An Interval Throwing Program for Baseball Pitchers Based upon Workload Data

Background

Interval throwing programs (ITP) have been used for decades to enable baseball pitchers to return to competition after injury or surgery by gradually applying load to the throwing arm. Past programs have been based on personal experience; however, advances in our understanding of the biomechanics and workloads of throwing allow for a more modern data-based program to be developed.

Hypothesis/Purpose

To 1) develop a updated ITP for rehabilitation of modern baseball pitchers based upon biomechanical and throwing workload data, and 2) compare the updated program with a past program to determine differences in chronic workload and acute:chronic workload ratios (ACWR).

Study Design

Cross-sectional study.

Methods

Workloads (i.e. daily, acute, chronic, and ACWR) for the original ITP were built from the prescribed throwing schedule. Elbow varus torque per throw was calculated based upon a relationship between elbow varus torque and throwing distance. Throw counts, daily/chronic/acute workloads, and ACWR were calculated and plotted over time. A new ITP was built to model current pitcher's throwing schedules and gradually increased ACWR over time.

Results

The original ITP had a throwing schedule of 136 days, final chronic workload 15.0, and the ACWR above or below the "safe" range (i.e. 0.7 - 1.3) for 18% of the program with a peak of 1.61. The updated ITP was built to consist of a 217-day schedule, final chronic workload of 10.8, and deviated from the safe range for 9% of the program, with a peak of 1.33.

Conclusion

The newly created ITP is more familiar to modern baseball pitchers while exhibiting a more gradual buildup of chronic workload than traditional ITP programs. This ITP may be used to return baseball pitchers back to competition as safely and efficiently as possible, and potentially with less risk of setbacks or reinjury. The ITP may be used following common injuries or surgeries to the throwing shoulder and elbow, such as Tommy John surgery, while also serving as a basis for future development of shorter duration ITPs.

Level of Evidence

2c.

Relationships between throwing mechanics and shoulder anterior force in high school and professional baseball pitchers

Background

Excessive shoulder anterior force has been implicated in pathology of the rotator cuff in little league and professional baseball pitchers; in particular, anterior laxity, posterior stiffness, and glenohumeral joint impingement. Distinctly characterized motions associated with excessive shoulder anterior force remain poorly understood.

Methods

High school and professional pitchers were instructed to throw fastballs while being evaluated with 3D motion capture (480 Hz). A supplementary random forest model was designed and implemented to identify the most important features for regressing to shoulder anterior force, with subsequent standardized regression coefficients to quantify directionality.

Results

130 high school pitchers (16.3 ± 1.2 yrs; 179.9 ± 7.7 cm; 74.5 ± 12.0 kg) and 322 professionals (21.9 ± 2.1 yrs; 189.7 ± 5.7 cm; 94.8 ± 9.5 kg) were included. Random forest models determined nearly all the variance for professional pitchers (R2 = 0.96), and less than half for high school pitchers (R2 = 0.41). Important predictors of shoulder anterior force in high school pitchers included: trunk flexion at maximum shoulder external rotation (MER) (X.IncMSE = 2.4, β = -0.23, p < 0.001), shoulder external rotation at ball release (BR)(X.IncMSE = 1.7, β = -0.34, p < 0.001), and shoulder abduction at BR (X.IncMSE = 3.1, β = 0.17, p < 0.001). In professional pitchers, shoulder horizontal adduction at foot contact (FC) was the highest predictor (X.IncMSE = 13.9, β = 0.50, p < 0.001), followed by shoulder external rotation at FC (X.IncMSE = 3.6, β = 0.26, p < 0.001), and maximum elbow extension velocity (X.IncMSE = 8.5, β = 0.19, p < 0.001).

Conclusion

A random forest model successfully selected a subset of features that accounted for the majority of variance in shoulder anterior force for professional pitchers; however, less than half of the variance was accounted for in high school pitchers. Temporal and kinematic movements at the shoulder were prominent predictors of shoulder anterior force for both groups.

Clinical relevance

: Our statistical model successfully identified a combination of features with the ability to adequately explain the majority of variance in anterior shoulder force among high school and professional pitchers. To minimize shoulder anterior force, high school pitchers should emphasize decreased shoulder abduction at BR, while professionals can decrease shoulder horizontal adduction at FC.

Pitch-classifier model for professional pitchers utilizing 3D motion capture and machine learning algorithms

Introduction

A pitcher's ability to achieve pitch location precision after a complex series of motions is of paramount importance. Kinematics have been used in analyzing performance benefits like ball velocity, as well as injury risk profile; however, prior utilization of such data for pitch location metrics is limited.

Objective

To develop a pitch classifier model utilizing machine learning algorithms to explore the potential relationships between kinematic variables and a pitcher's ability to throw a strike or ball.

Methods

This was a descriptive laboratory study involving professional baseball pitchers (n = 318) performing pitching tests under the setting of 3D motion-capture (480 Hz). Main outcome measures included accuracy, sensitivity, specificity, F1 score, positive predictive value (PPV), and negative predictive value (NPV) of the random forest model.

Results

The optimized random forest model resulted in an accuracy of 70.0 %, sensitivity of 70.3 %, specificity of 48.5 %, F1 equal to 80.6 %, PPV of 94.3 %, and a NPV of 11.6 %. Classification accuracy for predicting strikes and balls achieved an area under the curve of 0.67. Kinematics that derived the highest % increase in mean square error included: trunk flexion excursion(4.06 %), pelvis obliquity at foot contact(4.03 %), and trunk rotation at hand separation(3.94 %). Pitchers who threw strikes had significantly less trunk rotation at hand separation(p = 0.004) and less trunk flexion at ball release(p = 0.003) compared to balls. The positive predictive value for determining a strike was within an acceptable range, while the negative predictive value suggests if a pitch was determined as a ball, the model was not adequate in its prediction.

Conclusions

Kinematic measures of pelvis and trunk were crucial determinants for the pitch classifier sequence, suggesting pitcher kinematics at the proximal body segments may be useful in determining final pitch location.

Workload Comparison of Contemporary Interval Throwing Programs and a Novel Optimized Program for Baseball Pitchers

Background

In the rehabilitation of injured baseball pitchers, there is lack of consensus on how to guide a player back to pitching. It is unknown how different contemporary interval throwing programs (ITPs) progress in the amount of throwing workload.

Purposes

To 1) evaluate three prominent ITPs commonly employed in baseball pitcher rehabilitation and assess whether these ITPs produce training loads that increase in a controlled, graduated manner and 2) devise an ITP that produced training loads which increased steadily over time.

Study Design

Cross-sectional study.

Methods

Three publicly available ITPs from prominent sports medicine institutions were analyzed. Elbow varus torque per throw was calculated from a 2nd order polynomial regression based upon a relationship between recorded torque measurements and throwing distance measured from a database of 111,196 throws. The relative rate of workload increase was measured as an acute:chronic workload ratio (ACWR). For each ITP, throw counts, daily/acute/chronic workloads, and ACWR were calculated and plotted over time. Finally, an original ITP was devised based upon a computational model that gradually increases ACWR over time and finished with an optimal chronic workload.

Results

Each ITP exhibited a unique progression of throwing distances, quantities, and days to create different workload profiles. The three ITPs had throwing schedules ranging from 136 days to 187 days, ACWR spiked above or fell below a literature-defined "safe" range (i.e. 0.7 - 1.3) 19, 21, and 23 times. A novel ITP, predicated on a 146-day schedule and with a final chronic workload of 14.2, was designed to have no spikes outside of the safe range.

Conclusion

Existing ITPs widely utilized for rehabilitation of baseball pitchers exhibit significantly inconsistent variation in the rate of throwing load progression. Computational modeling may facilitate more incremental workload progression in ITPs, thereby reducing injury during rehabilitation and more efficiently condition a pitcher for return to competition.

Level of Evidence

3b.

Relationship Between Arm Path, Ball Velocity, and Elbow Varus Torque in Professional Baseball Pitchers

Background

Currently, most pitching instructors suggest a shorter arm path-the total distance the arm travels during pitching. Theoretically, this combination allows for better body segment sequencing, a more efficient energy transfer through the kinetic chain, and increased ball velocity, while limiting elbow varus torque.

Hypothesis

Shorter arm paths would be associated with increased ball velocity and decreased elbow varus torque.

Study Design

Descriptive laboratory study.

