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Yamaoka H, Kato K, Otoshi K, Kaneko Y, Tominaga R, Kaga T, Igari T, Sato R, Konno SI. Impact of low back pain experience on future occurrence of shoulder pain in adolescent baseball players: A 1-year prospective cohort study. J Orthop Sci 2024; 29:897-902. [PMID: 37002057 DOI: 10.1016/j.jos.2023.03.012] [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: 10/16/2022] [Revised: 02/18/2023] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Low back pain can affect musculoskeletal problems of the upper limb in adolescent overhead athletes. However, few epidemiological studies have examined this causal relationship. This prospective cohort study aimed to investigate the relationship between baseline low back pain experience and the occurrence of future shoulder and elbow pain among high school baseball players. METHODS Participants comprised 383 high school baseball players from 43 high school baseball teams who had undergone baseline medical evaluations (a self-completed questionnaire and physical examination). The occurrence of shoulder and elbow pain during a 1-year follow-up and associations with baseline low back pain (positive subjective symptom during the last year at baseline) adjusted for flexibility of the scapulo-thoracic region, shoulder, and lower extremities, such as straight-leg raise angle (hamstring tightness), Thomas test (iliopsoas tightness), heel-buttock-distance (quadriceps tightness) and passive range of motion of the hip were investigated using multivariable analysis. RESULTS A total of 307 players (80.2%) participated in the 1-year follow-up survey, with shoulder and elbow pain reported in 75 players (24.4%) and 119 players (38.8%), respectively, during follow-up. After adjusting for factors associated with shoulder pain using logistic regression modeling, significant associations between LBP experienced during the last year at baseline (odds ratio, 2.18; 95% confidence interval, 1.23-3.87; P = 0.0078) and new-onset of shoulder pain were noted. CONCLUSIONS Baseline low back pain impacted future shoulder pain in high school baseball players during the 1-year follow-up. Management of shoulder pain warrants careful attention to low back pain.
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Affiliation(s)
- Hirokazu Yamaoka
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kinshi Kato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan; Department of Sports Medicine, Fukushima Medical University School of Medicine, Koriyama City, Japan.
| | - Kenichi Otoshi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan; Department of Sports Medicine, Fukushima Medical University School of Medicine, Koriyama City, Japan
| | - Yota Kaneko
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Ryoji Tominaga
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takahiro Kaga
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan; Department of Sports Medicine, Fukushima Medical University School of Medicine, Koriyama City, Japan
| | - Takahiro Igari
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Ryohei Sato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shin-Ichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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Painter DF, Quinn M, Dove JH, Testa EJ, Snow R, Byrne RA, Pavlu MM, Jordan R, Owens BD. Arm Health in Elite Collegiate Summer League Baseball Players Assessed by the Kerlan-Jobe Orthopaedic Clinic Score. J Athl Train 2024; 59:255-261. [PMID: 37681668 PMCID: PMC10976342 DOI: 10.4085/1062-6050-0123.23] [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: 09/09/2023]
Abstract
CONTEXT Collegiate baseball players with professional aspirations often participate in summer leagues; foremost among them is the Cape Cod Baseball League (CCBL). Injuries acquired during the collegiate baseball season can be carried into the CCBL season and vice versa. OBJECTIVE To assess the history of throwing arm injury and current functionality in midseason CCBL players. DESIGN Cross-sectional study. SETTING Online questionnaire. PATIENTS OR OTHER PARTICIPANTS A total of 123 CCBL players participated. Qualifying athletes were ≥18 years old and were rostered CCBL players with remaining collegiate eligibility. MAIN OUTCOME MEASURE(S) After collecting background information, we used the Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow questionnaire to assess the history of throwing arm injury and current functionality. The maximum KJOC score is 100.0; higher scores correspond with greater functionality. RESULTS The mean KJOC score was 86.6 ± 14.5 (n = 92); 24.5% (23/94) of players reported a prior diagnosis of throwing arm injury other than a strain or sprain. A total of 49 (49/96, 51.0%) players had undergone rehabilitation for a throwing arm injury, and 7 (7/96, 7.3%) had experienced a medical procedure. Players with no previous treatment (n = 41, mean KJOC score = 88.9 ± 19.0) more frequently demonstrated KJOC scores of ≥90 than players with such treatment (n = 55, 80.9 ± 17.1; P < .001). The 18 players with time-loss arm injury in the last year had lower mean KJOC scores (71.3 ± 20.0) than players with no injury or time loss (90.3 ± 9.8; P < .001). Similarly, players who reported current arm trouble (n = 15) had lower KJOC scores (71.6 ± 17.5) than players with healthy arms (89.5 ± 11.9; P < .001). CONCLUSIONS The average KJOC score of the CCBL players was <90, with particularly low scores in athletes with prior arm injury and treatment.
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Affiliation(s)
| | - Matthew Quinn
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - James H. Dove
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Edward J. Testa
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | - Ryan Snow
- Alpert Medical School of Brown University, Providence, RI
| | - Rory A. Byrne
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI
| | | | | | - Brett D. Owens
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI
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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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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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Brenner JS, Watson A. Overuse Injuries, Overtraining, and Burnout in Young Athletes. Pediatrics 2024; 153:e2023065129. [PMID: 38247370 DOI: 10.1542/peds.2023-065129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/23/2024] Open
Abstract
Sports participation can have tremendous physical and mental health benefits for children. Properly implemented progressive training programs can yield a broad range of beneficial physiologic adaptations, but imbalances of training load and recovery can have important negative consequences. Overuse injuries, for example, can result from repetitive stress without sufficient recovery that leads to accumulated musculoskeletal damage. In addition, extended periods of increased training loads that exceed the intervening recovery can have systemic consequences such as overtraining syndrome, which results in decreased performance, increased injury and illness risk, and derangement of endocrine, neurologic, cardiovascular, and psychological systems. Burnout represents one of the primary reasons for attrition in youth sports. Broadly defined as physical or mental exhaustion and a reduced sense of accomplishment that leads to devaluation of sport, burnout represents a direct threat to the goal of lifelong physical activity and the wide-ranging health benefits that it provides. This clinical report is intended to provide pediatricians with information regarding the risk factors, diagnosis, management, and prevention of these conditions to assist in the identification of at-risk children, the treatment of young athletes, and the guidance of families in the promotion of safe and healthy sport participation.
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Affiliation(s)
- Joel S Brenner
- Sports Medicine Program, Children's Hospital of The King's Daughters; Department of Pediatrics, Eastern Virginia Medical School; Division of Sports Medicine, Children's Specialty Group, PLLC, Norfolk, Virginia
| | - Andrew Watson
- Division of Sports Medicine, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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McKenzie A, Larequi SA, Hams A, Headrick J, Whiteley R, Duhig S. Shoulder pain and injury risk factors in competitive swimmers: A systematic review. Scand J Med Sci Sports 2023; 33:2396-2412. [PMID: 37515375 DOI: 10.1111/sms.14454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/10/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
AIM To synthesize and assess the literature for shoulder pain and injury risk factors in competitive swimmers. DESIGN Systematic review with best-evidence synthesis. DATA SOURCES CINHAL, SportDiscus, Scorpus, PubMed, and Embase databases from 1966 to April 30 2022. SEARCH AND INCLUSION Cohort, cross-sectional, and case-control studies investigating shoulder pain or injury risk factors in competitive swimmers were included. Quality of eligible studies were assessed using a modified Newcastle-Ottawa scale. Risk factors were divided into four categories: modifiable-intrinsic, modifiable-extrinsic, non-modifiable, and other/secondary. RESULTS Of 1356 studies identified, 24 full texts were evaluated for methodological quality, 22 met the criteria and were included in best evidence synthesis. There was no strong evidence supporting or refuting the association between 80 assessed variables and shoulder injury or pain. The swimmers' competitive level (nondirectional), and shoulder muscle recruitment profiles (e.g., increased activity of serratus anterior) exhibited moderate evidence supporting an association. Conversely, internal and external range of motion, middle finger back scratch test, training frequency, specialty stroke, height/weight, sex, and age all had moderate evidence opposing an association. Limited evidence was found for 58 variables, and conflicting for 8. The highest quality study (n = 201) suggested high acute-to-chronic workload ratio and reduced posterior shoulder strength endurance are associated with injury. CONCLUSIONS Due to the paucity of high-quality studies, future prospective studies are needed to reevaluate known risk factor associations over exploring additional potential risk factors. Swimming practitioners should be aware of the nondirectional association of a swimmer's competitive level and pain, as squad changes could impact injury incidence. Moreover, swimmers experiencing shoulder pain may show increased activity in shoulder stabilizers during specific movements. Importantly, shoulder strength-endurance may be the most clinically relevant modifiable intrinsic risk factor.
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Affiliation(s)
- Alec McKenzie
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Queensland Academy of Sport, Brisbane, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institution Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Sophie-Alexandra Larequi
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Andrea Hams
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institution Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Jonathon Headrick
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Rod Whiteley
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Steven Duhig
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institution Queensland, Griffith University, Gold Coast, Queensland, Australia
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Kuboi T, Tajika T, Endo F, Ichinose T, Sasaki T, Hamano N, Shitara H, Sakamoto M, Takagishi K, Chikuda H. Ultrasonographic appearance of the pronator quadratus muscle in high school baseball pitchers with and without elbow symptoms: a pilot study. J Ultrasound 2023; 26:627-633. [PMID: 35666460 PMCID: PMC10468450 DOI: 10.1007/s40477-022-00685-0] [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] [Received: 03/01/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Earlier reports have described forearm flexor muscles as active stabilizers of the elbow to valgus stress during throwing motion. The pronator quadratus (PQ) muscle acts in coordination with the pronator teres muscle for forearm pronation. This study of high school pitchers was conducted to assess the association between sonographic appearance and a history of elbow symptoms. METHODS We examined 123 high school baseball pitchers, all of whom had completed a self-administered questionnaire, including items related to throwing-related elbow joint pain sustained during the prior year. Ultrasound examination was made of the pitchers with and without valgus stress of the medial aspect of the bilateral elbows. The sonographic appearance of the PQ was assessed on sagittal and axial images on the bilateral side. For participants with and without a history of elbow symptoms, we compared the maximum thickness of the PQ on sagittal and axial images of the throwing side. RESULTS Regarding maximum thickness of the PQ on the sagittal and axial images, a significant difference was found between the throwing and non-throwing sides (throwing side vs non-throwing side mean: sagittal 6.3 mm vs 5.7 mm, axial 8.2 mm vs 7.5 mm, 95% confidence interval: sagittal 0.41-0.70, p < 0.001, axial 0.53-0.82, p < 0.001). The maximum thickness of the PQ on axial images with elbow symptoms was significantly greater than the PQ thickness of those without elbow symptoms. Nevertheless, no association was found between elbow valgus instability and the maximum thickness of the PQ on sagittal and axial images of the throwing side. CONCLUSION Sonographic appearance of the PQ might be associated with elbow joint conditions in high school baseball players.
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Affiliation(s)
- Takuro Kuboi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tsuyoshi Tajika
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8514, Japan.
| | - Fumitaka Endo
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tsuyoshi Sasaki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Noritaka Hamano
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Masaaki Sakamoto
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8514, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Sada Hospital, 2-3-28 Watanabedori, Fukuoka Chuo-ku, Fukuoka, 810-0004, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Kato K, Otoshi K, Tominaga R, Kaga T, Igari T, Sato R, Kaneko Y, Konno SI. Age-Related Differences in the Limited Range of Motion of the Lower Extremity and Their Relation to Low Back Pain in Young Baseball Players: A Cross-Sectional Study of 1215 Players. SPORTS MEDICINE - OPEN 2023; 9:26. [PMID: 37138150 PMCID: PMC10156885 DOI: 10.1186/s40798-023-00572-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/20/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Age-related differences in the limited range of motion of the lower extremities and their relationship with low back pain in juvenile athletes have not been well assessed. This study investigated the relationship between low back pain and limited range of motion of the hip and knee in young baseball players during the baseball season. RESULTS Participants comprised 1215 baseball players (216 pitchers, 999 fielders) aged 6-16 years who underwent medical checkups (self-completed questionnaire and physical examination). Of the 1215 players, 255 (21.0%) experienced seasonal low back pain requiring rest during the previous year. The prevalence of low back pain and a positive Thomas test, straight-leg-raising test, and heel-to-buttock test increased with age. Univariate analysis revealed that a positive heel-to-buttock test in both the throwing and non-throwing arm sides in the 11-12 age group and a positive Thomas test in the throwing arm side in the 13-14 age group were associated with seasonal low back pain (P = 0.0051, P = 0.021, and P = 0.048, respectively). Multivariate analysis, adjusted for factors associated with low back pain, showed significant associations between the positive heel-to-buttock test (odds ratio 1.75, 95% confidence interval 1.11-2.79; P = 0.016) and low back pain in players aged 11-14 years. CONCLUSIONS A positive heel-to-buttock test is potentially associated with low back pain among juvenile baseball players. Particular attention should be paid to the limited range of motion of the knee joint and tightness of the quadriceps femoris muscle among baseball players with low back pain aged 11-14 years.
