The Relationship Between Baseball Participation and Health: A Systematic Scoping Review

Unaccounted for Pitch Volume Among Adolescent Baseball Pitchers During a Travel Baseball Season

OBJECTIVE

The primary aim was to compare differences in live game pitch counts (LGPCs) with all pitch counts (APCs) over the course of a youth baseball season.

DESIGN

Prospective longitudinal study.

SETTING

Midwest youth travel baseball.

PARTICIPANTS

Ten male baseball players part of a youth baseball travel team.

VARIABLES

Demographic data, pitch counts (practice, game, warm-up, and bullpen), innings pitched, and recommended rest days.

MAIN OUTCOME MEASURES

Live pitch counts compared with APCs and the relationship to recommended rest days.

RESULTS

During the season, 7866 pitches were recorded among 9 pitchers. By using the LGPC method alone, 42.5% of the pitches were unaccounted for. When considering age-specific rest days suggested by Pitch Smart Guidelines (PSGs), there were 104 rest days unaccounted for by using the live game pitch method.

CONCLUSION

There is a high number of unaccounted for pitches and an underestimation of rest days per outing when using live game methods. Revisions to the PSGs that include all pitches should be considered to accurately reflect pitching volume, which may be associated with the rising rate of injuries among these athletes.

Health Benefits of Different Sports: a Systematic Review and Meta-Analysis of Longitudinal and Intervention Studies Including 2.6 Million Adult Participants

BACKGROUND

Several reviews have examined the health benefits of participation in specific sports, such as baseball, cricket, cross-country skiing, cycling, downhill skiing, football, golf, judo, rugby, running and swimming. However, new primary studies on the topic have recently been published, and the respective meta-analytic evidence needs to be updated.

OBJECTIVES

To systematically review, summarise and appraise evidence on physical health benefits of participation in different recreational sports.

METHODS

Searches for journal articles were conducted in PubMed/MEDLINE, Scopus, SpoLit, SPORTDiscus, Sports Medicine & Education Index and Web of Science. We included longitudinal and intervention studies investigating physical health outcomes associated with participation in a given sport among generally healthy adults without disability.

RESULTS

A total of 136 papers from 76 studies conducted among 2.6 million participants were included in the review. Our meta-analyses of available evidence found that: (1) cycling reduces the risk of coronary heart disease by 16% (pooled hazard ratio [HR] = 0.84; 95% confidence interval [CI]: 0.80, 0.89), all-cause mortality by 21% (HR = 0.79; 95% CI: 0.73, 0.84), cancer mortality by 10% (HR = 0.90; 95% CI: 0.85, 0.96) and cardiovascular mortality by 20% (HR = 0.80; 95% CI: 0.74, 0.86); (2) football has favourable effects on body composition, blood lipids, fasting blood glucose, blood pressure, cardiovascular function at rest, cardiorespiratory fitness and bone strength (p < 0.050); (3) handball has favourable effects on body composition and cardiorespiratory fitness (p < 0.050); (4) running reduces the risk of all-cause mortality by 23% (HR = 0.77; 95% CI: 0.70, 0.85), cancer mortality by 20% (HR = 0.80; 95% CI: 0.72, 0.89) and cardiovascular mortality by 27% (HR = 0.73; 95% CI: 0.57, 0.94) and improves body composition, cardiovascular function at rest and cardiorespiratory fitness (p < 0.010); and (5) swimming reduces the risk of all-cause mortality by 24% (HR = 0.76; 95% CI: 0.63, 0.92) and improves body composition and blood lipids (p < 0.010).

CONCLUSIONS

A range of physical health benefits are associated with participation in recreational cycling, football, handball, running and swimming. More studies are needed to enable meta-analyses of health benefits of participation in other sports. PROSPERO registration number CRD42021234839.

Up Front and Open? Shrouded in Secrecy? Or Somewhere in Between? A Meta-Research Systematic Review of Open Science Practices in Sport Medicine Research

