: 38405009 PMCID: PMC10894543 DOI: 10.1177/23259671241229079] [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: 06/11/2023] [Accepted: 08/24/2023] [Indexed: 02/27/2024] Open
Abstract
Background Prevention of pitching-related elbow pain in youth baseball players is important. Overhead pitching involves a whole-body motion, including head-neck rotation. A limited range of motion of head-neck rotation may cause inefficient pitching motion; however, this association is unclear. Purpose To determine whether the range of motion of head-neck rotation is associated with the history of pitching-related elbow pain in youth baseball players. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 311 youth baseball players were selected and asked to complete a questionnaire survey about their age, weight, height, sex, baseball experience, main position, pitching side, and previous/current elbow pain during pitching. The range of motion of the upper and lower limb joints, head-neck rotation, and thoracic kyphosis angle were measured. Binomial logistic regression analysis was used to identify factors associated with the history of elbow pain related to pitching. Results There were 101 players with a history of pitching-related elbow pain (history group) and 142 players with no pitching-related elbow pain (no-history group). The history group had significantly lower values than the no-history group regarding the range of motion of head-neck rotation on the nondominant side (74.9°± 9° vs 77.7°± 9.6°; P = .02) and overall head-neck rotation (150.6°± 14.7° vs 154.9°± 18.4°; P = .04). Binomial logistic regression analysis identified head-neck rotation on the nondominant side (odds ratio [OR], 0.97 [95% CI, 0.94-1.00]), shoulder horizontal adduction on the dominant side (OR, 0.98 [95% CI, 0.96-1.00]), height (OR, 1.04 [95% CI, 1.00-1.08]), and playing position (pitcher) (OR, 0.40 [95% CI, 0.21-0.76]) as factors associated with a history of pitching-related elbow pain. Conclusion Our cross-sectional analysis demonstrated that youth baseball players with a history of pitching-related elbow pain had limited head-neck rotation range of motion on the nondominant side, and this was a significant factor associated with the history of pitching-related elbow pain.
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Affiliation(s)
- Masumi Yoshimoto
- Department of Physical Therapy, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo, Japan
| | - Masashi Kawabata
- Investigation performed at the Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Toru Miyata
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Yosuke Sato
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Daichi Naoi
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Mitsuaki Ashihara
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Nobuyuki Suzuki
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Chihiro Ikoma
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Hiroaki Tatsuki
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Ryota Kuratsubo
- Department of Rehabilitation, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan
- Department of Sports Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Watanabe
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Yohei Kusaba
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
- Department of Orthopaedic Surgery, Sagamihara Kyodo Hospital, Sagamihara, Kanagawa, Japan
| | - Daiki Watanabe
- Department of Orthopedic Sports Medicine, Yokohama Minami Kyosai Hospital, Yokohama, Kanagawa, Japan
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12
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Oliver GD, Fava A, Lozowski B, Zaremski JL, Holtz KA, Bowers RL. Evaluation of Hip Characteristics in Baseball and Softball Athletes with and Without Throwing Arm Pain. Int J Sports Med 2024; 45:71-78. [PMID: 37890497 DOI: 10.1055/a-2184-5893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
During throwing, the lower extremity assists in the generation and transfer of momentum. Lower extremity stability assists in this transfer by providing a base for distal mobility of the arm segments. This study aimed to determine differences between hip rotational range of motion and strength based on the presence of throwing-arm pain (yes/no) and throwing sport (baseball/softball). We hypothesized those experiencing pain would display decreases in hip range of motion and strength, and that softball players would display greater range of motion than baseball, but less strength based on sex-specific characteristics. Forty-four baseball (13±2 years, 165.2±13.0 cm, 58.5±13.4 kg) and 50 softball players (13±2 years, 160.9±11.2 cm, 62.7±17.9 kg) participated. Multivariate analysis of variance tests (2×2) determined differences in bilateral hip range of motion, total arc of motion, and strength between pain status and sport. There were no significant interactions (>0.05) for pain status and sport on hip range of motion, total arc of motion, and strength. Furthermore, no significant main effects (>0.05) were found for pain status or sport alone on range of motion or strength. Future work should be directed at explaining the effects of hip characteristics on the throwing motion and how it equates to throwing-arm health.
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Affiliation(s)
| | - Anthony Fava
- School of Kinesiology, Auburn University, Auburn, United States
| | - Billy Lozowski
- School of Kinesiology, Auburn University, Auburn, United States
| | - Jason L Zaremski
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, United States
| | - Kaila A Holtz
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert L Bowers
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, United States
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13
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Gomaz L, Bouwmeester C, van der Graaff E, van Trigt B, Veeger D. Machine Learning Approach for Pitch Type Classification Based on Pelvis and Trunk Kinematics Captured with Wearable Sensors. SENSORS (BASEL, SWITZERLAND) 2023; 23:9373. [PMID: 38067746 PMCID: PMC10708682 DOI: 10.3390/s23239373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023]
Abstract
The large stream of data from wearable devices integrated with sports routines has changed the traditional approach to athletes' training and performance monitoring. However, one of the challenges of data-driven training is to provide actionable insights tailored to individual training optimization. In baseball, the pitching mechanics and pitch type play an essential role in pitchers' performance and injury risk management. The optimal manipulation of kinematic and temporal parameters within the kinetic chain can improve the pitcher's chances of success and discourage the batter's anticipation of a particular pitch type. Therefore, the aim of this study was to provide a machine learning approach to pitch type classification based on pelvis and trunk peak angular velocity and their separation time recorded using wearable sensors (PITCHPERFECT). The Naive Bayes algorithm showed the best performance in the binary classification task and so did Random Forest in the multiclass classification task. The accuracy of Fastball classification was 71%, whilst the accuracy of the classification of three different pitch types was 61.3%. The outcomes of this study demonstrated the potential for the utilization of wearables in baseball pitching. The automatic detection of pitch types based on pelvis and trunk kinematics may provide actionable insight into pitching performance during training for pitchers of various levels of play.
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Affiliation(s)
- Larisa Gomaz
- Delft Institute of Applied Mathematics, Delft University of Technology, 2628 CD Delft, The Netherlands
- BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands (B.v.T.); (D.V.)
| | - Celine Bouwmeester
- BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands (B.v.T.); (D.V.)
| | | | - Bart van Trigt
- BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands (B.v.T.); (D.V.)
| | - DirkJan Veeger
- BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands (B.v.T.); (D.V.)
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14
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Sakata J, Tsutsui T, Uchida T, Akeda M, Hirose N. Risk factors of throwing injuries related to pitching mechanics in young baseball players: a longitudinal cohort study. J Shoulder Elbow Surg 2023; 32:2201-2206. [PMID: 37573932 DOI: 10.1016/j.jse.2023.07.009] [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: 04/12/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Risk factors for throwing injuries related to pitching mechanics are unknown. Insufficient pelvic rotation during pitching may be a risk factor for shoulder and elbow injury. This cohort study aimed to identify biomechanics risk factors for throwing injuries in young baseball players. We hypothesized that excessive mechanical load and motion errors would be risk factors for throwing injuries. METHODS Young baseball pitchers (aged 8-9 years) were recruited from regional baseball leagues between December 2016 and December 2019. Pitching measurements were performed before the start of each season and after the end of the last season in December 2019. The trunk tilt angular displacement, pelvic rotation angular displacement, and forearm rotation angle were calculated using a markerless motion capture system. We also measured elbow varus torque using an accelerometer. After the initial test session, each participant was followed up for 3 years to determine the occurrence of throwing injuries. Players with throwing shoulder and elbow injuries were categorized into the throwing injury group, and those without shoulder and elbow pain for 3 years were categorized into the noninjured group. RESULTS In this study, 97 baseball pitchers completed a 3-year follow-up. Among those participants, 66 (68.0%) had throwing injuries. A significant difference was observed between the throwing injury and noninjured groups, whereby the injured players had less pelvic rotation angular displacement. CONCLUSION Insufficient pelvic rotation during pitching is a newly discovered risk factor related to throwing injuries.
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Affiliation(s)
- Jun Sakata
- TOYOTA Athlete Support Center, Toyota Memorial Hospital, Toyota, Japan.
| | | | - Tomoya Uchida
- TOYOTA Athlete Support Center, Toyota Memorial Hospital, Toyota, Japan
| | - Masaki Akeda
- TOYOTA Athlete Support Center, Toyota Memorial Hospital, Toyota, Japan; Department of Orthopedic Sports Medicine, Yokohama Minami Kyosai Hospital, Yokohama, Japan
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15
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Manzi JE, Ruzbarsky JJ, Krichevsky S, Sudah SY, Estrada J, Wang Z, Moran J, Kunze KN, Ciccotti MC, Chen FR, Dines JS. Kinematic and Kinetic Comparisons of Arm Slot Position Between High School and Professional Pitchers. Orthop J Sports Med 2023; 11:23259671221147874. [PMID: 37900864 PMCID: PMC10601404 DOI: 10.1177/23259671221147874] [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: 09/28/2022] [Accepted: 10/21/2022] [Indexed: 10/31/2023] Open
Abstract
Background Throwing arm kinetics differ in pitchers at varying arm slot (AS) positions (frontal-plane arm position at ball release relative to the vertical axis). Purpose To determine how kinematic and kinetic values differ between professional and high school pitchers with varying AS positions, and whether these differences are similarly observed in both populations. Methods High school (n = 130) and professional (n = 288) pitchers threw 8 to 12 fastballs under 3-dimensional motion capture technology. Pitchers in each cohort were subdivided based on mean AS position at ball release: AS1 (least degree of AS: most overhand throwing styles), AS2 (intermediate degree of AS: three-quarter throwing styles), or AS3 (greatest degree of AS: most sidearm throwing styles). Kinetic and kinematic parameters were compared between groups. Study Design Controlled laboratory study. Results High school pitchers had a more overhand AS at ball release (50° ± 11°) compared with professional pitchers (58° ± 14°) (P < .001). In both cohorts, AS1 pitchers had significantly greater shoulder abduction (high school, P <0.001; professional, P <0.0001) and lateral trunk flexion (high school, P < 0.001; professional, P <0.0001) at ball release compared with AS3 pitchers. Professional pitchers with an AS3 position had significantly delayed timing of maximum upper trunk angular velocity compared with AS1 pitchers (64% ± 7% vs 57% ± 7% of pitch time, respectively; P < .0001). A significant positive correlation between AS and elbow flexion torque was found in high school pitchers (P = .002; β = 0.28), and a significant negative correlation between AS and elbow varus torque (P < .001; β = -0.22) and shoulder internal rotation torque (P < .001; β = -0.20) was noted in professional pitchers. Conclusion AS position was related to shoulder abduction and trunk lateral tilt. Professional and high school pitchers with varying AS positions did not experience similar changes in throwing arm kinetics. Clinical Relevance In professional pitchers, the earlier onset of maximum upper trunk angular velocity with overhand throwing style may reflect inappropriate pelvis-trunk timing separation, a parameter implicated in upper extremity injury, and the negative correlation between AS and elbow varus and shoulder internal rotation torque suggests that both excessive and minimal AS positions have negative implications.