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Affiliation(s)
- Kinshi Kato
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan.
- Department of Sports Medicine, Fukushima Medical University School of Medicine, Koriyama City, Japan.
| | - Kenichi Otoshi
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
- Department of Sports Medicine, Fukushima Medical University School of Medicine, Koriyama City, Japan
| | - Ryoji Tominaga
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
| | - Takahiro Kaga
- Department of Sports Medicine, Fukushima Medical University School of Medicine, Koriyama City, Japan
| | - Takahiro Igari
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
| | - Ryohei Sato
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
| | - Yota Kaneko
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
| | - Shin-Ichi Konno
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
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Fiegen AP, Nezlek SP, Loushin SR, Christoffer D, Verhoeven M, Kaufman KR, Camp CL. Changes in Elbow Stress and Ball Velocity During Reduced Effort Pitching: A Marker-Based Motion Capture Analysis. Am J Sports Med 2023; 51:779-785. [PMID: 36625428 DOI: 10.1177/03635465221144020] [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: 01/11/2023]
Abstract
BACKGROUND Baseball pitchers often participate in throwing programs that involve throwing at reduced effort levels to gradually increase the amount of stress experienced across the elbow. It is currently unknown how reduced effort pitching compares with maximum effort with respect to elbow stress and ball velocity. PURPOSE/HYPOTHESIS The purpose was to determine the correlation between elbow stress and ball velocity with reduced effort pitching. We hypothesized that decreased perceived effort would disproportionately correlate with elbow stress and ball velocity. STUDY DESIGN Descriptive laboratory study. METHODS Ten healthy male high school baseball pitchers threw 5 pitches from a regulation pitching mound at 3 effort levels: maximum effort, 75% effort, and 50% effort. Elbow stress, specifically elbow varus torque, was calculated for all pitches using a validated marker-based 3-dimensional motion capture system. Ball velocity was measured using a Doppler radar gun. Intrathrower variability was calculated for each effort level. RESULTS Elbow stress and ball velocity decreased with reduced effort throws (P < .001 and P = .003, respectively). However, the reductions in elbow stress and ball velocity were not proportional. At 75% effort throws, elbow stress measured 81% (intraclass correlation coefficient [ICC], 0.95), and ball velocity measured 90% (ICC, 0.80) of maximum, respectively. At 50% effort throws, elbow stress measured 75% (ICC, 0.93), and ball velocity measured 85% (ICC, 0.87) of maximum. Intrathrower reliability was excellent for elbow stress and ball velocity, with all ICCs ≥0.80. CONCLUSION Pitching at a reduced effort level resulted in decreased elbow stress and ball velocity. However, for every 25% reduction in perceived effort, elbow stress decreased by a mean 13%, and ball velocity decreased 7.5%. When baseball pitchers attempt to throw at a reduced effort of maximum, throwing metrics do not decrease proportionately. CLINICAL RELEVANCE While pitching at a reduced effort of maximum decreases elbow stress and ball velocity, the decrease is not proportional, subjecting the elbow to more stress than intended. This has significant clinical importance to pitchers, coaches, and medical professionals in the setting of injury prevention and return to sports.
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Affiliation(s)
- Anthony P Fiegen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Stuart P Nezlek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Stacy R Loushin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Dan Christoffer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kenton R Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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High-definition magnetic resonance images on medial elbow injuries in preadolescent Little Leaguers. J Orthop Sci 2023; 28:358-363. [PMID: 34998617 DOI: 10.1016/j.jos.2021.12.011] [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: 07/15/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The incidence of throwing-related elbow injuries is still rising. The study aimed to enhance the pathology of acute medial elbow injuries among young Little Leaguers by examining the medial elbows of symptomatic 9-10 years old Little Leaguers using High-Definition Magnetic Resonance Images (HDMRI), which uses a small-diameter surface coil on the target area, leading to greater image resolution. METHOD We identified Little Leaguers aged 9-10 years old. To minimize the detection of the chronic adaptative changes, players who experienced the medial elbow pain previously and whose HDMRI had not been taken within 4 weeks from the onset of medial elbow pain were excluded. This study considered 21 players, and the mean age was 9.4 ± 0.5 years. RESULT The fragmentation of the medial epicondyle apophysis via HDMRI was found in 15 elbows (71.4%), while the avulsion was seen in three cases. The signal hyperintensity at the medial epicondyle apophysis was observed in 2 cases. Our data showed abnormal changes to the medial epicondyle apophysis and surrounding structures, such as the ulnar collateral ligament (UCL), flexor-pronator tendons or the coronoid process of the ulna. We detected 11 abnormalities on X-ray imaging, while 20 subjects showed some abnormal findings via HDMRI. DISCUSSION The current study showed that initial medial elbow injury in Little Leaguers without a history of previous elbow injury could be attributed to multi-structure injury. Over 90% of subjects were injured in the perichondrium, while 71.4% demonstrated a fragmentation of the secondary ossification center, and 14.3% experienced an avulsion of the medial epicondyle apophysis. Because the injuries were not limited to bony structures, HDMRI may be beneficial for the appropriate evaluation of medial elbow pain. The pathology of initial medial elbow injuries in young baseball players may be due to acute trauma instead of repetitive microtrauma.
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Winkelmann MT, Achenbach L, Zeman F, Laver L, Walter SS. The throwing shoulder in youth elite handball: adaptions of inferior but not anterior capsule thickness differ between the two sexes. Res Sports Med 2023; 31:112-124. [PMID: 34176387 DOI: 10.1080/15438627.2021.1943391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim was to investigate side-to-side and sex differences of anterior and inferior capsule thickness (ACT, ICT) between the throwing and non-throwing shoulder (TS, NTS) in youth elite handball players. 125 youth female and male elite handball players (14.1±0.7yo) were assessed for ACT and ICT by ultrasound . ACT measurement was performed from anterior (3 o'clock) in upright position and for ICT from inferior (6 o'clock) in supine position. Measurements of ICT in the TS of all athletes (1.4±0.2 mm) differed significantly but marginally to those in the NTS (1.3±0.2 mm) (p = 0.001). Female (1.2±0.2 mm vs. 1.3±0.2 mm; p = 0.007) but not male youth players (1.4±0.2 mm vs. 1.4±0.2 mm, p = n.s.) demonstrated slight differences in ICT in the TS compared with the NTS. Although significant, the thickness in the TS compared to the NTS was within the measurement accuracy of the ultrasonic assessment. No difference in ACT was observed in the TS (1.4±0.3 mm) compared to the NTS (1.4±0.3 mm) for both sexes (n.s.).In conclusion, the anterior and inferior capsule thickness in youth elite handball athletes is not or only marginally different between throwing and non-throwing shoulders.
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Affiliation(s)
- Moritz T Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Leonard Achenbach
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany
| | - Lior Laver
- Department of Orthopaedics, Sports Medicine Unit, Hillel Yaffe Medical Center (HYMC), Hadera, Israel.,Rappaport Faculty of Medicine, Technion (Israel Institute of Technology), Halifax, Israel
| | - Sven S Walter
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
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12
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Bullock GS, Thigpen CA, Martin CL, Losciale J, Michener L, Whiteley R, Waterman BR, Tokish JM, Camp C, Shanley E. Shoulder Range of Motion Measurements and Baseball Elbow Injuries: Ambiguity in Scientific Models, Approach, and Execution is Hurting Overhead Athlete Health. Arthrosc Sports Med Rehabil 2022; 5:e297-e304. [PMID: 36866292 PMCID: PMC9971890 DOI: 10.1016/j.asmr.2022.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 12/14/2022] Open
Abstract
Elbow injuries are a significant and increasing issue in baseball. Elbow injuries account for 16% of all injuries sustained at the professional level and collegiate level. Because of the continued rise in injury rates, loss of performance value, and medical burden, sports medicine clinicians have attempted to research the causes underlying this injury epidemic in an attempt to help mitigate baseball elbow injuries. Shoulder range of motion (ROM) is the most researched clinical metric related to elbow injuries in baseball and has the greatest consensus as a viable prognostic factor specifically for medial elbow injury. Shoulder ROM is easy to measure, can be modified through stretching and manual therapy interventions, and can be easily assessed during preseason screening throughout all baseball levels. Despite a large number of studies and the widespread use of shoulder ROM in injury risk screening, current findings are unclear as to whether there is a true cause-effect relation with baseball elbow injuries. We argue that the conflicting findings revolving around the value of shoulder ROM measurements associated with baseball elbow injuries are the result of 4 gaps in the research approaches implemented to date: ambiguous research questions, mixed study populations, statistical models used, and shoulder ROM methodology. Specifically, there is a mismatch of methods, statistical models, and conclusions such as (1) investigating the association (i.e., correlation) between shoulder ROM measurements and injury and (2) investigating the cause-effect relation of shoulder ROM to baseball injuries. The purpose of this article is to detail the required scientific steps to evaluate whether preseason shoulder ROM is a potential causal factor for pitching elbow injury. We also provide recommendations to allow for future causal inferences to be made between shoulder ROM and elbow injury. This information will ultimately assist in informing clinical models of care and decision making for baseball throwers.
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Affiliation(s)
- Garrett S. Bullock
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A.,Department of Biostatistics & Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, England,Address correspondence to Garrett S. Bullock, P.T., D.P.T., D.Phil., Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, 475 Vine St, Winston-Salem, NC 27211, U.S.A.
| | | | - Chelsea L. Martin
- ATI Physical Therapy, Greenville, South Carolina, U.S.A.,Department of Epidemiology, Gillings School of Global Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Justin Losciale
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Lori Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, U.S.A
| | - Rod Whiteley
- Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Brian R. Waterman
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - John M. Tokish
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Christopher Camp
- Department of Orthopaedic Surgery, Mayo Clinic, Minneapolis, Minnesota, U.S.A
| | - Ellen Shanley
- ATI Physical Therapy, Greenville, South Carolina, U.S.A.,South Carolina Center for Effectiveness Research in Orthopedics, Greenville, South Carolina, U.S.A
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13
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Yoshimi M, Maeda N, Komiya M, Fukui K, Tashiro T, Kaneda K, Arima S, Tsutsumi S, Abekura T, Urabe Y. Effect of thoracic expansion restriction on scapulothoracic and glenohumeral joint motion during shoulder external rotation. J Back Musculoskelet Rehabil 2022; 35:1399-1406. [PMID: 35723089 PMCID: PMC9697060 DOI: 10.3233/bmr-220006] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Shoulder external rotation in the throwing motion involves movement of the scapulothoracic and glenohumeral joints, thoracic spine, and the thorax. Restriction of thoracic expansion may decrease scapulothoracic joint motion and compensate by excessive glenohumeral joint motion. However, it is unclear how restricting the expansion of the thorax alters shoulder motion. OBJECTIVE To elucidate changes in scapulothoracic and glenohumeral joint movements caused by restricted thoracic expansion. METHODS Kinematic data were obtained using an electromagnetic tracking device (Liberty; Polhemus), from 18 male participants, during shoulder external rotation in the sitting position with and without restriction of thoracic expansion. The displacements from the start position to the maximum external rotation position were compared, and Pearson's correlation coefficient was calculated. RESULTS A significant difference was observed in the scapulothoracic posterior tilt angle (P< 0.01) and glenohumeral external rotation angle (P< 0.01). A significant positive correlation existed between scapulothoracic posterior tilt and glenohumeral external rotation (P< 0.05) with and without restriction. CONCLUSIONS Restriction of thoracic expansion decreased scapulothoracic motion and increased glenohumeral motion. Thus, a decrease in thoracic expansion may change scapulothoracic and glenohumeral movements, which may be a risk factor for throwing injuries.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yukio Urabe
- Corresponding author: Yukio Urabe, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan. Tel.: +81 82 257 5405; Fax: +81 82 257 5405; E-mail:
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14
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Athletes Perceive Weighted Baseballs to Carry a Notable Injury Risk, yet Still Use Them Frequently: A Multicenter Survey Study. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202209000-00003. [PMID: 36083831 PMCID: PMC9467671 DOI: 10.5435/jaaosglobal-d-21-00306] [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: 11/24/2021] [Accepted: 06/21/2022] [Indexed: 11/18/2022]
Abstract
Weighted baseball use in throwing programs is widespread; however, their use remains controversial. Prior research shows that weighted baseball programs can increase ball velocity but potentially increase throwing arm injuries. This study aims to ascertain perceptions of weighted baseballs among elite baseball players.
