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Manzi JE, Nicholson A, Dowling B, Black GG, Krichevsky S, Quan T, Moran J, Kunze KN, Dines JS. Relationships between throwing mechanics and shoulder anterior force in high school and professional baseball pitchers. Shoulder Elbow 2024; 16:17-23. [PMID: 38425734 PMCID: PMC10901177 DOI: 10.1177/17585732221098721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 03/02/2024]
Abstract
Background Excessive shoulder anterior force has been implicated in pathology of the rotator cuff in little league and professional baseball pitchers; in particular, anterior laxity, posterior stiffness, and glenohumeral joint impingement. Distinctly characterized motions associated with excessive shoulder anterior force remain poorly understood. Methods High school and professional pitchers were instructed to throw fastballs while being evaluated with 3D motion capture (480 Hz). A supplementary random forest model was designed and implemented to identify the most important features for regressing to shoulder anterior force, with subsequent standardized regression coefficients to quantify directionality. Results 130 high school pitchers (16.3 ± 1.2 yrs; 179.9 ± 7.7 cm; 74.5 ± 12.0 kg) and 322 professionals (21.9 ± 2.1 yrs; 189.7 ± 5.7 cm; 94.8 ± 9.5 kg) were included. Random forest models determined nearly all the variance for professional pitchers (R2 = 0.96), and less than half for high school pitchers (R2 = 0.41). Important predictors of shoulder anterior force in high school pitchers included: trunk flexion at maximum shoulder external rotation (MER) (X.IncMSE = 2.4, β = -0.23, p < 0.001), shoulder external rotation at ball release (BR)(X.IncMSE = 1.7, β = -0.34, p < 0.001), and shoulder abduction at BR (X.IncMSE = 3.1, β = 0.17, p < 0.001). In professional pitchers, shoulder horizontal adduction at foot contact (FC) was the highest predictor (X.IncMSE = 13.9, β = 0.50, p < 0.001), followed by shoulder external rotation at FC (X.IncMSE = 3.6, β = 0.26, p < 0.001), and maximum elbow extension velocity (X.IncMSE = 8.5, β = 0.19, p < 0.001). Conclusion A random forest model successfully selected a subset of features that accounted for the majority of variance in shoulder anterior force for professional pitchers; however, less than half of the variance was accounted for in high school pitchers. Temporal and kinematic movements at the shoulder were prominent predictors of shoulder anterior force for both groups. Clinical relevance : Our statistical model successfully identified a combination of features with the ability to adequately explain the majority of variance in anterior shoulder force among high school and professional pitchers. To minimize shoulder anterior force, high school pitchers should emphasize decreased shoulder abduction at BR, while professionals can decrease shoulder horizontal adduction at FC.
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Affiliation(s)
| | - Allen Nicholson
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Brittany Dowling
- Sports Performance Center, Midwest Orthopaedics at Rush, Oak Brook, IL, USA
| | | | - Spencer Krichevsky
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Theodore Quan
- George Washington University School of Medicine, Washington, DC, USA
| | - Jay Moran
- Yale School of Medicine, New Haven, CT, USA
| | - Kyle N Kunze
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Joshua S Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
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Lu Y, Chen P, Chou WY, Yang CP, Sheu H, Tang HC, Weng CJ, Chiu JCH. Relationship between shoulder and elbow range of motion and ultrasonographic structural abnormalities in the elbow of Taiwanese high school baseball players. BMC Sports Sci Med Rehabil 2024; 16:44. [PMID: 38347601 PMCID: PMC10860268 DOI: 10.1186/s13102-024-00839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/04/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Ultrasonographic structural abnormalities are regarded as one of the risk factors of elbow injuries. Elbow injuries are commonly associated with decreased shoulder/elbow range of motion (ROM). The purpose of this study is to determine the relationship between shoulder/elbow ROM and elbow ultrasonographic structural abnormalities in Taiwan high school baseball players. METHODS A total of 533 Taiwan high school baseball players were enrolled. Physical examinations including measurements on shoulder/elbow ROM and elbow sonographic examinations were performed and recorded by professional physicians. The analyses were conducted in three subgroups according to their defensive position because the training programs were different. All