Acute Effects of Weighted Baseball Throwing Programs on Shoulder Range of Motion

The influence of a single 30-pitch session on elbow laxity in adolescent and collegiate baseball pitchers

BACKGROUND

Ulnar collateral ligament (UCL) injuries are a source of significant injury among baseball players, and are increasingly evaluated under ultrasound. The purpose of this study is to determine the effect of a single session of pitching upon UCL thickness and laxity via a cross sectional, controlled ultrasonographic study. We hypothesize that a single session of pitching will cause the ulnar collateral ligament to thicken and become more lax.

METHODS

This was a cross sectional comparative study of collegiate and high school pitchers. Pitchers underwent an ultrasonographic assessment of the UCL before and after a thirty-pitch bullpen warm-up. Laxity was measured as the change in the distance between the ulna and the trochlea with and without a 5-pound weight held in hand with the elbow at 30° of flexion. Pre- and post-throwing UCL thickness and medial laxity were statistically compared with paired tests.

RESULTS

Our study included 15 pitchers, 8 collegiate and 7 high school level athletes. All played baseball at least 6 days a week, and nearly all played for at least 10 months a year. Pitchers reported a peak velocity of 89 ± 6 (77 to 98) miles per hour. In the prior season, these pitchers pitched 56 ± 33 (10 to 120) games, throwing 62 ± 34 (25-140) pitches per game on average. After throwing, there was significantly less UCL laxity (P = .013). Post-throwing laxity was significantly positively correlated with both peak pitch velocity (P = .009) and an average number of pitches thrown per game (P = .10).

CONCLUSION

Throwing 30 pitches significantly decreases medial elbow laxity with stress, possibly due to flexor-pronator activation. Post-throwing medial laxity is correlated with both peak pitch velocity and average number of pitches thrown per game. Future studies should be conducted to determine the number of throws at which laxity begins to increase, as this may provide a workload management guideline for injury prevention.

Rehabilitation of the painful shoulder

Managing the painful shoulder in overhead athletes can be difficult because of a lack of time-loss injuries in overhead sports and focusing primarily on either pathoanatomic causes or movement impairments. Although managing the painful shoulder can be challenging, the combination of identifying pathoanatomic causes with movement impairments can provide a more focused rehabilitation approach directed at the causes of shoulder pain. Understanding the potential influence of scapular positioning as well as mobility and/or strength impairments on shoulder pain can help clinicians develop more directed rehabilitation programs. Furthermore, sports-specific methods such as long toss or the use of weighted balls for achieving physiological or performance-based gains have limited empirical evidence regarding their clinical and performance-based benefits, which may impede the rehabilitation process. Applying a comprehensive evaluation approach prior to and throughout the treatment process can assist clinicians with selecting the most appropriate treatment based on patient need. Reconsidering traditional treatments based on existing evidence may help refine the treatment process for overhead athletes with shoulder pain.

Most high school baseball pitchers are using weighted ball throwing programs to increase ball velocity: crosssectional analysis of US high school pitchers

Background

Weighted-ball velocity training programs are popular but may be associated with increased injury risk. The purpose of this study was to determine the current frequency of these programs, as well as their association with range of motion, strength, velocity, injury, and utilization in high school baseball pitchers.

Methods

This was a multicenter, prospective, community-based study including high schools from the Northeastern, Southeastern, Midwestern, and Western regions of the United States. Preseason pitchers were surveyed about their use of weighted ball velocity programs and history of injury. Preseason pitchers underwent standardized physical examinations and pitch velocity was measured. During a single high school season, pitch counts and injury incidence were prospectively collected.