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Affiliation(s)
| | | | - Spencer Krichevsky
- Stony Brook University, Department of Biomedical Informatics, Stony Brook, New York, USA
| | - Suleiman Y. Sudah
- Department of Orthopaedic Surgery, Monmouth Medical Center, Monmouth, New Jersey, USA
| | - Jennifer Estrada
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | | | - Jay Moran
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Kyle N. Kunze
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | | | - Frank R. Chen
- Anesthesia Department, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joshua S. Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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16
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Saito A, Okada K, Sato H, Shibata K, Kamada T, Namiki Y, Terui Y. Increased Medial Elbow Torque Is Associated With Ball Velocity Rather Than a History of Medial Elbow Injuries in Youth Baseball Pitchers. Arthroscopy 2023; 39:719-727. [PMID: 35970452 DOI: 10.1016/j.arthro.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/25/2022] [Accepted: 07/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE This study compared medial elbow torque in youth baseball pitchers with and without a history of medial elbow injuries to determine the relationship between medial elbow torque during pitching and having a history of medial elbow injuries. METHODS We recruited 171 youth baseball pitchers aged 9 to 12 years old. The exclusion criteria included current pain with pitching, history of surgery on the tested extremity, or osteochondritis dissecans of the humeral capitellum. The participants were grouped into 3 groups: injury <1-year, injury >1-year, and control, based on ultrasonographic abnormalities of the elbow and the presence of elbow pain. Pitchers pitched 3 fastballs while wearing a sensor sleeve that recorded the medial elbow torque, arm speed, and shoulder rotation. Ball velocity was measured using a radar gun. RESULTS The final analysis included 164 pitchers. Thirty were assigned to the injury <1-year group, 34 to the injury >1-year group, and 100 to the control group. The medial elbow torque was significantly greater in the injury <1-year group compared with the control group (18.6 ± 3.6 Nm vs 16.2 ± 4.8 Nm, P = .023). A multiple regression analysis revealed that ball velocity (B = 0.282, P < .001) and body weight (B = -0.224, P < .001) were significantly associated with medial elbow torque, but not with the history of medial elbow injuries. CONCLUSIONS Increased medial elbow torque was associated with greater ball velocity regardless of the history of medial elbow injuries. Youth baseball pitchers with a history of medial elbow injuries within one year had greater medial elbow torque during pitching; however, having a history of medial elbow injuries was not an independent factor in increasing medial elbow torque. Limiting the ball velocity can reduce medial elbow torque and may prevent elbow injuries in youth baseball pitchers. LEVEL OF EVIDENCE Level II, prospective comparative prognostic investigation with the patients enrolled at different time point.
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Affiliation(s)
- Akira Saito
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan.
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Hiromichi Sato
- Department of Rehabilitation, Akita Kousei Medical Hospital, Akita, Japan
| | | | - Tetsuaki Kamada
- Department of Rehabilitation, Akita Kousei Medical Hospital, Akita, Japan
| | - Yusuke Namiki
- Department of Rehabilitation, Akita City Hospital, Akita, Japan
| | - Yoshino Terui
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
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17
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Albiero ML, Kokott W, Dziuk C, Cross JA. Hip Strength and Pitching Biomechanics in Adolescent Baseball Pitchers. J Athl Train 2023; 58:271-278. [PMID: 35724364 PMCID: PMC10176844 DOI: 10.4085/1062-6050-0074.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Hip strength may influence the energy flow through the kinematic chain during baseball pitching, affecting athlete performance as well as the risk for injury. OBJECTIVE To identify associations between hip strength and pitching biomechanics in adolescent baseball pitchers during 3 key events of the pitching cycle. DESIGN Cross-sectional study. SETTING Biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 26 adolescent male baseball pitchers (age = 16.1 ± 0.8 years, height = 184.29 ± 5.5 cm, mass = 77.5 ± 8.5 kg). MAIN OUTCOME MEASURE(S) The main outcome measure was hip strength (external rotation, internal rotation, flexion, abduction, adduction, and extension). After strength measurements were acquired, motion capture was used to obtain a full-body biomechanical analysis at 3 events during the pitching cycle (foot contact, maximal external rotation, and ball release). We then evaluated these values for associations between hip strength and pitching biomechanics. Scatterplots were examined for linearity to identify an appropriate correlation test. The associations were linear; thus, 2-tailed Pearson correlation coefficients were used to determine correlations between biomechanical metrics. An α level of .01 was chosen. RESULTS Ten strong correlations were found between pitching biomechanics and hip strength: 8 correlations between hip strength and kinematics at key points during the pitch and 2 correlations of hip strength with peak elbow-varus torque. CONCLUSIONS Several correlations were noted between lower extremity strength and pitching biomechanics. This information provides data that may be used to improve performance or reduce injury (or both) in pitchers. Increased hip strength in adolescent pitchers may both improve performance and decrease the risk of injury.
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Affiliation(s)
| | | | - Cody Dziuk
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee
| | - Janelle A. Cross
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee
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18
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Factors that Increase Elbow Stress in the Throwing Athlete: a Systematic Review of Biomechanical and Motion Analysis Studies of Baseball Pitching and Throwing. Curr Rev Musculoskelet Med 2022; 16:115-122. [PMID: 36572821 PMCID: PMC10043103 DOI: 10.1007/s12178-022-09800-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Elbow pain poses a unique challenge in the throwing athlete. Due to the high levels of elbow stress during the throwing motion, elbow injuries are common in throwers of all ages. There are several postulated factors believed to contribute increased stress to the throwing elbow. A detailed review of the published biomechanical studies evaluating the stresses experienced by the throwing elbow is needed. Here, we review these biomechanical studies to extrapolate the contributing factors that increase stress, the modifications that may reduce such stress, and the post-injury rehabilitation that optimizes outcomes and reduces recurrence. RECENT FINDINGS The biomechanical forces on the elbow have been further investigated delineated in recent work. Rotational malalignment of the shoulder, including both GIRD and decreased adduction, increases torque experienced by the elbow during pitching motions. Exact interactions between lower extremity, lumbopelvic or trunk rotation, and elbow forces during throwing remain uncertain with mixed results in recent literature. Pitch types may influence elbow stresses although delivery mechanism and distance thrown do not. Several biomechanical factors influence the stresses imparted on the throwing elbow. Throwing volume, proper throwing mechanics, and appropriate rehabilitation are likely to be to be the most influential on mitigating unnecessary stresses imparted to the elbow in the throwing athlete. A proper understanding of these factors may reduce the occurrence of these injuries in this population. Moreover, an understanding of proper rehabilitation following injury may ensure optimized results and reduce recurrence.
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19
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Elhage KG, Yedulla NR, Cross AG, Mehta N, Guo EW, Bernstein DN, Makhni E. Forearm Flexor Tendon Injury in Adolescent Athletes: Risk Factors, Treatment, and Prevention. Curr Sports Med Rep 2022; 21:443-447. [PMID: 36508600 DOI: 10.1249/jsr.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABSTRACT Injury to the flexor pronator mass is a common condition that is especially prevalent in overhead throwing athletes. The increasing incidence of these injuries has promoted considerable efforts in research to better understand the pathology, risk factors, and potential mechanisms to prevent injury in these athletes. While there are numerous intrinsic and extrinsic factors associated with injury, a common theme involves chronic overuse and microtrauma with inadequate resting intervals between performances. The purpose of this review is to discuss medial elbow injuries in young athletes with a particular focus on the flexor pronator mass.
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Affiliation(s)
| | | | | | - Nabil Mehta
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Eric W Guo
- Department of Orthopaedic Surgery, University of Michigan Medicine, Ann Arbor, MI
| | | | - Eric Makhni
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI
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20
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Increasing rates of ulnar collateral ligament repair outpace reconstruction in isolated injuries: review of a Texas surgical database. JSES Int 2022; 7:192-197. [PMID: 36820426 PMCID: PMC9937821 DOI: 10.1016/j.jseint.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background The gold standard of treatment for ulnar collateral ligament (UCL) injuries has been reconstruction. Despite early repair studies yielding less than satisfactory results, there has been recent renewed interest in UCL repair due to improved outcomes and new technologies. Data regarding clinical use of these procedures are lacking. The purpose of this study was to define the epidemiological trends of UCL repair and reconstruction surgery from 2010 to 2019, compare demographic characteristics of patients undergoing either procedure, and determine incidence of concomitant procedures in each surgical group as well as comparing respective patient-level charges. Methods A retrospective database analysis of UCL surgeries was performed through the Texas Healthcare Information Collection database, a comprehensive and publicly available statewide billing dataset. Inclusion criteria were defined using Current Procedural Terminology billing codes for elbow UCL repair and reconstruction between 2010 through 2019, excluding patients who had concomitant elbow fractures or lateral collateral ligament tears indicative of high-energy trauma. Procedural volume changes, patient demographics, and commonly performed concomitant procedures including elbow arthroscopy, ulnar nerve surgery, and platelet-rich plasma injection were compared. Total patient-level charges were compared across groups. Results A total of 1664 patients were included, consisting of 484 UCL repairs and 1180 reconstructions. Total UCL surgeries increased eleven-fold when corrected for population growth from 2010 (N = 25) to 2019 (N = 315). In 2010, repair constituted 23% of all UCL tear surgeries and increased to 40% by the end of 2019. The annual frequency of UCL repair increased at a 5.4% faster rate than UCL reconstruction from 2010 to 2019 (P < .001). There were no significant differences between any demographic data between UCL repair and reconstruction except for rural surgical settings which demonstrated 1.8 times greater odds of undergoing reconstruction (P = .05). There were no differences among commonly associated procedures including ulnar nerve surgery (P = .217), elbow arthroscopy (P = .092), and platelet-rich plasma injection (P = .837) with no differences in patient-level charges at any time point (P = .47). Conclusion While reconstruction remains more common, the annual frequency of UCL repair is increasing at a faster rate. Since were no demographic differences aside from surgical setting, it can be inferred that patients who were previously receiving reconstruction are instead undergoing repair. This highlights the need for future studies to further identify surgical indications for the two interventions.