Methods

A total of 182 professional pitchers threw 8 to 12 fastball pitches while evaluated by 3-dimensional motion capture (480 Hz). The arm path was calculated as the total distance the hand marker traveled during the pitch. The pitch was divided into early, late, and total arm paths. A linear regression model assessed the interpitcher relationship between arm path, elbow varus torque, and ball velocity. A linear mixed-effects model with random intercepts assessed intrapitcher relationships.

Results

Interpitcher comparison showed that total arm path weakly correlated with greater elbow varus torque (P = .025). Strong correlations were found between ball velocity and early (R2 = 0.788; P < .001), late (R2 = 0.787; P = .024), and total arm paths (R2 = 0.792; P < .001). Strong positive intrapitcher correlations were found between elbow varus torque and early (R2 = 0.962; P < .001) and total arm path (R2 = 0.964; P < .001). For individual pitchers, there was a large variation in the early (30.1 ± 15.7 cm) and late (21.4 ± 12.1 cm) arm path. For every 30-cm (11.8-inch) increase in early arm path (the mean range for an individual pitcher), there was a 1.29-N (β = 0.0429) increase in elbow varus torque and a 0.354 m/s (0.79 mph) (β = 0.0118) increase in ball velocity.

Conclusion

A shorter arm path correlated with decreased elbow varus torque and decreased ball velocity in intrapitcher comparisons. Determining the individual mechanics that decrease elbow varus torque may help coaches and trainers correct these patterns.

Clinical Significance

A shorter arm path during the pitch can decrease elbow varus torque, which limits the load on the medial elbow but also has a detrimental effect on ball velocity. An improved understanding of the impact of shortening arm paths on stresses on the throwing arm may help minimize injury risk.

Three-Dimensional Motion Capture Data of a Movement Screen from 183 Athletes

Movement screens are widely used to identify aberrant movement patterns in hopes of decreasing risk of injury, identifying talent, and/or improving performance. Motion capture data can provide quantitative, objective feedback regarding movement patterns. The dataset contains three-dimensional (3D) motion capture data of 183 athletes performing mobility tests (ankle, back bend, crossover adduction, crossover rotation, elbows, head, hip turn, scorpion, shoulder abduction, shoulder azimuth, shoulder rotation, side bends, side lunges and trunk rotation) and stability tests (drop jump, hop down, L-cut, lunge, rotary stability, step down and T-balance) bilaterally (where applicable), the athletes' injury history, and demographics. All data were collected at 120 Hz or 480 Hz using an 8-camera Raptor-E motion capture system with 45 passive reflective markers. A total of 5,493 trials were pre-processed and included in .c3d and .mat formats. This dataset will enable researchers and end users to explore movement patterns of athletes of varying demographics from different sports and competition levels; develop objective movement assessment tools; and gain new insights into the relationships between movement patterns and injury.

Forearm Pronation at Foot Contact: A Biomechanical Motion-Capture Analysis in High School and Professional Pitchers

Background

It has previously been speculated that baseball pitchers who display excessive forearm pronation at foot contact (FC) have a higher propensity toward ulnar collateral ligament injury and subsequent surgery.

Purpose

To evaluate the association between degree of forearm pronation/supination at FC and throwing arm kinetics in high school and professional pitchers, at both the individual (intrapitcher) and the group (interpitcher) level.

Study Design

Descriptive laboratory study.

Methods

High school (n = 41) and professional (n = 196) pitchers threw 8 to 12 fastballs while being assessed with a 3-dimensional motion-capture system (480 Hz). Pitchers at each playing level were divided into a supination or pronation subgroup depending on degree of forearm pronation at FC. Regression models were built to observe the relationship between forearm pronation at FC and kinetic and kinematic parameters of interest.

Results

At both the individual and the group level of high school and professional pitchers, there was no significant correlation between forearm pronation at FC and elbow varus torque (P _min = .21). For every 10° increase in forearm pronation at FC in the individual high school pitcher, elbow flexion at FC decreased by 5°, whereas maximum elbow extension velocity was achieved 0.6% later in the pitch. In addition, elbow medial force increased by 4.1 N and elbow varus torque increased by 0.8 N·m for every 10° increase in forearm supination at FC. For every 10° increase in forearm supination in the individual professional pitcher, ball velocity increased by 0.5 m/s, shoulder external rotation at FC decreased by 11°, and elbow medial force decreased by 5.5 N.

Conclusion

Supination- or pronation-predominant forearm motion during the pitch did not significantly differ between playing levels. Excessive forearm pronation at FC was not a significant risk factor for increased throwing arm kinetics for high school or professional pitchers. There was a weak positive association between forearm supination at FC and elbow varus torque in the individual high school pitcher. Ultimately, coaches and pitchers may be better served by redirecting their focus to other mechanical aspects of the pitch that may have stronger associations with injury risk implications as well as performance.

Kinetic and kinematic comparisons in high school pitchers with low and high pitch location consistency

BACKGROUND

Although ball velocity has often been associated with increased kinetics at the upper extremity and risk of injury in youth and adolescent pitchers, it is unclear if the performance metric pitch location consistency has any positive or negative associations with pitching kinetics.

METHODS

High school pitchers (n = 59) pitched 8-12 fastballs using 3D motion capture (480 Hz). Pitchers were divided into high-consistency (HiCon) and low-consistency (LoCon) groups based on the absolute center deviation of each pitcher's pitch to the center of the pitcher's mean pitch location. Ninety-five percent confidence ellipses with major and minor radii were constructed, and kinematics and kinetics were compared between groups.

RESULTS

Compared with LoCon pitchers, HiCon pitchers had decreased lead hip flexion at elbow extension (40° ± 12° vs. 52° ± 13°, respectively, P = .008), and at foot contact, decreased back hip extension (-1° ± 10° vs. -10° ± 13°, respectively, P = .038) and increased back hip internal rotation (9° ± 15° vs. -2° ± 15°, respectively, P = .043). LoCon pitchers achieved maximum lead hip flexion earlier in the pitch (61.3% ± 23.2% vs. 75.8% ± 15.1%, respectively, P = .039). A multiregression model predicted 0.49 of variance in pitch location consistency using kinematic inputs.

DISCUSSSION AND CONCLUSION

Pitchers who differ in pitch location consistency outcomes do not appear to demonstrate physiologically unsafe kinematics. High school pitchers who strive for improved pitch consistency can consider adjusting parameters of hip kinematics during early portions of the pitch.

Influence of Pelvic Rotation on Lower Extremity Kinematics, Elbow Varus Torque, and Ball Velocity in Professional Baseball Pitchers

BACKGROUND

Early pelvic rotation has been associated with decreased throwing arm kinetics in college baseball pitchers, though professional pitchers have yet to be examined.

PURPOSE

To investigate the effect of pelvic rotation on trunk, pelvis and lower extremity kinematics, as well as throwing arm kinetics and pitch velocity in professional baseball pitchers.

STUDY DESIGN

Descriptive laboratory study.

METHODS

Data were analyzed for 157 professional baseball pitchers throwing fastballs using 3-dimensional motion capture (480 Hz). Pitchers were divided into an open pelvis (rotated toward target; n = 78) and a closed pelvis (n = 79) group based on pelvic rotation at foot contact. Variables of interest were compared between the groups using t tests and 2-way analysis of variance, while Spearman correlation was used to measure relationships between the variables of interest.

RESULTS

Pitchers in the open group had a longer stride length (81% ± 5% vs 77% ± 5% body height; P < .01, d = 0.74), greater lead knee flexion (49° ± 6° vs 47° ± 10°; P = .043, d = 0.33), faster peak knee extension velocity (424°/s ± 158°/s vs 325°/s ± 142 °/s; P < .01, d = 0.66), and faster ball velocity (39.1 ± 1.7 m/s vs 38.4 ± 2.1 m/s; P = .029, d = 0.35) compared with those in the closed group. There was no significant difference in elbow varus torque between the 2 groups (open: 87.8 ± 14.7 N·m, closed: 90.5 ± 17.2 N·m; P = .311). There were moderate negative relationships between pelvic rotation at foot contact and stride length (r S = -0.385, P < .001), lead knee extension (r S = -0.429, P < .001), and peak lead knee extension velocity (r S = -0.359, P < .001).

CONCLUSION

Professional pitchers who landed with an open pelvis demonstrated longer stride length, greater lead knee extension, faster lead knee velocity, and faster ball velocity compared with pitchers with a closed pelvis at foot contact. This increase in segment velocities and ball velocity was not associated with an increase in elbow varus torque and displays a potentially efficient method in which pitchers can increase ball velocity without an increase in elbow varus torque.