OBJECTIVE: To investigate open science practices in research published in the top 5 sports medicine journals from May 1, 2022, and October 1, 2022. DESIGN: A meta-research systematic review. LITERATURE SEARCH: Open science practices were searched in MEDLINE. STUDY SELECTION CRITERIA: We included original scientific research published in one of the identified top 5 sports medicine journals in 2022 as ranked by Clarivate: (1) British Journal of Sports Medicine, (2) Journal of Sport and Health Science, (3) American Journal of Sports Medicine, (4) Medicine and Science in Sports and Exercise, and (5) Sports Medicine-Open. Studies were excluded if they were systematic reviews, qualitative research, gray literature, or animal or cadaver models. DATA SYNTHESIS: Open science practices were extracted in accordance with the Transparency and Openness Promotion guidelines and patient and public involvement. RESULTS: Two hundred forty-three studies were included. The median number of open science practices in each study was 2, out of a maximum of 12 (range: 0-8; interquartile range: 2). Two hundred thirty-four studies (96%, 95% confidence interval [CI]: 94%-99%) provided an author conflict-of-interest statement and 163 (67%, 95% CI: 62%-73%) reported funding. Twenty-one studies (9%, 95% CI: 5%-12%) provided open-access data. Fifty-four studies (22%, 95% CI: 17%-27%) included a data availability statement and 3 (1%, 95% CI: 0%-3%) made code available. Seventy-six studies (32%, 95% CI: 25%-37%) had transparent materials and 30 (12%, 95% CI: 8%-16%) used a reporting guideline. Twenty-eight studies (12%, 95% CI: 8%-16%) were preregistered. Six studies (3%, 95% CI: 1%-4%) published a protocol. Four studies (2%, 95% CI: 0%-3%) reported an analysis plan a priori. Seven studies (3%, 95% CI: 1%-5%) reported patient and public involvement. CONCLUSION: Open science practices in the sports medicine field are extremely limited. The least followed practices were sharing code, data, and analysis plans. J Orthop Sports Phys Ther 2023;53(12):1-13. Epub 20 October 2023. doi:10.2519/jospt.2023.12016.

Elbow Injuries Among MLB Pitchers Increased During Covid-19 Disrupted Season, But Not Other Baseball Injuries

Background

The 2020 Major League Baseball Season (MLB) demonstrated season disruptions due to the COVID-19 pandemic. Changes in training and seasonal time frames may be associated with higher rates of injury.

Purpose

To use publicly available data to compare injury rates during the 2015-2019 seasons, COVID-19 shortened season (2020), and the 2021 season stratified by body region and position (pitchers versus position players).

Study Design

A retrospective cohort study utilizing publicly available data.

Methods

MLB players who competed in 1+ seasons between 2015-2021 were included and stratified by position (pitcher, position player). Incidence rate (IR), reported by 1000 x Athlete-Game Exposures (AGEs), was calculated for each season, and stratified by position and body region. Poisson regressions were performed for all injuries and stratified by position to determine association between season and injury incidence. Subgroup analyses were performed on the elbow, groin/hip/thigh, shoulder.

Results

Four thousand, two hundred and seventy-four injuries and 796,502 AGEs across 15,152 players were documented. Overall IR was similar across seasons (2015-2019:5.39; 2020:5.85; 2021:5.04 per 1000 AGEs). IR remained high for the groin/hip/thigh for position players (2015-2019:1.7; 2020:2.0; 2021:1.7 per 1000 AGEs). There was no difference in injury rates between 2015-2019 and 2020 seasons [1.1 (0.9-1.2), p=0.310]. The 2020 season demonstrated a significant increase in elbow injuries [2.7 (1.8-4.0), p<0.001]; when stratified by position, this increase remained significant for pitchers [pitchers: 3.5 (2.1-5.9), p<0.001; position players: 1.8 (0.9-3.6), p=0.073]. No other differences were observed.

Conclusion

The groin/hip/thigh demonstrated the highest IR in 2020 among position players across all season time frames, indicating that continued injury mitigation for this region is necessary. When stratified by body region, elbow injury rates among pitchers demonstrated 3.5 times the rate of injury in 2020 compared to previous seasons, impacting injury burden for the most vulnerable body region among pitchers.

Level of Evidence

Level III.

Upper Quarter Injury Rates and Risk in United States High School Athletes Prior To and During the Prolonged Sport Stoppage

Background

Upper quarter injuries are a serious problem in high school sports. The distinctive differences in males and females and within sports concerning specific upper quarter body parts necessitates the need to evaluate these injuries across these groups. The COVID-19 pandemic has created an opportunity to evaluate the potential added burden abrupt and prolonged sport stoppage had on upper quarter injury risk.

Hypothesis/Purpose

To 1) describe and compare upper quarter injury rates and risk in high school athletes in the 2019-2020 and 2020-2021 academic school years; 2) examine injuries by gender, sport, injury type, and location of injury.

