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Salamh PA, Entler K, Parks M, Vrbancic C, Usui T, Hegedus EJ, Cook CE, Bullock GS. Unaccounted for Pitch Volume Among Adolescent Baseball Pitchers During a Travel Baseball Season. Clin J Sport Med 2024:00042752-990000000-00197. [PMID: 38896543 DOI: 10.1097/jsm.0000000000001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024]
Abstract
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.
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Affiliation(s)
- Paul A Salamh
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana
| | - Kalie Entler
- Memorial Hermann Rockets Sports Medicine Institute, Houston, Texas
| | - Meredith Parks
- Riley Hospital at Indiana University Hospital, Indianapolis, Indiana
| | | | - Takumi Usui
- University of Chicago Medicine, Chicago, Illinois
| | - Eric J Hegedus
- Physical Therapy Program, Phoenix, Arizona
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts
| | - Chad E Cook
- Clinical Research, Doctor of Physical Therapy Program, Duke Clinical Research Institute, Department of Population Health, Duke University, Durham, North Carolina; and
| | - Garrett S Bullock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Bowman Gray Center for Medical Education, Winston-Salem, North Carolina
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Zaremski JL, Pazik M, Vasilopoulos T, Horodyski M. Workload Risk Factors for Pitching-Related Injuries in High School Baseball Pitchers. Am J Sports Med 2024; 52:1685-1691. [PMID: 38700088 DOI: 10.1177/03635465241246559] [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] [Indexed: 05/05/2024]
Abstract
BACKGROUND Pitch counts are only one measure of the true workload of baseball pitchers. Newer research indicates that workload measurement and prevention of injury must include additional factors. Thus, current monitoring systems gauging pitcher workload may be considered inadequate. PURPOSE/HYPOTHESIS The purpose of this study was to develop a novel method to determine workload in baseball pitchers and improve processes for prevention of throwing-related injuries. It was hypothesized that our pitching workload model would better predict throwing-related injuries occurring throughout the baseball season than a standard pitch count model. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS This prospective observational study was conducted at an academic medical center and community baseball fields during the 2019 to 2023 seasons. Pitchers aged 13 to 18 years were monitored for pitching-related injuries and workload (which included pitching velocity; intensity, using preseason and in-season velocity as a marker of effort; and pitch counts). RESULTS A total of 71 pitchers had 313 recorded pitcher outings, 11 pitching-related injuries, and 24,228 pitches thrown. Gameday pitch counts for all pitchers ranged from 19 to 219 (mean, 77.5 ± 41.0). Velocity ranged from 46.8 to 85.7 mph (mean, 71.3 ± 5.8 mph). Intensity ranged from 0.7 to 1.3 (mean, 1.0 ± 0.08). The mean workload was 74.7 ± 40.1 for all pitchers. Risk factors significant for injury included throwing at a higher velocity in game (P = .001), increased intensity (eg, an increase in mean velocity thrown from preseason to in-season; P < .001), and being an older pitcher (P = .014). No differences were found for workload between injured and noninjured pitchers because the analysis was underpowered. CONCLUSION Our workload model indicated that throwing at a higher velocity, throwing at a higher intensity, and older age were risk factors for injury. Thus, this novel workload model should be considered as a means to identify pitchers who may be at greater risk for injury.
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Affiliation(s)
- Jason L Zaremski
- Division of Sports Medicine, PM&R Residency, UF Health Throwing Clinic, Department of Physical Medicine & Rehabilitation, Department of Orthopaedic Surgery & Sports Medicine, University of Florida Health, Gainesville, Florida, USA
| | - Marissa Pazik
- Department of Orthopaedic Surgery and Sports Medicine, Division of Research, University of Florida, Gainesville, Florida, USA
| | - Terrie Vasilopoulos
- Department of Anesthesiology, Department of Orthopaedic Surgery & Sports Medicine, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - MaryBeth Horodyski
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida, USA
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Holtz KA, Zaremski JL, Janosky J, Friesen KB, Oliver GD. A Model for Causality of Pitching-related Overuse Injuries in Women's Fastpitch Softball. Int J Sports Med 2024. [PMID: 38802073 DOI: 10.1055/a-2312-5051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Fastpitch softball is a popular women's sport, and athletes, particularly pitchers, are at high risk for overuse injury. Softball-related injury rates are low; however, the prevalence of overuse injuries is high. Injuries at the high school and collegiate levels occur early in the season, and approximately 50% of shoulder and elbow injuries in softball are attributable to overuse. Survey research showed 77% of high school pitchers pitch with pain, and 73% of collegiate pitchers reported an overuse injury in the previous season. Modifiable and non-modifiable intrinsic and extrinsic risk factors contribute to injury risk in a model that can be used in history taking, clinical examination, and management of softball-related injuries. In this manuscript, we present a scoping review of fastpitch softball injury research by competitive levels from 1990 to present. We also introduce a model for overuse injury causality in this athlete population. With this information, clinicians will be able to identify risk factors related to injury in softball pitchers. More research is needed to make evidence-based recommendations for injury prevention in this athlete population.
