Effect of Pitching Restrictions and Mound Distance on Youth Baseball Pitch Counts

Background:

Studies have shown that higher pitch counts are directly related to a greater incidence of elbow and shoulder pain among youth baseball pitchers.

Purpose/Hypothesis:

The purpose of this study was to examine the effect of different pitching restriction rules on the number of pitches thrown in youth baseball leagues. We hypothesized that more pitches would be thrown in leagues with inning restrictions versus leagues with pitch count restrictions as well as in leagues with a longer mound distance (from pitching mound to home plate).

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Pitch count data were collected for 2 consecutive years over a 10-week season from 3 different leagues of 9- to 12-year-old baseball players in a single city. The Eastern league had a pitch count restriction and 46-ft (14.02-m) mound distance. The Southeastern and South leagues’ pitching restrictions were based on innings per week. The Southeastern league had a 50-ft (15.24-m) mound distance, while the South league had a 46-ft mound distance. Comparisons of total seasonal pitches thrown were made of the 3 highest-volume pitchers on each team. League averages for each value were then compared utilizing analysis of variance with Bonferroni post hoc analysis. The number of pitchers in each league who threw >600 pitches per season was compared using the chi-square test.

Results:

No significant difference in seasonal pitch counts or innings pitched was noted between the Eastern and South leagues, which differed only in their pitching restrictions. The Southeastern league, with a longer mound distance, was found to have higher seasonal pitch counts per thrower (598 ± 195 pitches) than the South league (463 ± 198 pitches) for the 3 highest-volume throwers for each team (P = .004). The Southeastern league also had a significantly larger number of pitchers who threw >600 pitches per season (33 vs 20 for Eastern and 13 for South; P = .009).

Conclusion:

There was no significant difference in seasonal pitch counts when the leagues in this study differed based on pitching restrictions. However, the league with a greater mound distance (Southeastern) had higher seasonal pitch counts for the highest-volume throwers. Pitching restrictions based on pitch counts, as opposed to innings, may be advisable.

Trends in concussion return-to-play timelines among high school athletes from 2007 through 2009

CONTEXT

Whereas guidelines about return-to-play (RTP) after concussion have been published, actual prognoses remain elusive.

OBJECTIVE

To develop probability estimates for time until RTP after sport-related concussion.

DESIGN

Descriptive epidemiology study.

SETTING

High school.

PATIENTS OR OTHER PARTICIPANTS

Injured high school varsity, junior varsity, or freshman athletes who participated in 1 of 13 interscholastic sports at 7 area high schools during the 2007-2009 academic years.

INTERVENTION(S)

Athletic trainers employed at each school collected concussion data. The athletic trainer or physician on site determined the presence of a concussion. Athlete-exposures for practices and games also were captured.

MAIN OUTCOME MEASURE(S)

Documented concussions were categorized by time missed from participation using severity outcome intervals (same-day return, 1- to 2-day return, 3- to 6-day return, 7- to 9-day return, 10- to 21-day return, >21-day return, no return [censored data]). We calculated Kaplan-Meier time-to-event probabilities that included censored data to determine the probability of RTP at each of these time intervals.

RESULTS

A total of 81 new concussions were documented in 478 775 athlete-exposures during the study period. After a new concussion, the probability of RTP (95% confidence interval) was 2.5% (95% confidence interval = 0.3, 6.9) for a 1- to 2-day return, 71.3% (95% confidence interval = 59.0, 82.9) for a 7- to 9-day return, and 88.8% (95% confidence interval = 72.0, 97.2) for a 10- to 21-day return.

CONCLUSIONS

For high school athletes, RTP within the first 2 days after concussion was unlikely. After 1 week, the probability of return rose substantially (approximately 71%). Prognostic indicators are used to educate patients about the likely course of disease. Whereas individual symptoms and recovery times vary, prognostic time-to-event probabilities allow clinicians to provide coaches, parents, and athletes with a prediction of the likelihood of RTP within certain timeframes after a concussion.