players pooled, pitchers-only, and fielders-only, due to several demographic differences among these subgroups. In all the subgroups, univariate analyses were conducted separately for participants with and those without elbow ultrasonographic structural abnormalities, and then multivariate analyses were conducted to identify factors significantly related. The odds ratios (ORs) were used to estimate the risk of elbow ultrasonographic structural abnormalities. RESULTS Demographic data showed that pitchers had taller body height (P < 0.001) and greater elbow flexion/extension ROM (P < 0.001). When all players were pooled, significant risk factors included started playing baseball at an younger age (OR = 1.202; 95% CI = 1.064-1.357; P = 0.003), longer experience of official baseball (OR = 1.154; 95% CI = 1.038-1.283; P = 0.008), lower total shoulder rotation angle (OR = 1.007; 95% CI = 1.000-1.014; P = 0.050), and less total elbow arm angle (OR = 1.052; 95% CI = 1.017-1.088; P = 0.003) For pitchers, significant risk factors included longer experience of official baseball (OR = 1.342; 95% CI = 1.098-1.640; P = 0.004), lower total shoulder rotation angle (OR = 1.016; 95% CI = 1.004-1.027; P = 0.006), and lower total elbow arm angle (OR = 1.075; 95% CI = 1.024-1.129; P = 0.004) (Table 5). There were no significant risk factors for elbow structural abnormalities in fielders. CONCLUSION For Taiwan high school pitchers, longer official baseball experience, decreased shoulder total rotational angle, and decreased elbow total flexion/extension angle, were related to ultrasonographic structural abnormalities in elbows.
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Affiliation(s)
- Yi Lu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Comprehensive Sports Medicine Center (CSMC), Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Poyu Chen
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Yi Chou
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Comprehensive Sports Medicine Center (CSMC), Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huan Sheu
- Department of Orthopedic Surgery, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hao-Che Tang
- Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chun-Jui Weng
- Department of Orthopedic Surgery, Kaohsiung Municipal Feng-Shan Hospital, Kaohsiung, Taiwan
| | - Joe Chih-Hao Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Comprehensive Sports Medicine Center (CSMC), Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- School of Medicine, Chang Gung University, No. 5, Fusing St., Gueishan District, Taoyuan City, 333, Taiwan.
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Miyashita K, Koshida S, Koyama T, Ota K, Tani Y, Okamune R. Biomechanical Characteristics of Scapular and Glenohumeral Movements during Pitching Motion in Injury-prone College Baseball Pitchers. Phys Ther Res 2023; 26:89-97. [PMID: 38125288 PMCID: PMC10730127 DOI: 10.1298/ptr.e10254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/20/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES The coordination of glenohumeral (GH) and scapular movements is central to the injury prevention of baseball pitchers. However, there is no objective data establishing the direct relationship between pitching injuries and associated GH and scapular movements. Therefore, this study demonstrated the biomechanical differences in the scapular and GH movements during pitching between injury-prone pitchers and healthy college baseball pitchers. METHODS A total of 30 collegiate baseball pitchers were classified into two groups according to their injury status: injury-prone group (n = 15) and control group (n = 15). We obtained pitching motion data using three-dimensional motion analysis technique. RESULTS The horizontal abduction angles of the GH joint during cocking and acceleration phases were considerably greater in the injury-prone pitchers (19.0° at stride foot contact [SFC], -4.0° at maximum external rotation [MER], and -0.3° at ball release) than those in healthy controls (11.7° at SFC, -10.0° at MER, and -6.9° at ball release). Additionally, in the cocking phase, the amount of angular change in the scapular external rotation (ER) was significantly smaller in the injury-prone group than that in the control group (mean difference, -13.0). CONCLUSION These results suggest that the injury-prone pitchers have less internal rotation of the scapula and a more horizontal abduction of the GH joint during the cocking and acceleration phases. Therefore, sports medicine practitioners may need to pay considerable attention to the coordination of scapular and GH horizontal movements during pitching for prevention of shoulder injuries.
