Participation in high school sports has grown 16.1% over the last decade, but few studies have compared the overall injury risks in girls' softball and boys' baseball.
To examine the incidence of injury in high school softball and baseball players.
Greenville, South Carolina, high schools.
Patients or Other Participants:
Softball and baseball players (n = 247) from 11 high schools.
Main Outcome Measure(s):
Injury rates, locations, types; initial or subsequent injury; practice or game setting; positions played; seasonal trends.
The overall incidence injury rate was 4.5/1000 athlete-exposures (AEs), with more injuries overall in softball players (5.6/1000 AEs) than in baseball players (4.0/1000 AEs). Baseball players had a higher initial injury rate (75.9/1000 AEs) than softball players (66.4/1000 AEs): rate ratio (RR) = 0.88, 95% confidence interval (CI) = 0.4, 1.7. The initial injury rate was higher than the subsequent injury rate for the overall sample (P < .0001) and for softball (P < .0001) and baseball (P < .001) players. For both sports, the injury rate during games (4.6/1000 AEs) was similar to that during practices (4.1/1000 AEs), RR = 1.22, 95% CI = 0.7, 2.2. Softball players were more likely to be injured in a game than were baseball players (RR = 1.92, 95% CI = 0.8, 4.3). Most injuries (77%) were mild (3.5/1000 AEs). The upper extremity accounted for the highest proportion of injuries (63.3%). The incidence of injury for pitchers was 37.3% and for position players was 15.3%. The rate of injury was highest during the first month of the season (7.96/1000 AEs).
The incidence of injury was low for both softball and baseball. Most injuries were minor and affected the upper extremity. The injury rates were highest in the first month of the season, so prevention strategies should be focused on minimizing injuries and monitoring players early in the season.
injury rates; injury epidemiology; athletic injuries
Adolescents ranging in age from 11–15 (early‐mid adolescence) comprise the largest percentage of baseball and softball athletes in the United States. Shoulder and elbow injuries are commonly experienced by these athletes with baseball pitchers and softball position players most likely to be injured.
Physeal injury often termed “Little League” shoulder or elbow is common and should be differentiated from soft tissue injuries such as biceps, rotator cuff, or UCL injuries. Regardless of diagnosis, rehabilitation of these athletes’ shoulder and elbow injuries provide a unique challenge given their rapidly changing physical status.
Common impairments include alterations in shoulder range of motion, decreased muscle performance, and poor neuromuscular control of the scapula, core, and lower extremity. A criterion based, progressive rehabilitation program is presented. Discharge from formal rehabilitation should occur only when the athlete has demonstrated a resolution of symptoms, acceptable ROM, muscle performance, and neuromuscular control while progressing through a symptom free return to sport.
Prevention of Reinjury:
Reintegration into the desired level of sport participation should be guided by the sports medicine professional with a focus on long‐term durability in sport performance as well as injury prevention. A prevention program which includes parent, coach, and athlete education, regular screening to identify those athletes at the highest risk, and monitoring athletes for the development of risk factors or warning signs of injury over the course of participation is indicated.
Level of Evidence:
Adolescent; throwing injuries; youth
To review the literature of the biomechanics of the windmill fast-pitch and its implications for injury. This information may be utilized in treating youth windmill pitchers.
A MEDLINE search was conducted to retrieve articles regarding the windmill pitch. Key terms were then taken from the pilot search and used to conduct a systematic search and review of the literature.
Articles containing information on the windmill pitch and injuries associated with the motion were reviewed. Additional information pertaining to the overhand baseball pitch and overuse injuries in youth were analyzed and synthesized into the body of information.
A complex sequence of actions is required to successfully perform the windmill pitch. Overuse injuries are common in windmill pitchers. A well-designed conditioning schedule and the regulation of the frequency and volume of pitching in youth fast-pitch may assist with managing injury associated with this activity. Further investigation of specific treatment methods is needed.