CLINICAL RELEVANCE

Instructing pitchers to rotate their pelvis toward the target at foot contact may allow pitchers to transfer momentum up the kinetic chain more efficiently, while producing greater ball velocity and limiting the torque sustained at the elbow.

Variability in Pitch Count Limits and Rest Day Requirements by State: Implications of Season-Long Pitch Counts in High School Baseball Pitchers

BACKGROUND

It is unknown how different pitch count limits and rest day requirements affect cumulative pitch counts during a baseball season.

PURPOSE

To determine (1) the variability of pitch count rules in high school baseball and (2) the theoretical effect of different pitch count limits and rest day combinations on game, weekly, and seasonal pitch totals in high school baseball pitchers.

STUDY DESIGN

Cross-sectional study.

METHODS

Pitch count rules for the 2019-2020 academic year for 48 sanctioned states were recorded from each state's athletic association website. Maximum pitch count limits were recorded along with the number of pitches allowed before requiring 0 to 5 rest days before the next pitching outing. Rules were also analyzed for several distinctions, including the athlete's level of competition, age, and grade. To determine the effect of pitch count rules and rest days, a theoretical 3-month season was calculated in the following scenarios: (1) variable maximum pitch count limits with a universal 3-day rest requirement, (2) universal 110 pitch count limit with variable rest day requirements (3, 4, or 5 days), and (3) actual pitch count limits and required rest days for every state assuming pitchers throw as many pitches as allowed. Analysis of variance and Student t tests were used to compare between-group and intragroup seasonal pitch totals based on variations in required rest days.

RESULTS

The most common maximum pitch count limit for a varsity high school athlete was 110 pitches (range, 100-125 pitches) with 4 rest days (range, 0-5 days). We found that 23 states (48%) did not make distinctions for pitch count rules based on the athlete's level of competition, age, or grade. We noted a 25% increase in total seasonal pitch counts between the smallest and largest pitch count limit when assuming constant 3-day rest. We found a 53% difference in total seasonal pitch count when rest days varied between 3 and 5 days with a constant 110-pitch limit. Allowing 140 pitches in a 4-day span without a specific rest day requirement resulted in the highest seasonal pitch count (Nevada). There was a 49% difference in maximum seasonal pitch counts between the most and least restrictive states (P < .001). Submaximum pitch limits resulted in higher seasonal pitch counts than maximum pitch limits in 56% of states.

CONCLUSION

Pitch count rules vary widely by state. Required rest days influenced total seasonal pitch counts more than maximum or submaximum pitch count limits.

Evaluating Pelvis Rotation Style at Foot Contact: A Propensity Scored Biomechanical Analysis in High School and Professional Pitchers

BACKGROUND

Early pelvis rotation has been associated with decreased throwing arm kinetics and conventionally was considered a component of proper pitching form in baseball throwers. However, previous assessments of pelvis rotation style have not accounted for confounders such as playing level, anthropometric characteristics, or ball velocity and have not evaluated sufficient sample sizes.

PURPOSE

To compare kinetic and kinematic parameters based on pelvis rotation style in high school and professional pitchers.

STUDY DESIGN

Descriptive laboratory study.

METHODS

High school and professional baseball pitchers threw 8 to 12 fastball pitches while being evaluated using 3-dimensional motion capture (480 Hz). These pitchers were 1:1 propensity score matched by age, height, weight, handedness, and ball velocity based on early (<60°) versus late (≥60°) pelvis rotation style at foot contact. A total of 26 kinematic and 10 kinetic parameters were compared between groups. The kinematic parameters were used to conduct a linear regression between early and late pelvis rotation at foot contact.

RESULTS

Pelvis rotation at foot contact was not significantly associated with ball velocity for either high school (P = .243) or professional pitchers (P = .075). No difference was found in elbow varus torque between high school early rotators (57.5 ± 14.9 N·m) and late rotators (51.3 ± 14.7 N·m; P = .036) and between professional early rotators (80.1 ± 11.8 N·m) and late rotators (79.0 ± 11.2 N·m; P = .663). At foot contact in high school pitchers, stride length increased by 2.1% of body height (B = -0.205; β = -0.470; P < .001), trunk rotation increased by 4.2° (B = -0.417; β = -0.488; P < .001), and trunk flexion at foot contact decreased by 4.4° (B = 0.442; β = 0.476; P < .001) with every 10° increase in pelvis rotation. At foot contact in professional pitchers, stride length increased by 2.3% of body height (B = -0.229; β = -0.478; P < .001), trunk rotation increased by 4.3° (B = -0.431; β = -0.515; P < .001), and trunk flexion decreased by 4.0° (B = 0.404; β = 0.373; P < .001) with every 10° increase in pelvis rotation.

CONCLUSION

Pelvis rotation at foot contact was associated with several kinematic parameters in both groups and may influence mechanics further along the kinetic chain. Landing open or closed was not significantly associated with throwing arm kinetics or ball velocity for both high school and professional baseball pitchers, contrary to previous thought.

CLINICAL RELEVANCE

Coaches and players may better focus their efforts on refining other kinematic parameters for enhanced performance outcomes and safe pitching mechanics.

The influence of shoulder abduction and external rotation on throwing arm kinetics in professional baseball pitchers

BACKGROUND

The relationships between shoulder abduction and external rotation with peak kinetic values at the shoulder and elbow in professional baseball pitchers are not well established.

METHODS

Professional pitchers (n = 322) threw 8-12 fastballs under 3D motion analysis (480 Hz). Pitchers were stratified into quartiles by shoulder abduction and external rotation at distinct timepoints. Regression analyses were performed to quantify associations between shoulder position and kinetics.

RESULTS

Shoulder abduction remained relatively consistent throughout the pitch (foot contact-ball release: 85.5 ± 11.1-90.7 ± 8.4°); shoulder external rotation increased dramatically (foot contact-ball release: 30.8 ± 24.6-165.2 ± 9.7°). For every 10° increase in maximum shoulder rotation, shoulder superior force increased by 2.3% body weight (p < 0.01), shoulder distraction force increased by 5.9% body weight (p < 0.01), and ball velocity increased by 0.60 m/s (p < 0.01). Shoulder abduction was significantly associated with shoulder superior force at all timepoints but not with ball velocity (p > 0.05). For every 10° increase in shoulder abduction at ball release, shoulder superior force increased by 3.7% body weight (p < 0.01) and shoulder distraction force increased by 11.7% body weight (p < 0.01).

CONCLUSION

Increased shoulder abduction at ball release and increased maximum shoulder external rotation were associated with greater superior and distraction forces in the shoulder. Pitchers can consider decreasing shoulder abduction at later stages of the pitch to around 80° in order to minimize shoulder superior force, with no impact on ball velocity.

The Relationship Between Maximum Shoulder Horizontal Abduction and Adduction on Peak Shoulder Kinetics in Professional Pitchers

BACKGROUND

Repetitive horizontal shoulder abduction during pitching can cause increased contact between the posterosuperior aspect of the glenoid and the greater tuberosity of the humeral head, theoretically putting baseball pitchers at increased risk of shoulder internal impingement and other shoulder pathologies.

HYPOTHESIS

Increased shoulder horizontal abduction is associated with increased shoulder anterior force, while increased horizontal adduction is associated with increased shoulder distraction force.

STUDY DESIGN

Descriptive laboratory study.

LEVEL OF EVIDENCE

Level 4.

METHODS

A total of 339 professional baseball pitchers threw 8 to 10 fastball pitches using 3D motion capture (480 Hz). Pitchers were divided into 2 sets of quartiles based on maximum shoulder horizontal abduction and adduction. Elbow flexion, shoulder external rotation, and peak shoulder kinetics were compared between quartiles with post hoc linear regressions conducted for the entire cohort.

RESULTS

At maximum shoulder horizontal abduction, there was no difference in ball velocity between quartiles (P = 0.76). For every 10º increase in maximum shoulder horizontal abduction, shoulder anterior force decreased by 2.2% body weight (BW) (P < 0.01, B = -0.22, β = -0.38), shoulder adduction torque decreased by 0.5%BW × body height (BH) (P < 0.01, B = -0.05, β = -0.19), and shoulder horizontal adduction torque decreased by 0.4%BW × BH (P < 0.01, B = -0.04, β = -0.48). For every 10º increase in maximum shoulder horizontal adduction, shoulder anterior force increased by 2%BW and ball velocity decreased by 1.2 m/s (2.7 MPH).