Methods

An ecological study of the athletes from 176 high schools over six states, matching high schools between 2019-2020 (19-20) and 2020-2021 (20-21) years was performed. Injuries were reported by at least one high school athletic trainer assigned to each school into a centralized database and data collected from July 1, 2019, to June 30, 2021. Injury rates were calculated per 1,000 athletes per academic year. Interrupted time series models assessed the incidence ratio between academic years.

Results

A total of 98,487 athletes from all sports participated in 19-20 and 72,521 in 20-21. Upper quarter injury rates increased in from 19-20 [41.9 (40.6, 43.1)] to 20-21 [50.7 (48.1, 51.3)]. Upper quarter injury risk [1.5 (1.1, 2.2)] was greater in 20-21 compared to 19-20. Females did not demonstrate increased injury rates between 19-20 [31.1 (29.4, 32.7)] to 20-21 [28.1 (26.4, 30.0)]. Males reported increased injury rates from 19-20 [50.3 (48.5, 52.2)] to 20-21 [67.7 (65.2, 70.2)]. Increased injury for the shoulder, elbow, and hand were reported in 20-21. Collision, field, and court upper quarter injury rates were increased in 20-21.

Discussion

Upper quarter injury rates and injury risk were greater during the 2020-2021 school year than in the prior year. Males demonstrated increased upper quarter injury rates, while females did not. Return to play protocols for high school athletes should be considered following abrupt sport stoppage.

Level of Evidence

2.

Personalized Injury Reduction Strategies in Sports Medicine: Lessons Learned from Advances in Breast Cancer Treatment: A Clinical Commentary

Background

Injury rates across sport have risen over the past twenty years, despite increased efforts in training and injury prevention. The rise in injury rates suggest that current approaches to estimating injury risk and risk management are not effective. One factor limiting progress is the inconsistency in screening, risk assessment, and risk management strategies to guide injury mitigation approaches.

Clinical Question

How can sports physical therapists identify and apply lessons learned from other healthcare fields to improve athlete injury risk and risk management strategies?

Key Results

Breast cancer mortality has consistently decreased over the last 30 years, largely attributed to advances in personalizing the prevention and treatment strategies which include modifiable and non-modifiable factors when assessing risk, the transition to personalized medicine, and the systematic approach used to investigate individual risk factors. Three critical phases have facilitated the identification and importance of individual risk factors and developing targeted, personalized strategies for breast cancer risk including: 1) Establishing the potential relationship between factors and outcomes; 2) Prospectively investigate the strength and direction of the relationship; 3) Investigating if intervening on identified factors alters prognosis.

Clinical Application

Applying lessons learned from other healthcare fields could improve shared decision making between the clinician and athlete concerning risk assessment and management. Examples include calculating only non-modifiable risk, creating individualized screening schedules based on risk assessment, or calculating the influence of each intervention on the athlete's injury risk. A systematic approach to identify and intervene on risk is needed to improve athlete outcomes.

Shoulder Range of Motion Measurements and Baseball Elbow Injuries: Ambiguity in Scientific Models, Approach, and Execution is Hurting Overhead Athlete Health

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.

Development of an Injury Burden Prediction Model in Professional Baseball Pitchers

Background

Baseball injuries are a significant problem and have increased in incidence over the last decade. Reporting injury incidence only gives context to rate but not in relation to severity or injury time loss.

Hypothesis/Purpose

The purpose of this study was to 1) incorporate both modifiable and non-modifiable factors to develop an arm injury burden prediction model in Minor League Baseball (MiLB) pitchers; and 2) understand how the model performs separately on elbow and shoulder injury burden.

Study Design

Prospective longitudinal study.

Methods

The study was conducted from 2013 to 2019 on MiLB pitchers. Pitchers were evaluated in spring training arm for shoulder range of motion and injuries were followed throughout the season. A model to predict arm injury burden was produced using zero inflated negative binomial regression. Internal validation was performed using ten-fold cross validation. Subgroup analyses were performed for elbow and shoulder separately. Model performance was assessed with root mean square error (RMSE), model fit (R2), and calibration with 95% confidence intervals (95% CI).

Results

Two-hundred, ninety-seven pitchers (94 injuries) were included with an injury incidence of 1.15 arm injuries per 1000 athletic exposures. Median days lost to an arm injury was 58 (11, 106). The final model demonstrated good prediction ability (RMSE: 11.9 days, R2: 0.80) and a calibration slope of 0.98 (95% CI: 0.92, 1.04). A separate elbow model demonstrated weaker predictive performance (RMSE: 21.3; R2: 0.42; calibration: 1.25 [1.16, 1.34]), as did a separate shoulder model (RMSE: 17.9; R2: 0.57; calibration: 1.01 [0.92, 1.10]).