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Affiliation(s)
- Koji Miyashita
- Department of Physical Therapy, College of Life and Health Sciences, Chubu University, Japan
| | - Sentaro Koshida
- Department of Judotherapy and Sports Medicine, Faculty of Health Sciences, Ryotokuji University, Japan
| | | | - Kenichiro Ota
- Watanabe Orthopedics and Rehabilitation Clinic, Japan
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Yoshida Y, Matsumura N, Miyamoto A, Oki S, Yokoyama Y, Yamada M, Yamada Y, Nakamura M, Nagura T, Jinzaki M. Three-dimensional shoulder kinematics: Upright four-dimensional computed tomography in comparison with an optical three-dimensional motion capture system. J Orthop Res 2023; 41:196-205. [PMID: 35430725 DOI: 10.1002/jor.25342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/16/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023]
Abstract
Although shoulder kinematics have been analyzed by various methods, dynamic shoulder motion is difficult to track. This study aimed to validate the shoulder kinematic analysis using upright four-dimensional computed tomography (4DCT) and to compare the results with optical three-dimensional motion capture. During active elevation, bilateral shoulders of 10 healthy volunteers were tracked using 4DCT and motion capture. The scapulothoracic and glenohumeral rotations and the scapulohumeral rhythm (SHR) at each position were calculated, and the differences between 4DCT and motion capture were compared. During 10-140° of humerothoracic elevation, the scapulothoracic joint showed upward rotation, internal rotation, and posterior tilting, and the glenohumeral joint showed elevation, external rotation, and anterior plane of elevation in both analyses. In scapulothoracic rotations, the mean differences between the two analyses were -2.6° in upward rotation, 13.9° in internal rotation, and 6.4° in posterior tilting, and became significant with humerothoracic elevation ≥110° in upward rotation, ≥50° in internal rotation, and ≥100° in posterior tilting. In glenohumeral rotations, the mean differences were 3.7° in elevation, 9.1° in internal rotation, and -8.8° in anterior plane of elevation, and became significant with humerothoracic elevation ≥110° in elevation, ≥90° in internal rotation, and ≥100° in anterior plane of elevation. The mean overall SHRs were 1.8 in 4DCT and 2.4 in motion capture, and the differences became significant with humerothoracic elevation ≥100°. The 4DCT analysis of in vivo shoulder kinematics using upright computed tomography scanner is feasible, but the values were different from those by skin-based analysis at the elevated arm positions.
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Affiliation(s)
- Yuki Yoshida
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Azusa Miyamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Satoshi Oki
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Takeo Nagura
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Manzi JE, Dowling B, Trauger N, Fu MC, Hansen BR, Dines JS. The influence of shoulder abduction and external rotation on throwing arm kinetics in professional baseball pitchers. Shoulder Elbow 2022; 14:90-98. [PMID: 35845618 PMCID: PMC9284251 DOI: 10.1177/17585732211010300] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/26/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The relationships between shoulder abduction and external rotation with peak kinetic values at the shoulder and elbow in professional baseball pitchers are not well established. METHODS Professional pitchers (n = 322) threw 8-12 fastballs under 3D motion analysis (480 Hz). Pitchers were stratified into quartiles by shoulder abduction and external rotation at distinct timepoints. Regression analyses were performed to quantify associations between shoulder position and kinetics. RESULTS Shoulder abduction remained relatively consistent throughout the pitch (foot contact-ball release: 85.5 ± 11.1-90.7 ± 8.4°); shoulder external rotation increased dramatically (foot contact-ball release: 30.8 ± 24.6-165.2 ± 9.7°). For every 10° increase in maximum shoulder rotation, shoulder superior force increased by 2.3% body weight (p < 0.01), shoulder distraction force increased by 5.9% body weight (p < 0.01), and ball velocity increased by 0.60 m/s (p < 0.01). Shoulder abduction was significantly associated with shoulder superior force at all timepoints but not with ball velocity (p > 0.05). For every 10° increase in shoulder abduction at ball release, shoulder superior force increased by 3.7% body weight (p < 0.01) and shoulder distraction force increased by 11.7% body weight (p < 0.01). CONCLUSION Increased shoulder abduction at ball release and increased maximum shoulder external rotation were associated with greater superior and distraction forces in the shoulder. Pitchers can consider decreasing shoulder abduction at later stages of the pitch to around 80° in order to minimize shoulder superior force, with no impact on ball velocity.
