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Chen PT, Lin YC, Chang HY, Chiu CH, Chen CY, Chen P, Lin YH. Effects of Shoulder Corrective Training Program on Pitching Loads and Sonographic Morphology in Elbow Joint in Youth Baseball Players. J Strength Cond Res 2024; 38:e440-e447. [PMID: 39072664 DOI: 10.1519/jsc.0000000000004804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
ABSTRACT Chen, P-T, Lin, Y-C, Chang, H-Y, Chiu, C-H, Chen, C-Y, Chen, P, and Lin, Y-H. Effects of shoulder corrective training program on pitching loads and sonographic morphology in elbow joint in youth baseball players. J Strength Cond Res 38(8): e440-e447, 2024-We assessed the effects of a 12-week shoulder corrective training program for shoulder flexibility and strengthening on pitching loads and sonographic morphology of the elbow joints in youth baseball players. Seventeen subjects were recruited and underwent evaluations before and after the training program. We found that following training, subjects demonstrated significantly increased ranges of shoulder internal rotation (38.9 ± 12.9° vs. 69.2 ± 10.8°, p < 0.001), external rotation (91.2 ± 14.6° vs. 107.3 ± 9.5°, p = 0.004), and horizontal adduction (21.5 ± 8.0° vs. 32.7 ± 7.3°, p = 0.002); improved strength in the shoulder internal rotators (8.7 ± 1.6 kg vs. 9.8 ± 2.1 kg, p = 0.04), external rotators (6.5 ± 1.9 kg vs. 7.5 ± 2.8 kg, p = 0.04), middle trapezius (12.7 ± 2.1 kg vs. 14.3 ± 2.4 kg, p = 0.04), and middle deltoid muscles (10.8 ± 3.3 kg vs. 14.8 ± 3.2 kg, p = 0.001); and decreased thickness of the ulnar collateral ligament (6.1 ± 0.6 mm vs. 4.8 ± 0.7 mm, p = 0.002). Although there was no substantial change in elbow torque and arm speed, significantly increased ball speed (51.2 ± 4.6 mph vs. 54.1 ± 4.5 mph, p < 0.001) and decreased arm slot (63.8 ± 11.9° vs. 53.0 ± 12.7°, p = 0.02) were observed. We suggest that adequate corrective training should be performed regularly to minimize or mitigate adverse soft tissue changes at the elbow in youth baseball players. Balanced shoulder strength and flexibility may decrease medial elbow stress during pitching. Future studies should consider the kinetic and kinematic effects of other corrective training programs on the shoulder or elbow joint during pitching.
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Affiliation(s)
- Po-Tsun Chen
- School of Physical Therapy and Graduate Institute of Rehabilitation Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Chun Lin
- School of Physical Therapy and Graduate Institute of Rehabilitation Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Yun Chang
- Department of Athletic Training and Health, National Taiwan Sport University, Taoyuan, Taiwan
| | - Chih-Hao Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Yu Chen
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, 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; and
| | - Yang-Hua Lin
- School of Physical Therapy and Graduate Institute of Rehabilitation Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Physical Therapy, Department of Physical Medicine & Rehabilitaion, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Stokes HL, Eaton K, Zheng N. Shoulder External Over Internal Rotation Ratio Is Related to Biomechanics in Collegiate Baseball Pitching. J Appl Biomech 2024; 40:209-216. [PMID: 38467121 DOI: 10.1123/jab.2023-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Abstract
Altering baseball pitching mechanics affects both performance and the risk of injury. The purpose of this study is to investigate the relationships of shoulder external over internal rotation ratio (SEIR) and other shoulder rotational properties during physical exam and biomechanics of pitching for 177 collegiate baseball pitchers. The shoulder range of motion was quantitatively measured using a custom-made wireless device. Pitching motion data were collected at 240 Hz, and a custom program was created to calculate the throwing arm motion and loading during baseball pitching. Linear regression and analysis of variance tests were performed to investigate the relationships between the shoulder physical exam outcomes and throwing arm biomechanics. SEIR had significant correlations with shoulder horizontal adduction angle at foot contact, maximum shoulder external rotation angle, maximum shoulder linear velocity, and elbow angle at ball release. SEIR groups had significant differences in shoulder proximal force, adduction torque, internal rotation torque, and horizontal adduction torque, and in elbow medial force and varus torque. Glenohumeral internal rotation deficit and total rotational motion deficit had no relationships with throwing arm motions or joint loadings. Shoulder health should be monitored to improve understanding of pitching mechanics in collegiate baseball pitchers.