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15
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Mair H, Kenney NA, Uhl TL, Ullery LR, Hosey RG. Effect of Pitching Restrictions and Mound Distance on Youth Baseball Pitch Counts. Orthop J Sports Med 2022; 10:23259671221110547. [PMID: 35859649 PMCID: PMC9289911 DOI: 10.1177/23259671221110547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Studies have shown that higher pitch counts are directly related to a greater
incidence of elbow and shoulder pain among youth baseball pitchers. Purpose/Hypothesis: The purpose of this study was to examine the effect of different pitching
restriction rules on the number of pitches thrown in youth baseball leagues.
We hypothesized that more pitches would be thrown in leagues with inning
restrictions versus leagues with pitch count restrictions as well as in
leagues with a longer mound distance (from pitching mound to home
plate). Study Design: Cohort study; Level of evidence, 2. Methods: Pitch count data were collected for 2 consecutive years over a 10-week season
from 3 different leagues of 9- to 12-year-old baseball players in a single
city. The Eastern league had a pitch count restriction and 46-ft (14.02-m)
mound distance. The Southeastern and South leagues’ pitching restrictions
were based on innings per week. The Southeastern league had a 50-ft
(15.24-m) mound distance, while the South league had a 46-ft mound distance.
Comparisons of total seasonal pitches thrown were made of the 3
highest-volume pitchers on each team. League averages for each value were
then compared utilizing analysis of variance with Bonferroni post hoc
analysis. The number of pitchers in each league who threw >600 pitches
per season was compared using the chi-square test. Results: No significant difference in seasonal pitch counts or innings pitched was
noted between the Eastern and South leagues, which differed only in their
pitching restrictions. The Southeastern league, with a longer mound
distance, was found to have higher seasonal pitch counts per thrower (598 ±
195 pitches) than the South league (463 ± 198 pitches) for the 3
highest-volume throwers for each team (P = .004). The
Southeastern league also had a significantly larger number of pitchers who
threw >600 pitches per season (33 vs 20 for Eastern and 13 for South;
P = .009). Conclusion: There was no significant difference in seasonal pitch counts when the leagues
in this study differed based on pitching restrictions. However, the league
with a greater mound distance (Southeastern) had higher seasonal pitch
counts for the highest-volume throwers. Pitching restrictions based on pitch
counts, as opposed to innings, may be advisable.
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Affiliation(s)
- Hailey Mair
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | | | - Timothy L Uhl
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - L Robert Ullery
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Robert G Hosey
- University of Kentucky Medical Center, Lexington, Kentucky, USA
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16
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Mayes M, Salesky M, Lansdown DA. Throwing Injury Prevention Strategies with a Whole Kinetic Chain-Focused Approach. Curr Rev Musculoskelet Med 2022; 15:53-64. [PMID: 35389192 PMCID: PMC9076771 DOI: 10.1007/s12178-022-09744-9] [Citation(s) in RCA: 1] [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] [Accepted: 12/17/2021] [Indexed: 12/14/2022]
Abstract
Purpose of Review This review examines the relationship between the baseball pitching motion and the kinetic chain. The goal was to determine the underlying causes of a deficiency in throwing mechanics throughout a throwing motion, and to provide an evidence-based approach on how to prevent injuries caused by a lack of proper mechanics. In doing so, we sought to provide a warm-up strategy that can be added to every baseball player’s daily on-field routine that is tailored to each phase of the throwing motion. Recent Findings To help minimize the risk of injury to overhead throwing athletes, a thorough understanding of the throwing motion is critical. Throwing a ball places extreme stress on the body, notably the shoulder and elbow joints. With a clear understanding of the biomechanics of throwing, we can develop an injury prevention routine to minimize unnecessary stresses throughout the kinetic chain. Summary The throwing cycle is a complex motion that places various stresses throughout the thrower’s body, from the ankle to the core, and from the back to the shoulder and elbow. A thorough understanding of the mechanics of this motion, along with specific exercises to target the specific actions of each phase, may allow for throwers, regardless of their age and experience, to minimize injury risk.
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Affiliation(s)
- Michael Mayes
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, 1500 Owens Street, San Francisco, CA, 94158, USA
| | - Madeleine Salesky
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, 1500 Owens Street, San Francisco, CA, 94158, USA
| | - Drew A Lansdown
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, 1500 Owens Street, San Francisco, CA, 94158, USA.
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17
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Kennedy SM, Sheedy P, Klein B, Gist MF, Hannon JP, Conway JE, Creed K, Garrison JC. Differences in Shoulder Internal Rotation Strength Between Baseball Players With Ulnar Collateral Ligament Reconstruction and Healthy Controls. Orthop J Sports Med 2022; 10:23259671211065025. [PMID: 35036451 PMCID: PMC8753246 DOI: 10.1177/23259671211065025] [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: 08/23/2021] [Accepted: 09/16/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Studies have indicated decreased shoulder internal rotation (IR) and external rotation (ER) strength in the throwing limb of baseball players after ulnar collateral ligament injury. There is limited evidence on the recovery of shoulder rotation strength after primary ulnar collateral ligament reconstruction (UCLR). Hypothesis: At the time of return to throwing, baseball players who underwent UCLR would demonstrate decreased IR and ER shoulder strength in the throwing arm as compared with healthy baseball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Male competitive high school and collegiate baseball athletes participated in this study. Athletes who underwent UCLR were compared with healthy controls who were matched by age, height, weight, and position. Bilateral isometric shoulder ER and IR strength was measured using a handheld dynamometer for all participants at the time of initial evaluation (UCLR group) and throughout the course of a season (healthy group). Independent t tests were run to calculate mean differences in ER and IR shoulder strength between the groups, with significance set at P < .05. Results: A total of 86 baseball athletes participated in this study (43 UCLR group, 43 healthy group). At the time of return to throwing (mean ± SD, 194 ± 30 days postoperatively), the 2 groups demonstrated no significant differences in nonthrowing arm ER or IR strength (P = .143 and .994, respectively). No significant difference was found between groups for throwing arm ER strength (P = .921); however, the UCLR group demonstrated significantly less throwing arm IR strength than the healthy group (144.2 ± 27.8 vs 157.6 ± 27.1 N; P = .023). Conclusion: The results of this study demonstrate that throwing arm rotator cuff strength may not fully recover before the initiation of a return-to-throwing program after UCLR. These data provide a potential framework for clinicians to assist in the management and exercise prescription of the baseball athlete after UCLR and before medical release and the initiation of a return-to-throwing program.
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Affiliation(s)
- Sean M Kennedy
- Memorial Hermann Health, IRONMAN Sports Medicine Institute, Houston, Texas, USA
| | - Philip Sheedy
- Texas Health Sports Medicine, Fort Worth, Texas, USA
| | | | - Mason F Gist
- Texas Health Sports Medicine, Fort Worth, Texas, USA
| | - Joseph P Hannon
- Texas Health Sports Medicine, Fort Worth, Texas, USA.,St Louis Children's Hospital, Young Athlete Center, St Louis, Missouri, USA
| | - John E Conway
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kalyssa Creed
- Texas Health Sports Medicine, Fort Worth, Texas, USA
| | - J Craig Garrison
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
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18
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Mine K, Milanese S, Jones MA, Saunders S, Onofrio B. Risk Factors of Shoulder and Elbow Injuries in Baseball: A Scoping Review of 3 Types of Evidence. Orthop J Sports Med 2022; 9:23259671211064645. [PMID: 34988240 PMCID: PMC8721392 DOI: 10.1177/23259671211064645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background Shoulder and elbow overuse injuries are the most common problems in baseball players. No scoping review has compared the findings from different types of evidence. Purpose To map the broad evidence from 3 types of evidence (epidemiological, biomechanical, and narrative) on potential risk factors for shoulder and elbow injuries in baseball and identify gaps in the existing literature to guide future research. Study Design Scoping review. Methods Eight electronic databases were searched from inception to May 14, 2020. Any peer-reviewed papers that investigated or discussed potential risk factors for shoulder and elbow injuries in baseball were included. Results A total of 302 studies (107 epidemiological studies, 85 biomechanical studies, and 110 narrative reviews) were included. Risk factors were categorized into 9 domains: sports profiles, physical characteristics/functions, pitching mechanics, performance, behavioral, psychosocial, biological and developmental, injury/sports profiles, and environmental factors. Studies were consistent in supporting limited shoulder range of motion (ROM) and player positions (pitchers or catchers) as risk factors for shoulder injuries. For elbow injuries, the majority of the included studies suggested that being pitchers or catchers and working with higher ball velocity can be risk factors. Conclusion Findings were consistent in some risk factors, such as limited shoulder ROM and positions. However, findings were inconsistent or limited for most factors, and substantial research gaps were identified. Research assessing those factors with inconsistent or limited evidence in the current literature were recognized to be priorities for future studies.
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Affiliation(s)
- Koya Mine
- University of South Australia, Adelaide, SA, Australia
| | | | - Mark A Jones
- University of South Australia, Adelaide, SA, Australia
| | - Steve Saunders
- University of South Australia, Adelaide, SA, Australia.,Saunders Physiotherapy, Adelaide, SA, Australia
| | - Ben Onofrio
- University of South Australia, Adelaide, SA, Australia.,Adelaide Giants, West Lakes, SA, Australia
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19
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Disantis AE, Martin R. Movement System Dysfunction Applied to Youth and Young Adult Throwing Athletes. Int J Sports Phys Ther 2022; 17:90-103. [PMID: 35024209 PMCID: PMC8720247 DOI: 10.26603/001c.30022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
Shoulder and elbow injuries in overhead athletes, especially baseball pitchers, have become more common and result in limited participation. Upper extremity injuries in baseball can occur secondary to high velocity repetitive loading at extreme ranges of motion causing microtrauma to the musculoskeletal structures. With the vast number of youth and young adult baseball players in the United States and the increasing number of throwing related injuries, it is crucial that clinicians can perform a movement system evaluation of the throwing motion. An adequate evaluation of the movement system as it relates to the throwing motion can provide insight into abnormal throwing mechanics and provide rationale for selecting appropriate interventions to address identified impairments that may lead to injury. The purpose of this clinical commentary is to present a recommended movement system evaluation that can be utilized during both pre-season and in-season to assess for modifiable injury risk factors in youth and young adult baseball players. LEVEL OF EVIDENCE 5.