Biomechanics; Underhand Pitching; Softball; Chiropractic; Shoulder; Elbow
Addressing loss of shoulder range of motion and rotator cuff weakness in injury-prevention programs might be an effective strategy for preventing throwing arm injuries in baseball pitchers. However, the influence of these clinical measures on pitching biomechanics is unclear.
To evaluate the relationships among clinical measures of shoulder rotational motion and strength and 3-dimensional pitching biomechanics and to evaluate the presence of coupling between the shoulder and the elbow during pitching to provide insight into the influence of clinical shoulder characteristics on elbow biomechanics.
Patients or Other Participants:
A total of 27 uninjured male high school baseball pitchers (age = 16 ± 1.1 years, height = 183 ± 7 cm, mass = 83 ± 12 kg).
Main Outcome Measure(s):
Clinical measures included shoulder internal- and external-rotation range of motion and peak isometric internal- and external-rotator strength. Three-dimensional upper extremity biomechanics were assessed as participants threw from an indoor pitching mound to a target at regulation distance. Linear regressions were used to assess the influence of clinical measures on the peak shoulder internal and external rotation moments and the peak elbow-adduction moment.
We found a positive relationship between clinically measured internal-rotator strength and shoulder external-rotation moment (R2 = 0.181, P = .04) during pitching. We also noted an inverse relationship between clinically measured external-rotation motion and the elbow-adduction moment (R2 = 0.160, P = .04) and shoulder internal-rotation moment (R2 = 0.250, P = .008) during pitching. We found a positive relationship between peak shoulder internal-rotation moment and the peak elbow-adduction moment (R2 = 0.815, P < .001) during pitching.
This study provides insight into the effects of shoulder strength and motion on pitching biomechanics and how these clinical measures might contribute to throwing arm injuries in the baseball pitcher. A relationship also was identified between peak shoulder and elbow moments in the throwing arm during pitching, providing biomechanical support for addressing clinical shoulder characteristics as a potential strategy for preventing elbow injury.
upper extremity; overhead athletes; throwing athletes; rehabilitation
Baseball and softball pitch types are distinguished by the path and speed of the ball which, in turn, are determined by the angular velocity of the ball and the velocity of the ball center at the instant of release from the pitcher's hand. While radar guns and video-based motion capture (mocap) resolve ball speed, they provide little information about how the angular velocity of the ball and the velocity of the ball center develop and change during the throwing motion. Moreover, mocap requires measurements in a controlled lab environment and by a skilled technician. This study addresses these shortcomings by introducing a highly miniaturized, wireless inertial measurement unit (IMU) that is embedded in both baseballs and softballs. The resulting “ball-embedded” sensor resolves ball dynamics right on the field of play. Experimental results from ten pitches, five thrown by one softball pitcher and five by one baseball pitcher, demonstrate that this sensor technology can deduce the magnitude and direction of the ball's velocity at release to within 4.6% of measurements made using standard mocap. Moreover, the IMU directly measures the angular velocity of the ball, which further enables the analysis of different pitch types.
inertial measurement unit; wireless sensor; baseball; softball; pitching; training
The magnitude of motion that is normal for the throwing shoulder in uninjured baseball pitchers has not been established. Chronologic factors contributing to adaptations in motion present in the thrower's shoulder also have not been established.
To develop a normative profile of glenohumeral rotation motion in uninjured high school baseball pitchers and to evaluate the effect of chronologic characteristics on the development of adaptations in shoulder rotation motion.
Baseball playing field.
Patients or Other Participants:
A total of 210 uninjured male high school baseball pitchers (age = 16±1.1 years, height = 1.8 + 0.1 m, mass = 77.5±11.2 kg, pitching experience = 6±2.3 years).
Using standard goniometric techniques, we measured passive rotational glenohumeral range of motion bilaterally with participants in the supine position.
Main Outcome Measure(s):
Paired t tests were performed to identify differences in motion between limbs for the group. Analysis of variance and post hoc Tukey tests were conducted to identify differences in motion by age. Linear regressions were performed to determine the influence of chronologic factors on limb motion.