Conclusions

The injury burden prediction model demonstrated excellent performance. Caution should be advised with predictions between one to 14 days lost to arm injury. Separate elbow and shoulder prediction models demonstrated decreased performance. The inclusion of both modifiable and non-modifiable factors into a comprehensive injury burden model provides the most accurate prediction of days lost in professional pitchers.

Level of Evidence

2.

Improving Clinical Utility of Real-World Prediction Models: Updating Through Recalibration

ABSTRACT

Bullock, GS, Shanley, E, Thigpen, CA, Arden, NK, Noonan, TK, Kissenberth, MJ, Wyland, DJ, and Collins, GS. Improving clinical utility of real-world prediction models: updating through recalibration. J Strength Cond Res XX(X): 000-000, 2022-Prediction models can aid clinicians in identifying at-risk athletes. However, sport and clinical practice patterns continue to change, causing predictive drift and potential suboptimal prediction model performance. Thus, there is a need to temporally recalibrate previously developed baseball arm injury models. The purpose of this study was to perform temporal recalibration on a previously developed injury prediction model and assess model performance in professional baseball pitchers. An arm injury prediction model was developed on data from a prospective cohort from 2009 to 2019 on minor league pitchers. Data for the 2015-2019 seasons were used for temporal recalibration and model performance assessment. Temporal recalibration constituted intercept-only and full model redevelopment. Model performance was investigated by assessing Nagelkerke's R-square, calibration in the large, calibration, and discrimination. Decision curves compared the original model, temporal recalibrated model, and current best evidence-based practice. One hundred seventy-eight pitchers participated in the 2015-2019 seasons with 1.63 arm injuries per 1,000 athlete exposures. The temporal recalibrated intercept model demonstrated the best discrimination (0.81 [95% confidence interval [CI]: 0.73, 0.88]) and R-square (0.32) compared with original model (0.74 [95% CI: 0.69, 0.80]; R-square: 0.32) and the redeveloped model (0.80 [95% CI: 0.73, 0.87]; R-square: 0.30). The temporal recalibrated intercept model demonstrated an improved net benefit of 0.34 compared with current best evidence-based practice. The temporal recalibrated intercept model demonstrated the best model performance and clinical utility. Updating prediction models can account for changes in sport training over time and improve professional baseball arm injury outcomes.

Effect of Rehabilitation Physical Training on PE Teaching Sports Injury under Ultrasonic Examination

In order to solve the problem of the effect of rehabilitation physical training on physical education teaching injury, a method based on ultrasonic examination of rehabilitation physical training on physical education teaching injury effect observation method is proposed. In this method, the ISOMED isokinetic muscle strength test, the body shape test, the balance ability test, the lower limb explosive power test, and other methods are used to evaluate the knee joint of patients systematically, and the specific rehabilitation physical training plan is formulated to achieve the treatment purpose. The experimental results show that after the targeted training, a series of indicators on the affected side increase significantly: the power increases by 45.6%, the force increases by 8.3%, and the speed increases by 38.7%. It is concluded that the muscle strength, shape, balance ability, and lower limb explosive power of patients are significantly improved, which lays a solid foundation for athletes to recover smoothly and achieve good competition results.

Initial kinematic chain injuries increase hazard of subsequent arm injuries in professional baseball pitchers

BACKGROUND

Currently, there are few studies that have evaluated the relationship between a lower extremity or trunk injury (kinematic chain) and subsequent arm injury. The purpose of this study was (1) to investigate the relationship between initial kinematic chain (lower extremity or trunk) injury and subsequent arm injury; and (2) to investigate the relationship between initial shoulder or elbow injury and subsequent arm injury.

METHODS

A 7-year prospective injury risk study was conducted with Minor League Baseball pitchers. Pitches, pitching appearances, athlete exposures (AEs), and arm injuries (≥1-day time loss) were documented throughout the season. Cox survival analyses with 95% confidence intervals (95% CIs) were performed. Confounders controlled for included age, body mass index, arm dominance, pitching role, previous arm injury, number of pitching appearances, and seasonal pitch load.