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Affiliation(s)
| | - RobRoy Martin
- Department of Physical Therapy, Duquesne University; University of Pittsburgh Medical Center, Center for Sports Medicine
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20
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Kato K, Otoshi K, Tominaga R, Kaga T, Igari T, Sato R, Kurita N, Konno SI. Association Between Musculoskeletal Pain and Psychological Stress Responses in High School Baseball Players: A Cross-sectional Study. Orthop J Sports Med 2021; 9:23259671211054422. [PMID: 34805423 PMCID: PMC8597074 DOI: 10.1177/23259671211054422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/04/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Musculoskeletal pain could represent a psychological stressor in adolescent athletes. However, few epidemiological studies have investigated this association. Purpose: To assess the relationship between musculoskeletal pain (shoulder, elbow, wrist, and low back) and psychological stress responses in high school baseball players. Study Design: Cross-sectional study. Methods: Participants comprised male Japanese high school baseball players who had completed a questionnaire as part of their annual medical evaluation in 2016. Experiences of shoulder, elbow, wrist, and low back pain during the previous season were investigated. Pain severity was graded as 1 (mild, playing without interference), 2 (moderate, playing with interference), or 3 (severe, could not play because of pain). The Stress Response Scale–18 was used to measure stress response: low, medium, rather high, and high. Prevalence rates of shoulder, elbow, wrist, and low back pain and their association with psychological stress responses were investigated using univariate and multivariable analyses. Results: A total of 944 players (223 pitchers and 721 fielders) were included in this study. Their mean age was 16.1 ± 0.6 years, and 66% were high school juniors, while 33.6% were seniors. In pitchers, the prevalence rates during the previous year of severe (grade 3) interference with playing because of elbow, shoulder, wrist, and low back pain were 21.5% (n = 48), 19.3% (n = 43), 3.6% (n = 8), and 18.4% (n = 41), respectively, whereas in fielders, the respective prevalence rates were 17.1% (n = 123), 17.9% (n = 129), 6.7% (n = 48), and 19.3% (n = 139). After adjusting for confounding factors (playing on a top-performing team, high school grade level, and all other sites of musculoskeletal pain), the authors found significant associations in pitchers between severe experiences of elbow pain and low back pain and medium to high psychological stress responses (odds ratio, 2.64 [95% CI, 1.32-5.39], P = .006 and odds ratio, 2.32 [95% CI, 1.12-4.89], P = .024, respectively). No significant associations were seen between musculoskeletal pain and psychological stress responses in fielders. Conclusion: In the current study, elbow and low back pain were associated with stronger psychological stress responses compared with other musculoskeletal pain in high school baseball pitchers.
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Affiliation(s)
- Kinshi Kato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kenichi Otoshi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Sports Medicine, Fukushima Medical University School of Medicine, Koriyama City, Japan
| | - Ryoji Tominaga
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takahiro Kaga
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.,Department of Sports Medicine, Fukushima Medical University School of Medicine, Koriyama City, Japan
| | - Takahiro Igari
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Ryohei Sato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Noriaki Kurita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan.,Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Shin-Ichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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21
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Furness J, McArthur K, Remnant D, Jorgensen D, Bacon CJ, Moran RW, Hing W, Climstein M. Traumatic surfing injuries in New Zealand: a descriptive epidemiology study. PeerJ 2021; 9:e12334. [PMID: 34733590 PMCID: PMC8544252 DOI: 10.7717/peerj.12334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/27/2021] [Indexed: 11/20/2022] Open
Abstract
Background New Zealand (NZ) has nearly 14,000 km of coastline and a surfing population of approximately 315,000 surfers. Given its popularity, surfing has a high frequency of injury claims, however, there remains a lack of data on traumatic surfing-related injuries from large population studies. The primary purpose of this study was to examine traumatic surfing injuries in NZ specific to injury incidence, duration, location, type, mechanism of injury and associated risk factors. Methods A sample of self-identified surfers currently living in NZ participated in an online retrospective cross-sectional survey between December 2015 and July 2016. Demographic and surfing injury data were collected and analysed. Results The survey yielded 1,473 respondents (18.3% female); a total of 502 surfers reported 702 major traumatic injuries with an overall incidence proportion of 0.34 (95% CI [0.32-0.37]). When comparing the number of injured surfers who sustained an injury at various body locations, a significantly higher proportion of competitive surfers, compared to recreational surfers, had an injury at the neck (6.8% vs 4%, χ 2 (1,1473) = 5.84, P = 0.019); shoulder (7.4% vs 4.3%, χ 2 (1,1473) = 6.34, P = 0.017), upper back (1% vs 2.4%, χ 2 (1,1473) = 4.77, P = 0.043), lower back (7% vs 3.1%, χ 2 (1,1473) = 11.98, P = 0.001) and knee (7% vs 3.4%, χ 2 (1,1473) = 9.67, P = 0.003). A significantly higher proportion of surfers who performed aerial manoeuvres compared to those who did not reported a higher proportion of knee injuries (9.7% vs 3.9%, χ 2 (1,1473) = 13.00, P = 0.001). With respect to injury duration, the shoulder represented the largest proportion of chronic injuries (>3 months) (44.4%), and the head and face represented the largest proportion of acute injuries (≤3 months) (88%). Muscle and tendon injuries were reported most frequently (25.6%) and direct contact injuries accounted for 58.1% of all injury mechanisms. Key risk factors for traumatic injury included: competitive compared to recreational status (41.0% vs 30.1%, Relative Risk (RR) = 1.36, P < 0.001), ability to perform aerial manoeuvres (48.1% vs 31.8%, RR = 1.51, P < 0.001) and intermediate or above skill level surfers compared to beginner surfers (35.8% vs 22.7%, RR = 1.58, P < 0.001). Conclusion One third of recreational surfers sustained a major traumatic injury in the previous 12 months. For competitive or aerialist surfers the risk was greater, with this proportion approximately half. Overall, the head/face was the most common location of traumatic injury, with competitive surfers being more likely to sustain a neck, shoulder, lower back, and knee injury compared to recreational surfers. The shoulder was associated with the highest proportion of injuries of chronic duration. Future research should investigate injury mechanisms and causation using prospective injury monitoring to better underpin targeted injury prevention programs.
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Affiliation(s)
- James Furness
- Faculty of Health Sciences/Water based Research Unit, Bond University, Gold Coast, QLD, Australia
| | - Katherine McArthur
- Faculty of Health Sciences/Water based Research Unit, Bond University, Gold Coast, QLD, Australia
| | - Debbie Remnant
- Osteopathy, Unitec Institute of Technology, Auckland, New Zealand
| | - Darcy Jorgensen
- Faculty of Health Sciences/Water based Research Unit, Bond University, Gold Coast, QLD, Australia
| | - Catherine J Bacon
- Osteopathy, Unitec Institute of Technology, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Robert W Moran
- Osteopathy, Unitec Institute of Technology, Auckland, New Zealand
| | - Wayne Hing
- Faculty of Health Sciences/Water based Research Unit, Bond University, Gold Coast, QLD, Australia
| | - Mike Climstein
- Faculty of Health Sciences/Water based Research Unit, Bond University, Gold Coast, QLD, Australia.,Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group/ Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia.,Faculty of Health, Southern Cross University, Gold Coast, QLD, Australia
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22
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Agel J, Post E. Early Sport Specialization. J Bone Joint Surg Am 2021; 103:1948-1957. [PMID: 34375322 DOI: 10.2106/jbjs.21.00018] [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] [Indexed: 02/01/2023]
Abstract
➤ Early sport specialization has been recognized as a potential factor in the relationship between physical activity and health since the early 1970s. ➤ There is no universally agreed-upon terminology or definition for early sport specialization, but early sport specialization typically encompasses preteen athletes who play 1 sport competitively throughout the year or play on several teams within 1 season, leading to intensive participation without variation in physical activity. ➤ There is a limited number of comprehensive long-term outcome studies that have identified a potential link between early sport specialization and musculoskeletal injury or burnout. ➤ Methodologically sound prospective research looking at chronologic age and years of participation by sports played will help to answer whether there is an impact from early sport specialization on the relationship with successful participation and injury occurrence.
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Affiliation(s)
- Julie Agel
- Department of Orthopedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, Washington
| | - Eric Post
- Indiana State University, Terre Haute, Indiana
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23
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Platt BN, Zacharias AV, Conley C, Hockensmith L, Stockwell N, Sciascia A, Stone AV. Association Between Pitch Break on the 4-Seam Fastball and Slider and Shoulder Injury in Major League Baseball Pitchers: A Case-Control Study. Orthop J Sports Med 2021; 9:23259671211038961. [PMID: 34660825 PMCID: PMC8516387 DOI: 10.1177/23259671211038961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background Few specific risk factors are known for shoulder injury in professional pitchers. New pitch-tracking data allow for risk stratification based on advanced metrics. Purpose/Hypothesis The purpose of this study was to determine the association between shoulder injury, pitch frequency, and pitch metrics (velocity, total break, break angle, and spin rate) for the 4-seam fastball, curveball, and slider. We hypothesized that more frequent use of the 4-seam fastball would be associated with shoulder injury. Study Design Case-control study; Level of evidence, 3. Methods The Major League Baseball (MLB) database was queried for pitchers who had been placed on the injury list (IL) with a shoulder injury between 2015 and 2019. Injured pitchers were matched 1:1 with controls (pitchers not on the IL with a shoulder injury during the study period), based on age (±1 year), history of ulnar collateral ligament reconstruction, position (starter vs reliever), and pitches thrown during the injury season (±500). Pitch frequency, velocity, horizontal break, vertical break, total break, and spin rate for the season were collected from the Baseball Savant website for the 4-seam fastball, curveball, and slider. Univariate analysis was used to determine group differences for individual variables. Multiple logistic regression was performed to determine odds ratios (ORs) for shoulder injury associated with pitch frequency, velocity, total break, break angle, and spin rate. Covariates included age, position, ulnar collateral ligament reconstruction status, expected weighted on-base average, and total pitches thrown. Results Overall, 233 injured pitchers were evaluated. The most common reason for IL placement was inflammation (78/233; 33.5%) followed by strain or sprain (61/233; 26.2%). Increased total pitch break was associated with an increased risk of shoulder injury for the 4-seam fastball (OR, 1.340 [95% confidence interval (CI), 1.199-1.509]; P < .001) and slider (OR, 1.360 [95% CI, 1.206-1.554]; P < .001). For the slider, a decreased spin rate (OR = 0.998 [95% CI, 0.997-0.999]; P = .026) and a more vertical break angle (OR = 1.170 [95% CI: 1.073-1.278]; P = .004) were associated with increased risk of injury. Conclusion Increased pitch break of the 4-seam fastball and slider was associated positively with shoulder injury in MLB pitchers. These findings add to the understanding of throwing injury and ability to detect risk using ball-tracking technology.
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Affiliation(s)
- Brooks N Platt
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Anthony V Zacharias
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Caitlin Conley
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Lindsay Hockensmith
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Nicholas Stockwell
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Aaron Sciascia
- Department of Exercise and Sport Science, Eastern Kentucky University, Richmond, Kentucky, USA
| | - Austin V Stone
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, USA
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24
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Carsen S, Grammatopoulos G, Zaltz I, Ward L, Smit K, Beaulé PE. The Effects of Physical Activity on Physeal and Skeletal Development. JBJS Rev 2021; 9:01874474-202110000-00002. [PMID: 34637401 DOI: 10.2106/jbjs.rvw.21.00060] [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: 11/14/2022]
Abstract
» There is increasing evidence in the literature regarding the important health impact of and risk factors for injury in youth sport. » Increasing pediatric and adolescent activity intensity, such as is seen in earlier single-sport focus and specialization, may be associated with morphological changes in the growing skeleton. » Chronic subacute injury to the developing physes in the active child can lead to stress on the growth plate and surrounding tissues that induces developmental morphological changes in the joint. » There is evidence to suggest that frequent participation in sports that place particular stress across the physes of the proximal humerus, the proximal femur, and the distal radius can be associated with an increased risk of inducing developmental and morphological changes that could lead to future joint dysfunction and premature degeneration. » Additional research is necessary to better define the pathoetiology of activity-mediated morphological changes, as well as to create and validate parameters for safe involvement in competitive physical activities.