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Affiliation(s)
- Joseph E Manzi
- Weill Cornell Medical College, New
York, NY, USA,Joshua S Dines, Hospital for Special
Surgery, Sports Medicine Institute, West Side, 610 West 58th Street, New York,
NY 10019, USA.
| | - Brittany Dowling
- Sports Performance Center, Midwest
Orthopaedics at Rush, Oak Brook, IL, USA
| | | | - Michael C Fu
- Sports Medicine Institute, Hospital for Special
Surgery, New York, NY, USA
| | | | - Joshua S Dines
- Sports Medicine Institute, Hospital for Special
Surgery, New York, NY, USA
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Manzi JE, Dowling B, Trauger N, Hansen BR, Quan T, Dennis E, Fu MC, Dines JS. The Relationship Between Maximum Shoulder Horizontal Abduction and Adduction on Peak Shoulder Kinetics in Professional Pitchers. Sports Health 2022:19417381221104038. [PMID: 35762130 DOI: 10.1177/19417381221104038] [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: 11/16/2022] Open
Abstract
BACKGROUND Repetitive horizontal shoulder abduction during pitching can cause increased contact between the posterosuperior aspect of the glenoid and the greater tuberosity of the humeral head, theoretically putting baseball pitchers at increased risk of shoulder internal impingement and other shoulder pathologies. HYPOTHESIS Increased shoulder horizontal abduction is associated with increased shoulder anterior force, while increased horizontal adduction is associated with increased shoulder distraction force. STUDY DESIGN Descriptive laboratory study. LEVEL OF EVIDENCE Level 4. METHODS A total of 339 professional baseball pitchers threw 8 to 10 fastball pitches using 3D motion capture (480 Hz). Pitchers were divided into 2 sets of quartiles based on maximum shoulder horizontal abduction and adduction. Elbow flexion, shoulder external rotation, and peak shoulder kinetics were compared between quartiles with post hoc linear regressions conducted for the entire cohort. RESULTS At maximum shoulder horizontal abduction, there was no difference in ball velocity between quartiles (P = 0.76). For every 10º increase in maximum shoulder horizontal abduction, shoulder anterior force decreased by 2.2% body weight (BW) (P < 0.01, B = -0.22, β = -0.38), shoulder adduction torque decreased by 0.5%BW × body height (BH) (P < 0.01, B = -0.05, β = -0.19), and shoulder horizontal adduction torque decreased by 0.4%BW × BH (P < 0.01, B = -0.04, β = -0.48). For every 10º increase in maximum shoulder horizontal adduction, shoulder anterior force increased by 2%BW and ball velocity decreased by 1.2 m/s (2.7 MPH). CONCLUSION Professional pitchers with the least amount of maximum horizontal adduction had faster ball velocity and decreased shoulder anterior force. Pitchers with greater maximum shoulder horizontal abduction had decreased shoulder anterior force, shoulder adduction torque, and shoulder horizontal adduction torque. To maximize ball velocity as a performance metric while minimizing shoulder anterior force, pitchers can consider decreasing maximum shoulder adduction angles at later stages of the pitch. CLINICAL RELEVANCE Identifying risk factors for increased throwing shoulder kinetics (ie, shoulder anterior force, shoulder adduction torque) has potential implications in injury prevention. Specifically, mitigating shoulder anterior forces may be beneficial in reducing risk of injury.