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21
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Tanaka Y, Ishida T, Ino T, Suzumori Y, Samukawa M, Kasahara S, Tohyama H. The effects of relative trunk rotation velocity on ball speed and elbow and shoulder joint torques during baseball pitching. Sports Biomech 2022:1-13. [PMID: 36223307 DOI: 10.1080/14763141.2022.2129431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 09/22/2022] [Indexed: 10/17/2022]
Abstract
In baseball pitching, suppressing trunk rotation while rotating the pelvis in the early phase of arm cocking is important for throwing a fast ball. However, quantitative evaluation of trunk rotation during pitching has not been established, and its associations with elbow and shoulder torques are unclear. The purpose of this study was to examine the correlation of a new measure of trunk rotation suppression with ball speed and elbow and shoulder torques during pitching. Eighteen adult male baseball pitchers (21.7 ± 1.2 years old) participated. Three qualified pitches were analysed using a three-dimensional motion capture system. Trunk rotation velocity, normalised to the peak velocity, was derived at the time of peak pelvic velocity. Pearson's correlation coefficient was used to determine correlations. The normalised trunk rotation velocity at the peak pelvic velocity was significantly correlated with elbow valgus torque (R = -0.508, P = 0.032), shoulder external rotation torque (R = -0.507, P = 0.032) and ball speed (R = -0.504, P = 0.033). A smaller normalised trunk rotation angular velocity at the time of peak pelvic rotation velocity could increase ball speed but may also increase elbow and shoulder torques among pitchers who demonstrate trunk rotation after foot contact.
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Affiliation(s)
- Yousuke Tanaka
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Takumi Ino
- Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Japan
| | - Yuki Suzumori
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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22
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Crotin RL, Slowik JS, Brewer G, Cain EL, Fleisig GS. Determinants of Biomechanical Efficiency in Collegiate and Professional Baseball Pitchers. Am J Sports Med 2022; 50:3374-3380. [PMID: 36122355 DOI: 10.1177/03635465221119194] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biomechanical efficiency, defined as fastball velocity per unit of normalized elbow varus torque, is a relatively new metric applied to improving the performance and health of baseball pitching. PURPOSE/HYPOTHESIS The purpose of this work was to evaluate kinematic parameters influencing biomechanical efficiency among professional and collegiate pitchers. Kinematic differences were compared between pitchers of high and low biomechanical efficiency. We hypothesized that professional pitchers would have greater biomechanical efficiency than collegiate pitchers. STUDY DESIGN Descriptive laboratory study. METHODS A deidentified biomechanical database of 545 pitchers (447 professional, 98 collegiate) was analyzed. A multivariate linear regression model was used to evaluate significant findings a priori with α = .05. Additionally, biomechanical differences were identified between competition levels and between high and low biomechanical efficiency groups using Mann-Whitney U test (α = .05). RESULTS Competition level and 11 (of 21) kinematic variables explained 27% of the variance in biomechanical efficiency, with most of the predictors being throwing arm kinematics (elbow flexion at stride foot contact [SFC]: β, -1.47; SE, 0.26; shoulder abduction at SFC: β, -1.78; SE, 0.39; shoulder external rotation at SFC: β, 0.60; SE, 0.22; maximum external rotation [MER] angle: β, 1.82; SE, 0.42; shoulder horizontal adduction at MER: β, -3.42; SE, 0.71) (all P≤ .05). Professional pitchers had greater biomechanical efficiency than collegiate pitchers (711.0 ± 101.0 vs 657.0 ± 99.3, respectively; P < .001; d = 0.53). Compared with the low-efficiency group, the high-efficiency group had significantly lower normalized elbow varus torque with greater weight and height (high: 0.047 ± 0.004 %wt*ht vs. low: 0.063 ± 0.006 %wt*ht, P <.001; d = 3.20). At the instant of SFC, the high-efficiency group demonstrated greater shoulder external rotation and less elbow flexion, shoulder abduction, and pelvic rotation. The high-efficiency group also had greater MER and less shoulder horizontal adduction at MER, trunk side tilt at ball release, and knee excursion from foot contact to ball release. CONCLUSION Professional pitchers had greater biomechanical efficiency than collegiate pitchers. Biomechanical efficiency was also affected by 11 kinematic variables identified in this study. Pitchers with higher efficiency had distinct differences in arm position, trunk side tilt, and lead-knee extension range of motion in the delivery. Thus, pitchers and baseball organizations should focus on these factors to lower normalized elbow varus torque relative to ball velocity.
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Affiliation(s)
- Ryan L Crotin
- Human Performance Laboratories, Department of Kinesiology, Louisiana Tech University, Ruston, Louisiana, USA.,Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | | | - Gene Brewer
- Memory & Attention Control Laboratory, Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - E Lyle Cain
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Glenn S Fleisig
- American Sports Medicine Institute, Birmingham, Alabama, USA
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Manzi JE, Zeitlin JH, Dowling B, Roberts N, Ruzbarsky JJ, Ciccotti MC, Dines JS. Evaluating Pelvis Rotation Style at Foot Contact: A Propensity Scored Biomechanical Analysis in High School and Professional Pitchers. Am J Sports Med 2022; 50:2271-2280. [PMID: 35604221 DOI: 10.1177/03635465221094323] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Early pelvis rotation has been associated with decreased throwing arm kinetics and conventionally was considered a component of proper pitching form in baseball throwers. However, previous assessments of pelvis rotation style have not accounted for confounders such as playing level, anthropometric characteristics, or ball velocity and have not evaluated sufficient sample sizes. PURPOSE To compare kinetic and kinematic parameters based on pelvis rotation style in high school and professional pitchers. STUDY DESIGN Descriptive laboratory study. METHODS High school and professional baseball pitchers threw 8 to 12 fastball pitches while being evaluated using 3-dimensional motion capture (480 Hz). These pitchers were 1:1 propensity score matched by age, height, weight, handedness, and ball velocity based on early (<60°) versus late (≥60°) pelvis rotation style at foot contact. A total of 26 kinematic and 10 kinetic parameters were compared between groups. The kinematic parameters were used to conduct a linear regression between early and late pelvis rotation at foot contact. RESULTS Pelvis rotation at foot contact was not significantly associated with ball velocity for either high school (P = .243) or professional pitchers (P = .075). No difference was found in elbow varus torque between high school early rotators (57.5 ± 14.9 N·m) and late rotators (51.3 ± 14.7 N·m; P = .036) and between professional early rotators (80.1 ± 11.8 N·m) and late rotators (79.0 ± 11.2 N·m; P = .663). At foot contact in high school pitchers, stride length increased by 2.1% of body height (B = -0.205; β = -0.470; P < .001), trunk rotation increased by 4.2° (B = -0.417; β = -0.488; P < .001), and trunk flexion at foot contact decreased by 4.4° (B = 0.442; β = 0.476; P < .001) with every 10° increase in pelvis rotation. At foot contact in professional pitchers, stride length increased by 2.3% of body height (B = -0.229; β = -0.478; P < .001), trunk rotation increased by 4.3° (B = -0.431; β = -0.515; P < .001), and trunk flexion decreased by 4.0° (B = 0.404; β = 0.373; P < .001) with every 10° increase in pelvis rotation. CONCLUSION Pelvis rotation at foot contact was associated with several kinematic parameters in both groups and may influence mechanics further along the kinetic chain. Landing open or closed was not significantly associated with throwing arm kinetics or ball velocity for both high school and professional baseball pitchers, contrary to previous thought. CLINICAL RELEVANCE Coaches and players may better focus their efforts on refining other kinematic parameters for enhanced performance outcomes and safe pitching mechanics.
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Affiliation(s)
- Joseph E Manzi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York, USA
| | | | - Brittany Dowling
- Sports Performance Center, Midwest Orthopaedics at Rush, Oak Brook, Illinois, USA
| | | | | | | | - Joshua S Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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Lu Y, Chou WY, Wu KT, Chen ACY, Chan YS, Chiu CH. Shoulder and Elbow Injuries in Elite Taiwanese High School Baseball Pitchers From 2016 to 2017. Orthop J Sports Med 2022; 10:23259671221093960. [PMID: 35647214 PMCID: PMC9134447 DOI: 10.1177/23259671221093960] [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: 01/27/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Numerous studies have discussed the risk factors for shoulder and elbow injuries in high school baseball players worldwide. Purpose To determine the risk factors for pitching-related shoulder and elbow injuries in Taiwanese high school pitchers. Study Design Cross-sectional study; Level of evidence, 3. Methods Included in the study were 144 pitchers from 11 top-ranked Taiwanese high school baseball teams between 2016 and 2017 high school baseball season. The participants answered a 55-item questionnaire concerning physical characteristics, pitching activities, injury history, and off-season activities. Univariate analyses were conducted separately for participants with and those without a pitching-related injury in the 12-month study period. The chi-square test or Fisher exact test was applied to categorical variables, and the F test or t test was applied to continuous variables. A stepwise multivariate logistic regression analysis was used to identify factors related to pitching-related injuries, and those results were calculated as odds ratios (ORs). Results Having a pitching-related injury was significantly related to the number of pitches per week in the past 12 months (OR, 1.01; P = .006), pain over the shoulder and/or elbow in the past 12 months (OR, 3.56; P = .008), pitching competitive baseball for more than 8 of the past 12 months (OR, 2.53; P = .036), throwing sliders (OR, 2.97; P = .026), and lack of participating in other over-the-shoulder activities (0.03-0.11 fewer odds; P ≤ .010). Conclusion For elite high school pitchers in Taiwan, pitching-related shoulder and elbow injuries were related to the number of pitches per week, pitching competitive baseball for more than 8 of the past 12 months, pain over the shoulder and/or elbow in the past 12 months, throwing sliders, and a lack of participation in other sports with over-the-shoulder activities.