CONCLUSION

Professional pitchers with the least amount of maximum horizontal adduction had faster ball velocity and decreased shoulder anterior force. Pitchers with greater maximum shoulder horizontal abduction had decreased shoulder anterior force, shoulder adduction torque, and shoulder horizontal adduction torque. To maximize ball velocity as a performance metric while minimizing shoulder anterior force, pitchers can consider decreasing maximum shoulder adduction angles at later stages of the pitch.

CLINICAL RELEVANCE

Identifying risk factors for increased throwing shoulder kinetics (ie, shoulder anterior force, shoulder adduction torque) has potential implications in injury prevention. Specifically, mitigating shoulder anterior forces may be beneficial in reducing risk of injury.

Joint and segment sequencing and its relationship to ball velocity and throwing arm kinetics in professional pitchers

BACKGROUND

Temporal variations during the pitch have demonstrated significant impacts on the kinetic chain, and as such, have implications in injury risk.

PURPOSE

To determine the effect of varying chronological orders of maximum joint and segment velocities on ball velocity and upper extremity kinetics.

METHODS

Professional baseball pitchers (n = 287) were assessed with 3D-motion capture (480 Hz) while pitching. Pitches were categorized into one of the following groups dependent on the first maximum joint or segment velocity achieved out of chronological order in an inferior to superior direction: knee extension (DscK), pelvis rotation (DscP), trunk rotation (DscT), shoulder rotation (DscS), forearm pronation (DscF), and Proper (for pitchers with the correct temporal sequence), and Total Population, for all pitchers. Ten normalized throwing arm kinetic variables were compared among groups. Regression analysis was conducted on the timing of maximum velocities with ball velocity.

RESULTS

The majority of pitches were in the DscK group (64.5%). The DscK group had a significantly slower maximum lead knee extension velocity compared with the Proper group (253°/s vs. 316°/s, P = .017). The Proper group had a significantly faster ball velocity compared with the Total Population (39.0 ± 1.9 m/s vs. 38.3 ± 2.1 m/s, P = .013). The DscP group had a significantly slower maximum pelvis rotation velocity compared with the Proper group (596°/s vs. 698°/s, P < .001). The Proper group had no significant difference in kinetics relative to the population. For every 1 standard deviation delay in attaining maximum lead knee extension velocity, ball velocity increased by 0.38 m/s (B = 3.5, β = 0.18, P < .001). For every 1 standard deviation delay in timing to achieve maximum pelvis rotation velocity, maximum pelvis rotation velocity and ball velocity increased by 22.5°/s (B = 1107.0, β = 0.23, P < .001) and 0.48 m/s (B = 23.4, β = 0.23, P < .001), respectively.

CONCLUSION

Pitchers with a discordant sequence of knee extension and pelvis rotation velocity timing had significantly slower corresponding segment/joint velocities. Conversely, pitchers with a proper sequence had the fastest ball velocity with minimal differences in throwing arm kinetics. To maximize ball velocity, professional pitchers should consider achieving maximal velocities in an inferior to superior chronological sequence, with a particular focus on the knee and pelvis.

The relationship among lead knee extension, fastball velocity and elbow torque in professional baseball pitchers

The purpose of this study was to investigate potential differences in lead knee extension velocity, elbow varus torque and lead knee extension (the change in lead knee flexion from foot contact to ball release) in high and low velocity professional pitchers. Three-dimensional motion capture (480 Hz) was used to assess 322 professional pitchers.         T-test were used to compare the two groups and multiple linear regression analyses were performed on all pitchers (n = 322). The high-velocity group (n = 99; 40.3 ±  0.9m/s) had greater lead knee extension (17 ± 13 vs 5 ± 14°, p < 0.001, g = 0.9), lead knee extension velocity (419 ± 135 vs 297 ± 121°/s, p < 0.001, g = 0.9) and elbow varus torque (91.1 ± 15.5 vs 84.0 ± 14.7 Nm, p < 0.001, g = 0.5) compared to the low-velocity group (n = 88; 36.1  ± 1.2 m/s). Lead knee extension (R2 = 0.352, p < 0.001) and lead knee extension velocity (R2 = 0.326, p < 0.001) were found to be positive predictors of ball velocity but not elbow varus torque (p = 0.807). Instructing professional pitchers to utilise a lead leg bracing technique that facilitates increased lead knee extension can contribute to faster ball velocity, but most likely results from a combination of other mechanics.

Pitching Mechanics and the Relationship to Accuracy in Professional Baseball Pitchers

BACKGROUND

Biomechanical predictors of pitching accuracy are underevaluated in baseball research. It is unclear how pitchers with higher accuracy differ in terms of kinematics and upper extremity kinetics.

PURPOSE

To differentiate high- and low-accuracy professional pitchers by full-body kinematic and upper extremity kinetic parameters.

STUDY DESIGN

Descriptive laboratory study.

METHODS

In total, 121 professional baseball pitchers threw 8 to 12 fastballs while assessed with motion-capture technology (480 Hz). Pitchers were divided into high-accuracy (n = 33), moderate-accuracy (n = 52), and low-accuracy (n = 36) groups based on the absolute center deviation of each pitcher's average pitch to the center of the pitching chart by greater or less than 0.5 SD from the mean, respectively. The 95% confidence ellipses with comparisons of major and minor radii and pitching probability density grids were constructed. Analysis of variance was used to compare kinematic and kinetic values between groups.

RESULTS

The absolute center deviation (14.5% ± 6.7% vs 33.5% ± 3.7% grid width; P < .001) was significantly lower in the high-accuracy compared with the low-accuracy group, with no significant difference in ball velocity (38.0 ± 1.7 vs 38.5 ± 2.0 m/s; P = .222). Lead knee flexion at ball release (30.6°± 17.8° vs 40.1°± 16.3°; P = .023) was significantly less for the high-accuracy pitchers. Peak normalized shoulder internal rotation torque (5.5% ± 1.0% vs 4.9% ± 0.7% body weight [BW] × body height [BH]; P = .008), normalized elbow varus torque (5.4% ± 1.0% vs 4.8% ± 0.7% BW × BH; P = .008), and normalized elbow medial force (42.9% ± 7.3% vs 38.6% ± 6.2% BW; P = .024) were significantly greater for the low-accuracy group compared with the high-accuracy group.

CONCLUSION

Professional pitchers with increased accuracy experienced decreased throwing arm kinetics. These pitchers had increased lead knee extension at later stages of the pitch, potentially providing more stable engagement with the ground and transference of kinetic energy to the upper extremities. Professional pitchers can consider increasing lead knee extension at the final stages of the pitch to improve the accuracy of their throws and mitigate elbow varus torque.

CLINICAL RELEVANCE

Increased elbow varus torque, shoulder internal rotation torque, and elbow medial force in less accurate pitchers may contribute to increased injury risk in this group.

Chronic Workload, Subjective Arm Health, and Throwing Injury in High School Baseball Players: 3-Year Retrospective Pilot Study

BACKGROUND

Baseball workloads are monitored by pitch counts, appearances, innings per appearance, ball velocity, and distance, whereas current workload standards neglect throws made during nongame situations. The association between total workloads, subjective measures, and injury in baseball is poorly understood. The question remains whether baseball athletes are at higher risk of injury by throwing more often or if they generate injury resilience when appropriately transitioned into the higher demands of throwing.

HYPOTHESIS

Increased chronic load, along with subjective arm health measures, are related to decreased injury risk.

STUDY DESIGN

Clinical research.

LEVEL OF EVIDENCE

Level 3.

METHODS

A total of 49 male baseball players (age 17.9 ± 0.4 years, height 181.8 ± 6.8 cm, body mass 80.6 ± 9.1 kg) competing at the varsity high school level were included in this 3-year retrospective data analysis from 2016 to 2019. Players wore the motusTHROW sleeve and sensor during all throwing activities.

RESULTS

A total of 898,492 throws and 9455 athletic exposures were captured with the motusTHROW sensors. There were 24 injuries recorded throughout the 3-year analysis, with 11 throwing-related and 13 non-throwing related injuries. Results of the 1-way analysis of variance found chronic load was significantly related to throwing-injury occurrence (P < 0.01). Six of the throwing-related injuries occurred when athletes had a chronic load greater than 11.3, marking 75th percentile across all observations. There was a relationship between arm health and throwing arm-related injury occurrence (P < 0.01). Higher chronic load was associated with increased throwing-related injuries even when adjusted for arm health (P = 0.01). Specifically, injuries were more likely to occur in pitchers (either as a combination player or pitcher only) with a chronic load greater than 9.2.