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Affiliation(s)
- Kaila A Holtz
- Department of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Jason L Zaremski
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, United States
| | - Joseph Janosky
- Sports Medicine Institute, Hospital for Special Surgery, New York, United States
| | - Kenzie B Friesen
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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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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Aso T, Kagaya Y. Effects of Repetitive Pitching on Trunk Muscle Endurance and Thoracic and Shoulder Kinematics. Int J Sports Phys Ther 2023; 18:388-396. [PMID: 37020436 PMCID: PMC10069391 DOI: 10.26603/001c.73038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/14/2023] [Indexed: 04/03/2023] Open
Abstract
Background Baseball players are aware of the potential of shoulder problems due to repetitive throwing. However, few studies have examined how pitching repeatedly affects the thoracic spine and shoulder. Purpose This study aimed to determine the effects of pitching repeatedly on the endurance of trunk muscles and kinematics of the thoracic spine and shoulder. Study design Cohort study. Methods Trunk muscle endurance was assessed in flexion, extension, and lateral flexion positions in 12 healthy amateur baseball players. The positions of stride foot contact (SFC) during the early cocking phase and maximal shoulder external rotation (MER) during the late cocking phase were used to compute the thoracic and shoulder kinematics in degrees. Participants were then asked to throw 135 fastballs (~9 innings with 15 throws per inning). Throwing motions were monitored throughout the first, seventh, eighth, and nine innings, whereas trunk muscular endurance was assessed before and after the repetitive throwing activity. Ball speed during pitching was measured using a radar gun. All outcome measures were statistically compared to examine differences over time. Results The trunk muscle endurance declined after the throwing task. In the eighth inning, compared with the first inning, the thoracic rotation angle at the SFC increased toward the throwing side. In contrast, the shoulder horizontal adduction angle at MER decreased in the seventh and ninth innings. Conclusion With repeated pitching, trunk muscle endurance gradually declines, and repetitive throwing significantly altered kinematics of the thoracic rotation at SFC and shoulder horizontal plane at MER. Level of Evidence 2a.
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Affiliation(s)
- Takuya Aso
- Department of Rehabilitation Showa University Fujigaoka Rehabilitation Hospital
| | - Yoshinori Kagaya
- Department of Physical Therapy Showa University School of Nursing and Rehabilitation Sciences
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Gibson ES, Cairo A, Räisänen AM, Kuntze C, Emery CA, Pasanen K. The Epidemiology of Youth Sport-Related Shoulder Injuries: A Systematic Review. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:8791398. [PMID: 38655170 PMCID: PMC11022765 DOI: 10.1155/2022/8791398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 04/26/2024]
Abstract
Background Youth around the globe place their shoulders at risk for injury when participating in sports. Shoulder injuries may vary in severity, produce the potential for time-loss from sport, and result in functional disability. We sought to explore sport-related shoulder injuries in youth by identifying injury rates, risk factors, injury mechanisms, and injury prevention strategies. Methods All relevant full-text articles were identified by searching MEDLINE, EMBASE, CINAHL, Sport Discus, and the Cochrane Controlled Trials Registry. No date restrictions were used. All full-text studies reporting original research describing sport-related shoulder injury among female and/or male youth from 5 to 18 years old were included. Results Of 3,889 studies screened, 97 described shoulder injury in youth sports. Shoulder injuries were identified in 24 unique sports. The median seasonal prevalence of shoulder injury was 10.9% (range 1.2-28.2%). The most common injury mechanisms identified were contacted with another player, contact with the playing environment, and falling to the ground. Risk factors for shoulder injury identified were side-to-side strength imbalances, weak external rotator muscles, and scapular dyskinesia. One study evaluated a successful training strategy to prevent shoulder injuries, but two other interventions demonstrated no effect. Conclusions Sport-related shoulder injuries are prevalent among youth athletes. Injury risk factors identified included modifiable intrinsic factors such as strength, range of motion, and training load. The most common injury mechanism was direct contact with either another person or an object in the playing environment. Innovative shoulder-specific strategies are needed to reduce shoulder injuries in this population. Trial Registration: PROSPERO ID: CRD42020189142.