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Affiliation(s)
- Yi Lu
- Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Yi Chou
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial
Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Center of Comprehensive Sports Medicine, Kaohsiung Chang Gung
Memorial Hospital, Kaohsiung, Taiwan
| | - Kuan-Ting Wu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial
Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Center of Comprehensive Sports Medicine, Kaohsiung Chang Gung
Memorial Hospital, Kaohsiung, Taiwan
| | - Alvin Chao-Yu Chen
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial
Hospital, Taoyuan, Taiwan
- Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial
Hospital, Taoyuan, Taiwan
| | - Yi-Sheng Chan
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial
Hospital, Taoyuan, Taiwan
- Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial
Hospital, Taoyuan, Taiwan
| | - Chih-Hao Chiu
- Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial
Hospital, Taoyuan, Taiwan
- Department of Orthopedic Surgery, Taoyuan Chang Gung Memorial
Hospital, Taoyuan, Taiwan
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Manzi JE, Dowling B, Wang Z, Lamb JR, Fry EG, McElheny KD, Fu MC, Dines JS. Joint and segment sequencing and its relationship to ball velocity and throwing arm kinetics in professional pitchers. J Shoulder Elbow Surg 2022; 31:1026-1034. [PMID: 34896252 DOI: 10.1016/j.jse.2021.10.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/26/2021] [Accepted: 10/30/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Temporal variations during the pitch have demonstrated significant impacts on the kinetic chain, and as such, have implications in injury risk. PURPOSE To determine the effect of varying chronological orders of maximum joint and segment velocities on ball velocity and upper extremity kinetics. METHODS Professional baseball pitchers (n = 287) were assessed with 3D-motion capture (480 Hz) while pitching. Pitches were categorized into one of the following groups dependent on the first maximum joint or segment velocity achieved out of chronological order in an inferior to superior direction: knee extension (DscK), pelvis rotation (DscP), trunk rotation (DscT), shoulder rotation (DscS), forearm pronation (DscF), and Proper (for pitchers with the correct temporal sequence), and Total Population, for all pitchers. Ten normalized throwing arm kinetic variables were compared among groups. Regression analysis was conducted on the timing of maximum velocities with ball velocity. RESULTS The majority of pitches were in the DscK group (64.5%). The DscK group had a significantly slower maximum lead knee extension velocity compared with the Proper group (253°/s vs. 316°/s, P = .017). The Proper group had a significantly faster ball velocity compared with the Total Population (39.0 ± 1.9 m/s vs. 38.3 ± 2.1 m/s, P = .013). The DscP group had a significantly slower maximum pelvis rotation velocity compared with the Proper group (596°/s vs. 698°/s, P < .001). The Proper group had no significant difference in kinetics relative to the population. For every 1 standard deviation delay in attaining maximum lead knee extension velocity, ball velocity increased by 0.38 m/s (B = 3.5, β = 0.18, P < .001). For every 1 standard deviation delay in timing to achieve maximum pelvis rotation velocity, maximum pelvis rotation velocity and ball velocity increased by 22.5°/s (B = 1107.0, β = 0.23, P < .001) and 0.48 m/s (B = 23.4, β = 0.23, P < .001), respectively. CONCLUSION Pitchers with a discordant sequence of knee extension and pelvis rotation velocity timing had significantly slower corresponding segment/joint velocities. Conversely, pitchers with a proper sequence had the fastest ball velocity with minimal differences in throwing arm kinetics. To maximize ball velocity, professional pitchers should consider achieving maximal velocities in an inferior to superior chronological sequence, with a particular focus on the knee and pelvis.
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Affiliation(s)
| | - Brittany Dowling
- Sports Performance Center, Midwest Orthopaedics at Rush, Oak Brook, IL, USA
| | - Zhaorui Wang
- Weill Cornell Medical College, New York, NY, USA
| | - Jim R Lamb
- Department of Mechanical Engineering, University of Minnesota-Twin Cities, Minneapolis, MN, USA
| | | | - Kathryn D McElheny
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Michael C Fu
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Joshua S Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA.
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Manzi JE, Brusalis CM, Dowling B, Krichevsky S, Quan T, Huang D, Moran J, Kunze KN, Dines JS. The influence of stride width on kinematic and kinetics in high school and professional baseball pitchers: a propensity-matched biomechanical evaluation. J Sci Med Sport 2022; 25:599-605. [DOI: 10.1016/j.jsams.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022]
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Four-dimensional computed tomography evaluation of shoulder joint motion in collegiate baseball pitchers. Sci Rep 2022; 12:3231. [PMID: 35217693 PMCID: PMC8881615 DOI: 10.1038/s41598-022-06464-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/24/2022] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study is to evaluate the glenohumeral contact area, center of glenohumeral contact area, and center of humeral head during simulated pitching motion in collegiate baseball pitchers using four-dimensional computed tomography (4D CT). We obtained 4D CT data from the dominant and non-dominant shoulders of eight collegiate baseball pitchers during the cocking motion. CT image data of each joint were reconstructed using a 3D reconstruction software package. The glenohumeral contact area, center of glenohumeral contact area, center of humeral head, and oblateness of humeral head were calculated from 3D bone models using customized software. The center of glenohumeral contact area translated from anterior to posterior during maximum external rotation to maximum internal rotation (0.58 ± 0.63 mm on the dominant side and 0.99 ± 0.82 mm on the non-dominant side). The center of humeral head translated from posterior to anterior during maximum external rotation to maximum internal rotation (0.76 ± 0.75 mm on the dominant side and 1.21 ± 0.78 mm on the non-dominant side). The increase in anterior translation of the center of glenohumeral contact area was associated with the increase in posterior translation of the center of humeral head. Also, the increase in translation of the center of humeral head and glenohumeral contact area were associated with the increase in oblateness of the humeral head. 4D CT analyses demonstrated that the center of humeral head translated in the opposite direction to that of the center of glenohumeral contact area during external rotation to internal rotation in abduction in the dominant and non-dominant shoulders. The oblateness of the humeral head may cause this diametric translation. 4D CT scanning and the software for bone surface modeling of the glenohumeral joint enabled quantitative assessment of glenohumeral micromotion and be used for kinematic evaluation of throwing athletes.
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Manzi JE, Wang Z, Wright-Chisem J, Nicholson A, Dennis E, Dines JS. Elbow varus torque and ball velocity associations in high school and professional pitchers with increased sagittal-plane trunk tilt. J Shoulder Elbow Surg 2022; 31:151-158. [PMID: 34474134 DOI: 10.1016/j.jse.2021.07.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/18/2021] [Accepted: 07/26/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Increased sagittal-plane trunk tilt is thought to increase drive in the anterior direction toward home plate, transferring energy from the trunk to the distal upper extremity, ultimately generating greater ball velocity. Increased sagittal trunk tilt has also been implicated in the risk of upper-extremity joint loading in baseball pitchers by way of elbow varus torque (EVT), a metric previously associated with elbow injury in professional pitchers. The purposes of this study were (1) to compare sagittal trunk tilt positioning between high school and professional pitchers throughout the pitch and (2) to identify the potential associations between sagittal-plane trunk tilt, ball velocity, and EVT for both cohorts. METHODS Professional and high school pitchers were instructed to throw fastballs while being evaluated with 3-dimensional motion capture (480 Hz). Sagittal trunk tilt motion throughout the pitching motion was compared between cohorts from maximum knee height to maximum shoulder internal rotation. To assess the effects of sagittal-plane trunk tilt on ball velocity and EVT, linear mixed-effect models were created. RESULTS Professional pitchers (n = 100, 882 pitches) achieved greater sagittal trunk tilt than high school pitchers (n = 57, 519 pitches) during early portions of the pitching motion, including maximum positive sagittal trunk tilt (46.6° ± 8.3° vs. 43.6° ± 10.2°, P = .042). Professional pitchers also had greater sagittal trunk tilt excursion throughout the pitch motion (68.0° ± 11.4° vs. 62.5° ± 11.0°, P = .004). For every 10° increase in sagittal trunk tilt at ball release for professional pitchers, ball velocity increased by 0.36 m/s (B = 0.036 and β = 0.194, P < .001) or 0.9% average ball velocity whereas EVT increased by 0.14% body weight × body height (B = 0.014 and β = 0.159, P < .001) or 2.9% average normalized EVT. For every 10° increase in sagittal trunk tilt at ball release for high school pitchers, ball velocity increased by 0.34 m/s (B = 0.097 and β = 0.025, P = .025) or 1.1% average ball velocity whereas EVT increased by 0.07% body weight × body height (B = 0.007 and β = 0.086, P = .016) or 1.7% average normalized EVT. CONCLUSION Increased positive sagittal-plane trunk tilt was significantly associated with greater ball velocity and increased EVT for both professional and high school pitchers. Peak EVT estimates were consistently more pronounced than ball velocity benefits for both populations, suggesting that no specific time point may provide a ball velocity benefit while concomitantly minimizing EVT. Both professional and high school pitchers should consider this trade-off, which may influence injury risk, when engaging in higher degrees of positive sagittal-plane trunk tilt.
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Affiliation(s)
| | - Zhaorui Wang
- Weill Cornell Medical College, New York, NY, USA
| | | | - Allen Nicholson
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Elizabeth Dennis
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Joshua S Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA.
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Lead Foot Progression Angle in Baseball Pitchers: Implications to Ball Velocity and Upper-Extremity Joint Moments. J Appl Biomech 2022; 38:129-135. [DOI: 10.1123/jab.2021-0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/18/2022]
Abstract
The instant of foot contact is an important transition point during the pitch cycle between the linear portion of the pitch, as a pitcher strides down the mound and the rotational portion of the pitch. Understanding the implications of lead foot angle at foot contact is an essential information needed to assist pitching coaches in their work with individual pitchers. Therefore, the purpose of this study was to determine the association between lead foot progression angle at foot contact and ball velocity, elbow varus moment, and pelvic rotation. Kinematic and kinetic data were collected from 99 collegiate pitchers and analyzed using a random intercept, mixed-effects regression model. Significant associations were found between lead foot progression angle at foot contact and elbow varus moment (P = .004), as well as pelvic rotation throughout the pitching motion (P < .001). The data indicate that increased lead foot internal rotation at foot contact is associated with increases in the elbow varus moment but is not associated with ball velocity. This study provides scientific evidence that the rotational positioning of the lead foot can affect both pelvic motion and upper-extremity joint moments.
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Haischer MH, Howenstein J, Sabick M, Kipp K. Torso kinematic patterns associated with throwing shoulder joint loading and ball velocity in Little League pitchers. Sports Biomech 2021:1-14. [PMID: 34930092 DOI: 10.1080/14763141.2021.2015427] [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: 07/30/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to investigate the associations between kinematic patterns of the torso segment and shoulder joint loading as well as pitching performance in youth pitchers. Twenty-four Little League pitchers threw fastballs while motion capture and force plate data were collected and ball speed was measured with a radar gun. Three-dimensional torso segment kinematics (absolute angles and angular velocities) and shoulder net joint moments (NJM) and forces were calculated. The time-series kinematic data were used as inputs to a principal components analysis to extract torso movement patterns. Associations between torso movement patterns and discrete peak shoulder NJM, compressive force, and ball speed were investigated with nonparametric correlations. Torso segment motion patterns related to forward flexion, lateral flexion (away from pitching arm), and axial rotation and rotational velocities were associated with shoulder joint kinetics and ball speed. In addition, excessive axial (transverse plane) torso rotation at ball release correlated positively with shoulder joint loads but not ball speed, which may indicate the prospect for decreasing joint kinetics while maintaining pitching performance through targeted interventions. These results provide a deeper understanding about the interrelationships between torso kinematic patterns, shoulder kinetics, and pitching performance.