Pulmonary infections in the athlete

Despite their general high level of health, athletes are not free from the threat of developing pulmonary infection. Prompt diagnosis and proper treatment are important given the effects of pulmonary infection upon athletic performance and time away from training. This article reviews common etiologies of community-acquired pneumonia and a more in-depth discussion of mycoplasma pneumonie and influenza. Current treatment guidelines, acute bronchitis, fungal pulmonary infection, and return to play principles also are discussed.

Evaluation and management of stress fractures of the pelvis and sacrum

Most stress fractures of the pelvis and sacrum can be treated nonoperatively with activity modification and thorough assessment of training activities and nutritional factors.

Outcomes of a Weight-Bearing Rehabilitation Program for Patients Diagnosed With Patellofemoral Pain Syndrome

OBJECTIVE

To determine the effects of a weight-bearing rehabilitation program on quadriceps and gluteus medius electromyographic activity, pain, and function in subjects diagnosed with patellofemoral pain syndrome (PFPS).

DESIGN

Pretest and posttest 6-week intervention study.

SETTING

Musculoskeletal research laboratory.

PARTICIPANTS

Fourteen subjects diagnosed with PFPS and 14 healthy control subjects volunteered to participate in this study. No subjects withdrew from the study because of adverse effects.

INTERVENTION

Subjects diagnosed with PFPS participated in a 6-week rehabilitation program. The rehabilitation program consisted of weight-bearing exercises that focused on strengthening the quadriceps and hip abductor musculature.

MAIN OUTCOME MEASURES

Electromyographic onsets of the vastus medialis oblique (VMO) and vastus lateralis and onset and duration of the gluteus medius were collected during a stair-stepping task that was performed during the pretest and posttest. A visual analog scale (VAS) and Functional Index Questionnaire (FIQ) were administered at pretest and posttest and each week of the intervention.

RESULTS

Vastus lateralis and VMO onset timing differences (vastus lateralis electromyographic onset minus VMO electromyographic onset) and VAS and FIQ scores significantly improved for patients diagnosed with PFPS. Vastus lateralis and VMO onset timing in the PFPS group were significantly different from those in the control group at baseline and were not significantly different from the control group after the intervention. We did not find differences in gluteus medius onsets or duration of activity.

CONCLUSIONS

Subjects diagnosed with PFPS responded favorably and quickly to a therapeutic exercise program that incorporated quadriceps and hip musculature strengthening. The efficacy of the therapeutic exercise program used in this study should be further investigated in a larger subject population.

Ergogenic aids: an update on ephedra

Ephedra has been used medicinally for thousands of years dating back to ancient Chinese medicine. Since its introduction to Western medicine in the 20th century, ephedra has been used for various ailments. The amphetamine-like activity of ephedra made it a popular supplement for promotion of weight loss and enhancement of athletic performance, despite limited supporting data. With the implementation of the Dietary Supplement Health and Education Act of 1994, the US Food and Drug Administration's (FDA) regulation of ephedra-containing supplements diminished. As these products became increasingly available, adverse effects associated with their use also increased. These adverse effects are mainly a result of ephedra's sympathomimetic activity and have been manifested by premature cardiovascular and central nervous system disease. With mounting evidence concerning the unsafe nature of these products, the FDA was able to ban the sale of ephedra-containing dietary supplements in April of 2004.

Nitric oxide therapy: fact or fiction?

Nitric oxide (NO) has been the topic of many studies regarding its therapeutic benefit in patients with cardiac disease. Recent studies are now revealing potential advantages for healthy individuals and endurance athletes. This article discusses current research focused on NO augmentation in relation to muscular strength and endurance. Arginine, an NO precursor, has been more extensively studied as a supplement for performance enhancement. Its role in cardiovascular endurance and strength training is assessed in individuals with various athletic backgrounds. The therapeutic role of NO in the treatment of tendinopathies is also reviewed.