Rotation motion characteristics for the population were established. We found no difference between sides for external rotation (ER) at 0° of abduction (t209 = 0.658, P = .51), but we found side-to-side differences in ER (t209 = −13.012, P<.001) and internal rotation (t209 = 15.304, P<.001) at 90° of abduction. Age at the time of testing was a significant negative predictor of ER motion for the dominant shoulder (R2 = 0.019, P = .049) because less ER motion occurred at the dominant shoulder with advancing age. We found no differences in rotation motion in the dominant shoulder across ages (F4,205 range, 0.451–1.730, P>.05).
This range-of-motion profile might be used to assist with the interpretation of normal and atypical shoulder rotation motion in this population. Chronologic characteristics of athletes had no influence on range-of-motion adaptations in the thrower's shoulder.
shoulder; throwing; range of motion
Objective: To construct interval throwing programs followed by a simulated game for collegiate softball players at all positions. The programs are intended to be used as functional progressions within a comprehensive rehabilitation program for an injured athlete or to augment off-season conditioning workouts.
Design and Setting: We collected data over a single season of National Collegiate Athletic Association softball at the University of Delaware and Goldey Beacom College. We observed 220 half-innings of play and 2785 pitches during data collection.
Subjects: The subjects were collegiate-level softball players at all positions of play.
Measurements: We recorded the number of pitches for pitchers. For catchers, we recorded the number of sprints to back up a play, time in the squat stance, throws back to the pitcher, and the perceived effort and distance of all other throws. We also collected the perceived effort and distance of all throws for infielders and outfielders.
Results: Pitchers threw an average of 89.61 pitches per game; catchers were in the squat stance 14.13 minutes per game; infielders threw the ball between 4.28 times per game and 6.30 times per game; and outfielders threw distances of up to 175 feet.
Conclusions: We devised the interval throwing programs from the data collected, field dimensions, the types of injuries found to occur in softball, and a general understanding of tissue healing. We designed programs that allow a safe and efficient progressive return to sport.
simulated game; college softball conditioning; rehabilitation for softball; softball injuries
Throwing is a vigorous activity that generates large internal loads. There is limited evidence of the effect of these loads on bone adaptation. The aim of this study was to investigate the: 1) magnitude of bone adaptation within the midshaft humerus of female fast-pitch softball players and 2) influence of throwing mechanics (windmill vs. overhand throwing) on the magnitude of adaptation.
Midshaft humeral bone mass, structure and estimated strength were assessed via peripheral quantitative computed tomography in fast-pitch softball players (throwers; n=15) and matched controls (controls; n=15). The effect of throwing was examined by comparing dominant-to-nondominant differences in throwers to controls, while the influence of mechanics was determined by comparing dominant-to-nondominant differences in throwers who primarily play as pitcher (windmill thrower), catcher (overhand thrower) or fielder (overhand thrower).
Throwers had greater dominant-to-nondominant difference in midshaft humeral bone mass, structure and estimated strength relative to controls (all P<0.05). The largest effect was for estimated torsional strength with throwers having a mean dominant-to-nondominant difference of 22.5% (range, 6.7% to 43.9%) compared to 4.4% (range, -8.3% to 17.5%) in controls (P<0.001). Throwing mechanics appeared to influence the magnitude of skeletal adaptation, with overhand throwers having more than double dominant-to-nondominant difference in midshaft humeral bone mass, structure and estimated strength than windmill throwers (all P<0.05).
Throwing induces substantial skeletal adaptation at the midshaft humerus of the dominant upper extremity. Throwing mechanics appears to the influence the magnitude of adaptation as catchers and fielders (overhand throwers) had twice as much adaptation as pitchers (windmill throwers). The latter finding may have implications for skeletal injury risk at the midshaft humerus in throwing athletes.
BIOMECHANICS; BONE; EXERCISE; GROWTH AND DEVELOPMENT; MECHANICAL LOADING; OSTEOPOROSIS
Objectives: To investigate safety risks in slowpitch softball by conducting laboratory and experimental studies on the performance of high tech softball bats with polyurethane softballs. To compare the results with the recommended safety standards.