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Affiliation(s)
- Michael H Haischer
- Department of Physical Therapy - Program in Exercise Science, Marquette University, Milwaukee, WI, USA
- Athletic and Human Performance Research Center, Marquette University, Milwaukee, WI, USA
| | | | - Michelle Sabick
- Ritchie School of Engineering and Computer Science, University of Denver, Denver, CO, USA
| | - Kristof Kipp
- Department of Physical Therapy - Program in Exercise Science, Marquette University, Milwaukee, WI, USA
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DeFroda SF, Sugimoto D, Staffa SJ, Bae DS, Shanley E, Thigpen CA, Kriz PK. Reliability of an Observational Biomechanical Analysis Tool in Adolescent Baseball Pitchers. Int J Sports Phys Ther 2021; 16:1523-1531. [PMID: 34909257 PMCID: PMC8637241 DOI: 10.26603/001c.29869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Improper pitching mechanics are a risk factor for arm injuries. While 3-dimensional (3D) motion analysis remains the gold standard for evaluation, most pitchers and clinicians do not have access to this costly technology. Recent advances in 2-dimensional (2D) video technology provide acceptable resolution for clinical analysis. However, no systematic assessment tools for pitching analysis exist. PURPOSE To determine the reliability of the Assessment of biomeChanical Efficiency System (ACES) screening tool using 2D video analysis to identify common biomechanical errors in adolescent pitchers. STUDY DESIGN Cross-sectional. METHODS Adolescent baseball pitchers underwent analysis using 2D video in indoor settings. Observational mechanics were collected using a 20-item scoring tool (ACES) based on 2D video analysis. Fleiss' kappa, interclass correlation coefficients (ICC), and frequencies were used to examine intra-/interrater reliability based on common pitching errors. RESULTS Twenty asymptomatic pitchers ages 12-18 years were included. Total ACES scores ranged from 1 to 13, normally distributed. ACES total score demonstrated excellent intra-rater reliability within each rater (ICC for rater 1 = 0.99 (95% CI; 0.98, 0.99); ICC for rater 2 = 0.94; 95% CI: 0.84, 0.97); ICC for rater 3 = 0.98 (95% CI: 0.96, 0.99)). There was excellent interrater reliability across the trials and raters (ICC = 0.91; 95% CI: 0.82, 0.96). The ACES tool demonstrated acceptable kappas for individual items and strong ICC 0.91 (95% CI: 0.82, 0.96) for total scores across the trials. Regarding identification of biomechanical errors, "front side position" was rated erroneous in 84/120 ratings (70%), stride length in 52/120 ratings (43.3%) and lead hip position in 53/120 ratings (44.2%). CONCLUSIONS The 20-item ACES scoring tool with 2D video analysis demonstrated excellent intra- and interrater reliability when utilized by raters of different musculoskeletal disciplines. Future studies validating 2D vs. 3D methodology are warranted before ACES is widely disseminated and utilized for adolescent pitchers. ACES is a practical and reliable clinical assessment tool utilizing 2D video analysis for coaches, instructors, and sports medicine providers to screen adolescent pitchers for common biomechanical errors. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Steven F DeFroda
- Departments of Orthopedics, Warren Alpert Medical School, Brown University
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston; Department of Orthopaedic Surgery, Harvard Medical School
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital
| | - Donald S Bae
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital
| | - Ellen Shanley
- ATI Physical Therapy; Hawkins Foundation; Center for Effectiveness Research in Orthopedics
| | - Charles A Thigpen
- ATI Physical Therapy; Hawkins Foundation; Center for Effectiveness Research in Orthopedics
| | - Peter K Kriz
- Departments of Orthopedics, Warren Alpert Medical School, Brown University
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Tajika T, Oya N, Kuboi T, Endo F, Ichinose T, Shimoyama D, Sasaki T, Hamano N, Omodaka T, Kobayashi H, Mieda T, Okamura K, Shitara H, Iizuka Y, Yamamoto A, Nakajima I, Kobayashi T, Sakamoto M, Takagishi K, Chikuda H. Risk Factors for Throwing-Related Shoulder and Elbow Pain in Adolescent Baseball Players: A Prospective Study of Physical and Developmental Factors. Orthop J Sports Med 2021; 9:23259671211017129. [PMID: 34552989 PMCID: PMC8450620 DOI: 10.1177/23259671211017129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Throwing-related shoulder and elbow pain continues to be reported among adolescent baseball players. Few prospective studies have specifically examined the association between throwing-related shoulder and elbow pain and physical and developmental changes. Purpose: To evaluate the changes in physical and developmental characteristics during 1 year with respect to throwing-related shoulder and elbow pain in adolescent baseball players. Study Design: Case-control study; Level of evidence, 3. Methods: This 1-year prospective follow-up study investigated 164 baseball players aged 7 to 13 years. Player data (age, height, weight, field position, and pitch count), lower extremity muscle tightness, and range of motion (ROM) of the shoulder, elbow, and hip joints were assessed during the 2016 and 2017 preseason medical examinations. After the 2016 season, the participants completed questionnaires related to throwing-related shoulder and elbow pain, defined as an inability to play for ≥1 week because of elbow or shoulder difficulties. For study participants with and without throwing-related shoulder or elbow pain during the 2016 season, we conducted univariate and multivariate logistic regression analysis to identify risk factors for throwing-related shoulder or elbow pain. Results: Overall, 21 players (12.8%) reported a shoulder pain episode, 56 players (34.1%) had an elbow pain episode, and 70 players (42.7%) reported having experienced shoulder and/or elbow pain during the 2016 season. In multivariate logistic regression analysis, (1) shoulder pain was associated with 2016 preseason height (odds ratio [OR], 1.06; 95% CI, 1.01-1.11; P = .01) and change in dominant-side elbow extension ROM from 2016 to 2017 (OR, 1.12; 95% CI, 1.02-1.24; P = .02); (2) elbow pain was associated with change in weight from 2016 to 2017 (OR, 1.21; 95% CI, 1.04-1.41; P = .014); and (3) throwing-related shoulder and/or elbow pain was associated with greater 2016 preseason height (OR, 1.04; 95% CI, 1.003-1.68; P = .03) and an increase in height from 2016 to 2017 (OR, 1.17; 95% CI, 1.01-1.35; P = .03). Conclusion: Our results indicated that adolescent baseball players who were taller in the preseason and those with an increase in height over the 1-year study period faced significant risks for developing throwing-related shoulder and/or elbow pain.
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Affiliation(s)
- Tsuyoshi Tajika
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Noboru Oya
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takuro Kuboi
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Fumitaka Endo
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tsuyoshi Ichinose
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Daisuke Shimoyama
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tsuyoshi Sasaki
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Noritaka Hamano
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takuya Omodaka
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hiroki Kobayashi
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tokue Mieda
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Koichi Okamura
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hitoshi Shitara
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Yoichi Iizuka
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Atsushi Yamamoto
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Ichiro Nakajima
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tsutomu Kobayashi
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Masaaki Sakamoto
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Kenji Takagishi
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hirotaka Chikuda
- Investigation performed at the Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
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Albiero ML, Kokott W, Dziuk C, Cross JA. Relationships between Hip Flexibility and Pitching Biomechanics in Adolescent Baseball Pitchers. J Athl Train 2021; 57:704-710. [PMID: 34543423 DOI: 10.4085/1062-6050-0103.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Inadequate hip active range of motion (AROM) may stifle the energy flow through the kinematic chain and decrease pitching performance while increasing the risk for pitcher injury. OBJECTIVE To examine the relationship of hip AROM and pitching biomechanics during a fastball pitch in adolescent baseball pitchers. DESIGN Cross-Sectional study. SETTING Biomechanics laboratory. PARTICIPANTS A voluntary sample of 21 adolescent baseball pitchers (16.1 ± 0.8 yrs.; 183.9 ± 5.2 cm; 77.9 ± 8.3 kg). Main Outcome Measure (s): Bilateral hip internal rotation (IR), external rotation (ER), flexion, extension, and abduction AROM were measured. Three-dimensional biomechanics were assessed as participants threw from an indoor pitching mound to a strike zone net at regulation distance. Pearson correlation coefficients were used to determine correlations between hip AROM and biomechanical metrics. RESULTS Statistically significant negative correlations were found at foot contact between back hip ER AROM and back hip abduction angle (p=0.030, r=-0.474), back hip ER AROM and torso rotation angle (p=0.032, r=-0.468),and back hip abduction AROM and lead hip abduction angle (p=0.037, r=-0.458). Back hip extension AROM was positively correlated with increased stride length (p=0.043, r=0.446). Lead hip abduction AROM was also positively correlated with normalized elbow varus torque (p=0.034, r=0.464). CONCLUSIONS There were several relationships between hip AROM and biomechanical variables during the pitching motion. The findings support the influence hip AROM can have on pitching biomechanics. Overall, greater movement at the hips allows for the kinematic chain to work at its maximal efficiency, increasing pitch velocity potential.
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Affiliation(s)
- Maxwell L Albiero
- Maxwell L. Albiero, Medical Student, Medical College of Wisconsin, Wisconsin, Milwaukee, WI,
| | - Wesley Kokott
- Wesley Kokott, DPT, OCS, COMT, Senior Physical Therapist, Aurora Sports Health, Lake Geneva, WI,
| | - Cody Dziuk
- Cody Dziuk, Research Technologist II, Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI,
| | - Janelle A Cross
- Janelle A. Cross, PhD, Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI,
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Kibler WB, Sciascia A, Pike JSM, Howell M, Wilk KE. Effect of Forearm Position on Glenohumeral External Rotation Measurements in Baseball Players. Sports Health 2021; 14:577-584. [PMID: 34323144 DOI: 10.1177/19417381211032917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Alterations in glenohumeral internal rotation (GIR), glenohumeral external rotation (GER), and the total arc of motion (TAM) have been linked with increased injury risk in the shoulder and elbow. These motions have been routinely measured with the forearm in neutral rotation (GIRN, GERN, TAMN). GER capacity appears to be especially important. The throwing motion, however, requires forearm pronation as GER occurs to achieve optimal cocking (GERP). No previous studies have evaluated GERP to determine GER capacity or pronated TAM (TAMP) values. HYPOTHESIS There would be significant differences between GERN and TAMN and between GERP and TAMP. STUDY DESIGN Cross-sectional. LEVEL OF EVIDENCE Level 3. METHODS Sixty asymptomatic male Minor League Baseball players (32 pitchers, 28 position players) participated in the study and were tested on the first day of spring training. Passive range of motion measurements were recorded using a long-arm bubble goniometer for GIRN, GERN, and GERP on both arms. TAM was calculated separately as the sum of internal and external rotational measurements under neutral and pronated conditions. RESULTS Within pitchers and position players, all measurements were statistically reduced for the throwing arm (P ≤ 0.03) except for GERN of the pitchers. GERP measures were significantly less than GERN for both arms of each group (P < 0.01): pitchers throwing arm +11.8°/nonthrowing arm +4.8°, position players throwing arm = +8.6°/nonthrowing arm +4.0°. CONCLUSION The forearm position of pronation, which appears to be mediated by tightness of the biceps, decreases GER capacity and TAM. GER and TAM should be calculated in neutral and pronated positions, considering that 80% of the players have a demonstrated difference between 8° and 12°. CLINICAL RELEVANCE Measurement of GERP more accurately reflects the GER required in throwing, allows better quantification of the motion capacity necessary to withstand the loads in throwing, and may suggest interventions for at risk athletes.