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Affiliation(s)
- Eric S. Gibson
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Alexis Cairo
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Anu M. Räisänen
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Department of Physical Therapy Education, College of Health Sciences - Northwest, Western University of Health Sciences, Lebanon, Oregon, USA
| | - Colleen Kuntze
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Carolyn A. Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Kati Pasanen
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
- Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Finland
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Lizzio VA, Makhni EC. Editorial Commentary: Baseball Catchers Who Throw From a Squatted Position May Reduce Medial Elbow Torque by Stretching Exercise to Increase Passive Internal Rotation of the Throwing-Side Hip. Arthroscopy 2022; 38:1144-1145. [PMID: 35369917 DOI: 10.1016/j.arthro.2021.12.032] [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] [Received: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 02/02/2023]
Abstract
Youth baseball pitchers who also play catcher are at nearly 3-fold increased risk of developing a shoulder or elbow injury throughout the course of a season. The risk of injury has been largely attributed to the increased workload from a greater overall number of throws. In addition, throws performed by catchers are often performed in the squatting or kneeling position, which is radically different from all other positions. Fortunately, recent research shows no difference in medial elbow torque between squatting and standing throws a standard distance from home plate to the pitcher and also shows that greater passive internal rotation of the hip on the throwing side is protective against loads on the medial elbow when throwing from the squatting position. Improving passive hip range of motion through stretching exercises may prevent injury in young baseball catchers.
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Chalmers PN, Mcelheny K, D’Angelo J, Ma K, Rowe D, Erickson BJ. How does the All-Star break affect injury rates in professional baseball? JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:17-19. [PMID: 37588278 PMCID: PMC10426681 DOI: 10.1016/j.xrrt.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Injury rates in professional baseball players are increasing. It is unclear if the time of rest from the All-Star break affects injury risk. Methods Every professional baseball game (A-, A+, AA, AAA, and Major League Baseball) played between 2011 and 2017 was included. Each game was then classified as control game (games played in April, May, June, and September) or game within one month after the All-Star break. Incidence of injuries in games within one month of the All-Star break was compared with the control games. Results Our analysis included 66,642 games: 46,630 control games and 20,012 games played within one month after the All-Star break. On univariate analysis, there was a mean ± standard deviation of 0.45 ± 0.72 injuries per game in control games and 0.41 ± 0.68 injuries per game in games played within one month after the All-Star break (P<.001). On multivariate analysis, there was a significant association between games played within one month after the All-Star break and number of injuries per game (P<.001) after adjusting for the level of play and game duration. However, the effect size was 0.001, suggesting this effect is clinically insignificant. Conclusion There does not appear to be a clinically significant difference in injury rates per game in professional baseball players between games played in the month after the All-Star break and all other games played during the season. Although the All-Star break provides most players with a chance to rest, it does not appear to have an effect on injury rates.
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Affiliation(s)
- Peter N. Chalmers
- University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA
| | | | - John D’Angelo
- Major League Baseball Commissioner’s Office, New York, NY, USA
| | - Kevin Ma
- Major League Baseball Commissioner’s Office, New York, NY, USA
| | - Dana Rowe
- Major League Baseball Commissioner’s Office, New York, NY, USA
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Zaremski JL. Weighted Ball Velocity Throwing Programs Are Effective. Are the Benefits Worth the Risk? Clin J Sport Med 2022; 32:5-7. [PMID: 33914497 DOI: 10.1097/jsm.0000000000000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Jason L Zaremski
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida
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10
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Matsel KA, Weiss EE, Butler RJ, Hoch MC, Westgate PM, Malone TR, Uhl TL. A Nation-Wide Survey of High School Baseball Coaches' Perceptions Indicates their Arm Care Programs Play a Role in Injury Prevention. Int J Sports Phys Ther 2021; 16:816-826. [PMID: 34123533 PMCID: PMC8169022 DOI: 10.26603/001c.24247] [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: 08/16/2020] [Accepted: 11/26/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Arm care programs consisting of upper extremity strengthening and stretching have been recommended for injury prevention for pitchers of all ages. There has been no investigation into high school baseball coaches' usage and perceptions of arm care programs to mitigate physical impairments associated with injuries in baseball players. HYPOTHESIS/PURPOSE The purpose of this study was to investigate the current usage of arm care programs by high school baseball coaches. The primary objective was to determine if coaches use group-based or individualized arm care programs. The secondary objective sought to determine if the use of arm care programs is influenced by coaches' age, education, and experience level. Finally, this study explored the potential barriers to arm care implementation and high school baseball coaches' current awareness and beliefs of injury prevention. STUDY DESIGN Descriptive cross-sectional survey. METHODS A 29-item online survey was emailed to 18,500 high school baseball coaches throughout the United States. Data were collected for three months, and the response rate was 3.7%. RESULTS A total of 87.3% (n=571/654) of responding coaches use arm care programs with their players. Of coaches