Results

In total, 115 pitchers were recruited, of whom 63% had participated in a weighted ball program. There were no differences in range of motion or strength between groups who used weighted balls and those who did not. Pitchers that utilized weighted ball programs demonstrated a higher average fastball velocity (114.26 vs. 106.22 km/h [71 vs. 66 mph]; P < .001) as well as peak fastball velocity (115.87 vs. 109.44 km/h [72 vs. 68 mph]; P = .001) compared to those that did not use weighted ball programs. Pitchers that utilized weighted ball programs were no more likely to be single-sport athletes (44%) than those who were multisport athletes (49%, P = .667). Within the group who had used a weighted ball program 29% (13/45) reported a history of injury and within the group who had not used a weighted ball program 25% (10/40) reported a history of injury (P = .687). As only a single injury occurred in the entire cohort, comparison of injury rates could not be completed.

Conclusion

In this prospective study, the majority of high school pitchers reported using weighted ball programs to increase velocity, and these programs were associated with increased average and peak velocity compared to pitchers who did not use weighted ball programs. There were no significant differences in injury history between the 2 groups. Further study is necessary to understand the injury risk associated with weighted ball programs.

Role of Pelvis and Trunk Biomechanics in Generating Ball Velocity in Baseball Pitching

ABSTRACT

Orishimo, KF, Kremenic, IJ, Mullaney, MJ, Fukunaga, T, Serio, N, and McHugh, MP. Role of pelvis and trunk biomechanics in generating ball velocity in baseball pitching. J Strength Cond Res 37(3): 623-628, 2023-The purpose of this study was to determine the impact of pelvis rotation velocity, trunk rotation velocity, and hip-shoulder separation on ball velocity during baseball pitching. Fastball pitching kinematics were recorded in 29 male pitchers (age 17 ± 2 years, 23 high school, 6 college). Pelvis and trunk angular velocities and hip-shoulder separation were calculated and averaged for the 3 fastest pitches. Associations between peak pelvis velocity, peak trunk velocity, hip-shoulder separation at foot contact, and ball velocity were assessed using Pearson correlation coefficients and multiple regression. The average ball velocity was 33.5 ± 2.8 m·s -1 . The average hip-shoulder separation at foot contact was 50 ± 12°. The peak pelvis velocity (596 ± 88°·s -1 ) occurred at 12 ± 11% of the time from stride foot contact to ball release, with the peak trunk velocity (959 ± 120°·s -1 ) occurring at 36 ± 11%. Peak trunk velocity was predictive of ball velocity ( p = 0.002), with 25% of the variability in ball velocity explained. No combination of factors further explained ball velocity. Hip-shoulder separation at foot contact (17%, p = 0.027), peak pelvis velocity (23%, p = 0.008), and the timing of peak pelvis velocity (16%, p = 0.031) individually predicted peak trunk velocity. The combination of peak pelvis velocity, hip-shoulder separation at foot contact, and the timing of peak trunk velocity explained 55% of the variability in trunk rotation velocity ( p < 0.001). These data highlight the importance of interactions between pelvis and trunk for maximizing velocity in pitching. Training to improve pelvis-trunk axial dissociation may increase maximal trunk rotation velocity and thereby increase ball velocity without increasing training load on the shoulder and elbow.

Athletes Perceive Weighted Baseballs to Carry a Notable Injury Risk, yet Still Use Them Frequently: A Multicenter Survey Study

Weighted baseball use in throwing programs is widespread; however, their use remains controversial. Prior research shows that weighted baseball programs can increase ball velocity but potentially increase throwing arm injuries. This study aims to ascertain perceptions of weighted baseballs among elite baseball players.

Weighted Baseball Training Affects Arm Speed Without Increasing Elbow and Shoulder Joint Kinetics

Long-term training effects of weighted ball throwing programs have been well documented. However, the mechanisms that facilitate these effects are poorly understood. The purpose of this study is to investigate within-session effects of throwing overload and underload baseballs to provide mechanistic evidence for weighted baseball training methods. Twenty-six collegiate- and professional-level baseball pitchers aged 20-30 years (mean age 23.5 [2.7] y) participated in a biomechanical evaluation while pitching a series of leather weighted baseballs. A 1-way repeated-measures analysis of variance was used to evaluate the intrasubject effect of ball weight on a total of 15 kinematic, kinetic, and performance parameters. Ball weight significantly affected pitch velocity, maximum elbow flexion, maximum pelvis rotation velocity, maximum shoulder internal rotation velocity, maximum elbow extension velocity, and anterior trunk tilt at ball release. None of the measured arm joint kinetics were significantly affected by ball weight. Training with 3- to 7-ounce (85- to 198-g) baseballs can be used to work on increasing pitching velocity without increasing throwing arm joint kinetics.