Ultrasound assessment of spleen size in collegiate athletes

OBJECTIVES

To determine normal spleen dimensions in a healthy collegiate athletic population.

METHODS

631 Division I collegiate athletes from one university participated in the study. During pre-participation examinations, demographic data collected were collected from volunteer athletes including sex, race, measurement of height and weight, and age. Subjects also completed a medical history form to determine any history of mononucleosis infection, platelet disorder, sickle cell disease (or trait), thalassaemia, or recent viral symptoms. Subjects then underwent a limited abdominal ultrasound examination, where splenic length and width were recorded.

RESULTS

Mean (SD) splenic length was 10.65 (1.55) cm and width, 5.16 (1.21) cm. Men had larger spleens than women (p<0.001). White subjects had larger spleens than African-American subjects (p<0.001). A previous history of infectious mononucleosis or the presence of recent cold symptoms had no significant affect on spleen size. In more than 7% of athletes, baseline spleen size met current criteria for splenomegaly.

CONCLUSIONS

There is a wide range of normal spleen size among collegiate athletes. Average spleen size was larger in men and white athletes than in women and black athletes. A single ultrasound examination for determination of splenomegaly is of limited value in this population.

Training room management of medical conditions: infectious diseases

Management of infectious diseases in athletes encompasses a wide range of pathogens, clinical presentations, and treatment options. Certain athletic activities and training regimens may predispose athletes to increased risk of contracting infectious diseases, some of which may limit athletic participation and pose the threat of significant morbidity. The sports medicine physician plays an important role as a first line of defense in preventing, recognizing, and appropriately treating infectious diseases in athletes.

Soft-tissue injuries of the lower extremity

A diverse set of conditions affect the lower extremities in athletes. Good history taking and knowledge of the anatomy of the affected areas can aid in accurate diagnosis. Most conditions can be treated conservatively with great success. Familiarity with rehabilitation strategies can assist physicians in working with physical therapists. New advances, especially in the therapy of plantar fasciitis, may aid physicians in more rapid treatment of conditions of overuse. Surgery can provide definitive relief from symptoms for athletes with whom conservative measures have failed.

Medial and lateral collateral injuries: prognosis and treatment

This article presents a comprehensive review of medial and lateral knee ligament injuries. It reviews the basic anatomy, physical examination, imaging techniques, and current treatment of medial and lateral knee injuries. It includes a step-by-step guide to proper physical examination of the knee as well as MRI images. Current treatment of medial and lateral knee injuries is extensively reviewed to aid the primary care physician in diagnosis and provision of care.

Medical aspects of sports: epidemiology of injuries, preparticipation physical examination, and drugs in sports

The epidemiology of sports injuries helps identify the necessity for medical event coverage, injury risk factors, and potential prevention strategies. The preparticipation examination provides an opportunity for the team physician to identify athletes at risk of injury, to teach injury prevention, and to address athlete wellness. Knowledge of performance-enhancing drugs, nutritional supplements,and banned and legal medications is critical in caring for athletes.

High-speed video analysis of head-first and feet-first sliding techniques in collegiate baseball players

OBJECTIVE

To determine the method of sliding that propels the baseball athlete to the desired base in the shortest amount of time. To assess the athlete's perception of the quickest, safest, and preferred sliding technique.

DESIGN

A single occasion with repeated measures design was used. The independent variable was slide type, and the dependent variable was time.

SETTING

The study was conducted in October 2000 at the University of Kentucky baseball complex.

PARTICIPANTS

Twenty collegiate baseball players.

INTERVENTIONS

High-speed video (to 1/200th of second) analysis of 20 collegiate baseball players performing 3 trials each of both head-first and feet-first sliding techniques. Additionally, each participant was asked to complete a sliding survey.

MAIN OUTCOME MEASURES

The videotape of each slide performed was reviewed separately (using the same viewing equipment) by 2 of the study investigators. Slide type and time were recorded for each slide.