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Affiliation(s)
- W Ben Kibler
- Shoulder Center of Kentucky, Lexington Clinic, Lexington, Kentucky
| | - Aaron Sciascia
- Department of Exercise and Sport Science, Eastern Kentucky University, Richmond, Kentucky
| | | | - Michael Howell
- Shoulder Center of Kentucky, Lexington Clinic, Lexington, Kentucky
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Hamano N, Shitara H, Tajika T, Ichinose T, Sasaki T, Kuboi T, Shimoyama D, Kamiyama M, Miyamoto R, Endo F, Nakase K, Kobayashi T, Yamamoto A, Takagishi K, Chikuda H. Relationship between upper limb injuries and hip range of motion and strength in high school baseball pitchers. J Orthop Surg (Hong Kong) 2021; 29:23094990211003347. [PMID: 33779394 DOI: 10.1177/23094990211003347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We aimed to examine the relationship between hip range of motion (ROM) and abduction strength and throwing-related shoulder/elbow injuries in high school baseball pitchers. The study included 135 baseball pitchers. We asked them to fill out a questionnaire at the checkups, that included the dominant arm and the years of baseball experience. To avoid a confirmation bias, the examiners were blinded to the participants' hand dominance. All players underwent physical function measurements, such as height, weight, shoulder and hip strength, and shoulder and hip ROM. Shoulder and elbow injury was defined as shoulder and elbow pain that the patient had been aware of in the past 3 years. The results of injured and non-injured pitchers were compared. Eighty-five pitchers had experienced a shoulder or elbow injury in the past 3 years. The shoulder ROM and strength in the injured and non-injured groups did not differ to a statistically significant extent. The hip external rotation ROM on the dominant side, the hip abduction strength on the non-dominant side, and the hip abduction strength on the dominant side were significantly lower in the injured group than in the non-injured group. The results may contribute to reducing the incidence of these injuries.
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Affiliation(s)
- Noritaka Hamano
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan
| | - Tsuyoshi Sasaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan
| | - Takuro Kuboi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan
| | - Daisuke Shimoyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan
| | - Masataka Kamiyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan
| | - Ryosuke Miyamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan
| | - Fumitaka Endo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan
| | - Kurumi Nakase
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan
| | - Tsutomu Kobayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan
| | - Atsushi Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan
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Sakata J, Tamaki T, Kishino A, Kubota S, Akeda M. Risk factors for throwing elbow injuries during pitching analyzed by simulation using human musculoskeletal model in youth baseball pitchers. J Shoulder Elbow Surg 2021; 30:1309-1315. [PMID: 33675973 DOI: 10.1016/j.jse.2021.01.039] [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: 10/24/2020] [Revised: 01/16/2021] [Accepted: 01/31/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pitching mechanics are believed to be risk factors for throwing elbow injury. Thus, a prospective study of abnormal mechanics in youth baseball players is needed. This study aimed to analyze the ulnar collateral ligament during normal pitching using SIMM (Software for Interactive Musculoskeletal Modeling) for analysis and investigate the risk parameters of throwing elbow injuries in youth baseball players. We hypothesized that excessive ulnar collateral ligament force during pitching would be a risk factor for throwing elbow injuries in this population. METHODS In this cohort study, youth baseball pitchers (aged 9-11 years) were instructed to throw a ball into a netted target. Using a SIMM musculoskeletal model, we analyzed the force of the anterior band of the anterior oblique ligament, posterior band of the anterior oblique ligament (AOL_PB), and elbow varus moment during pitching (foot contact to ball release). We calculated the integral of each force of the anterior band of the anterior oblique ligament and AOL_PB during pitching and summarized these data to establish an impulse at the medial epicondyle. Each participant was followed up for 12 months to assess the occurrence of throwing elbow injury. RESULTS During the 12-month follow-up period, 18 pitchers (28.1%) reported throwing elbow injuries in the throwing arm. The results of this study showed that the maximum AOL_PB force and the impulse at the medial epicondyle were risk factors for throwing elbow injuries. The maximum AOL_PB force was significantly higher in the throwing elbow injury group than in the uninjured group (59.4 ± 17.8 N vs. 47.1 ± 17.5 N, P = .014). The impulse at the medial epicondyle was also significantly different (11.1 ± 4.0 N ・ s in the throwing elbow injury group vs. 8.3 ± 4.4 N ・ s in the uninjured group, P = .025). CONCLUSIONS Increasing the AOL_PB force or the impulse at the medial epicondyle may increase the risk of throwing elbow injuries in youth baseball pitchers. It may be possible to reduce injury risk by focusing on ways to decrease AOL_PB load and cumulative stress on the medial epicondyle throughout the throwing motion while still maintaining high levels of ball velocity.
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Affiliation(s)
- Jun Sakata
- Department of Rehabilitation, Toyota Memorial Hospital, Toyota, Japan.
| | - Tatsuya Tamaki
- Department of Rehabilitation, Yokohama Sports Medical Center, Yokohama, Japan
| | - Asami Kishino
- Department of Rehabilitation, Yokohama Sports Medical Center, Yokohama, Japan
| | - Satoshi Kubota
- Department of Rehabilitation, Yokohama Sports Medical Center, Yokohama, Japan; Department of Sport Sciences, School of Human and Social Sciences, Tokyo International University, Tokyo, Japan
| | - Masaki Akeda
- Department of Orthopedic Sports Medicine, Yokohama Minami Kyosai Hospital, Yokohama, Japan
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Reintgen C, Zeppieri G, Bruner M, Horodyski M, Waligora A, Smith MS, Farmer KW. Youth Baseball Caregiver Understanding of Safe Pitching Guidelines and Player Injury. Int J Sports Phys Ther 2021; 16:807-815. [PMID: 34123532 PMCID: PMC8169035 DOI: 10.26603/001c.22532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As more athletes participate in youth baseball, there has been an associated increase in upper extremity injuries. Knowledge of baseball injury prevention guidelines continues to be developed and defined as throwing-related injuries rise. The purpose of this study was to evaluate how knowledgeable youth baseball caregivers were about safe pitching guidelines and secondarily determine pitching practices which may be associated with increased risk of player injury. METHODS A twenty-two question survey comprised of demographic data, knowledge of overhead throwing guidelines, pitching history, presence of risk factors associated with overhead throwing and pitching habits was distributed to the caregivers of youth baseball pitchers in North Central Florida. RESULTS Eighty-three percent (81/98) of those polled were unaware of the existence of safe pitching guidelines, regardless of the pitcher's playing experience (p > 0.05). Those who pitched more than six months out of the year were significantly more prone to experience throwing arm pain after a performance (p < 0.05). Fifty-two percent (51/98) of the caregivers recalled their child having throwing arm pain as a direct result of pitching, with twenty-six percent (25/98) of pitchers having to miss either a game or a pitching appearance. Twenty-seven percent (26/98) of all players went on to seek medical evaluation for arm discomfort due to pitching. Pitchers 13 years of age and older were more likely to throw curveballs and miss games because of throwing arm pain (p < 0.05). CONCLUSION Despite implementation and accessibility of safe pitching guidelines, a large portion of those surveyed were unaware or noncompliant with these established recommendations. Given the results of this study, further measures need to be taken to improve caregivers' understanding of current guidelines to help increase compliance and protect youth pitchers. LEVEL OF EVIDENCE Cross-sectional survey study, 3b.
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Bullock G, Hulburt TC, Collins G, Waterman BR, Nicholson KF. Comparative Pitching Biomechanics Among Adolescent Baseball Athletes: Are There Fundamental Differences Between Pitchers and Non-pitchers? Int J Sports Phys Ther 2021; 16:488-495. [PMID: 33842044 PMCID: PMC8016426 DOI: 10.26603/001c.21495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/11/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Approximately 25% of youth baseball players pitch, with most young athletes predominately playing multiple positions. While some youth baseball players may primarily pitch, other players may only pitch on occasion, potentially creating a pitching skill level discrepancy. Understanding potential kinematic and kinetic differences between pitching and non-pitching baseball players can inform injury risk reduction strategies for amateur athletes. PURPOSE/HYPOTHESIS To analyze differences in pitching biomechanics for fastballs, breaking balls, and change-ups in adolescent youth baseball players that identify as pitchers and non-pitchers. STUDY DESIGN Retrospective cross-sectional study. METHODS Baseball players were designated as pitchers or non-pitchers, who then threw fastballs (FB), breaking balls (BB), and change-ups (CH) during a biomechanical assessment. T-tests, Mann-Whitney U tests, and ANOVAs with Bonferroni correction, and effect sizes (ES) were performed. RESULTS Sixty baseball players (pitchers = 40; non-pitchers = 20; Age: 15.0 (1.1); Left-handed: 15%; Height 1.77 (0.09) m; Weight: 70.0 (12.5) kg) threw 495 pitches (FB: 177, BB: 155, CH: 163) for analysis. Pitchers threw 2 m/s faster and produced greater trunk rotation velocity (ES: 0.71 (95% CI: 0.39, 1.30, p<0.0001) than non-pitchers. Furthermore, pitchers demonstrated greater ground reaction force for FB compared to CH (ES: 0.48 (95% CI: 0.01, 0.94), p<0.0001). No other biomechanical differences were observed between pitchers and non-pitchers or between pitch types. CONCLUSION Despite throwing at greater velocity for all pitch types, baseball players that identify primarily as pitchers had overall similar kinematics and kinetics in comparison to baseball players that primarily identify as non-pitchers. Self-identified pitching baseball athletes have improved force transfer strategies for ball propulsion, utilizing different force production and attenuation strategies across different pitch types when compared to non-pitchers. Coaches should consider that novice pitchers may potentially have dissimilar trunk and ground reaction strategies in comparison to primary pitchers when designing appropriate pitch loading and recovery strategies. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Garrett Bullock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford; Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford
| | | | - Gary Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford; Oxford University Hospitals NHS Foundation Trust
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Zipser MC, Plummer HA, Kindstrand N, Sum JC, Li B, Michener LA. Hip Abduction Strength: Relationship to Trunk and Lower Extremity Motion During A Single-Leg Step-Down Task in Professional Baseball Players. Int J Sports Phys Ther 2021; 16:342-349. [PMID: 33842030 PMCID: PMC8016437 DOI: 10.26603/001c.21415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/08/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The single-leg step down task (SLSD) is a clinical tool to assess movement and control of the lower extremity and trunk. Hip abduction weakness may impact movement quality during the SLSD, however the relationships between movement and strength are unclear. PURPOSE To determine the relationship between hip abduction isometric strength and movement during the SLSD of trunk lean, pelvic drop, knee valgus, and hip flexion. STUDY DESIGN Cross sectional, cohort study. METHODS One hundred-eighteen Minor League baseball players (age=21.6 ± 2.0 years; n=68 pitchers, n=50 position players) participated. Bilateral hip abduction isometric strength was measured using a handheld dynamometer (HHD), and then multiplied by distance from the greater trochanter to the HHD and expressed as hip abduction torque. Video cameras captured the SLSD, with participants standing on one leg while lowering their contralateral heel to touchdown on the floor from a 0.203m (8in.) step. Trunk lean, trunk flexion, pelvic drop, knee valgus, and hip flexion were measured using Dartfish at heel touchdown. A value of 180° indicated no knee valgus. Pearson correlations examined the relationships between hip abduction torque and SLSD motions. RESULTS There were no significant correlations for position players. For pitchers, on the lead leg increased hip abduction torque weakly correlated with a decrease in knee valgus (r= 0.24, p=0.049). Also for pitchers on the trail leg, increased hip abduction torque weakly correlated with decreased pelvic drop (r= -0.28, p=0.021). CONCLUSION Hip abduction strength contributes to dynamic control of the trunk and legs. Specifically in pitchers, hip abduction weakness was related to increased movement of the lower extremity and lumbopelvic regions during the dynamic SLSD task. These deficits could translate to altered pitching performance and injury. LEVELS OF EVIDENCE 2.