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Affiliation(s)
| | - Brittany Dowling
- Sports Performance Center, Midwest Orthopaedics at Rush, Oak Brook, Illinois
| | | | | | - Theodore Quan
- George Washington University School of Medicine, Washington, DC
| | - Elizabeth Dennis
- Sports Medicine Institute Hospital for Special Surgery, New York, New York
| | - Michael C Fu
- Sports Medicine Institute Hospital for Special Surgery, New York, New York
| | - Joshua S Dines
- Sports Medicine Institute Hospital for Special Surgery, New York, New York
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Manzi JE, Ciccotti MC, Trauger N, Black GG, Thacher RR, Boddapati V, Dines JS. Increased Elbow and Olecranon Injury History in Professional Pitchers With Increased Elbow Flexion at Ball Release. Am J Sports Med 2022; 50:1054-1060. [PMID: 35107350 DOI: 10.1177/03635465211072223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Elbow flexion at late portions of the pitch has been associated with increased elbow varus torque, a kinetic surrogate associated with injury risk. Direct examinations of injury incidence with elbow flexion angles have not been conducted in professional pitchers. PURPOSE To compare elbow and shoulder injury incidence among professional baseball players stratified by degree of elbow flexion at ball release (BR). STUDY DESIGN Descriptive laboratory study. METHODS Professional pitchers (N = 314) were instructed to pitch between 8 and 12 fastballs while being evaluated using motion capture technology. Upper extremity injury incidence was recorded upon interview. Pitchers were subsequently subdivided into 3 groups based on increasing elbow flexion at BR. Analysis of variance was used to compare participant characteristics and kinematic and peak kinetic variables. An odds ratio (OR) was calculated to determine the risk of having a previous upper extremity injury based on the degree of elbow flexion at BR. RESULTS A total of 116 pitchers (132 documented injuries) had a previous upper extremity injury, with elbow injury (76 injuries; 57.6%) being the most common. Evaluation of kinetic values showed that pitchers with the smallest elbow flexion at BR had significantly less peak elbow flexion torque than did those with greatest elbow flexion at BR (3.8 ± 0.5 vs 4.1 ± 0.6 %weight × height; P = .003). Pitchers who demonstrated a greater than average degree of elbow flexion at BR when pitching were more likely to have a history of elbow injury (OR, 1.97; 95% CI, 1.14-3.40; P = .015) and olecranon spur formation or stress fracture (OR, 5.79; 95% CI, 1.25-26.85; P = .025). CONCLUSION Pitchers with greater elbow flexion at BR had significantly higher odds of previous injury of the elbow and olecranon. Increasing elbow flexion has been shown to place the medial elbow in a position to carry a greater amount of load, which may be exacerbated during the final moments of the pitching motion. Professional pitchers can consider decreasing elbow flexion at BR as a potential, modifiable risk factor for elbow injury, in particular for olecranon spur formation and fracture. CLINICAL RELEVANCE This study attempts to associate injury incidence with a modifiable, kinematic variable for an at-risk population.