Methods: ASTM standard compression testing of seven softball models was conducted. Using these seven softball models, bat/ball impact testing was performed using seven adult male softball players and six high tech softball bat models to determine mean batted ball speeds. Over 500 bat/ball impact measurements were recorded and analysed. Available pitcher reaction time was calculated from the mean batted ball speed measurements.
Results: According to the United States Specialty Sports Association and the Amateur Softball Association, the maximum initial batted ball speed should be 137.2 km/h, which corresponds to a minimum pitcher reaction time of 0.420 second. These experiments produced mean batted ball speeds of 134.0–159.7 km/h, which correspond to available pitcher reaction times of 0.409–0.361 second.
Conclusion: The use of high tech softball bats with polyurethane softballs can result in batted ball speeds that exceed the recommended safety limits, which correspond to decreased available pitcher reaction times.
Representative data on typical pitch volume for collegiate pitchers functioning in their specific roles is sparse and is needed for training specificity.
To report pitch volumes in Division I collegiate pitchers. The authors hypothesize that pitcher role will result in different pitch volumes.
Pitchers from twelve Division I collegiate baseball teams pitch volume during the 2009 baseball season was retrospectively reviewed through each team's website. The number of pitches and innings pitched for each pitcher were recorded. Pitchers were categorized based on their role as “Starter-only” (n=15), “Reliever-only” (n=76), or “Combined Starter/Reliever” (n=94) and compared using ANOVA.
“Starter-only” pitchers threw the most pitches (97±10) and pitched the most innings (6.0±1.0) per appearance (p=<.001). “Combined Starter/Reliever” functioning as a starter threw significantly more pitches (68±19) and pitched more innings (4.0±1.3) per appearance compared to “Combined Starter/Reliever” functioning as a reliever and “Reliever-only” pitchers (p=<.001). The cumulative volume during a 13 week regular season revealed that “Starter-only” pitchers threw significantly more total pitches (1204±387) compared to “Combined Starter/Reliever” pitchers (613±182) who threw significantly more than “Reliever-only” pitchers (254±77) (P<.001).
Pitcher's specific roles and representative volumes should be used to design training and rehabilitation programs. Comparison of this data to reported adolescent pitch volumes reveal that adolescent pitch volume per appearance approaches collegiate levels.
Collegiate pitcher roles dictate their throwing volume. Starter-only pitchers (8%) throw the greatest cumulative number of pitches and should be trained differently than the majority of college pitchers (92%) who function primarily as a reliever or in combination starter/reliever roles that on average only requires approximately 40 pitches per appearance.
Overhead Throwing Athletes; Rehabilitation; Pitching
The purpose of this study is to evaluate the effectiveness of a screening survey in identifying injuries in youth baseball pitchers. It is hypothesized that a standalone survey is unlikely to give a complete picture and that an additional physical examination is necessary to identify all injuries.
Seventy-seven youth baseball players who pitched in the last 12 months completed the survey. Players underwent physical examination if they reported a history of time-loss injury (16 players) or if they had any current complaints of pain without a history of time-loss injury (22 players).
This screening protocol resulted in positive physical examination findings in 37.6% of all 77 players. This included a rate of 56.3% of pitchers with a positive time-loss injury history and 90.9% of pitchers with a negative time-loss injury, but positive complaint of pain. The most common complaint in both groups was elbow tenderness with the most common location being the medial epicondyle.
While the survey was effective at identifying time-loss injuries, it may neglect more mild injuries, underestimating the percentage of players with pain and positive physical examination findings. The high frequency of positive examination findings in athletes without a history of time-loss injury demands further investigation.
Collegiate baseball pitchers, as well as position
players, exhibit increased humeral retrotorsion compared with individuals with
no history of overhead sport participation. Whether the humeral retrotorsion
plays a role in the development of throwing-related injuries that are prevalent
in collegiate baseball pitchers is unknown.