RESULTS

A total of 297 pitchers participated (total player days = 85,270). Arm injury incidence was 11.4 arm injuries/10,000 AEs, and kinematic chain incidence was 5.2 injuries/10,000 AEs. Pitchers who sustained a kinematic chain injury demonstrated a greater hazard (2.6 [95% CI: 1.2, 5.6], P = .019) of sustaining an arm injury. Pitchers who sustained an initial shoulder injury demonstrated a greater hazard (9.3 [95% CI: 1.1, 83], P = .047) of sustaining a subsequent shoulder or elbow injury compared with pitchers who sustained an initial elbow injury.

CONCLUSIONS

Pitchers who sustained an initial lower extremity or trunk injury demonstrated an increased subsequent arm injury hazard compared with pitchers who did not. Pitchers who sustained an initial shoulder injury demonstrated a greater hazard of sustaining a subsequent arm injury compared with pitchers who sustained an initial elbow injury. However, this secondary analysis should be interpreted with caution. Clinicians should monitor risk with workload accumulation, which may be related to pitching compensatory strategies in a fatigued state. Pitchers who sustain a shoulder injury should be evaluated and perform both shoulder and elbow rehabilitation strategies before return to sport.

Biomechanical Analysis of the Throwing Athlete and Its Impact on Return to Sport

Throwing sports remain a popular pastime and frequent source of musculoskeletal injuries, particularly those involving the shoulder and elbow. Biomechanical analyses of throwing athletes have identified pathomechanic factors that predispose throwers to injury or poor performance. These factors, or key performance indicators, are an ongoing topic of research, with the goals of improved injury prediction, prevention, and rehabilitation. Important key performance indicators in the literature to date include shoulder and elbow torque, shoulder rotation, kinetic chain function (as measured by trunk rotation timing and hip-shoulder separation), and lower-extremity mechanics (including stride characteristics). The current gold standard for biomechanical analysis of the throwing athlete involves marker-based 3-dimensional) video motion capture. Emerging technologies such as marker-less motion capture, wearable technology, and machine learning have the potential to further refine our understanding. This review will discuss the biomechanics of throwing, with particular attention to baseball pitching, while also delineating methods of modern throwing analysis, implications for clinical orthopaedic practice, and future areas of research interest.

Level of Evidence

V, expert opinion.

Machine Learning and Statistical Prediction of Pitching Arm Kinetics

BACKGROUND

Over the past decade, research has attempted to elucidate the cause of throwing-related injuries in the baseball athlete. However, when considering the entire kinetic chain, full body mechanics, and pitching cycle sequencing, there are hundreds of variables that could influence throwing arm health, and there is a lack of quality investigations evaluating the relationship and influence of multiple variables on arm stress.

PURPOSE

To identify which variables have the most influence on elbow valgus torque and shoulder distraction force using a statistical model and a machine learning approach.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

A retrospective review was performed on baseball pitchers who underwent biomechanical evaluation at the university biomechanics laboratory. Regression models and 4 machine learning models were created for both elbow valgus torque and shoulder distraction force. All models utilized the same predictor variables, which included pitch velocity and 17 pitching mechanics.

RESULTS

The analysis included a total of 168 high school and collegiate pitchers with a mean age of 16.7 years (SD, 3.2 years) and BMI of 24.4 (SD, 1.2). For both elbow valgus torque and shoulder distraction force, the gradient boosting machine models demonstrated the smallest root mean square errors and the most precise calibrations compared with all other models. The gradient boosting model for elbow valgus torque reported the highest influence for pitch velocity (relative influence, 28.4), with 5 mechanical variables also having significant influence. The gradient boosting model for shoulder distraction force reported the highest influence for pitch velocity (relative influence, 20.4), with 6 mechanical variables also having significant influence.

CONCLUSION

The gradient boosting machine learning model demonstrated the best overall predictive performance for both elbow valgus torque and shoulder distraction force. Pitch velocity was the most influential variable in both models. However, both models also revealed that pitching mechanics, including maximum humeral rotation velocity, shoulder abduction at foot strike, and maximum shoulder external rotation, significantly influenced both elbow and shoulder stress.

CLINICAL RELEVANCE

The results of this study can be used to inform players, coaches, and clinicians on specific mechanical variables that may be optimized to mitigate elbow or shoulder stress that could lead to throwing-related injury.

Health Conditions, Substance Use, Physical Activity, and Quality of Life in Current and Former Baseball Players

Background:

A comprehensive understanding of lifestyle (health conditions and substance use), health-related quality of life (HRQoL), flourishing (holistic representation of health), and physical activity can inform stakeholders (players, coaches, and clinicians) and help improve long-term health across the life span.

Purpose:

To describe health conditions (comorbidities or diagnoses), substance use, physical activity, HRQoL, and flourishing in current and former collegiate and professional baseball players and to assess the relationship between playing position and HRQoL/flourishing in former baseball players.