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Affiliation(s)
| | | | - Nicolas Trauger
- Cornell University College of Engineering, Ithaca, New York, USA
| | - Grant G Black
- Weill Cornell Medical College, New York, New York, USA
| | - Ryan R Thacher
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Venkat Boddapati
- Columbia University Irving Medical Center Orthopedic Surgery, New York, New York, USA
| | - Joshua S Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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Manzi JE, Dowling B, Wang Z, Luzzi A, Thacher R, Rauck RC, Dines JS. Pitching Mechanics and the Relationship to Accuracy in Professional Baseball Pitchers. Am J Sports Med 2022; 50:814-822. [PMID: 35006015 DOI: 10.1177/03635465211067824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biomechanical predictors of pitching accuracy are underevaluated in baseball research. It is unclear how pitchers with higher accuracy differ in terms of kinematics and upper extremity kinetics. PURPOSE To differentiate high- and low-accuracy professional pitchers by full-body kinematic and upper extremity kinetic parameters. STUDY DESIGN Descriptive laboratory study. METHODS In total, 121 professional baseball pitchers threw 8 to 12 fastballs while assessed with motion-capture technology (480 Hz). Pitchers were divided into high-accuracy (n = 33), moderate-accuracy (n = 52), and low-accuracy (n = 36) groups based on the absolute center deviation of each pitcher's average pitch to the center of the pitching chart by greater or less than 0.5 SD from the mean, respectively. The 95% confidence ellipses with comparisons of major and minor radii and pitching probability density grids were constructed. Analysis of variance was used to compare kinematic and kinetic values between groups. RESULTS The absolute center deviation (14.5% ± 6.7% vs 33.5% ± 3.7% grid width; P < .001) was significantly lower in the high-accuracy compared with the low-accuracy group, with no significant difference in ball velocity (38.0 ± 1.7 vs 38.5 ± 2.0 m/s; P = .222). Lead knee flexion at ball release (30.6°± 17.8° vs 40.1°± 16.3°; P = .023) was significantly less for the high-accuracy pitchers. Peak normalized shoulder internal rotation torque (5.5% ± 1.0% vs 4.9% ± 0.7% body weight [BW] × body height [BH]; P = .008), normalized elbow varus torque (5.4% ± 1.0% vs 4.8% ± 0.7% BW × BH; P = .008), and normalized elbow medial force (42.9% ± 7.3% vs 38.6% ± 6.2% BW; P = .024) were significantly greater for the low-accuracy group compared with the high-accuracy group. CONCLUSION Professional pitchers with increased accuracy experienced decreased throwing arm kinetics. These pitchers had increased lead knee extension at later stages of the pitch, potentially providing more stable engagement with the ground and transference of kinetic energy to the upper extremities. Professional pitchers can consider increasing lead knee extension at the final stages of the pitch to improve the accuracy of their throws and mitigate elbow varus torque. CLINICAL RELEVANCE Increased elbow varus torque, shoulder internal rotation torque, and elbow medial force in less accurate pitchers may contribute to increased injury risk in this group.
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Affiliation(s)
| | - Brittany Dowling
- Sports Performance Center, Midwest Orthopaedics at Rush, Oak Brook, Illinois, USA
| | - Zhaorui Wang
- Weill Cornell Medical College, New York, NY, USA
| | - Andrew Luzzi
- Columbia University Irving Medical Center Orthopedic Surgery, New York, New York, USA
| | - Ryan Thacher
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Ryan C Rauck
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Joshua S Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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Manzi JE, Estrada JA, Dowling B, Ruzbarsky JJ, Dines JS. Intra- versus inter-pitcher comparisons: Associations of ball velocity with throwing-arm kinetics in professional baseball pitchers. J Shoulder Elbow Surg 2021; 30:2596-2603. [PMID: 33930560 DOI: 10.1016/j.jse.2021.