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Affiliation(s)
- Sasha Carsen
- Division of Orthopaedic Surgery, CHEO (the Children's Hospital of Eastern Ontario), Ottawa, Ontario, Canada
| | | | - Ira Zaltz
- Department of Orthopedic Surgery, Beaumont Health, Royal Oak, Michigan
| | - Leanne Ward
- Division of Endocrinology, CHEO (the Children's Hospital of Eastern Ontario), Ottawa, Ontario, Canada
| | - Kevin Smit
- Division of Orthopaedic Surgery, CHEO (the Children's Hospital of Eastern Ontario), Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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25
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Downs JL, Wasserberger KW, Barfield JW, Saper MG, Oliver GD. Increased Upper Arm Length and Loading Rate Identified as Potential Risk Factors for Injury in Youth Baseball Pitchers. Am J Sports Med 2021; 49:3088-3093. [PMID: 34319818 DOI: 10.1177/03635465211028555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the throwing elbow, increased elbow torque has been correlated with increased injury risk. Additional insight into the relationships between anthropometric factors and elbow joint loading is warranted. PURPOSE To investigate the relationship among physical limb length characteristics, elbow kinetics, and elbow kinematics in youth baseball pitchers and to examine the relationship between elbow varus loading rate and elbow kinetics. DESIGN Descriptive laboratory study. METHODS A total of 27 male youth baseball pitchers participated (mean ± SD: age, 15.8 ± 2.7 years; height, 176.3 ± 13.0 cm; weight, 71.7 ± 16.4 kg). Upper arm (UA) and forearm (FA) lengths were measured using a moveable sensor to digitize bony landmarks. Kinematic data were collected at 240 Hz using an electromagnetic tracking system. Participants threw 3 fastballs to a catcher at a regulation distance (60 ft 6 in), and the fastest velocity trial was used for analysis. Linear regression was used to determine the relationship among limb length characteristics, elbow kinetics, and elbow kinematics after accounting for the effects of body weight and height. RESULTS Pitchers with longer UA length experienced increased maximum elbow varus torque (P = .005) and maximum net elbow force (P = .001). Pitchers with an increased forearm to UA ratio had decreased elbow compression force (P < .001) and exhibited a more flexed elbow at foot contact (P = .001). Pitchers with greater maximum loading rates experienced greater elbow varus torque (P = .002). CONCLUSION In youth baseball pitchers, longer UA length and greater loading rate increase varus torque about the elbow during a fastball pitch. CLINICAL RELEVANCE Longer UA length and greater loading rate may place pitchers at risk of injury because of their relationship with kinetic values.
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Affiliation(s)
- Jessica L Downs
- Sports Medicine & Movement Lab, School of Kinesiology, Auburn University, Auburn, AL, USA
| | - Kyle W Wasserberger
- Sports Medicine & Movement Lab, School of Kinesiology, Auburn University, Auburn, AL, USA
| | - Jeff W Barfield
- Department of Physical Education & Exercise Science, Lander University, Greenwood, South Carolina, USA
| | - Michael G Saper
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Gretchen D Oliver
- Sports Medicine & Movement Lab, School of Kinesiology, Auburn University, Auburn, AL, USA
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26
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Sasaki T, Shitara H, Tajika T, Kuboi T, Ichinose T, Shimoyama D, Hamano N, Kamiyama M, Miyamoto R, Nakase K, Yamamoto A, Kobayashi T, Takagishi K, Chikuda H. Four-year trend in shoulder and elbow injuries in competitive-level high school baseball pitchers: a repeated cross-sectional survey. JSES Int 2021; 5:789-792. [PMID: 34223431 PMCID: PMC8245981 DOI: 10.1016/j.jseint.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Shoulder and elbow injuries are the main cause of throwing disability among high school baseball pitchers. However, longitudinal studies on shoulder and elbow injuries among competitive-level high school baseball pitchers have been insufficient. This study aimed to investigate shoulder and elbow injuries in competitive-level high school baseball pitchers over a four-year period and elucidate the effects of implementing medical checkups on the incidence of shoulder and elbow injuries. Methods Five hundred fifty-two high school baseball pitchers, who received preseason medical checkups from February 2012 to February 2015, were enrolled in this study. Shoulder and elbow injuries occurring during the season after medical checkups were prospectively evaluated by a postseason questionnaire. Pitchers who were not able to pitch for >7 days owing to shoulder or elbow pain were defined as having shoulder and elbow injuries during the season. The incidence rates of shoulder and elbow injuries during the seasons were calculated and compared over the 4-year period. Results Ninety-six percent of medical checkup participants were included in the study. The mean questionnaire collection rate of the prospective study was 71.6% (range: 67.7-78.9%). The incidence of shoulder and elbow injuries significantly decreased from 20.0% in 2012 to 7.7% in 2015 (P = .013). Conclusion The four-year trend in the incidence of shoulder and elbow injuries in competitive-level high school baseball pitchers was evaluated. The incidence of shoulder and elbow injuries during the season significantly decreased with a linear downward trend during the survey period after the implementation of medical checkups.
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Affiliation(s)
- Tsuyoshi Sasaki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takuro Kuboi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Daisuke Shimoyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Noritaka Hamano
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masataka Kamiyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Ryosuke Miyamoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kurumi Nakase
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Atsushi Yamamoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tsutomu Kobayashi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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27
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Post EG, Rosenthal MD, Pennock AT, Rauh MJ. The association of sport participation behaviors with throwing-arm health in Little League Baseball pitchers. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:90-95. [PMID: 37588148 PMCID: PMC10426709 DOI: 10.1016/j.xrrt.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background and Hypothesis There is increasing concern about the role sport specialization might play in the increasing injury rates observed among youth baseball pitchers. However, existing research on specialization in baseball has focused on high school and professional baseball populations. We hypothesized that pitchers who were highly specialized, reported pitching more than eight months in the past year, received private coaching, or pitched with pain or fatigue in the previous year would report worse throwing-arm health. Methods One-hundred eighty-four Little League pitchers (boys N = 181, age 9.8 ± 1.6 years old) between 7 and 12 years of age completed an anonymous, online questionnaire with their parents' assistance. The questionnaire consisted of participant demographics, sport specialization status, months of pitching per year, whether they traveled regularly to participate in showcases, if they received private coaching, whether they pitched with elbow or shoulder pain, whether they pitched with fatigue, and the Youth Throwing Score (YTS), a valid and reliable patient-reported outcome measure for youth baseball players. The associations between variables of interest and YTS were examined using multivariable linear regression, adjusting for covariates. Results Sport specialization, pitching year-round, and receiving private coaching were not associated with the YTS (P > .05). Pitching with pain in the previous year was associated with a worse YTS score than pitching without pain (least square mean [standard error]: 49.6 [1.8] vs. 57.8 [1.1], P < .001). Similarly, pitching with fatigue in the previous year was associated with worse YTS scores (least square mean [standard error]: 52.1 [1.4] vs. 55.3 [1.3], P = .01). Pitchers who reported traveling regularly for showcases scored worse on the YTS compared with those who did not travel regularly for showcase events (least square mean [standard error]: 51.0 [2.0] vs. 56.4 [0.9], P = .01). Conclusions Pitching with pain or fatigue was associated with worse throwing-arm health in Little League baseball pitchers. While traveling at least once a month to participate in showcases was also associated with worse throwing-arm health, specialization and private coaching were not related to worse throwing health. Clinicians working with pediatric patient populations should be aware that while the factors examined in this article were reported relatively infrequently, screening for Little League pitchers who participate in showcases or pitch with pain or fatigue may be an effective strategy for identifying these individuals who are at higher risk of injury.
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Affiliation(s)
- Eric G. Post
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN, USA
| | | | | | - Mitchell J. Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA, USA
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28
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Kennedy SM, Hannon JP, Conway JE, Creed K, Garrison JC. Effect of Younger Starting Pitching Age on Humeral Retrotorsion in Baseball Pitchers With an Ulnar Collateral Ligament Injury. Am J Sports Med 2021; 49:1160-1165. [PMID: 33646834 DOI: 10.1177/0363546521990808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Increased humeral retrotorsion (HRT) has been found to be a risk factor for ulnar collateral ligament (UCL) tears in baseball players. Recent work has demonstrated the age of 11 years as a potential watershed age for HRT development. HYPOTHESIS In a group of baseball pitchers with UCL injuries, athletes who started pitching before the age of 10 years will demonstrate significantly more dominant limb humeral retrotorsion (DHRT) when compared with a group of baseball pitchers who reported starting pitching at 10 years or older. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 84 baseball pitchers with a diagnosed UCL injury were divided into 2 groups based upon the age at which participants began pitching: 33 players reporting a starting pitching age of 10 years or older (group 1) were compared with 51 baseball pitchers reporting a starting pitching age under 10 years (group 2). Participants' DHRT and nondominant limb humeral retrotorsion (NDHRT) were measured using diagnostic ultrasound. Independent t tests were run to compare mean group differences of all patient data, starting pitching age, age at time of injury, DHRT, NDHRT, and humeral retrotorsion difference (HRTdiff). RESULTS There were no significant differences between groups with regard to age at time of injury, height, weight, or playing years' experience. There was a statistically significant difference in the participant-reported starting pitching age. Significant differences between groups were noted for DHRT (group 1: 20.0°± 9.4°, group 2: 14.5°± 10.3°, P = .015) and for NDHRT (group 1: 38.6°± 8.8°, group 2: 32.9°± 9.5°, P = .007). No significant differences between groups were found for HRTdiff (P = .940). CONCLUSION Baseball pitchers with a UCL injury who reported a starting pitching age younger than 10 years demonstrated significantly greater DHRT and NDHRT when compared with UCL-injured baseball pitchers who reported a starting pitching age at 10 years or later. The results of this study demonstrate that a younger starting pitching age results in increased HRT in players with UCL injuries.
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Affiliation(s)
| | | | - John E Conway
- Clear Fork Orthopaedics, P.L.L.C., Fort Worth, Texas, USA
| | - Kalyssa Creed
- Texas Health Sports Medicine, Fort Worth, Texas, USA
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29
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Post EG, Rosenthal MD, Pennock AT, Rauh MJ. Prevalence and Consequences of Sport Specialization Among Little League Baseball Players. Sports Health 2021; 13:223-229. [PMID: 33530863 DOI: 10.1177/1941738120970956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Baseball is one of the most popular boy's youth sports, and there has been a rise in the rates of certain overuse injuries among players. Specialization has been identified as a risk factor for overuse injury in high school athlete populations, but there is little understanding of the prevalence or consequences of sport specialization in Little League baseball players. HYPOTHESIS Sport specialization will be highly prevalent among Little League baseball players and specialization will be associated with worse throwing arm health. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS A total of 246 Little League baseball players (male; N = 241; age, 9.5 ± 1.6 years) between 7 and 12 years old completed an anonymous, online questionnaire with their parent's assistance. The questionnaire consisted of participant demographics and baseball participation information, including sport specialization status and the Youth Throwing Score (YTS), a valid and reliable patient-reported outcome measure for youth baseball players. RESULTS Only 29 (11.8%) players met the criteria for high specialization. Approximately one-third of all players (n = 77; 31.3%) reported participating in baseball year-round or receiving private coaching outside of their league (n = 81; 32.9%). Highly specialized athletes demonstrated worse scores on the YTS on average compared with low-specialization athletes (mean [SE]: 56.9 [1.6] vs 61.1 [1.2]; P = 0.01). Similarly, pitching in the previous year (P < 0.01) or traveling overnight regularly for showcases (P = 0.01) were associated with a worse score on the YTS. CONCLUSION While the prevalence of high sport specialization was low among Little League baseball players, other behaviors associated with specialization such as year-round play and the receiving of private coaching were more common. Highly specialized Little League players demonstrated worse throwing arm health compared with low-specialization players. CLINICAL RELEVANCE Little League players and their parents may represent a potential target audience for dissemination campaigns regarding sport specialization.
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Affiliation(s)
- Eric G Post
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, Indiana
| | - Michael D Rosenthal
- Doctor of Physical Therapy Program, San Diego State University, San Diego, California
| | | | - Mitchell J Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, California
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30
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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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31
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Matsel KA, Butler RJ, Malone TR, Hoch MC, Westgate PM, Uhl TL. Current Concepts in Arm Care Exercise Programs and Injury Risk Reduction in Adolescent Baseball Players: A Clinical Review. Sports Health 2021; 13:245-250. [PMID: 33514287 DOI: 10.1177/1941738120976384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Awareness of important injury risk factors associated with excessive pitching volume has been highlighted in the literature, but injury rates remain high. Shoulder pain in baseball players is associated with various changes in musculoskeletal movements, which presents as measurable impairments throughout the kinetic chain. Baseball coaches and rehabilitation professionals have utilized exercise programs targeting strength and flexibility of the throwing arm to prevent injuries. The purpose of this review is to summarize the current evidence regarding the effectiveness of arm care exercise programs in reducing upper extremity injury rates in adolescent baseball players. EVIDENCE ACQUISITION A search of electronic databases, including CINAHL with full text, MEDLINE, and SPORTDiscus was conducted to retrieve available articles in English from the years 2010 through 2020. The search terms injury prevention, exercise, and adolescent baseball were used. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Improving shoulder internal rotation range of motion by stretching the posterior shoulder muscles daily was associated with a 36% risk reduction of shoulder and elbow injuries. Group-based arm care exercise programs that target multiple musculoskeletal impairments demonstrated an approximately 50% reduced risk of elbow injury. CONCLUSION For adolescent baseball players, arm care injury prevention programs focusing on important musculoskeletal impairments are effective at reducing injury incidence rates. Multimodal injury prevention programs that improve multiple musculoskeletal impairments are more comprehensive and may result in better injury reduction than programs focusing on a singular impairment.