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Miyazaki S, Yamako G, Totoribe K, Sekimoto T, Kadowaki Y, Tsuruta K, Chosa E. Shadow pitching deviates ball release position: kinematic analysis in high school baseball pitchers. BMC Sports Sci Med Rehabil 2021; 13:26. [PMID: 33731187 PMCID: PMC7968203 DOI: 10.1186/s13102-021-00255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/05/2021] [Indexed: 11/25/2022]
Abstract
Background Although shadow pitching, commonly called “towel drill,” is recommended to improve the throwing motion for the rehabilitation of pitching disorders before the initiation of a throwing program aimed at returning to throwing using a ball, the motion differs from that of normal throwing. Learning improper motion during ball release (BR) may increase shoulder joint forces. Abnormal throwing biomechanics leads to injures. However, there has been no study of shadow pitching focusing on the BR position. The purpose of the present study was to evaluate the BR position and kinematic differences between shadow pitching and normal throwing. In addition, the effect of setting a target guide for BR position on throwing motion was examined in shadow pitching. Methods The participants included in this study were 20 healthy male students who were overhand right-handed pitchers with no pain induced by a throwing motion. Participants performed normal throwing (task 1), shadow pitching using a hand towel (task 2), and shadow pitching by setting a target of the BR position (task 3). A motion capture system was used to evaluate kinematic differences in throwing motions, respectively. Examination items comprised joint angles and the differences in BR position. Results BR position of task 2 shifted significantly toward the anterior, leftward, and downward directions compared with task 1. The distance of BR position between tasks 1 and 2 was 24 ± 10%. However, task 3 had decreased BR deviation compared with task 2 (the distance between 3 and 1 was 14 ± 7%). Kinematic differences were observed among groups at BR. For shoulder joint, task 2 showed the highest value in abduction and horizontal adduction among groups. In spine flexion, left rotation and thorax flexion, task 2 was significantly higher than task 1. Task 3 showed small differences compared with task 1. Conclusions The BR position of shadow pitching deviated significantly in the anterior, leftward, and downward directions compared with normal throwing. Furthermore, we demonstrated that the setting of BR target reduces this deviation. Thus, the target of BR position should be set accurately during shadow pitching exercises in the process of rehabilitation.
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Affiliation(s)
- Shigeaki Miyazaki
- Rehabilitation Unit, University of Miyazaki Hospital, 5200 Kihara Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan
| | - Go Yamako
- Department of Mechanical Design Systems Engineering, Faculty of Engineering, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki, Miyazaki, 889-2192, Japan.
| | - Koji Totoribe
- Rehabilitation Unit, University of Miyazaki Hospital, 5200 Kihara Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan
| | - Tomohisa Sekimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan
| | - Yuko Kadowaki
- Clinical Research Support Center, University of Miyazaki Hospital, 5200 Kihara Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan
| | - Kurumi Tsuruta
- School of Nursing, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan
| | - Etsuo Chosa
- Rehabilitation Unit, University of Miyazaki Hospital, 5200 Kihara Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan
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Hamano N, Shitara H, Tajika T, Ichinose T, Sasaki T, Kuboi T, Shimoyama D, Kamiyama M, Miyamoto R, Endo F, Nakase K, Kobayashi T, Yamamoto A, Takagishi K, Chikuda H. Relationship between the Lower Limb Function and Shoulder and Elbow Injuries in Elementary School Baseball Pitchers. Prog Rehabil Med 2021; 6:20210015. [PMID: 33728384 PMCID: PMC7952376 DOI: 10.2490/prm.20210015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/03/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives We aimed to examine the relationship between the hip range of motion (ROM) and ankle ROM and throwing-related shoulder and elbow injuries in elementary school baseball pitchers. Methods This retrospective comparative study (Level of evidence: Level III) included 195 baseball pitchers (mean age 10.8±1.0 years, range 8-12 years). All pitchers underwent physical function measurements, including height, weight, shoulder strength, and hip and ankle ROM. Shoulder and elbow injury was defined as shoulder and elbow pain that the pitchers had been aware of in the past or at the time of medical checkups. The results for the injured and non-injured groups were then compared. Results The shoulder ROM and strength in the injured and non-injured groups did not differ to a statistically significant extent. The hip external rotation on the dominant side (injured vs. non-injured: 48.9±11.1° vs. 53.3±9.7°, P<0.01), the hip internal rotation on the non-dominant side (injured vs. non-injured: 36.6±12.0° vs. 40.9±11.0°, P=0.01), and ankle plantar flexion on the non-dominant side (injured vs. non-injured: 52.0±6.8° vs. 54.3±6.7°, P=0.02) were significantly smaller in the injured group than in the non-injured group. Conclusions The hip external rotation ROM on the dominant side and the hip internal rotation and ankle plantar flexion on the non-dominant side were significantly lower in the injured group than in the non-injured group. These results may suggest measures to reduce the incidence of elbow and shoulder injuries in elementary school baseball pitchers.
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Affiliation(s)
- Noritaka Hamano
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsuyoshi Sasaki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takuro Kuboi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Daisuke Shimoyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masataka Kamiyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ryosuke Miyamoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Fumitaka Endo
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kurumi Nakase
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsutomu Kobayashi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Atsushi Yamamoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
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Hamano N, Shitara H, Tajika T, Kuboi T, Ichinose T, Sasaki T, Kitagawa T, Kobayashi H, Yamamoto A, Kobayashi T, Takagishi K, Chikuda H, Endo F, Kamiyama M, Shimoyama D, Takanime S, Miyamoto R, Nakase K. Relationship Between Upper Limb Injuries and Hip Range of Motion in Elementary and Junior High School Baseball Players. Orthop J Sports Med 2021; 9:2325967120970916. [PMID: 33623793 PMCID: PMC7878951 DOI: 10.1177/2325967120970916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/01/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Shoulder and elbow injuries are major problems in baseball players. Tightness of the upper extremities has been reported as a risk factor for shoulder and elbow injuries in elementary and junior high school baseball players. However, few studies have been conducted on the relationship between decreased hip range of motion (ROM) and shoulder and elbow injuries. Purpose/Hypothesis: This study aimed to prospectively examine the relationship between hip ROM and throwing-related shoulder and elbow injuries in elementary and junior high school baseball players. The hypothesis was that players with unrestricted ROM in the hip would have a reduced risk of upper extremity injuries. Methods: The study included 263 baseball players (mean ± SD age, 10.5 ± 1.3 years; range, 7-14 years). The following physical parameters were assessed: (1) hip flexion ROM measured in the supine position and (2) hip internal and external rotation in the prone position. After the season, players completed questionnaires regarding shoulder and/or elbow injuries. For comparison, the players were classified as injured (not able to play for ≥8 days because of shoulder and/or elbow problems) or noninjured. Results: During the season, 52 players had shoulder and/or elbow injuries. When the injured and noninjured groups were compared, hip flexion on the dominant side (121.5° ± 12.0° vs 126.7° ± 9.8°, respectively; P < .01), hip flexion on the nondominant side (119.6° ± 11.7° vs 126.0° ± 9.9°, respectively; P < .01), and internal rotation on the dominant side (52.5° ± 11.3° vs 56.8° ± 10.8°, respectively; P = .01) were significantly reduced in the injured group. Conclusion: We identified preseason decreases in flexion bilaterally and internal rotation on the dominant side as risk factors for shoulder and elbow injuries in elementary and junior high school baseball players. Further studies are required to prevent disabilities in elementary and junior high school baseball players through development of prevention and intervention programs.
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Affiliation(s)
- Noritaka Hamano
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hitoshi Shitara
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tsuyoshi Tajika
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takuro Kuboi
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tsuyoshi Ichinose
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tsuyoshi Sasaki
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takanori Kitagawa
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroki Kobayashi
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Atsushi Yamamoto
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tsutomu Kobayashi
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kenji Takagishi
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hirotaka Chikuda
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Fumitaka Endo
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masataka Kamiyama
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Daisuke Shimoyama
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shuhei Takanime
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Ryosuke Miyamoto
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kurumi Nakase
- Investigation performed at Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Calcei JG, Schulman BL, Workman WB. Pitching Mechanics: Do Certain Mechanics Predispose Pitchers to Shoulder Injuries? OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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A New Method for Evaluating Pelvic and Trunk Rotational Pitching Mechanics: From Qualitative to Quantitative Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030905. [PMID: 33494309 PMCID: PMC7908422 DOI: 10.3390/ijerph18030905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to build on existing qualitative to quantitative approaches to develop a new quantitative method for evaluating pelvic and trunk rotational pitching mechanics. Thirty pitchers were divided into two groups ("Pattern1": closed "hip-to-shoulder separation"; "Pattern2": open "hip-to-shoulder separation"). Several parameters were analyzed. Higher ball speeds were found in group of Pattern1, four key characteristics of which were identified. Based on the results, a new evaluation method was developed. Pelvic and trunk rotational mechanics were classified into four types. Type1 (proper mechanics) enabled significantly higher ball speed than the other three types and was thought to involve proper energy transfer from the stride foot to the throwing upper limb. Types 2-4, however, were regarded as "improper mechanics", which could result in slower ball speeds and less efficient energy transfer. A qualitative approach, based on "expert opinion", can specify optimal pelvis and trunk rotational mechanics. However, quantitative analysis is more precise in identifying three improper types of pelvis and trunk rotational mechanics. Furthermore, special programs, such as core strengthening and flexibility training, can be developed for various improper practices in order to improve pitching mechanics.