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/25/2021] [Accepted: 04/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The association between ball velocity and elbow varus torque has shown differences when evaluated within a single pitcher and within a cohort. The impact of increasing ball velocity on additional throwing-arm kinetics, in particular shoulder distraction forces, with intra- vs. inter-pitcher evaluations has not been evaluated, even though these kinetic measures have been implicated in injury risk. The purpose of this study was to compare intra- vs. inter-pitcher relationships between ball velocity and all major kinetics at the shoulder and elbow in professional pitchers. METHODS A total of 323 professional baseball pitchers threw 8-12 fastball pitches while simultaneously being evaluated with 3-dimensional motion-capture technology (480 Hz). A linear regression analysis was performed to evaluate pitch velocity as a predictor of peak kinetic values at the shoulder and elbow among pitchers. A linear mixed model with random intercepts was then created to evaluate ball velocity as a predictor of peak kinetic values when comparing pitches within an individual pitcher. RESULTS 91 pitchers were included in the analyses. Ball velocity among pitchers had weak correlations with shoulder distraction force (R2 = 0.228, P < .001) and elbow distraction force (R2 = 0.175, P < .001). Within an individual pitcher, strong correlations (R2 > 0.85) were observed for (1) shoulder internal rotation torque (P < .001), (2) shoulder horizontal adduction torque (P = .006), (3) shoulder superior force (P < .001), (4) shoulder anterior force (P < .001), (5) elbow varus torque (P < .001), (6) elbow medial force (P < .001), (7) elbow anterior force (P < .001), (8) elbow flexion torque (P < .001), (9) shoulder distractive force (P < .001), and (10) elbow distractive force (P < .001). CONCLUSION Faster pitch velocity is a weak predictor of shoulder and elbow distraction forces experienced among professional pitchers. However, when controlling for an individual pitcher, peak kinetics at the shoulder and elbow can be strongly predicted by ball velocity. Therefore, the assumption that higher peak throwing-arm kinetic values are experienced by pitchers with faster ball velocity is likely an inappropriate assumption among pitchers but may be correct for each player who increases pitch velocity.
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Affiliation(s)
| | - Jennifer A Estrada
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Brittany Dowling
- Sports Performance Center, Midwest Orthopaedics at Rush, Oak Brook, IL, USA
| | | | - Joshua S Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA.
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Miyazaki S, Yamako G, Totoribe K, Sekimoto T, Kadowaki Y, Tsuruta K, Chosa E. Shadow pitching deviates ball release position: kinematic analysis in high school baseball pitchers. BMC Sports Sci Med Rehabil 2021; 13:26. [PMID: 33731187 PMCID: PMC7968203 DOI: 10.1186/s13102-021-00255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/05/2021] [Indexed: 11/25/2022]
Abstract
Background Although shadow pitching, commonly called “towel drill,” is recommended to improve the throwing motion for the rehabilitation of pitching disorders before the initiation of a throwing program aimed at returning to throwing using a ball, the motion differs from that of normal throwing. Learning improper motion during ball release (BR) may increase shoulder joint forces. Abnormal throwing biomechanics leads to injures. However, there has been no study of shadow pitching focusing on the BR position. The purpose of the present study was to evaluate the BR position and kinematic differences between shadow pitching and normal throwing. In addition, the effect of setting a target guide for BR position on throwing motion was examined in shadow pitching. Methods The participants included in this study were 20 healthy male students who were overhand right-handed pitchers with no pain induced by a throwing motion. Participants performed normal throwing (task 1), shadow pitching using a hand towel (task 2), and shadow pitching by setting a target of the BR position (task 3). A motion capture system was used to evaluate kinematic differences in throwing motions, respectively. Examination items comprised joint angles and the differences in BR position. Results BR position of task 2 shifted significantly toward the anterior, leftward, and downward directions compared with task 1. The distance of BR position between tasks 1 and 2 was 24 ± 10%. However, task 3 had decreased BR deviation compared with task 2 (the distance between 3 and 1 was 14 ± 7%). Kinematic differences were observed among groups at BR. For shoulder joint, task 2 showed the highest value in abduction and horizontal adduction among groups. In spine flexion, left rotation and thorax flexion, task 2 was significantly higher than task 1. Task 3 showed small differences compared with task 1. Conclusions The BR position of shadow pitching deviated significantly in the anterior, leftward, and downward directions compared with normal throwing. Furthermore, we demonstrated that the setting of BR target reduces this deviation. Thus, the target of BR position should be set accurately during shadow pitching exercises in the process of rehabilitation.