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Affiliation(s)
- Kyle A Matsel
- University of Kentucky, Lexington, Kentucky.,University of Evansville, Evansville, Indiana
| | - Robert J Butler
- Saint Louis Cardinals Baseball Organization, St Louis, Missouri
| | | | | | | | - Tim L Uhl
- University of Kentucky, Lexington, Kentucky
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32
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Winkelmann MT, Walter SS, Laver L, Zeman F, Fehske K, Achenbach L. Increased posterior shoulder capsule thickness in youth elite handball players: a sonographic investigation. J Shoulder Elbow Surg 2021; 30:194-199. [PMID: 32807372 DOI: 10.1016/j.jse.2020.04.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE Range of motion adaptations in the shoulders of overhead throwing athletes have been reported, but knowledge about the development of soft-tissue adaptations is limited. The purpose of this study was to investigate differences in posterior shoulder capsule thickness and internal rotation between the throwing and non-throwing shoulder. METHODS On the basis of the sample size calculation, we assessed 63 youth elite handball players (33 boys and 30 girls, mean age: 13.6 ± 0.9 years) for glenohumeral internal and external rotational range of motion, humeral retrotorsion, and posterior capsule thickness (PCT) with a manual goniometer and a portable ultrasound device and calculated sports-specific differences between the throwing and non-throwing shoulder as well as correlations with PCT. RESULTS Youth handball players showed side-to-side differences in internal rotation, external rotation, and humeral retrotorsion between the throwing and non-throwing shoulder. Posterior shoulder capsules were 1.21 times thicker (95% confidence interval: 1.1-1.3) in the throwing shoulder than in the non-throwing shoulder (1.3 ± 0.3 mm vs. 1.2 ± 0.2 mm, P < .0001). Loss of internal rotation did not correlate with PCT. CONCLUSIONS In youth elite handball athletes, posterior shoulder tightness and subsequent sports-specific loss of internal rotation in the throwing shoulder are not related to PCT. Thus, in this age class, other (soft-tissue) factors must be responsible for this condition.
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Affiliation(s)
- Moritz T Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Sven S Walter
- Department for Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany.
| | - Lior Laver
- Department for Othopedics, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Florian Zeman
- Department for Clinical Studies, Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany
| | - Kai Fehske
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Leonard Achenbach
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
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Radel LC, Kobelski GP, O'Brien MJ, Meehan WP, Sugimoto D. Youth American football quarterback injuries: a descriptive study of 15 years of retrospective data. PHYSICIAN SPORTSMED 2020; 48:463-468. [PMID: 32228392 DOI: 10.1080/00913847.2020.1749907] [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: 10/24/2022]
Abstract
Objectives: To describe common injuries of youth American football quarterbacks (QBs) cared for in a regional sports medicine center within the last 15 years. Methods: A retrospective chart review of all male youth American football QB patients who sustained sports-related injuries at a regional pediatric medical center between 01/01/2003 and 10/01/2018. Patients were identified using HoundDog to search the term 'quarterback.' Records were then reviewed to identify all male QBs ≤ 18 years of age. Injures that were not a result of football participation were excluded. Main outcome variables were injured anatomic locations, injury types, surgical status, and settings in which the injury was sustained. Descriptive statistics were used to analyze the outcome variables. Results: A total of 374 QBs (mean age: 14.6 ± 2.1) sustained a total of 423 injuries. The top 5 injured anatomic locations were shoulder (22%), knee (15%) head/neck (14%), elbow (13%), and wrist/hand/lower arm (11%). Most injuries (64.3%) were acute; 35.7% were chronic in nature. Most acute injuries (55.5%) occurred during games. Of the chronic injuries, 47.0% occurred during off-season and 34.4% occurred in-season. Among all injuries, 22.9% were surgical cases, and the top 3 anatomic locations of surgery were knee (35.0%), shoulder (20.7%), and elbow (18.7%). Conclusions: The shoulder is the most commonly injured body part among young QBs seeking care in a regional pediatric medical center, although the knee is the most commonly injured body part that requires surgery. Most QB injuries are acute in mechanism and the majority of these acute injuries occur during games.
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Affiliation(s)
- Luke C Radel
- Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic , Rochester, MN, USA
| | - Greggory P Kobelski
- The Micheli Center for Sports Injury Prevention , Waltham, MA, USA.,Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital , Boston, MA, USA
| | - Michael J O'Brien
- The Micheli Center for Sports Injury Prevention , Waltham, MA, USA.,Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital , Boston, MA, USA.,Department of Orthopaedic Surgery, Harvard Medical School , Boston, MA, USA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention , Waltham, MA, USA.,Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital , Boston, MA, USA.,Department of Orthopaedic Surgery, Harvard Medical School , Boston, MA, USA
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention , Waltham, MA, USA.,Faculty of Sports Sciences, Waseda University , Tokyo, Japan
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Sasanuma H, Iijima Y, Saito T, Yano Y, Nakama S, Kameda M, Takeshita K. Satisfaction With Elbow Function and Return Status After Autologous Osteochondral Transplant for Capitellar Osteochondritis Dissecans in High School Baseball Players. Am J Sports Med 2020; 48:3057-3065. [PMID: 32941055 DOI: 10.1177/0363546520952782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondral autograft transplant (OAT), a surgical treatment for capitellar osteochondritis dissecans (OCD), has favorable rates of elbow recovery and return to sports in adolescents. However, few reports have investigated how long patients continue to play baseball after OAT and their satisfaction with their treatment outcome. PURPOSE To evaluate the rate of boys who played baseball and received OAT for OCD in junior high school or earlier (age <15 years) and continued to play baseball in high school and the players' satisfaction with their elbow function during play. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 32 elbows of boys who played baseball and received OAT at age ≤15 years (mean, 14.1 years) were examined and divided into pitcher (n = 11) and nonpitcher (n = 21) groups according to their player position before surgery. The clinical Timmerman-Andrews score at the end of their high school baseball, participation percentage of players who continued to play baseball, and satisfaction level during play (on a scale of 0-10 during pitching and batting and in a 4-choice format) were compared between the 2 groups. RESULTS The Timmerman-Andrews scores significantly improved after surgery in both groups, with no significant difference between the groups. Of the 32 players, 30 (93.8%) continued to play baseball throughout high school, including all players in the pitcher group and 19 (90.5%) of those in the nonpitcher group. The percentage of players who continued to pitch was 55.6% (6/11) in the pitcher group. Satisfaction with elbow joint function at the time of pitching was significantly lower in the pitcher group. Further, 5 players reported being "a little unsatisfied" because of elbow pain during pitching. All of the players indicated satisfaction with elbow function during batting. CONCLUSION The percentage of players who received OAT for OCD in junior high school and continued to play baseball in high school was favorable. However, satisfaction with elbow function during throwing was lower in pitchers than in nonpitchers. CLINICAL RELEVANCE Before surgery, consent should be obtained from patients who are pitchers after it is explained that satisfaction with elbow joint function during pitching could be decreased after OAT.
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Affiliation(s)
- Hideyuki Sasanuma
- Tochigi Medical Center Shimotsuga, Department of Orthopaedics, Tochigi, Japan
| | - Yuki Iijima
- Jichi Medical University Hospital, Department of Orthopaedics, Tochigi, Japan
| | - Tomohiro Saito
- Jichi Medical University Hospital, Department of Orthopaedics, Tochigi, Japan
| | - Yuichiro Yano
- Tochigi Medical Center Shimotsuga, Department of Orthopaedics, Tochigi, Japan
| | - Sueo Nakama
- Tochigi Medical Center Shimotsuga, Department of Orthopaedics, Tochigi, Japan
| | | | - Katsushi Takeshita
- Jichi Medical University Hospital, Department of Orthopaedics, Tochigi, Japan
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Sport specialization is associated with upper-extremity overuse injury in high school baseball players. J Shoulder Elbow Surg 2020; 29:1775-1782. [PMID: 32381476 DOI: 10.1016/j.jse.2020.01.092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Sport specialization is increasingly common in youth sports and is a risk factor for lower-extremity overuse injuries. However, limited data exist on whether specialization is associated with upper-extremity (UE) overuse injuries, specifically in youth baseball players. We hypothesized that specialization in baseball and being a pitcher would be associated with poorer arm health and UE overuse injury history in the previous year. METHODS During the 2019 spring baseball season, 551 high school baseball athletes (aged 15.9 ± 1.3 years) from 3 states (Alabama, n = 200; California, n = 188; and Michigan, n = 163) completed an anonymous questionnaire. Athletes were recruited from 5 high schools in each state, with schools matched based on factors that influence specialization rates. The questionnaire consisted of (1) demographic characteristics, (2) baseball participation information (including sport specialization status), and (3) throwing-arm health and UE injury history in the previous 12 months. Throwing-arm health was assessed using the Youth Throwing Score (YTS), a validated and reliable outcome measure for youth baseball players. Multivariate regression analyses were used to examine the association between variables of interest and the YTS or UE overuse injury history, adjusting for covariates. RESULTS After adjustment for covariates, highly specialized athletes were more likely to report a UE overuse injury in the previous year compared with low-specialization athletes (odds ratio [OR], 3.77; 95% confidence interval [CI], 1.39-10.2, P = .009). Both athletes who reported playing baseball for more than 8 months per year (OR, 2.03; 95% CI, 1.12-3.65; P = .019) and athletes who reported being a pitcher (OR, 2.11; 95% CI, 1.20-3.72; P = .010) were more likely to report a history of UE overuse injury. Highly specialized players reported lower (worse) YTS values compared with low-specialization players (least-squares mean estimate ± standard error, 56.5 ± 1.1 vs. 53.3 ± 0.7; P = .034). Players who reported pitching as one of their positions scored worse on the YTS than non-pitchers (least-squares mean estimate ± standard error, 51.6 ± 0.8 vs. 57.2 ± 0.6; P < .001). CONCLUSION Although baseball recommendations that discourage sport specialization are widely available for parents, athletes, and coaches, high rates of sport specialization were reported in our sample. We found that being highly specialized in baseball was associated with UE overuse injury history and worse throwing-arm health in high school baseball athletes. Continued education for baseball parents, athletes, and coaches is necessary to raise awareness of the risks associated with high specialization.
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Holshouser C, Jayaseelan DJ. Multifaceted Exercise Prescription in the Management of an Overhead Athlete with Suspected Distal Biceps Tendinopathy: A Case Report. J Funct Morphol Kinesiol 2020; 5:E56. [PMID: 33467271 PMCID: PMC7739288 DOI: 10.3390/jfmk5030056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND PURPOSE Distal biceps brachii tendinopathy is an uncommon diagnosis. Various exercise prescriptions have demonstrated efficacy in the management of tendinopathy, although studies frequently focus on the effects of a specific type of muscular contraction (i.e., concentric, isometric, or eccentric). Currently, there is limited research guiding the conservative management of distal biceps tendinopathy, particularly with overhead athletes, and even less evidence reporting a multifaceted exercise prescription for individuals with tendinopathy. The purpose of this case report is to describe the integration of various modes of therapeutic exercise into a rehabilitation program for an overhead athlete with suspected distal biceps brachii tendinopathy. CASE DESCRIPTION A 19-year-old male collegiate baseball pitcher presented to an outpatient physical therapy clinic via direct access for left antecubital pain, which began 6 weeks prior to the evaluation while pitching during try-outs. Following physical examination, distal biceps tendinopathy was the likely clinical diagnosis. Interventions focused on early eccentric exercise eventually progressing to concentric and plyometric activity for return to sport. OUTCOMES The patient was seen five times over the course of 4 weeks. He had significant improvements of pain, patient-reported functional outcomes, global rating of change, strength, tenderness, and provocation testing. The patient was able to return to an off-season pitching program. DISCUSSION An impairment-based and task-specific exercise prescription was effective for this patient with distal biceps tendinopathy. Understanding the biomechanical demands of an individual's functional limitation, in this case baseball pitching, may assist the decision-making process and optimize outcomes. Additional research into the most effective exercise prescriptions for individuals with uncommon tendinopathies is warranted.