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45
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Baseball pitching biomechanics in relation to pain, injury, and surgery: A systematic review. J Sci Med Sport 2021; 24:13-20. [DOI: 10.1016/j.jsams.2020.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 06/02/2020] [Accepted: 06/16/2020] [Indexed: 12/28/2022]
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Tanaka H, Hayashi T, Inui H, Muto T, Tsuchiyama K, Ninomiya H, Nakamura Y, Kobashi S, Nobuhara K. Stride-Phase Kinematic Parameters That Predict Peak Elbow Varus Torque. Orthop J Sports Med 2020; 8:2325967120968068. [PMID: 33403214 PMCID: PMC7745573 DOI: 10.1177/2325967120968068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background: During baseball pitching, a high amount of elbow varus torque in the arm cocking-to-acceleration phase is thought to be a biomechanical risk factor for medial elbow pain and injury. The biomechanics of the stride phase may provide preparation for the arm cocking-to-acceleration phase that follows it. Purpose: To determine the kinematic parameters that predict peak elbow varus torque during the stride phase of pitching. Study Design: Descriptive laboratory study. Methods: Participants were 107 high school baseball pitchers (age range, 15-18 years) without shoulder or elbow problems. Whole-body kinematics and kinetics during fastball pitching were analyzed using 3-dimensional measurements from 36 retroreflective markers. A total of 26 kinematic parameters of the upper and lower limbs during the stride phase leading up to the stride foot contact were extracted for multiple regression analysis to assess their combined effect on the magnitude of peak elbow varus torque. Results: Increased wrist extension, elbow pronation, knee flexion on the leading leg, knee extension on the trailing leg at stride foot contact, and upward displacement of the body’s center of mass in the stride phase were significantly correlated with decreased peak elbow varus torque (all P < .05). Moreover, 38% of the variance in peak elbow varus torque was explained by a combination of these 5 significant kinematic variables (P < .001). Conclusion: We found that 5 kinematic parameters during the stride phase and the combination of these parameters were associated with peak elbow varus torque. The stride phase provides biomechanical preparation for pitching and plays a key role in peak elbow varus torque in subsequent pitching phases. Clinical Relevance: The present data can be used to screen pitching mechanics with motion capture assessment to reduce peak elbow varus torque. Decreased peak elbow varus torque is expected to reduce the risk of elbow medial pain and injury.
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Affiliation(s)
- Hiroshi Tanaka
- Nobuhara Hospital and Institute of Biomechanics, Tatsuno, Japan
| | - Toyohiko Hayashi
- Graduate School of Science and Technology, Niigata University, Niigata, Japan
| | - Hiroaki Inui
- Nobuhara Hospital and Institute of Biomechanics, Tatsuno, Japan
| | - Tomoyuki Muto
- Nobuhara Hospital and Institute of Biomechanics, Tatsuno, Japan
| | - Kohnan Tsuchiyama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroki Ninomiya
- Nobuhara Hospital and Institute of Biomechanics, Tatsuno, Japan
| | - Yasuo Nakamura
- Faculty of Health and Sports Science, Doshisha University, Kyotanabe, Japan
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Kurokawa D, Muraki T, Ishikawa H, Shinagawa K, Nagamoto H, Takahashi H, Yamamoto N, Tanaka M, Itoi E. The Influence of Pitch Velocity on Medial Elbow Pain and Medial Epicondyle Abnormality Among Youth Baseball Players. Am J Sports Med 2020; 48:1601-1607. [PMID: 32364755 DOI: 10.1177/0363546520914911] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pitch velocity is associated with elbow injuries among skillful baseball players. However, the relationship between pitch velocity and throwing elbow injuries among youth players has not yet been clarified. PURPOSE To investigate the influence of pitch velocity on medial elbow pain and medial epicondyle abnormality among youth baseball players. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The participants consisted of 256 elementary school players (mean age, 11 ± 1 years; range, 9-12 years). The medial aspect of the elbow was evaluated using ultrasound imaging. A questionnaire was used to investigate past or present pain in the elbow, background of the players (age, height, body mass index, and years of baseball experience), and playing environment (number of days of practice in a week, experience as a pitcher, and cryotherapy of the shoulder and elbow after practice). Positioning of the scapula, range of motion in shoulder internal/external rotations and hip internal rotation, angle of the straight-leg raise, and heel-to-buttock distance were measured. The pitch velocity was recorded using a pitch velocity radar gun. The relationship between these variables and the presence of medial epicondyle abnormality, as well as past or present elbow pain, were statistically analyzed. RESULTS A medial epicondyle abnormality was observed in 130 players (51%), elbow pain in the past in 65 players (25%), and elbow pain during the examination in 14 players (5%). Sixty-nine players (27%) experienced elbow pain either in the past or during examination. Abnormality of the medial epicondyle had a relationship with the pitch velocity (odds ratio [OR], 1.1 for increase of 1 km/h; 95% CI, 1.1-1.2; P < .0001) and the number of practice days in a week (OR, 1.8 for increase of the practice days; 95% CI, 1.4-2.5; P < .0001). Pitch velocity was also significantly related with past pain, present pain, and past and/or present pain of the elbow (OR [km/h], 1.1, 1.1, 1.1; 95% CI, 1.0-1.1, 1.0-1.2, 1.1-1.2; P < .0001, P = .002, P < .0001, respectively). CONCLUSION Pitch velocity was significantly associated with abnormality of the medial epicondyle and elbow pain. A 10-km/h increase in pitch velocity would increase the risk of medial epicondyle abnormality and medial elbow pain by 3 times.
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Affiliation(s)
- Daisuke Kurokawa
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan.,Nonprofit Organization, Network for Sports Medicine and Science, Sendai, Japan
| | - Takayuki Muraki
- Nonprofit Organization, Network for Sports Medicine and Science, Sendai, Japan.,Department of Physical Medicine and Rehabilitation, Tohoku University School of Medicine, Sendai, Japan
| | - Hiroaki Ishikawa
- Nonprofit Organization, Network for Sports Medicine and Science, Sendai, Japan.,Department of Physical Medicine and Rehabilitation, Tohoku University School of Medicine, Sendai, Japan
| | - Kiyotsugu Shinagawa
- Nonprofit Organization, Network for Sports Medicine and Science, Sendai, Japan.,Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Hideaki Nagamoto
- Nonprofit Organization, Network for Sports Medicine and Science, Sendai, Japan.,Department of Orthopaedic Surgery, Kurihara Central Hospital, Kurihara, Miyagi, Japan
| | - Hiroyuki Takahashi
- Nonprofit Organization, Network for Sports Medicine and Science, Sendai, Japan.,Department of Orthopaedic Surgery, Kesen-numa City Hospital, Kesen-numa, Miyagi, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Minoru Tanaka
- Nonprofit Organization, Network for Sports Medicine and Science, Sendai, Japan.,Sendai Tanaka Sports Clinic, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
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48
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Courseault J, Labbe A, Mercer C, Moran A, Weldy J. Rehabilitation of the Throwing Athlete—How to Get Them Back to Sport. OPER TECHN SPORT MED 2020. [DOI: 10.1016/j.otsm.2020.150737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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49
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Lizzio VA, Gulledge CM, Smith DG, Meldau JE, Borowsky PA, Moutzouros V, Makhni EC. Predictors of elbow torque among professional baseball pitchers. J Shoulder Elbow Surg 2020; 29:316-320. [PMID: 31812585 DOI: 10.1016/j.jse.2019.07.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Overuse injuries of the shoulder and elbow continue to be prevalent in elite baseball pitchers. Pitch velocity has been shown to impact medial elbow torque in adolescent baseball pitchers. However, the determinants of medial elbow torque in professional baseball pitchers are not known. PURPOSE To determine the influence of pitch type, velocity, and player characteristics on medial elbow torque in professional baseball pitchers. METHODS Professional baseball pitchers were recruited for participation. Height, weight, body mass index (BMI), and throwing arm measurements were obtained for all study participants. While wearing a gyroscopic sensor equipped with an accelerometer, participants were instructed to throw a standard, randomized sequence of fastballs, changeups, and curveballs. Elbow torque, arm slot, arm speed, shoulder rotation, and ball velocity were recorded for each pitch. A linear mixed model was used to evaluate the association of pitch type with each pitch parameter, adjusting for pitchers' demographics. RESULTS A total of 12 professional baseball pitchers were included in this study. Among the pitch types, medial elbow torque was significantly higher in fastballs than in curveballs (P = .001). An increased BMI value was independently associated with decreased elbow torque in pitchers (P = .035). CONCLUSION Fastballs place significantly higher torque on the medial elbow than do curveballs, which is consistent with previous studies done on high school and collegiate populations. Pitchers with a higher BMI experience significantly less torque across the medial elbow.
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Affiliation(s)
- Vincent A Lizzio
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Caleb M Gulledge
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - D Grace Smith
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Jason E Meldau
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Peter A Borowsky
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Vasilios Moutzouros
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA.
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50
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Arnold AJ, Thigpen CA, Beattie PF, Kissenberth MJ, Tokish JM, Shanley E. Sport Specialization and Increased Injury Frequency in Youth Baseball Players: A Prospective Study. J Athl Train 2020; 54:1115-1122. [PMID: 31633417 DOI: 10.4085/1062-6050-349-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Sport specialization is thought to be a primary contributor to the throwing-related injury risk in youth baseball players. OBJECTIVE To (1) establish arm-injury incidence in a cohort of male youth (9-12 years old) baseball players and (2) examine sport specialization and the frequency of arm injuries in the same cohort. DESIGN Cohort study. SETTING Greenville, South Carolina, youth baseball programs and tournaments. PATIENTS OR OTHER PARTICIPANTS A total of 159 asymptomatic youth baseball players (age = 11.1 ± 1.1 years) were physically assessed and then were prospectively followed for 6.7 ± 1.5 months. MAIN OUTCOME MEASURE(S) Athlete demographics and playing and injury histories were initially recorded. Athlete-exposures and presence of arm injury were prospectively tracked. All injuries were physically confirmed by a licensed physical therapist. RESULTS Youth players demonstrated an arm-injury incidence rate of 2.22 per 1000 athlete-exposures. Parents and players underestimated sport-specialization status based on the standard research definition (self versus research based: 31% versus 83%, respectively; P = .001). The frequency of arm injuries was higher in specialized players (100%) than in nonspecialized players (80%, P = .03) but did not differ between pitchers and position players (13.2% each, P = 1.00). CONCLUSIONS Sport specialization was associated with throwing-related arm injuries in a small cohort of youth baseball players. It is concerning that 57.9% of parents and specialized players were unaware of the athletes' status. Larger studies with longer follow-up periods are needed to further evaluate injury-risk profiles in physically developing youth populations.
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Affiliation(s)
- Amanda J Arnold
- Louisiana State University Health Science Center-New Orleans
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