performing arm care, only 18.5% of 571 individualize their arm care exercises based on specific player needs. However, older and more experienced coaches are more likely to individualize their programs. Among the 12.7% (n=83/654) of coaches who do not use arm care programs, the two most commonly cited reasons for not implementing arm care were lack of observed benefit (41%) and insufficient staff (31%). Although 42% of 654 coaches recognized reduced shoulder mobility as a major contributor to injury, risk factors such as throwing with a fatigued arm, previous injury history, and throwing > 8 months per year were not consistently identified as primary risk factors. CONCLUSION The results of this study suggest that the majority high school baseball coaches implement group-based arm care exercise programs to prevent injury. Lack of confidence in the effectiveness and staffing limitations were major barriers to implementation of arm care programming. However, the responding coaches exhibited inconsistent risk factor awareness and dated injury prevention beliefs. Therefore, better educational collaboration between rehabilitation professionals and high school coaches regarding injury risk factors and preventative strategies is warranted. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- K A Matsel
- University of Kentucky; University of Evansville
| | | | - R J Butler
- Saint Louis Cardinals Baseball Organization
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11
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Grant C, Tuff T, Corso M, Young JJ, Stern PJ, Côté E, Côté P. Incidence and risk factors for musculoskeletal disorders of the elbow in baseball pitchers: a systematic review of the literature. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2020; 64:165-179. [PMID: 33487638 PMCID: PMC7815176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To determine the incidence and risk factors of musculoskeletal disorders of the elbow in baseball pitchers. DESIGN Systematic review. DATA SOURCES Medline, CINAHL, Cochrane, PubMed and SportDiscus from onset to July 7, 2018. ELIGIBILITY CRITERIA Eligible studies included randomized controlled trials, cohort studies and case-control studies. Independent pairs of reviewers screened titles and abstracts for eligibility. Relevant articles were critically appraised for internal validity using the SIGN criteria. We included low risk of bias studies in our best evidence synthesis. RESULTS We retrieved 4502 articles, 39 were critically appraised and nine had a low risk of bias. These were included in the evidence synthesis. The incidence of musculoskeletal disorders of the elbow ranges from 2.3% in adolescent pitchers to 40.6% in youth pitchers. Evidence suggests that pitch characteristics, inadequate rest, biomechanical and anthropometric factors may be risk factors of UCL tears. SUMMARY/CONCLUSION Baseball pitchers develop musculoskeletal disorders of the elbow. There is little high-quality evidence to understand the etiology. Preliminary evidence suggests the risk factors are multifactorial.PROSPERO Trial Registration Number: CRD42018092081.
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Affiliation(s)
- Chris Grant
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Taylor Tuff
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Melissa Corso
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Centre for Disability Prevention and Rehabilitation at Ontario Tech University and CMCC
| | - James J. Young
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Paula J. Stern
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Elie Côté
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Centre for Disability Prevention and Rehabilitation at Ontario Tech University and CMCC
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12
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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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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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Jayanthi NA, Post EG, Laury TC, Fabricant PD. Health Consequences of Youth Sport Specialization. J Athl Train 2020; 54:1040-1049. [PMID: 31633420 DOI: 10.4085/1062-6050-380-18] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Sport specialization is a training method now commonly used by young athletes who hope to achieve elite-level success. This may be defined as (1) choosing a main sport, (2) quitting all other sports to focus on 1 sport, and (3) year-round training (greater than 8 months per year). A number of sports medicine organizations have published recommendations based on the limited evidence available on this topic. The objective of this article was to perform a narrative review of the currently available evidence and sports medicine organizational recommendations regarding sport specialization and its effects on health to guide athletic trainers and sports medicine providers. To accomplish this goal, we conducted a narrative review of articles and position statements on sport specialization published from 1990 through 2018. Injury, overuse injury, serious overuse injury, and lower extremity injury were likely associated with higher degrees of sport specialization in various populations. Sports medicine organizations in general recommended against sport specialization in young athletes and instead promoted multisport participation for physical and psychological benefits. Few long-term data suggest that sport specialization has negative health-related quality-of-life consequences. Higher degrees of sport specialization likely pose risks of overuse injury; however, the age of specialization at which this risk occurs is not known. Because different populations and sports activities may put children at risk for certain injuries, future researchers should monitor large populations with sport-specific prospective active surveillance.
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Affiliation(s)
- Neeru A Jayanthi
- Emory Sports Medicine Center.,Department of Orthopedics, Department of Family Medicine, Emory University School of Medicine, Atlanta, GA
| | - Eric G Post
- School of Exercise and Nutritional Sciences, San Diego State University, CA
| | | | - Peter D Fabricant
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, and Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY
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