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Affiliation(s)
| | - Dhinu J. Jayaseelan
- Department of Health Human Function and Rehabilitation Sciences, The George Washington University, Washington, DC 20006, USA;
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Cools AM, Maenhout AG, Vanderstukken F, Declève P, Johansson FR, Borms D. The challenge of the sporting shoulder: From injury prevention through sport-specific rehabilitation toward return to play. Ann Phys Rehabil Med 2020; 64:101384. [PMID: 32320753 DOI: 10.1016/j.rehab.2020.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 12/26/2022]
Abstract
Shoulder injuries and sports-related shoulder pain are substantial burdens for athletes performing a shoulder loading sport. The burden of shoulder problems in the athletic population highlights the need for prevention strategies, effective rehabilitation programs, and a individually based return-to-play (RTP) decision. The purpose of this clinical commentary is to discuss each of these 3 challenges in the sporting shoulder, to assist the professional in: (1) preventing injury; (2) providing evidence-based practice rehabilitation and; (3) to guide the athlete toward RTP. The challenges for injury prevention may be found in the search for (the interaction between) relevant risk factors, develop valid screening tests, and implement feasible injury prevention programmes with maximal adherence from the athletes. Combined analytical and functional testing seems mandatory screening an athlete's performance. Many questions arise when rehabilitating the overhead athlete, from exercise selection, over the value of stretching, toward kinetic chain implementation and progression to high performance training. Evidence-based practice should be driven by the available research, clinical expertise and the patient's expectations. Deciding when to return to sport after a shoulder injury is complex and multifactorial. The main concern in the RTP decision is to minimize the risk of re-injury. In the absence of a "gold standard", clinicians may rely on general guidelines, based on expert opinion, regarding cutoff values for normal range of motion, strength and function, with attention to risk tolerance and load management.
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Affiliation(s)
- Ann M Cools
- Dept. of Rehabilitation Sciences, Faculty of Health Sciences, Campus UZ Gent, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000 Gent, Belgium; Dept. of Occupational and Physical Therapy and Institute of Sports Medicine, University of Copenhagen, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, Denmark.
| | - Annelies G Maenhout
- Dept. of Rehabilitation Sciences, Faculty of Health Sciences, Campus UZ Gent, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000 Gent, Belgium
| | - Fran Vanderstukken
- Dept. of Rehabilitation Sciences, Faculty of Health Sciences, Campus UZ Gent, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000 Gent, Belgium
| | - Philippe Declève
- Dept. of Rehabilitation Sciences, Faculty of Health Sciences, Campus UZ Gent, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000 Gent, Belgium; Dept. of Physical Therapy, Institut Parnasse-ISEI, Avenue Mounier 84, 1200 Brussels, Belgium
| | - Fredrik R Johansson
- Sophiahemmet University, Musculoskeletal & Sports Injury Epidemiology Center, Box 5605, 114 86 Stockholm, Sweden
| | - Dorien Borms
- Dept. of Rehabilitation Sciences, Faculty of Health Sciences, Campus UZ Gent, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000 Gent, Belgium
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Injuries and associated risk factors of the shoulder and elbow among adolescent baseball pitchers: A systematic review and meta-analysis. Phys Ther Sport 2020; 43:108-119. [PMID: 32143085 DOI: 10.1016/j.ptsp.2020.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/21/2020] [Accepted: 02/24/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The purpose of this study was to perform a systematic review and meta-analysis of the current literature surrounding risk factors associated with shoulder and elbow injuries among adolescent baseball pitchers. METHODS Relevant studies were assessed for inclusion and retained from PubMed, EMBASE, SportDiscus, and CINAHL databases. Data was extracted from the retained studies and underwent methodological quality assessment and meta-analysis. RESULTS The search resulted in 1238 studies identified with 10 ultimately retained for systematic review. Five studies including one case-control, two prospective cohort, and two cross-sectional studies met inclusion criteria for meta-analysis. This meta-analysis revealed that playing with arm fatigue was a significant risk factor (pooled odds ratio = 13.32, 95% confidence interval: 3.22-55.09). The other three risk factors (long competitive season, pitching for more than one team or league, and playing catcher as a secondary position) were not statistically significant. CONCLUSION Pitching with arm fatigue is a significant risk factor for shoulder and elbow injuries among adolescent baseball pitchers. Future efforts in assessment and mitigation of pitching with arm fatigue among this population may help to reduce the risk of arm injuries. Furthermore, investigations of additional risk factors in a more homogeneous population of adolescent pitchers may be warranted.
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Preseason Clinical Shoulder Test Results and Shoulder Injury Rate in Adolescent Elite Handball Players: A Prospective Study. J Orthop Sports Phys Ther 2020; 50:67-74. [PMID: 31775554 DOI: 10.2519/jospt.2020.9044] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate whether adolescent elite female and male handball players with shoulder muscle weakness, deficits in shoulder rotation range of motion (ROM) or in joint position sense (JPS), or scapular dyskinesis in the preseason had a higher rate of new shoulder injuries compared to players without these characteristics. DESIGN Prospective cohort study. METHODS We studied 344 uninjured players (452 player-seasons, 50% female). We measured their shoulder strength in isometric external rotation (IER), isometric internal rotation (IIR), isometric abduction, and eccentric external rotation, as well as their shoulder ROM, JPS, and scapular dyskinesis, during the preseason. Players were monitored weekly regarding match and training hours and shoulder injuries during 1 or 2 seasons. We used multivariable Cox proportional hazard models to calculate hazard rate ratios related to the first injury and 95% confidence intervals (CIs). RESULTS During 2 seasons, the participants reported 48 new shoulder injuries. In female players, the hazard rate ratio was 2.37 (95% CI: 1.03, 5.44) for IER weakness and 2.44 (95% CI: 1.06, 5.61) for IIR weakness. The hazard rate ratio was 0.85 (95% CI: 0.39, 1.83) for an IER/IIR ratio of less than 0.75 and 1.53 (95% CI: 0.36, 6.52) for scapular dyskinesis. In male players, the hazard rate ratio was 1.02 (95% CI: 0.44, 2.36) for IER weakness, 0.74 (95% CI: 0.31, 1.75) for IIR weakness, 2.0 (95% CI: 0.68, 5.92) for an IER/IIR ratio of less than 0.75, and 3.43 (95% CI: 1.49, 7.92) for scapular dyskinesis. There were no associations between new shoulder injuries and deficits in ROM or JPS. CONCLUSION In adolescent elite handball, male players with preseason scapular dyskinesis and female players with preseason IIR or IER shoulder weakness had an increased shoulder injury rate. J Orthop Sports Phys Ther 2020;50(2):67-74. Epub 27 Nov 2019. doi:10.2519/jospt.2020.9044.
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Zaremski JL, Zeppieri G, Tripp BL. Sport Specialization and Overuse Injuries in Adolescent Throwing Athletes: A Narrative Review. J Athl Train 2020; 54:1030-1039. [PMID: 31633409 DOI: 10.4085/1062-6050-333-18] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A significant number of adolescent athletes throughout the world participate in various throwing-dominant sports, including but not limited to baseball, cricket, handball, softball, track and field throwing events, and water polo. Due to the unique stresses placed on the throwing arm and entire body in these sports, a robust volume of literature has highlighted concerns about sport specialization in these athletes and an associated increased risk of injury, particularly to the dominant shoulder and elbow, with sport specialization. This review will highlight the evidence-based literature for this athletic niche, focusing on risk factors for injury, national and international organizations' recommendations for limiting overuse injuries, principles of conditioning and rehabilitative programs, and potential future areas of research to curb the growing incidence of throwing-related injuries among adolescent throwing athletes.
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Affiliation(s)
- Jason L Zaremski
- Department of Orthopaedics and Rehabilitation, Divisions of Physical Medicine and Rehabilitation, Sports Medicine, & Research, College of Health and Human Performance, University of Florida, Gainesville
| | - Giorgio Zeppieri
- Orthopaedics and Sports Medicine Institute, Physical Therapy, College of Health and Human Performance, University of Florida, Gainesville
| | - Brady L Tripp
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville
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Pozzi F, Plummer HA, Shanley E, Thigpen CA, Bauer C, Wilson ML, Michener LA. Preseason shoulder range of motion screening and in-season risk of shoulder and elbow injuries in overhead athletes: systematic review and meta-analysis. Br J Sports Med 2020; 54:1019-1027. [PMID: 31937577 PMCID: PMC7456673 DOI: 10.1136/bjsports-2019-100698] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2019] [Indexed: 11/18/2022]
Abstract
Objective To characterise whether preseason screening of shoulder range of motion (ROM) is associated with the risk of shoulder and elbow injuries in overhead athletes. Design Systematic review and meta-analysis. Data sources Six electronic databases up to 22 September 2018. Eligibility criteria Inclusion criteria were (1) overhead athletes from Olympic or college sports, (2) preseason measures of shoulder ROM, (3) tracked in-season injuries at the shoulder and elbow, and (4) prospective cohort design. Exclusion criteria were (1) included contact injuries, (2) lower extremity, spine and hand injuries, and (3) full report not published in English. Results Fifteen studies were identified, and they included 3314 overhead athletes (baseball (74.6%), softball (3.1%), handball (16.1%), tennis (2.0%), volleyball (2.0%) and swimming (2.2%)). Female athletes are unrepresented (12% of the overall sample). Study quality ranged from 11 to 18 points on a modified Downs and Black checklist (maximum score 21, better quality). In one study, swimmers with low (<93°) or high (>100°) shoulder external rotation were at higher risk of injuries. Using data pooled from three studies of professional baseball pitchers, we showed in the meta-analysis that shoulder external rotation insufficiency (throwing arm <5° greater than the non-throwing arm) was associated with injury (odds ratio=1.90, 95% confidence interval 1.24 to 2.92, p<0.01). Conclusion Preseason screening of shoulder external rotation ROM may identify professional baseball pitchers and swimmers at risk of injury. Shoulder ROM screening may not be effective to identify handball, softball, volleyball and tennis players at risk of injuries. The results of this systematic review and meta-analysis should be interpreted with caution due to the limited number of studies and their high degree of heterogeneity. PROSPERO registration number CRD42017072895.
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Affiliation(s)
- Federico Pozzi
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA .,Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | | | - Ellen Shanley
- ATI Physical Therapy, Greenville, South Carolina, USA
| | | | - Chase Bauer
- Western University of Health Sciences, Pomona, California, USA
| | - Melissa L Wilson
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
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Post EG, Rosenthal MD, Rauh MJ. Attitudes and Beliefs towards Sport Specialization, College Scholarships, and Financial Investment among High School Baseball Parents. Sports (Basel) 2019; 7:sports7120247. [PMID: 31835455 PMCID: PMC6955882 DOI: 10.3390/sports7120247] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 12/05/2022] Open
Abstract
Adolescent athletes are increasingly encouraged to specialize in a single sport year-round in an effort to receive a college scholarship. For collegiate baseball, only 11.7 scholarships are available for a 35-player team. The beliefs of the parents of baseball athletes towards sport specialization are unknown, along with whether they have an accurate understanding of college baseball scholarship availability. The parents of high school baseball athletes were recruited to complete an anonymous questionnaire that consisted of (1) parent and child demographics, (2) child baseball participation information, and (3) parent attitudes and beliefs regarding sport specialization and college baseball scholarships. One hundred and fifty-five parents participated in the questionnaire (female: 52.9%, age: 49.4 ± 5.5 years old). The parents spent a median of 3000 USD [Interquartile Range (IQR): 1500–6000] on their child’s baseball participation. Most parents believed that specialization increased their child’s chances of getting better at baseball (N = 121, 79.6%). The parents underestimated the number of college baseball scholarships available per team (median [IQR]: 5 [0–5]), but 55 parents (35.9%) believed it was likely that their child would receive a college baseball scholarship. Despite having a realistic understanding of the limited college scholarships available, the parents were optimistic that their child would receive a baseball scholarship.