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Affiliation(s)
- Hannah L Stokes
- Depatment of Mechanical Engineering and Engineering Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Koco Eaton
- Tampa Bay Rays and University of South Florida, Tampa, FL, USA
| | - Naiquan Zheng
- Depatment of Mechanical Engineering and Engineering Science, University of North Carolina at Charlotte, Charlotte, NC, USA
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Strama E, Keenan KA, Sell T, Faherty M, Rafferty D, Salesi K, Csonka J, Varnell M. Throwing Shoulder Adaptations Are Not Related to Shoulder Injury or Pain: A Preliminary Report. Sports Health 2024; 16:347-357. [PMID: 37740495 PMCID: PMC11025517 DOI: 10.1177/19417381231197217] [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: 09/24/2023] Open
Abstract
BACKGROUND Overhead throwing in baseball and softball athletes induces shoulder adaptations theorized to increase risk of shoulder musculoskeletal injury (MSI) and/or pain due to range of motion (ROM) deficits. HYPOTHESIS Shoulder ROM adaptations are associated with a higher risk for developing shoulder MSI and pain. STUDY DESIGN Prospective cohort study. LEVEL OF EVIDENCE Level 3. METHODS A total of 60 National Collegiate Athletic Association Division I athletes cleared for full athletic participation and free from upper extremity MSI in the last 4 weeks (age, 19.0 ± 1.2 years; weight, 82.1 ± 13.7 kg; height, 178.6 ± 11.2 cm; softball, n = 23; baseball, n = 37). Passive glenohumeral internal rotation (IR), external rotation (ER), and horizontal adduction (HA) ROM were measured with the scapula stabilized and used to categorize participants with/without external rotation gain (ERG), external rotation insufficiency (ERI), glenohumeral internal rotation deficit (GIRD), pathological GIRD, and posterior shoulder tightness (PST) before the competitive season. Groups were then compared to assess the incidence of shoulder MSI prospectively and prevalence of shoulder pain at the initial evaluation. RESULTS Baseball and softball athletes demonstrated significantly less IR ROM in the dominant shoulder (50.6° ± 9.4°) compared with the nondominant shoulder (59.1° ± 8.6°; P < 0.01) and significantly more ER ROM (dominant, 104.6° ± 12.1°; nondominant, 97.7° ± 12.0°; P < 0.01). Incidence of shoulder MSI was 15% but was not significantly related to any shoulder adaptations. No significant relationship was found between prevalence of pain and any shoulder adaptations in the 27% of athletes with pain. CONCLUSION Increased ER and decreased IR ROM adaptations in intercollegiate overhead throwing athletes do not appear to be correlated to risk of shoulder MSI or pain. CLINICAL RELEVANCE The findings of this level 3 prospective study provide clinicians working with overhead athletes information regarding shoulder MSI risk and pain. It is recommended that clinicians should not use ROM adaptations exclusively to determine increased risk of shoulder MSI.
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Affiliation(s)
- Emily Strama
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Timothy Sell
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | | | - Deirdre Rafferty
- Department of Medicine, Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Karl Salesi
- University of Pittsburgh, Pittsburgh, Pennsylvania
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Ishigaki T, Akuzawa H, Sekine C, Yokota H, Hirabayashi R, Edama M. Elbow valgus stress during towel drills in college baseball players. J Shoulder Elbow Surg 2024; 33:765-772. [PMID: 37865153 DOI: 10.1016/j.jse.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND In baseball players with elbow injuries, towel drills are clinically used before initiating active throwing exercises to gradually increase stress across the elbow. However, elbow valgus torque during towel drills remains unknown. Moreover, towel drills and active ball throws might have different relationships between biomechanical metrics, such as elbow stress, arm slot, and arm speed. Therefore, the aims of this study were 1) to demonstrate the difference in elbow valgus stress between towel drills and active ball throws and 2) to evaluate the correlation between elbow valgus torque and other biomechanical metrics including arm slot and arm speed in towel drills and active ball throws. METHODS Seventeen healthy college baseball players performed three towel drills using a face towel, short foam tube, and long foam tube, followed by full-effort throwing on flat ground. Each participant completed five consecutive trials of each task, and the elbow valgus torque, arm slot, and arm speed were measured using wearable sensors. One-way repeated analysis of variance and post-hoc tests were used to determine the differences in biomechanical metrics among the tasks. Furthermore, the correlation between the elbow valgus torque and other metrics was evaluated using Pearson correlation coefficients. RESULTS Elbow valgus torque was lower in towel drills compared to that of active ball throws; however, the stress during towel drills using a face towel reached almost 80% of the maximum effort of active ball throws. There was no relationship between elbow valgus stress and arm slot in either the towel or active ball throw tasks. However, a higher arm speed was associated with greater elbow valgus torque in towel drills, whereas no relationship between elbow stress and arm speed was found in active ball throws. CONCLUSION Precaution must be taken in athletes following a progressive throwing program because elbow valgus stress reaches almost 80% of the full-effort throw, even when using a face towel in a towel drill. Hence, the subjective intensity must be controlled even in towel drills to gradually increase the medial elbow stress. Moreover, the mechanisms underlying changes in elbow stress may differ between towel drills and active ball throws. Future investigations on the difference between towel drills and active ball throws may help understand the underlying mechanism of alterations in elbow valgus torque during the throwing movement.