CONCLUSION

This study revealed a significant relationship between chronic load, subjective arm health, and throwing-related injury in varsity high school baseball players. Contrary to our hypothesis, increased chronic load was associated with increased injury risk. However, subjective arm health measures remain a relevant factor in assessing injury risk. Normative data for this population also provide key information around positional demands along with overall demands of the sport during the competitive season and off-season.

Increased Shoulder Distraction Force and Shoulder Horizontal Abduction in Professional Baseball Pitchers With Discordant Torso Rotation Order

BACKGROUND

Inefficient energy transfer from the pelvis and trunk has been shown to increase compensation at the level of the shoulder. Kinetic chain sequencing of the core segments is underexamined in professional baseball pitchers, especially as it relates to changes in upper extremity kinetics.

PURPOSE

To evaluate elbow and shoulder kinetics in a cohort of professional pitchers differentiated by instances of discordant pelvic to upper torso sequencing during the pitch.

STUDY DESIGN

Descriptive laboratory study.

METHODS

285 professional baseball pitchers were evaluated using 3D motion capture (480 Hz). Pitchers were divided into "chronological" and "discordant" groups based on whether maximum pelvic rotation velocity occurred before (chronological) or after (discordant) maximum upper torso rotation velocity during the pitch motion. Pelvic, upper torso, and shoulder kinematic parameters, shoulder distraction force, shoulder internal rotation torque, and pitch efficiency (PE) were compared between groups.

RESULTS

Pitchers with discordant torso sequencing (n = 30; 110 pitches) had greater shoulder horizontal adduction at maximum external rotation (mean difference, 3.6°; 95% CI, -5.2° to -2.0°; t = -4.5; P < .001) and greater maximum shoulder external rotation (mean difference, 3.7°; 95% CI, 5.7° to 1.5°; t = -3.5; P < .001) than chronological pitchers (n = 255; 2974 pitches). PE did not differ between groups (P = .856), whereas ball velocity was significantly faster in the discordant group (mean difference, 0.6 m/s; 95% CI, -1.1 to -0.3 m/s; t = -3.3; P = .0012). Chronological pitchers had significantly reduced shoulder distraction force (mean difference, -4.7% body weight (BW); 95% CI, -7.9% to -1.5% BW; t = -2.9; P = .004) with no difference in shoulder internal rotation torque (P = .160). These kinematic and kinetic differences were not observed when accounting for interpitcher variability.

CONCLUSION

Between pitchers, those who had a discordant pelvic to upper torso sequence experienced significantly greater shoulder distraction forces, potentially compensating by increasing maximum shoulder external rotation and horizontal abduction. Achieving maximal pelvic rotation velocity before maximal rotation velocity may be advantageous in preventing compensation at the upper extremity and excessive throwing arm loading.

CLINICAL RELEVANCE

Identifying risk factors for increased upper extremity forces has potential implications in injury prevention. Specifically, mitigating shoulder distraction forces may be beneficial in reducing risk of injury.

Intra- versus inter-pitcher comparisons: Associations of ball velocity with throwing-arm kinetics in professional baseball pitchers

BACKGROUND

The association between ball velocity and elbow varus torque has shown differences when evaluated within a single pitcher and within a cohort. The impact of increasing ball velocity on additional throwing-arm kinetics, in particular shoulder distraction forces, with intra- vs. inter-pitcher evaluations has not been evaluated, even though these kinetic measures have been implicated in injury risk. The purpose of this study was to compare intra- vs. inter-pitcher relationships between ball velocity and all major kinetics at the shoulder and elbow in professional pitchers.

METHODS

A total of 323 professional baseball pitchers threw 8-12 fastball pitches while simultaneously being evaluated with 3-dimensional motion-capture technology (480 Hz). A linear regression analysis was performed to evaluate pitch velocity as a predictor of peak kinetic values at the shoulder and elbow among pitchers. A linear mixed model with random intercepts was then created to evaluate ball velocity as a predictor of peak kinetic values when comparing pitches within an individual pitcher.

RESULTS

91 pitchers were included in the analyses. Ball velocity among pitchers had weak correlations with shoulder distraction force (R² = 0.228, P < .001) and elbow distraction force (R² = 0.175, P < .001). Within an individual pitcher, strong correlations (R² > 0.85) were observed for (1) shoulder internal rotation torque (P < .001), (2) shoulder horizontal adduction torque (P = .006), (3) shoulder superior force (P < .001), (4) shoulder anterior force (P < .001), (5) elbow varus torque (P < .001), (6) elbow medial force (P < .001), (7) elbow anterior force (P < .001), (8) elbow flexion torque (P < .001), (9) shoulder distractive force (P < .001), and (10) elbow distractive force (P < .001).

CONCLUSION

Faster pitch velocity is a weak predictor of shoulder and elbow distraction forces experienced among professional pitchers. However, when controlling for an individual pitcher, peak kinetics at the shoulder and elbow can be strongly predicted by ball velocity. Therefore, the assumption that higher peak throwing-arm kinetic values are experienced by pitchers with faster ball velocity is likely an inappropriate assumption among pitchers but may be correct for each player who increases pitch velocity.

Association of Pitch Timing and Throwing Arm Kinetics in High School and Professional Pitchers

BACKGROUND

Understanding the relationship between the temporal phases of the baseball pitch and subsequent joint loading may improve our understanding of optimal pitching mechanics and contribute to injury prevention in baseball pitchers.

PURPOSE

To investigate the temporal phases of the pitching motion and their associations with ball velocity and throwing arm kinetics in high school (HS) and professional (PRO) baseball pitchers.

STUDY DESIGN

Descriptive laboratory study.

METHODS

PRO (n = 317) and HS (n = 54) baseball pitchers were evaluated throwing 8 to 12 fastball pitches using 3-dimensional motion capture (480 Hz). Four distinct phases of the pitching motion were evaluated based on timing of angular velocities: (1) Foot-Pelvis, (2) Pelvis-Torso, (3) Torso-Elbow, and (4) Elbow-Ball. Peak elbow varus torque, shoulder internal rotation torque, and shoulder distraction force were also calculated and compared between playing levels using 2-sample t tests. Linear mixed-effect models with compound symmetry covariance structures were used to correlate pitch velocity and throwing arm kinetics with the distinct temporal phases of the pitching motion.

RESULTS

PRO pitchers had greater weight and height, and faster ball velocities than HS pitchers (P < .001). There was no difference in total pitch time between groups (P = .670). PRO pitchers spent less time in the Foot-Pelvis (P = .010) and more time in the Pelvis-Torso (P < .001) phase comparatively. Shorter time spent in the earlier phases of the pitching motion was significantly associated with greater ball velocity for both PRO and HS pitchers (Foot-Pelvis: B = -6.4 and B = -11.06, respectively; Pelvis-Torso: B = -6.4 and B = -11.4, respectively), while also associated with increased shoulder proximal force (Pelvis-Torso: B = -76.4 and B = -77.5, respectively). Decreased time in the Elbow-Ball phase correlated with greater shoulder proximal force for both cohorts (B = -1150 and B = -645, respectively) with no significant correlation found for ball velocity.

CONCLUSION

Significant differences in temporal phases exist between PRO and HS pitchers. For all pitchers, increased time spent in the final phase of the pitching motion has the potential to decrease shoulder distraction force with no significant loss in ball velocity.

CLINICAL RELEVANCE

Identifying risk factors for increased shoulder and elbow kinetics, acting as a surrogate for loading at the respective joints, has potential implications in injury prevention.