Study Design:

Descriptive epidemiology study.

Methods:

Eligible participants were those ≥18 years old with ≥1 season of collegiate or professional baseball experience. Participants completed a survey on health conditions (asthma, diabetes, hypertension, hypercholesterolemia, and depression), substance use (tobacco, alcohol, and energy drinks), physical activity (International Physical Activity Questionnaire–Short Form), HRQoL (Veterans Rand 12-Item Health Survey [VR-12] physical and mental component scores), and flourishing (Flourishing Scale). Adjusted multivariable regressions were performed for HRQoL and flourishing.

Results:

Overall, 260 baseball players opened the survey, and 214 (current players, 97; former players, 117) participated for an 82% response rate. Of the former players, 32% had hypertension or hypercholesterolemia. In addition, 26% of current players had used smokeless tobacco (median, 3 years; interquartile range [IQR], 1-5 years) as compared with 34% of former players (median, 15 years; IQR, 5-25 years). In addition, 14% of current players had used electronic cigarettes (median, 2 years; IQR, 0-4 years) as opposed to 3% of former (median, 3 years; IQR, 2-4 years). Energy drinks were consumed by 31% and 14%, respectively, of current and former players on at least a weekly basis. Current baseball players performed 8667 metabolic equivalents per week of physical activity as opposed to 3931 in former players. Pitching was associated with worse VR-12 Mental Component Scores (–5.0; 95% confidence interval, –9.0 to –1.0). Playing position was not related to VR-12 Physical Component Scores or flourishing in former baseball players.

Conclusion:

The similar smokeless tobacco prevalence between current and former baseball players suggests that they may start using tobacco products during baseball participation and continue after retirement. Similar reported HRQoL as compared with the general US population and high flourishing and physical activity levels suggest that baseball players may present with good musculoskeletal and psychological health.

Association Between Musculoskeletal Pain and Psychological Stress Responses in High School Baseball Players: A Cross-sectional Study

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.

The relationship between cricket participation, health and wellbeing: A scoping review

Summarising and synthesising the evidence on cricket health and wellbeing can help inform cricket stakeholders and navigate future research directions. The purpose of this study was to investigate the relationship between cricket participation, health and wellbeing at all ages and playing standards, and identify research gaps in the existing literature. A scoping review was performed from inception to March, 2020. Studies were included if they assessed a construct related to health and/or wellbeing in cricketers, available in English. 219 articles were eligible. Injury incidence per 1,000 player exposures ranged from 1.8-5.7 injuries. 48% of former cricketers experienced persistent joint pain. However, former cricketers reported greater physical activity levels and mental-components of quality of life compared to the general population. Heat injury/illness and skin cancer are concerns and require further research. Cricket participation is associated with an inherent injury risk, which may have negative implications for musculoskeletal health in later life. However, cricket participation is associated with high quality of life which can persist after retirement. Gaps in the literature include prospective studies on health and wellbeing of cricketers, female cricketers, injury prevention strategies, and the impact of cricket participation on metabolic health and lifetime physical activity.

The Prevalence of Mental Health Conditions Among High School and Collegiate Student-Athletes: A Systematic Review

The physical impacts of overtraining, sport specification, and burnout are well documented in the literature; however, the state of the student-athlete’s (SA’s) mental health is something that needs to be investigated more comprehensively. Literature on SA mental health has gained prevalence within the last 5 years. The combination of pressure from sport and academics, as well as the stigmatization of clinical mental health treatment, can have a significant effect on the SA’s psyche. This review explores the prevalence of mental health conditions (MHCs) in high school and collegiate SAs. This includes signs and symptoms of mental health diagnoses to include substance- and alcohol-related addictive disorders and risk factors of such. A systematic review of the CINAHL, ERIC, SPORTDiscus, APA PsycINFO, and Rehabilitation & Sports Medicine resource databases was conducted. The initial search yielded 855 results. Following double screening, 22 studies were included, all of which were deemed medium to high quality. The findings indicate an alarming presence of MHCs ranging from risk factors of alcohol use and major depressive disorders among SAs. There was a high prevalence of mental health issues among SAs who are Black, Indigenous, people of color (BIPOC), and Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ). In most cases, participation in competitive athletics (varsity) did not contribute to additional MHCs for SAs. Sport psychologists should play a role in mental health programming within athletic departments. Athletic departments should develop proactive, targeted strategies to address MHCs for SAs.