Understanding the Disabled Throwing Shoulder Requires Updated Review of Anatomy, Mechanics, Pathomechanics, and Treatment

Understanding both shoulder health and shoulder pathology in throwers is relevant to overhead athletes, and also relevant to nonoverhead athletes and even nonathletes. The thrower's shoulder is a clinically relevant topic of medical research scholarship today. Some of the greatest advances in sports medicine result from our ability to visualize normal and pathologic anatomy of joints, including the shoulder, using a small camera and a fiberoptic light source, through small portals, and without disruptive surgical dissection, or, in a word, "arthroscopy." Updates on the thrower's shoulder, including anatomy, mechanics, pathomechanics, and treatment, are essential for clinicians and researchers treating or investigating the shoulder.

Disabled Throwing Shoulder: 2021 Update: Part 2-Pathomechanics and Treatment

The purpose of this paper is to provide updated information for sports healthcare specialists regarding the disabled throwing shoulder (DTS). A panel of experts, recognized for their experience and expertise in this field, was assembled to address and provide updated information on several topics that have been identified as key areas in creating the DTS spectrum. Each panel member submitted a concise presentation on one of the topics within these areas, each of which were then edited and sent back to the group for their comments and consensus agreement in each area. Part two presents the following consensus conclusions and summary findings regarding pathomechanics and treatment, including (1) internal impingement results from a combination of scapular protraction and humeral head translation; (2) the clinically significant labral injury that represents pathoanatomy can occur at any position around the glenoid, with posterior injuries most common; (3) meticulous history and physical examination, with a thorough kinetic chain assessment, is necessary to comprehensively identify all the factors in the DTS and clinically significant labral injury; (4) surgical treatment should be carefully performed, with specific indications and techniques incorporating low profile implants posterior to the biceps that avoid capsular constraint; (5) rehabilitation should correct all kinetic chain deficits while also developing high-functioning, throwing-specific motor patterns and proper distribution of loads and forces across all joints during throwing; and (6) injury risk modification must focus on individualized athlete workload to avoid overuse. LEVEL OF EVIDENCE: V, expert opinion.

Effects of 4 Weeks of Variability of Practice Training in Padel Double Right Wall: A Randomized Controlled Trial

This study aimed to analyze the effect of a variable practice training in the double wall right forehand by using wrist weights. Thirty-four experienced padel players participated in this study. Players were randomly distributed in two groups (control group [CG] and training group [TG]). The TG performed 1 month of variable training, induced by weighted wrist bands, twice a week, with the same number of sessions and volume of training as the CG. TG obtained significant difference in posttest measurements (effect size = 0.437) in terms of the number of successful shots compared to CG (effect size = 0.027). These findings showed a significant effect of the TG with respect to the CG. Results reinforce the role of variability in the exploration and reinforcement of motor learning.

The Safety and Efficacy of Weighted Baseballs

One of the most common methods of training to enhance pitching velocity is the use of weighted baseballs. As with anything else, the excitement and popularity often proceed our scientific understanding. While there is still a lot to learn, our understanding of the science and efficacy of weighted baseball training has grown in recent years. The purpose of this clinical viewpoint is to summarize our current scientific understanding.

The Effect of Straight-Line Long-Toss Versus Ultra-Long-Toss Throwing on Passive Glenohumeral Range of Motion Recovery After Pitching

BACKGROUND

Repetitive throwing in baseball pitchers can lead to pathologic changes in shoulder anatomy, range of motion (notably glenohumeral internal rotation deficit), and subsequent injury; however, the ideal strengthening, recovery, and maintenance protocol of the throwing shoulder in baseball remains unclear. Two strategies for throwing shoulder recovery from pitching are straight-line long-toss (SLT) throwing and ultra-long-toss (ULT) throwing, although neither is preferentially supported by empirical data.