Kinematic and kinetic findings in high vs. low consistency professional baseball pitchers

While the performance metric ball velocity has often been associated with increased kinetics at the upper extremity and risk of injury in baseball pitchers, it is unclear if the performance metric pitch location consistency has any positive/negative associations with pitching kinetics. Professional pitchers subdivided into high(Hcon) and low(Lcon) consistency groups were instructed to throw 8-12 fastballs while assessed with motion-capture technology(480 Hz). To further assess pitching consistency, 95% confidence ellipses with comparisons of major and minor radii were conducted with an external comparison to a cohort of high school pitchers. Lastly, kinematic and kinetic values were compared between Hcon and Lcon professional pitchers. Professional baseball pitchers(n = 338) had consistency in pitch location comparable to high school pitchers(n = 59) (22.0 ± 6.7 vs. 23.2 ± 7.5% grid width respectively, p-value = 0.21). Hcon professional pitchers(n = 91) compared to Lcon pitchers(n = 98) had a smaller major radius(15.2 ± 3.0 vs. 26.3 ± 5.9 respectively, p-value<0.001) and a smaller minor radius(9.4 ± 1.9 vs. 16.1 ± 4.4 respectively, p-value<0.001) in the 95% confidence ellipses. Hcon pitchers compared to Lcon pitchers had increased arm slot(59.7 ± 13.5 vs. 54.7 ± 12.4° respectfully, p-value = 0.009), trunk tilt(-33.4 ± 9.1 vs. -37.2 ± 8.9° respectfully, p-value = 0.004), and trunk lateral flexion(-27.1 ± 9.3 vs. -31.8 ± 9.0° respectfully, p-value<0.001) at ball release. These pitchers also had lower shoulder(112.4 ± 15.9 vs. 118.3 ± 15.1% BW respectfully, p-value = 0.001) and elbow distraction forces(110.5 ± 17 vs. 117.0 ± 15.2% BW respectfully, p-value = 0.006) during arm deceleration. Professional pitchers who approach a sidearm style of pitching, typically involving less contralateral trunk tilt, may achieve higher consistency in their throws while also experiencing diminished peak distractive forces at the elbow and shoulder.

The association of stride length to ball velocity and elbow varus torque in professional pitchers

Professional basebal pitchers (n =315) were divided into quartiles based on increasing stride length and random intercept linear mixed-effect models were used to correlate stride length with ball velocity, pelvis and trunk rotation at foot contact, and throwing arm kinetics. Average stride length among all pitchers was 78.3±5.3%body height (%BH). For every 10% increase in stride length, ball velocity increased by 0.9 m/s (B =0.089, β =0.25, p <0.001) and trunk rotation initiation occurred 4.23 ms earlier (B =-0.42, β =-0.14, p <0.001). When divided into quartiles pelvis rotation was less towards home plate in Q1 compared to Q3 and Q4 (70.0±10.7° vs. 60.9±8.9° and 58.6±9.1°, p <0.001). No significant differences in shoulder internal rotation torque (p =0.173) or elbow varus torque (p =0.072) were noted between quartiles. Professional baseball pitchers who reached stride lengths of 80%BH or greater achieved faster ball velocity without an increase in elbow varus torque. This may, be a byproduct of rotating the pelvis for a greater proportion of the pitching motion and thereby more effectively utilising the lower extremities in the kinetic chain. Encouraging players to achieve this threshold of stride length may enhance ball velocity outcomes.

A Review of Workload-Monitoring Considerations for Baseball Pitchers

Because of the unique demands of a pitch, baseball players have the greatest percentage of injuries resulting in surgery among high school athletes, with a majority of these injuries affecting the shoulder and elbow due to overuse from throwing. These injuries are believed to occur because of repeated microtrauma to soft tissues caused by the repetitive mechanical strain of throwing. Researchers and practitioners have suggested that baseball pitchers' workloads are a significant risk factor for injury in adolescent players, resulting in lost time and slowing of performance development. The purpose of our review was to investigate the current research relative to monitoring workload in baseball throwers and discuss techniques for managing and regulating cumulative stress on the arm, with a focus on preventing injury and optimizing performance in adolescent baseball pitchers.

Effects of Mound Versus Flat-Ground Pitching and Distance on Arm Mechanics and Elbow Torque in High School Pitchers

Background:

Although the monitoring of a pitcher’s throwing arm workload has become a hot topic in both research and the pitching world, the impact of mound height and distance still remains unclear.

Purpose:

To compare the kinetics and kinematics between pitches from a mound and flat ground at 2 different distances.

Study Design:

Descriptive laboratory study.

Methods:

A total of 21 healthy high school varsity baseball pitchers (age, 16.2 ± 1.3 years; weight, 73.6 ± 11.0 kg; height, 181.3 ± 6.4 cm) participated in this study. Players were fitted with a motusBASEBALL sensor and sleeve. Each pitcher was instructed to pitch 5 fastballs under 4 conditions: mound at 60.5 ft (regulation distance), flat ground at 60.5 ft, mound at 50.5 ft, and flat ground at 50.5 ft. Linear mixed-effects models were used to account for both intra- and interplayer variability. A multivariable model was used to evaluate the association of mound pitching, flat-ground pitching, and their distances (50.5 ft and 60.5 ft), and their interaction to arm speed, arm slot, arm rotation, elbow varus torque, and ball velocity.

Results:

There were no statistically significant effects of mound, flat-ground, or distance variation on arm speed or shoulder rotation. Arm slot was significantly higher (+3.0°; P = .02) on pitches from the mound at 60.5 ft compared with 50.5 ft. Elbow varus torque was lower (–1.5 N·m; P = .02) on mound pitches at 60.5 ft compared with 50.5 ft. Pitches thrown from the mound displayed significantly faster ball velocity compared with flat-ground pitches at both distances (P < .01 for both), with pitches at 60.5 ft having higher velocity (+0.7 m/s; P < .01).

Conclusion:

Contrary to long-standing notions, the study results suggest that pitching from the mound does not significantly increase stress on the elbow compared with flat-ground pitching. Lower elbow varus torque and faster ball velocity at the regulation distance compared with the reduced distance indicate that elbow stress and ball velocity may not correlate perfectly, and radar guns may not be an appropriate surrogate measure of elbow varus torque.

Clinical Relevance:

A better understanding of the kinetic and kinematic implications of various throwing programs will allow for the designing of programs that are driven by objective data with aims directed toward injury prevention and rehabilitation in baseball pitchers.

Classifying Elite From Novice Athletes Using Simulated Wearable Sensor Data

Movement screens are frequently used to identify differences in movement patterns such as pathological abnormalities or skill related differences in sport; however, abnormalities are often visually detected by a human assessor resulting in poor reliability. Therefore, our previous research has focused on the development of an objective movement assessment tool to classify elite and novice athletes’ kinematic data using machine learning algorithms. Classifying elite and novice athletes can be beneficial to objectively detect differences in movement patterns between the athletes, which can then be used to provide higher quality feedback to athletes and their coaches. Currently, the method requires optical motion capture, which is expensive and time-consuming to use, creating a barrier for adoption within industry. Therefore, the purpose of this study was to assess whether machine learning could classify athletes as elite or novice using data that can be collected easily and inexpensively in the field using inertial measurement units (IMUs). A secondary purpose of this study was to refine the architecture of the tool to optimize classification rates. Motion capture data from 542 athletes performing seven dynamic screening movements were analyzed. A principal component analysis (PCA)-based pattern recognition technique and machine learning algorithms with the Euclidean norm of the segment linear accelerations and angular velocities as inputs were used to classify athletes based on skill level. Depending on the movement, using metrics achievable with IMUs and a linear discriminant analysis (LDA), 75.1–84.7% of athletes were accurately classified as elite or novice. We have provided evidence that suggests our objective, data-driven method can detect meaningful differences during a movement screening battery when using data that can be collected using IMUs, thus providing a large methodological advance as these can be collected in the field using sensors. This method offers an objective, inexpensive tool that can be easily implemented in the field to potentially enhance screening, assessment, and rehabilitation in sport and clinical settings.

Kinematic and kinetic comparison between American and Japanese collegiate pitchers

OBJECTIVES

Understanding the differences in baseball pitching biomechanics between American and Japanese pitchers may help with training and developing these athletes. The purpose of this study was to investigate the kinematic and kinetic differences in collegiate baseball pitchers from United States of American and Japan.

DESIGN

Controlled laboratory study.

METHODS

Data were analyzed for 11 American and 11 Japanese collegiate pitchers throwing fastballs using 3D motion capture (480Hz).

RESULTS

The Americans were heavier (95±7kg vs 81±7kg), taller (189±3cm vs 180±6cm), and had faster ball velocity (39±1m/s vs 35±2m/s). By the end of arm cocking phase, the American pitchers had rotated their shoulder to a greater degree (p=0.021, d=1.5) and at ball release the Japanese had greater knee flexion (p=0.020, d=1.2). American pitchers exhibited greater peak kinetics on the throwing arm; however, when normalized for height and weight only three differences remained.

CONCLUSION

The differences found between the American and Japanese players could contribute to the increased ball velocity in the American pitchers. Additionally, throwing arm peak kinetics were greater in the American pitchers which may help generate greater ball velocity; however, increased kinetics may also lead to increased risk of injury.