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Affiliation(s)
- Shigeaki Miyazaki
- Rehabilitation Unit, University of Miyazaki Hospital, 5200 Kihara Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan
| | - Go Yamako
- Department of Mechanical Design Systems Engineering, Faculty of Engineering, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki, Miyazaki, 889-2192, Japan.
| | - Koji Totoribe
- Rehabilitation Unit, University of Miyazaki Hospital, 5200 Kihara Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan
| | - Tomohisa Sekimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan
| | - Yuko Kadowaki
- Clinical Research Support Center, University of Miyazaki Hospital, 5200 Kihara Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan
| | - Kurumi Tsuruta
- School of Nursing, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan
| | - Etsuo Chosa
- Rehabilitation Unit, University of Miyazaki Hospital, 5200 Kihara Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan
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Tanaka H, Hayashi T, Inui H, Muto T, Tsuchiyama K, Ninomiya H, Nakamura Y, Kobashi S, Nobuhara K. Stride-Phase Kinematic Parameters That Predict Peak Elbow Varus Torque. Orthop J Sports Med 2020; 8:2325967120968068. [PMID: 33403214 PMCID: PMC7745573 DOI: 10.1177/2325967120968068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background: During baseball pitching, a high amount of elbow varus torque in the arm cocking-to-acceleration phase is thought to be a biomechanical risk factor for medial elbow pain and injury. The biomechanics of the stride phase may provide preparation for the arm cocking-to-acceleration phase that follows it. Purpose: To determine the kinematic parameters that predict peak elbow varus torque during the stride phase of pitching. Study Design: Descriptive laboratory study. Methods: Participants were 107 high school baseball pitchers (age range, 15-18 years) without shoulder or elbow problems. Whole-body kinematics and kinetics during fastball pitching were analyzed using 3-dimensional measurements from 36 retroreflective markers. A total of 26 kinematic parameters of the upper and lower limbs during the stride phase leading up to the stride foot contact were extracted for multiple regression analysis to assess their combined effect on the magnitude of peak elbow varus torque. Results: Increased wrist extension, elbow pronation, knee flexion on the leading leg, knee extension on the trailing leg at stride foot contact, and upward displacement of the body’s center of mass in the stride phase were significantly correlated with decreased peak elbow varus torque (all P < .05). Moreover, 38% of the variance in peak elbow varus torque was explained by a combination of these 5 significant kinematic variables (P < .001). Conclusion: We found that 5 kinematic parameters during the stride phase and the combination of these parameters were associated with peak elbow varus torque. The stride phase provides biomechanical preparation for pitching and plays a key role in peak elbow varus torque in subsequent pitching phases. Clinical Relevance: The present data can be used to screen pitching mechanics with motion capture assessment to reduce peak elbow varus torque. Decreased peak elbow varus torque is expected to reduce the risk of elbow medial pain and injury.
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Affiliation(s)
- Hiroshi Tanaka
- Nobuhara Hospital and Institute of Biomechanics, Tatsuno, Japan
| | - Toyohiko Hayashi
- Graduate School of Science and Technology, Niigata University, Niigata, Japan
| | - Hiroaki Inui
- Nobuhara Hospital and Institute of Biomechanics, Tatsuno, Japan
| | - Tomoyuki Muto
- Nobuhara Hospital and Institute of Biomechanics, Tatsuno, Japan
| | - Kohnan Tsuchiyama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroki Ninomiya
- Nobuhara Hospital and Institute of Biomechanics, Tatsuno, Japan
| | - Yasuo Nakamura
- Faculty of Health and Sports Science, Doshisha University, Kyotanabe, Japan
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Morishima T, Ito M, Tsuchiya Y, Ueda H, Ochi E. Physical characteristics and fitness in elite collegiate baseball players in Japan: comparison of pitchers vs. fielders. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2020. [DOI: 10.23736/s0393-3660.19.04048-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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