RESULTS

There was no significant difference between head-first versus feet-first slide times (P = 0.357). The average time for feet-first slides was 3.67 seconds, while that for head-first was 3.65 seconds. Sixty-eight percent of the players felt that head-first slides were faster than feet-first slides. Seventy-four percent identified the feet-first slide as the technique they most used, while 90% of the athletes perceived the feet-first technique to be safer.

CONCLUSIONS

On average, head-first and feet-first sliding techniques employed at the end aspect of base running propel the baseball player to the base in similar times. The head-first sliding technique is perceived to be faster and more dangerous.

Sudden cardiac death

Sudden cardiac death is a rare but devastating event. The majority of cases in young athletes are caused by congenital cardiac abnormalities that are routinely clinically silent before causing sudden death. An optimal screening practice to help identify underlying asymptomatic cardiac abnormalities has met with much debate. Beyond the American Heart Association's recommendations for cardiovascular screening guidelines for the preparticipation physical examination [47], there are conflicting views regarding the use of more advanced diagnostic screening tests. Athletes in whom a potentially life-threatening cardiovascular abnormality is found face the probability of being restricted from participating in certain types of athletic activity. Participation guidelines for athletes with cardiovascular disease are detailed in the recommendations of the 26th Bethesda Conference [36]. Future goals should continue to focus on the prevention of SCD. The development of a cost-effective screening process that incorporates the use of echocardiography, although having its own set of inherent limitations, may prove to be the most viable option.

Exercise-induced anaphylaxis and urticaria

In a select group of persons, exercise can produce a spectrum of allergic symptoms ranging from an erythematous, irritating skin eruption to a life-threatening anaphylactic reaction. The differential diagnosis in persons with exercise-induced dermatologic and systemic symptoms should include exercise-induced anaphylaxis and cholinergic urticaria. Both are classified as physical allergies. Mast cell degranulation with the release of vasoactive substances appears to be an inciting factor for the production of symptoms in both cases. Exercise-induced anaphylaxis and cholinergic urticaria can be differentiated on the basis of urticarial morphology, reproducibility, progression to anaphylaxis and response to passive warming. Diagnosis is usually based on a thorough history and examination of the morphology of the lesions. Management of acute episodes of exercise-induced anaphylaxis includes cessation of exercise, administration of epinephrine and antihistamines, vascular support and airway maintenance. Long-term care may require modification of or abstinence from exercise, avoidance of co-precipitating factors and the prophylactic use of medications such as antihistamines and mast cell stabilizers.

Baseball and softball sliding injuries. Incidence, and the effect of technique in collegiate baseball and softball players

We prospectively observed seven softball and three baseball Division I collegiate teams to study the incidence of sliding injuries, the types of injuries resulting from the sliding technique, and the amount of time lost from participation. Slides were categorized as either feet- or head-first on the basis of the leading part of the body during the slide. Slides were further stratified depending on whether a diveback technique was performed. We recorded 37 injuries in 3889 slides in 637 games and 7596 athlete game exposures. The overall incidence of sliding injuries was 9.51 per 1000 slides and 4.87 per 1000 game exposures. Softball players had a significantly higher incidence of sliding injuries (12.13 per 1000 slides) than did baseball players (6.01 per 1000 slides). In baseball, the injury rate was higher for feet-first slides (7.31 per 1000 slides) than for headfirst slides (3.53 per 1000 slides) or divebacks (5.75 per 1000 divebacks). In softball, injury rates were higher for head-first slides (19.46 per 1000 slides) than for feet-first slides (10.04 per 1000 slides) or divebacks (7.49 per 1000 divebacks). The majority of injuries sustained were minor, with only four (11%) injuries causing the athlete to miss more than 7 days of participation.

In my experience: a postgame nightmare

I have always enjoyed attending scholastic football games. I've savored the enthusiasm, intensity, and desire displayed by the young athletes. This began when I was old enough to join my father, a high school coach, on the sidelines, and it continues today as I serve as a team physician for a local high school.