Differences in Rotational Kinetics and Kinematics for Professional Baseball Pitchers With Higher Versus Lower Pitch Velocities

Pitch velocity (PV) is important for pitching success, and the pelvis and trunk likely influence pitch performance. The purposes of this study were to examine the differences in pelvis and trunk kinetics and kinematics in professional baseball pitchers who throw at lower versus higher velocities (HVPs) and to examine the relationships among pelvis and trunk kinetics and kinematics and PV during each phase of the pitch delivery. The pitch velocity, pelvis and trunk peak angular velocities, kinetic energies and torques, and elbow and shoulder loads were compared among HVPs (n = 71; PV ≥ 40.2 m/s) and lower velocities pitchers (n = 78; PV < 39.8 m/s), as were trunk and pelvis rotation, flexion, and obliquity among 7 phases of the pitching delivery. Relationships among the kinetic and kinematic variables and PVs were examined. Higher velocity pitchers achieved greater upper trunk rotation at hand separation (+7.2°, P < .001) and elbow extension (+5.81°, P = .002) and were able to generate greater upper trunk angular velocities (+36.6 m/s, P = .01) compared with lower velocity pitcher. Trunk angular velocity (r = .29) and upper trunk rotation at hand separation (r = .18) and foot contact (r = .17) were weakly related to PV. Therefore, HVPs rotate their upper trunk to a greater degree during the early phases of the pitching motion and subsequently generate greater trunk angular velocities and PV.

Objectively Differentiating Movement Patterns between Elite and Novice Athletes

INTRODUCTION

Movement screens are frequently used to identify abnormal movement patterns that may increase risk of injury or hinder performance. Abnormal patterns are often detected visually based on the observations of a coach or clinician. Quantitative or data-driven methods can increase objectivity, remove issues related to interrater reliability and offer the potential to detect new and important features that may not be observable by the human eye. Applying principal component analysis (PCA) to whole-body motion data may provide an objective data-driven method to identify unique and statistically important movement patterns, an important first step to objectively characterize optimal patterns or identify abnormalities. Therefore, the primary purpose of this study was to determine if PCA could detect meaningful differences in athletes' movement patterns when performing a non-sport-specific movement screen. As a proof of concept, athlete skill level was selected a priori as a factor likely to affect movement performance.

METHODS

Motion capture data from 542 athletes performing seven dynamic screening movements (i.e., bird-dog, drop-jump, T-balance, step-down, L-hop, hop-down, and lunge) were analyzed. A PCA-based pattern recognition technique and a linear discriminant analysis with cross-validation were used to determine if skill level could be predicted objectively using whole-body motion data.

RESULTS

Depending on the movement, the validated linear discriminant analysis models accurately classified 70.66% to 82.91% of athletes as either elite or novice.

CONCLUSIONS

We have provided proof that an objective data-driven method can detect meaningful movement pattern differences during a movement screening battery based on a binary classifier (i.e., skill level in this case). Improving this method can enhance screening, assessment, and rehabilitation in sport, ergonomics, and medicine.

Changes in Throwing Arm Mechanics at Increased Throwing Distances During Structured Long-Toss

BACKGROUND

Elbow injuries among adolescent baseball players have been outpacing those of college and professional players. In attempts to prevent injuries and maximize return-to-play potential following injury, attention has been focused on "return to throw" programs, which include long-toss throws. Because the few studies that were conducted on long-toss throwing focused primarily on college-aged athletes, it is not known what type of load is incurred at the elbow during interval throwing progression among high school baseball players.

PURPOSE

To quantify the change in arm slot, arm speed, shoulder external rotation, and elbow varus torque across increasing throwing distances within a given athlete.

STUDY DESIGN

Descriptive laboratory study.

METHODS

Ninety-five high school baseball players performed a long-toss protocol while wearing an inertial sensor and sleeve. Each participant was tested for 5 throws at distances of 9 m, 18 m, 27 m, 37 m, and 46 m. Linear mixed-effects models and likelihood ratio tests were used to estimate the within-participant relationship between throw distance and arm slot, arm speed, shoulder external rotation, and elbow varus torque.

RESULTS

Arm slot ( P < .01), arm speed ( P < .01), shoulder external rotation ( P < .01), and elbow varus torque ( P < .01) were significantly associated with long-toss throw distance. As the throw distance increased, there was an increase in arm speed and shoulder external rotation and a decrease in arm slot for each distance. However, elbow varus torque increased with each distance up to 37 m and then remained the same at 46 m.

CONCLUSION

The use of longer distances for conditioning and rehabilitation may be beneficial in increasing shoulder range of motion and arm speed; however, precaution needs to be taken, as throwing longer distances are accompanied by an increase in arm rotation, arm speed, and elbow torque, with a decrease in arm slot.

CLINICAL RELEVANCE

Return-to-throw programs have been utilized by sports medicine clinicians and coaches to help guide a player during rehabilitation. These programs involve throwing at increased efforts through increased distances with no immediate feedback on elbow stress. This investigation describes arm biomechanical changes during submaximum interval throwing and demonstrates a tool that can be utilized to measure arm stress in real time for clinicians and athletes progressing through an interval throwing program.

Role of Rotational Kinematics in Minimizing Elbow Varus Torques for Professional Versus High School Pitchers

Background:

Elbow injury rates among baseball pitchers are rapidly rising. However, this increase has been most dramatic among high school (HS) pitchers.

Purpose:

To examine pitch velocity and the kinetic and kinematic characteristics of HS versus professional (PRO) pitchers to identify potential differences that may play a role in the increased risk of ulnar collateral ligament injury in youth pitchers.

Study Design:

Controlled laboratory study.

Methods:

A total of 37 HS (mean ± SD: age, 16 ± 1 years) and 40 PRO (age, 21 ± 2 years) baseball pitchers completed maximal-effort baseball pitches during a single testing session, from which pitch velocity (PV), absolute and normalized elbow varus torque (EVT_A and EVT_N, respectively) during arm cocking and at maximum shoulder external rotation (MER), and 8 other elbow and shoulder torques or forces and rotational kinematics of the pelvis and trunk were analyzed, recorded, and compared.

Results:

PV was greater in PRO than HS athletes; EVT_A was greater in PRO than HS athletes during arm cocking and at MER; but EVT_N was similar during arm cocking and greater in HS than PRO athletes at MER. In PRO athletes, PV was not related to EVT_A during arm cocking or MER (r = 0.01-0.05). Furthermore, in PRO athletes, EVT_A during arm cocking and at MER were inversely related to upper trunk rotation at hand separation and foot contact and to pelvis rotation at elbow extension (r = –0.30 to –0.33). In contrast, in HS athletes, PV was strongly related to EVT_A during arm cocking and MER (r = 0.76-0.77). Furthermore, in HS athletes, PV and EVT_A during arm cocking and at MER were moderately or strongly related to the other elbow and shoulder torques and forces (r = 0.424-0.991), and EVT_A was not related to upper trunk rotation or pelvis rotation throughout the throwing motion (r = –0.16 to 0.15).

Conclusion:

The kinetic and rotational kinematic differences observed between PRO and HS pitchers in this study may help explain the greater performance of PRO pitchers while allowing them to minimize EVT during pitching. HS pitchers, however, do not appear to be as capable of utilizing the forces generated by rotation of their trunk and pelvis to aid in pitching, and those who throw the hardest generate the greatest forces at the shoulder and elbow. As a result, they experience higher EVTs relative to their body size, which may place them at an increased risk of injury.

Clinical Relevance:

HS pitchers throw harder primarily by generating larger forces in the arm and shoulder. Thus, owing to the relative physical immaturity of HS versus PRO pitchers, these factors may place them at an increased risk of injury. Coaches may first wish to focus on improving the rotational kinematics of HS pitchers rather than first focusing on achieving greater pitch velocities.

The Relationship of Throwing Arm Mechanics and Elbow Varus Torque: Within-Subject Variation for Professional Baseball Pitchers Across 82,000 Throws

BACKGROUND

Likely due to the high level of strain exerted across the elbow during the throwing motion, elbow injuries are on the rise in baseball. To identify at-risk athletes and guide postinjury return-to-throw programs, a better understanding of the variables that influence elbow varus torque is desired.

PURPOSE

To describe the within-subject relationship between elbow varus torque and arm slot and arm rotation in professional baseball pitchers.

STUDY DESIGN

Descriptive laboratory study.