HYPOTHESIS

ULT will be more effective in returning baseline internal rotation as compared with SLT in collegiate pitchers after a pitching session.

STUDY DESIGN

Cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

A total of 24 National Collegiate Athletic Association Division I baseball pitchers with mean age 20.0 ± 1.1 years were randomized to either the ULT group (n = 13; 9 right-hand dominant, 4 left-hand dominant) or SLT group (n = 11; 10 right-hand dominant, 1 left-hand dominant). Measurements (dominant and nondominant, 90° abducted external rotation [ER], internal rotation [IR], and total range of motion [TROM]) were taken at 5 time points across 3 days: before and immediately after a standardized bullpen session on day 1; before and immediately after a randomized standardized ULT or SLT session on day 2; and before practice on Day 3.

RESULTS

ULT demonstrated significantly greater final ER compared with baseline (+10°; P = 0.05), but did not demonstrate significant IR changes. Similarly, SLT demonstrated significantly greater post-SLT ER (+12°; P = 0.02) and TROM (+12°;P = 0.01) compared with baseline, but no significant IR changes. Final ER measurements were similar between ULT (135° ± 14°) and SLT (138° ± 10°) (P = 0.59). There was also no statistically significant difference in final IR between ULT (51° ± 14°) and SLT (56° ± 8°) (P = 0.27).

CONCLUSION

The routine use of postperformance, ULT throwing to recover from range of motion alterations, specifically IR loss, after a pitching session is not superior to standard, SLT throwing. Based on these findings, the choice of postpitching recovery throwing could be player specific based on experience and comfort.

CLINICAL RELEVANCE

The most effective throwing regimens for enhancing performance and reducing residual impairment are unclear, and ideal recovery and maintenance protocols are frequently debated with little supporting data. Two strategies for throwing shoulder recovery from pitching are SLT and ULT throwing. These are employed to help maintain range of motion and limit IR loss in pitchers. The routine use of ULT throwing for recovery and to limit range of motion alterations after a pitching session is not superior to SLT throwing.

The Evidence Behind Weighted Ball Throwing Programs for the Baseball Player: Do They Work and Are They Safe?

PURPOSE OF REVIEW

Weighted baseball throwing programs have gained significant attention recently. They have been promoted as proven option for pitchers wishing to increase their throwing velocity and improve throwing mechanics. However, there is some concern that, if not applied properly, they may increase injury risk. In this review, we aim to (1) give a brief description of the potential mechanisms through with weighed ball programs that could improve throwing velocity, (2) summarize the available evidence regarding their effectiveness in increasing throwing velocity, (3) summarize the evidence on injury risk, and (4) propose directions for future studies.

RECENT FINDINGS

Initial research on weighted ball programs was published in the 1960s. Recently there has been an increase in research as interest from baseball organizations, instructors, players, and medical providers has grown. A recent randomized controlled trial demonstrated that pitching velocity can be increased through a 6-week weighted ball program; however, with that, they found that the rate of injury also increased. An earlier systematic review outlined 10 studies that evaluated weighted ball programs effect on pitching velocity and reported that 7 studies described increases in throwing velocity, while most studies did not comment on injury risk. They note that the results on rate of injury have been variable, likely secondary to the variability in time and intensity of different programs. The inconsistency in the methodology of weighted ball programs and studies has made it challenging to draw (scientifically) meaningful conclusions. Nevertheless, several studies have offered empirical evidence in support of the claim that weighted ball programs can increase pitching velocity through improved throwing mechanics. At the same time, these studies have emphasized the improvements in performance, while the potential effects on injury mechanisms have been less well understood. There is a need for improved standardization of these programs to allow for future study and subsequent modification to optimize performance.