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Affiliation(s)
- Tomonobu Ishigaki
- Athlete Support Research Center, Niigata University of Health and Welfare, Niigata, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan; Institute of Life Innovation Research Center, Toyo University, Tokyo, Japan.
| | - Hiroshi Akuzawa
- Athlete Support Research Center, Niigata University of Health and Welfare, Niigata, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Chie Sekine
- Athlete Support Research Center, Niigata University of Health and Welfare, Niigata, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Hirotake Yokota
- Athlete Support Research Center, Niigata University of Health and Welfare, Niigata, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryo Hirabayashi
- Athlete Support Research Center, Niigata University of Health and Welfare, Niigata, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mutsuaki Edama
- Athlete Support Research Center, Niigata University of Health and Welfare, Niigata, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
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Saito A, Okada K, Sato H, Shibata K, Kamada T, Namiki Y, Terui Y. Increased Medial Elbow Torque Is Associated With Ball Velocity Rather Than a History of Medial Elbow Injuries in Youth Baseball Pitchers. Arthroscopy 2023; 39:719-727. [PMID: 35970452 DOI: 10.1016/j.arthro.2022.07.016] [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: 02/18/2022] [Revised: 05/25/2022] [Accepted: 07/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE This study compared medial elbow torque in youth baseball pitchers with and without a history of medial elbow injuries to determine the relationship between medial elbow torque during pitching and having a history of medial elbow injuries. METHODS We recruited 171 youth baseball pitchers aged 9 to 12 years old. The exclusion criteria included current pain with pitching, history of surgery on the tested extremity, or osteochondritis dissecans of the humeral capitellum. The participants were grouped into 3 groups: injury <1-year, injury >1-year, and control, based on ultrasonographic abnormalities of the elbow and the presence of elbow pain. Pitchers pitched 3 fastballs while wearing a sensor sleeve that recorded the medial elbow torque, arm speed, and shoulder rotation. Ball velocity was measured using a radar gun. RESULTS The final analysis included 164 pitchers. Thirty were assigned to the injury <1-year group, 34 to the injury >1-year group, and 100 to the control group. The medial elbow torque was significantly greater in the injury <1-year group compared with the control group (18.6 ± 3.6 Nm vs 16.2 ± 4.8 Nm, P = .023). A multiple regression analysis revealed that ball velocity (B = 0.282, P < .001) and body weight (B = -0.224, P < .001) were significantly associated with medial elbow torque, but not with the history of medial elbow injuries. CONCLUSIONS Increased medial elbow torque was associated with greater ball velocity regardless of the history of medial elbow injuries. Youth baseball pitchers with a history of medial elbow injuries within one year had greater medial elbow torque during pitching; however, having a history of medial elbow injuries was not an independent factor in increasing medial elbow torque. Limiting the ball velocity can reduce medial elbow torque and may prevent elbow injuries in youth baseball pitchers. LEVEL OF EVIDENCE Level II, prospective comparative prognostic investigation with the patients enrolled at different time point.
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Affiliation(s)
- Akira Saito
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan.