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Achenbach L, Clément AC, Hufsky L, Greiner S, Zeman F, Walter SS. The throwing shoulder in youth elite handball: soft-tissue adaptations but not humeral retrotorsion differ between the two sexes. Knee Surg Sports Traumatol Arthrosc 2019; 27:3937-3943. [PMID: 31243504 DOI: 10.1007/s00167-019-05578-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/17/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE In youth handball players, knowledge about the development of soft-tissue adaptation and humeral retrotorsion is limited. The purpose of this study was to investigate differences in adaptations in the glenohumeral rotational range of motion and humeral retrotorsion of the throwing arm between male and female youth elite handball players. METHODS One-hundred and thirty-eight youth elite handball players (mean age: 14.1 ± 0.7 years) were assessed for glenohumeral external (ER) and internal (IR) rotational ranges of motion and humeral retrotorsion (HRT) by means of a manual goniometer and a portable ultrasound device. Sports-specific adaptations between the dominant and non-dominant shoulders and between male and female adolescents were calculated. RESULTS Handball players showed side-to-side differences in IR and ER in the throwing shoulder. HRT did not correlate with the measurements of rotational ROM of the throwing arm. Male athletes showed a more pronounced glenohumeral internal rotation deficit than female athletes (13.1° ± 22.8° vs. 5.1° ± 14.0°, p = 0.014). Adaptations in HRT but no sex differences could be seen in the throwing shoulder (16.5° ± 9.6°) compared to the non-throwing shoulder (13.5° ± 9.4°, p < 0.001). CONCLUSION Loss of internal rotation and gain in external rotation in youth handball players seem to be more related to adaptive changes in the soft-tissues than to HRT. Male athletes showed stronger throwing-related adaptations in the rotational range of motion but not in humeral torsion in their dominant shoulder than female athletes. LEVEL OF EVIDENCE Cross-sectional study, Level II.
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Affiliation(s)
- Leonard Achenbach
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany.
| | | | | | - Stefan Greiner
- Sporthopaedicum Regensburg-Straubing, Regensburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany
| | - Sven Stephan Walter
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
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Post EG, Biese KM, Schaefer DA, Watson AM, McGuine TA, Brooks MA, Bell DR. Sport-Specific Associations of Specialization and Sex With Overuse Injury in Youth Athletes. Sports Health 2019; 12:36-42. [PMID: 31724908 DOI: 10.1177/1941738119886855] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Significant evidence has emerged that sport specialization is associated with an increased risk of overuse injury in youth athletes. Several recommendations exist to reduce the risk of overuse injury in youth sports, but the risk of overuse injuries may be dependent on specific movements required by a given sport. HYPOTHESES Associations between specialized sport participation and overuse injury will exist in volleyball athletes but not soccer or basketball athletes. Female athletes will be more likely to report an overuse injury in the previous year, regardless of sport. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS Youth athletes between the ages of 12 and 18 years were recruited in-person at club team tournaments, competitions, and events around the state of Wisconsin during the 2016-2017 school year. Participants were asked to complete an anonymous questionnaire that consisted of (1) participant demographics, (2) sport specialization status, (3) monthly and weekly sport volume, and (4) sport-related injury history in the previous year. RESULTS A total of 716 youth athletes completed the questionnaire (70.8% female; mean age, 14.21 ± 1.50 years; 43.2% basketball, 19.4% soccer, 37.4% volleyball; 41.8% highly specialized; 32.3% reported overuse injury in the previous year). Sex was associated with overuse injury among basketball athletes, with female basketball athletes nearly 4 times more likely to report an overuse injury compared with male basketball athletes (odds ratio, [OR], 3.7; 95% CI, 2.1-6.6; P < 0.001). High specialization (OR, 2.3; 95% CI, 1.1-4.9; P = 0.02) and participating in a single sport for more than 8 months per year (OR, 2.0; 95% CI, 1.1-3.5; P < 0.05) were associated with overuse injury only among volleyball athletes. CONCLUSION Specialization and exceeding 8 months per year in a single sport was associated with overuse injury in volleyball, which is one of the most popular youth sports for female athletes. Specialization was not associated with overuse injury in basketball or soccer athletes. Female basketball athletes were nearly 4 times more likely to report a history of overuse injury compared with male basketball athletes. The sex of a youth athlete and the sport that he or she plays may influence the risk of overuse injury associated with sport specialization. CLINICAL RELEVANCE Youth athletes, parents, and clinicians should be aware that the potential risks of specialization might vary based on the athlete's sport and sex.
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Affiliation(s)
- Eric G Post
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California
| | - Kevin M Biese
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Daniel A Schaefer
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Andrew M Watson
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
| | - Timothy A McGuine
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
| | - M Alison Brooks
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
| | - David R Bell
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
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Barfield JW, Oliver GD. Sport Specialization and Single-Legged-Squat Performance Among Youth Baseball and Softball Athletes. J Athl Train 2019; 54:1067-1073. [PMID: 31633412 DOI: 10.4085/1062-6050-356-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Previous research has indicated that throwing sports expose athletes to overuse injuries and that specialization in sport is linked to injury. However, the effect of overexposure to a throwing sport on a dynamic movement task is unknown. OBJECTIVE To determine if sport specialization in youth throwing athletes affected performance on the single-legged squat (SLS). DESIGN Descriptive laboratory study. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 49 youth baseball and softball athletes (23 baseball, 26 softball; age = 12.96 ± 2.32 years, height = 165.01 ± 13.05 cm, mass = 61.42 ± 13.04 kg) were recruited. MAIN OUTCOME MEASURE(S) Participants were grouped into 3 categories based on specialization definitions: (1) 8 months or longer in season, (2) 8 months or longer in training, or (3) 8 months or longer in season and previously quit another sport. We measured SLS kinematics and used a set of 1-way multivariate analyses of variances to determine if trunk kinematics differed by group. RESULTS Athletes who spent 8 months or more in sport-specific training exhibited significantly more trunk control, revealed by less trunk lateral flexion (Λ = 0.69, F6,38 = 2.89, P = .020) and less trunk flexion (Λ = 0.69, F6,38 = 2.88, P = .021) throughout an SLS. CONCLUSIONS These results agree with the principle of specific adaptation to imposed demands. Surprisingly, athletes who spent 8 months or more playing a unilateral sport showed no differences in SLS performance. Clinicians should emphasize that neuromuscular adaptations of the lumbopelvic-hip complex for dynamic movement, such as an SLS, may be achieved through training instead of strict sport participation. Future researchers should consider how much of the training protocol is actually specialized for sport training.
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Affiliation(s)
- Jeff W Barfield
- Sports Medicine & Movement Laboratory, School of Kinesiology, Auburn University, AL
| | - Gretchen D Oliver
- Sports Medicine & Movement Laboratory, School of Kinesiology, Auburn University, AL
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Nguyen JC, Lin B, Potter HG. Maturation-dependent findings in the shoulders of pediatric baseball players on magnetic resonance imaging. Skeletal Radiol 2019; 48:1087-1094. [PMID: 30607454 DOI: 10.1007/s00256-018-3130-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/15/2018] [Accepted: 12/03/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the prevalence and characteristics of shoulder osseous and soft tissue findings on magnetic resonance imaging (MRI) with respect to skeletal maturation in symptomatic pediatric baseball players without a history of acute trauma. METHODS The IRB-approved, HIPAA-compliant retrospective study analyzed 87 consecutive pediatric baseball players (86 boys and 1 girl; mean age, 15.4 ± 2.1 years) with shoulder MRI performed between March 1, 2012 and September 30, 2017. In consensus, two radiologists assessed the MRI studies for findings involving the humerus, the glenoid, the labrum, the rotator cuff, and the acromioclavicular joint. Exact Cochran-Armitage trend and Mantel-Haenszel Chi-square tests were used to investigate the association between these findings and skeletal maturation. RESULTS The mean ages between players who are skeletally immature (37 shoulders), maturing (26 shoulders), and matured (24 shoulders) were significantly different (p < 0.001). Bone marrow edema (p < 0.001) and sclerosis (p < 0.001) within the proximal humeral metaphysis decreased with skeletal maturation. Glenoid remodeling (p = 0.038) was more severe in the skeletally immature players and the prevalence of Bennett lesions (p = 0.048) increased with skeletal maturation. The prevalence of labral tears, rotator cuff tendinosis, and acromioclavicular joint separation did not significantly change with skeletal maturation. CONCLUSIONS The change in the prevalence of findings within the proximal humerus and glenoid with skeletal maturation suggest differences in the distribution of stress within the shoulders of pediatric baseball players during development.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Bin Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th street, New York, NY, 10021, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th street, New York, NY, 10021, USA
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Kraan RBJ, Nobel D, Eygendaal D, Daams JG, Kuijer PPFM, Maas M. Incidence, prevalence, and risk factors for elbow and shoulder overuse injuries in youth athletes: A systematic review. TRANSLATIONAL SPORTS MEDICINE 2019. [DOI: 10.1002/tsm2.82] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Rik B. J. Kraan
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres, Amsterdam Movement Sciences University of Amsterdam Amsterdam the Netherlands
- Academic Centre for Evidence based Sports medicine (ACES) Amsterdam the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS) International Olympic Committee (IOC) Research Centre Amsterdam University Medical Centres Amsterdam the Netherlands
| | - Daniëlle Nobel
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres, Amsterdam Movement Sciences University of Amsterdam Amsterdam the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery Amsterdam University Medical Centres Amsterdam the Netherlands
- Department of Orthopaedic Surgery Amphia Hospital Breda the Netherlands
| | - Joost G. Daams
- Medical Library, Amsterdam University Medical Centres University of Amsterdam Amsterdam the Netherlands
| | - Peter Paul F. M. Kuijer
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres University of Amsterdam Amsterdam the Netherlands
| | - Mario Maas
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centres, Amsterdam Movement Sciences University of Amsterdam Amsterdam the Netherlands
- Academic Centre for Evidence based Sports medicine (ACES) Amsterdam the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS) International Olympic Committee (IOC) Research Centre Amsterdam University Medical Centres Amsterdam the Netherlands
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Garner S, Wicke J, Legreaux S, Chianchiano B. Effects of deceleration-focused exercise strategies on shoulder range of motion and throwing velocity in baseball and softball athletes. Sports Biomech 2019; 20:86-95. [PMID: 30702384 DOI: 10.1080/14763141.2018.1556325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study examined the effects of deceleration-focused exercises on shoulder range of motion and throwing velocity in both softball and baseball players. Volunteers included 28 Division III William Paterson University baseball and softball athletes (18 females and 10 males), who were evenly distributed across two groups both undertaking 14 sessions of either resistance band or handheld medicine ball exercises (band vs. ball group). A pre-test and post-test measured participants' best active internal/external shoulder rotation and best throwing velocity at a target 40 ft away. A two-tailed, independent t-test showed no significant differences in velocity, internal rotation or external rotation (p < 0.01) between the band and ball groups. However, the average change in velocity in the ball group was double that of the band group (1.50 ± 2.06 m/s versus 0.73 ± 2.24 m/s). For change in both internal and external rotation the band group (2.86 ± 5.27° and 3.29 ± 3.87°, respectively) was greater than the ball mean (1.93° ± 3.32° and 1.29 ± 6.52°, respectively). These findings suggest that overhead athletes aiming to increase throwing velocity can benefit from performing deceleration training with weighted balls whereas resistance bands appear to improve shoulder rotation.
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Affiliation(s)
- Sara Garner
- Department of Kinesiology, William Paterson University , Wayne, NJ, USA
| | - Jason Wicke
- Department of Kinesiology, William Paterson University , Wayne, NJ, USA
| | - Samantha Legreaux
- Department of Kinesiology, William Paterson University , Wayne, NJ, USA
| | - Ben Chianchiano
- Department of Kinesiology, William Paterson University , Wayne, NJ, USA
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