METHODS

A total of 81 professional pitchers performed 82,000 throws while wearing a motusBASEBALL sensor and sleeve. These throws represented a combination of throw types, such as warm-up/catch, structured long-toss, bullpen throwing from a mound, and live game activity. Variables recorded for each throw included arm slot (angle of the forearm relative to the ground at ball release), arm speed (maximal rotational velocity of the forearm), arm rotation (maximal external rotation of the throwing arm relative to the ground), and elbow varus torque. Linear mixed-effects models and likelihood ratio tests were used to estimate the relationship between elbow varus torque and arm slot, arm speed, and arm rotation within individual pitchers.

RESULTS

All 3 metrics-arm slot (χ² = 428, P < .001), arm speed (χ² = 57,683, P < .001), and arm rotation (χ² = 1392, P < .001)-were found to have a significant relationship with elbow varus torque. Within individual athletes, a 1-N.m increase in elbow varus torque was associated with a 13° decrease in arm slot, a 116 deg/s increase in arm speed, and an 8° increase in arm rotation.

CONCLUSION

Elbow varus torque increased significantly as pitchers increased their arm rotation during the arm cocking phase, increased the rotational velocity of their arm during the arm acceleration phase of throwing, and decreased arm slot at ball release. Thus, shoulder flexibility, arm speed, and elbow varus torque (and likely injury risk) are interrelated and should be considered collectively when treating pitchers.

CLINICAL RELEVANCE

It is well established that elbow varus torque is related to ulnar collateral ligament injuries in overhead throwers. This study describes the relationship of arm slot, arm speed, and arm rotation to elbow varus torque in an attempt to identify modifiable risk factors for injury.

Weightbearing ankle dorsiflexion range of motion and sagittal plane kinematics during single leg drop jump landing in healthy male athletes

BACKGROUND

Passive ankle dorsiflexion range of motion (DROM) measures have been identified as a risk factor for injury during landings. However, passive measurements might not be indicative of dynamic ankle movement, whereas a weightbearing ROM might be a better tool when evaluating movement. The purpose of this study was to investigate the relationship between weightbearing DROM and sagittal plane landing mechanics in a single leg drop jump task.

METHODS

Seventy-three male athletes (22.1±3.9 years old, height 186.2±11 cm, and weight 100.2±21.8 kg) performed bilateral modified-lunge tasks and bilateral single leg drop jump landings while 3D kinematic data were collected. Hip, knee, and ankle joint angles were calculated at initial contact (IC) maximum knee flexion (MKF), and total excursion (TE) during a single leg drop jump landing.

RESULTS

No bilateral differences in DROM and single leg landing mechanics existed. Decreased ankle DROM was correlated to decreased ankle dorsiflexion at MKF (P=0.00) and TE (P=0.00) for both dominant and non-dominant limbs. Decreased ankle DROM was also correlated to decreased knee flexion at IC (P=0.00), MKF (P=0.00), and TE (P=0.1), for both dominant and non-dominant limbs. Ankle DROM correlated to hip flexion at MKF (r=0.25) and TE (r=0.30) in the dominant limb.

CONCLUSIONS

Restrictions in DROM may contribute to a stiff landing with less flexion at the ankle and knee. These findings may be useful in designing training programs aimed at increasing DROM in order to improve an athlete's landing mechanics and decrease risk of injury.

Laboratory toxicity and benthic invertebrate field colonization of Upper Columbia River sediments: finding adverse effects using multiple lines of evidence

From 1930 to 1995, the Upper Columbia River (UCR) of northeast Washington State received approximately 12 million metric tons of smelter slag and associated effluents from a large smelter facility located in Trail, British Columbia, approximately 10 km north of the United States-Canadian border. Studies conducted during the past two decades have demonstrated the presence of toxic concentrations of heavy metals in slag-based sandy sediments, including cadmium, copper, zinc, and lead in the UCR area as well as the downstream reservoir portion of Lake Roosevelt. We conducted standardized whole-sediment toxicity tests with the amphipod Hyalella azteca (28-day) and the midge Chironomus dilutus (10-day) on 11 samples, including both UCR and study-specific reference sediments. Metal concentrations in sediments were modeled for potential toxicity using three approaches: (1) probable effects quotients (PEQs) based on total recoverable metals (TRMs) and simultaneously extracted metals (SEMs); (2) SEMs corrected for acid-volatile sulfides (AVS; i.e., ∑SEM - AVS); and (3) ∑SEM - AVS normalized to the fractional organic carbon (f(oc)) (i.e., ∑SEM - AVS/f(oc)). The most highly metal-contaminated sample (∑PEQ(TRM) = 132; ∑PEQ(SEM) = 54; ∑SEM - AVS = 323; and ∑SEM - AVS/(foc) = 64,600 umol/g) from the UCR was dominated by weathered slag sediment particles and resulted in 80% mortality and 94% decrease in biomass of amphipods; in addition, this sample significantly decreased growth of midge by 10%. The traditional ∑AVS - SEM, uncorrected for organic carbon, was the most accurate approach for estimating the effects of metals in the UCR. Treatment of the toxic slag sediment with 20% Resinex SIR-300 metal-chelating resin significantly decreased the toxicity of the sample. Samples ∑SEM - AVS > 244 was not toxic to amphipods or midge in laboratory testing, indicating that this value may be an approximate threshold for effects in the UCR. In situ benthic invertebrate colonization studies in an experimental pond (8-week duration) indicated that two of the most metal-contaminated UCR sediments (dominated by high levels of sand-sized slag particles) exhibited decreased invertebrate colonization compared with sand-based reference sediments. Field-exposed SIR-300 resin samples also exhibited decreased invertebrate colonization numbers compared with reference materials, which may indicate behavioral avoidance of this material under field conditions. Multiple lines of evidence (analytical chemistry, laboratory toxicity, and field colonization results), along with findings from previous studies, indicate that high metal concentrations associated with slag-enriched sediments in the UCR are likely to adversely impact the growth and survival of native benthic invertebrate communities. Additional laboratory toxicity testing, refinement of the applications of sediment benchmarks for metal toxicity, and in situ benthic invertebrate studies will assist in better defining the spatial extent, temporal variations, and ecological impacts of metal-contaminated sediments in the UCR system.

Preliminary evaluation after setting up a post-assessment attention deficit hyperactivity disorder clinic in a community setting

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a common neuro-behavioural condition affecting school age children, older adolescents and young adults. It often leads to challenging educational, social and personal difficulties and co-morbidities which makes it an appropriate focus for the setting up of a dedicated clinic.

AIM

This service innovation was planned to ensure that ADHD patients receive regular multi-disciplinary reviews and to improve the training standards of junior doctors. We hypothesised that multimodal treatment approach shall be more acceptable to parents and children with ADHD than medication alone. It was our belief that the setting up of a post-assessment ADHD clinic will lead to efficient use of existing resources thereby saving clinical time.

METHOD

Our local audit identified 51 young people with ADHD stabilised on medication. One year after setting up the post-assessment ADHD clinic, feedback was obtained using questionnaires from clinicians and parents.

RESULTS

Seventy-five percent of parents and all the clinicians responded. Parents indicated that they were quite satisfied with the changes made. Clinicians were of the opinion that the dedicated ADHD clinic was more efficient in meeting the children's needs.

CONCLUSION

This survey validated our hypothesis that multi-modal reviews were more acceptable to parents of children with ADHD. The setting up of the dedicated clinic proved to be an efficient way of using the existing resources without any additional costs.

Correlation of cartilage oligomeric matrix protein (COMP) levels in equine tendon with mechanical properties: a proposed role for COMP in determining function-specific mechanical characteristics of locomotor tendons

Over-strain injury of the superficial digital flexor tendon (SDFT) is a common injury in the horse. Tendon appears to adapt to loads placed on it during development, but fatigue damage accumulates after skeletal maturity, which is inadequately repaired and predisposes to clinical tendinitis. In any population of horses, there is a wide variation in SDFT mechanical properties. A noncollagenous protein, cartilage oligomeric matrix protein (COMP), is particularly abundant during growth in the equine SDFT and has been proposed to have an organisational role in the formation of collagenous matrices. This study aimed to determine whether COMP levels were correlated to mechanical properties at skeletal maturity. Tendons from 2 groups of 12 horses were analysed: Group 1 horses with restricted age, 2 years +/- 2 months, showed a significant correlation between both ultimate tensile stress modulus of elasticity and stiffness and COMP, while Group 2 mature horses with varying age did not, because of age- and exercise-induced loss of COMP. These data supports the hypothesis that COMP is an important mediator in the growth of tendon. This data would suggest that the identification of low COMP levels in tendon during growth would indicate horses prone to tendon injury and methods of promoting COMP synthesis during growth would potentially improve tendon quality and reduce the risk of subsequent tendinitis.