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Hiromichi Sato
- Department of Rehabilitation, Akita Kousei Medical Hospital, Akita, Japan
| | | | - Tetsuaki Kamada
- Department of Rehabilitation, Akita Kousei Medical Hospital, Akita, Japan
| | - Yusuke Namiki
- Department of Rehabilitation, Akita City Hospital, Akita, Japan
| | - Yoshino Terui
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
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Factors that Increase Elbow Stress in the Throwing Athlete: a Systematic Review of Biomechanical and Motion Analysis Studies of Baseball Pitching and Throwing. Curr Rev Musculoskelet Med 2022; 16:115-122. [PMID: 36572821 PMCID: PMC10043103 DOI: 10.1007/s12178-022-09800-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Elbow pain poses a unique challenge in the throwing athlete. Due to the high levels of elbow stress during the throwing motion, elbow injuries are common in throwers of all ages. There are several postulated factors believed to contribute increased stress to the throwing elbow. A detailed review of the published biomechanical studies evaluating the stresses experienced by the throwing elbow is needed. Here, we review these biomechanical studies to extrapolate the contributing factors that increase stress, the modifications that may reduce such stress, and the post-injury rehabilitation that optimizes outcomes and reduces recurrence. RECENT FINDINGS The biomechanical forces on the elbow have been further investigated delineated in recent work. Rotational malalignment of the shoulder, including both GIRD and decreased adduction, increases torque experienced by the elbow during pitching motions. Exact interactions between lower extremity, lumbopelvic or trunk rotation, and elbow forces during throwing remain uncertain with mixed results in recent literature. Pitch types may influence elbow stresses although delivery mechanism and distance thrown do not. Several biomechanical factors influence the stresses imparted on the throwing elbow. Throwing volume, proper throwing mechanics, and appropriate rehabilitation are likely to be to be the most influential on mitigating unnecessary stresses imparted to the elbow in the throwing athlete. A proper understanding of these factors may reduce the occurrence of these injuries in this population. Moreover, an understanding of proper rehabilitation following injury may ensure optimized results and reduce recurrence.
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Stokes H, Eaton K, Zheng NN. Shoulder External Rotational Properties During Physical Examination Are Associated With Injury That Requires Surgery and Shoulder Joint Loading During Baseball Pitching. Am J Sports Med 2021; 49:3647-3655. [PMID: 34554883 DOI: 10.1177/03635465211039850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Throwing arm injuries are common because of the demand on the shoulder. The shoulder is qualitatively checked regularly by team physicians. Excessive instability and joint loading in baseball pitching are risk factors for throwing arm injuries. Knowledge of shoulder flexibility, range of motion, and joint loading may provide new insights for treatments to reduce the likelihood of injury incidence. PURPOSE To investigate the relationship among injuries, shoulder external rotational properties, and shoulder joint loading in baseball pitchers. STUDY DESIGN Descriptive laboratory study. METHODS Pitching kinetics, shoulder rotational tests, and self-reported injury questionnaires were used to study 177 collegiate baseball pitchers. Pitching motion data were collected at 240 Hz using a motion capture system. A custom program calculated the shoulder joint loading. The shoulder rotational test quantitatively records shoulder range of motion and flexibility using a custom-made wireless device. Self-reported injury questionnaires were filled out during tests and yearly follow-ups. The total length of the study was 5 years. Analysis of variance, chi-square, and regression tests were performed to compare differences among groups and detect correlations with surgery and shoulder joint loadings. RESULTS There were significant differences in shoulder flexibility among surgery groups. Shoulder external rotational properties during physical examination were significantly associated with shoulder joint loading in baseball pitching. High shoulder external rotation was associated with 14% to 36% lower shoulder posterior force and adduction, internal rotation, and horizontal adduction torque (P < .05). High shoulder flexibility was associated with 13% higher anterior force (P < .05). High shoulder external rotation before external rotation torque was applied was associated with 13% to 33% lower shoulder inferior force and adduction, internal rotation, and horizontal adduction torque (P < .05). There were no significant differences in shoulder joint loading among the surgery groups. CONCLUSION Shoulder injuries that require surgery were associated with shoulder external rotation flexibility. High shoulder external rotation may be advantageous because it lowers the force and torque on the shoulder joint. CLINICAL RELEVANCE The ability to understand shoulder external rotational properties, joint loading, and injury during baseball pitching helps further our understanding of injury mechanisms. The shoulder rotational test should be used as a screening tool to identify players at risk.
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Affiliation(s)
- Hannah Stokes
- Department of Mechanical Engineering and Engineering Science, Center for Biomedical Engineering and Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Koco Eaton
- Tampa Bay Rays and the University of South Florida, Tampa, Florida, USA
| | - Naiquan Nigel Zheng
- Department of Mechanical Engineering and Engineering Science, Center for Biomedical Engineering and Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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