Humeral retrotorsion will be significantly different in
collegiate pitchers with throwing-related shoulder or elbow injury history
compared with pitchers with no injury history. Humeral retrotorsion can also
discriminate participants with and without shoulder or elbow injury.
Comparisons of ultrasonographically-obtained humeral
retrotorsion were made between 40 collegiate pitchers with and without history
of throwing-related shoulder or elbow injury. The ability of humeral
retrotorsion to discriminate injury history was determined from the receiver
operating characteristic area under the curve.
Participants with an elbow injury history demonstrated a
greater humeral retrotorsion limb difference (mean difference = 7.2°,
P = 0.027) than participants with no history of upper
extremity injury. Participants with shoulder injury history showed no
differences in humeral torsion compared with participants with no history of
injury. Humeral retrotorsion limb difference exhibited a fair ability (receiver
operating characteristic area under the curve = 0.74) to discriminate elbow
Collegiate pitchers with a history of elbow injury
exhibited a greater limb difference in humeral retrotorsion compared with
pitchers with no history of injury. No differences in humeral retrotorsion
variables were present in participants with and without shoulder injury
Baseball players with a history of elbow injury
demonstrated increased humeral retrotorsion, suggesting that the amount of
retrotorsion and the development of elbow injury may be associated.
shoulder; elbow; baseball; injury; retroversion
Context: Girls' participation in high school sports has increased 79.5% since 1975–1976. The incidence of injury among boys in high school sports has been well documented, but information regarding the incidence, severity, and type of injury among girls in high school sports is limited.
Objective: To examine the effects of subsequent injuries among high school girls in 5 sports.
Design: Observational cohort.
Setting: Existing data from the 1995–1997 National Athletic Trainers' Association High School Injury Surveillance database.
Patients or Other Participants: Girl athletes (n = 25 187 player-seasons) participating in 5 varsity high school sports: basketball, field hockey, soccer, softball, and volleyball.
Main Outcome Measure(s): Injury status, body location, injury type, time lost from injury, and number of players at risk for injury as recorded by athletic trainers and submitted to the Sports Injury Monitoring System.
Results: Overall, 23.3% of the athletes had 2 or more injuries within a sport; basketball and soccer athletes were most vulnerable. Overall, the probability of an athlete sustaining 3 or more injuries was 38.6%, and the risk was highest for field hockey players (61.9%). The risk of subsequent injury at a new body location was almost 2 times higher than reinjury at the same body location (risk ratio = 1.7, 95% confidence interval = 1.6, 1.8) and was similar for all sports except volleyball. Only in softball was the proportion of reinjuries causing 8 or more days lost from participation greater than the proportion of new injuries causing similar time loss. Softball and volleyball had the highest proportion of reinjuries at the shoulder, especially rotator cuff strains. The proportion of knee reinjuries was significantly higher than new injuries for all sports except soccer. The proportion of anterior cruciate ligament injuries was significantly higher for volleyball players only. Overall, the proportion of reinjuries was significantly higher for stress fractures and musculoskeletal condition injuries.
Conclusions: Patterns of subsequent injury risk appear to vary among these 5 sports. Almost one quarter of the athletes incurred 2 or more injuries over a 3-year period, so the effects of subsequent injuries deserve more consideration.
epidemiology; surveillance; sports injuries; reinjuries; female athletes
To identify and describe alcohol use among NCAA Division I female college basketball, softball, and volleyball players and to determine to what extent the players have been exposed to alcohol or other drug education programs.
Design and Setting:
Mailed self-reporting questionnaire, sample of convenience. The study was conducted in the Department of Physical Education at the University of South Carolina.
NCAA Division I athletic trainers of ten female basketball teams, ten female softball teams, and eleven female volleyball teams received questionnaires. A total of 371 participants returned questionnaires: 106 basketball players, 138 softball players, and 127 volleyball players.
After reviewing the related literature, I developed a questionnaire and pilot tested it with a group of female swimmers and track and field athletes. The questionnaire consisted of three sections: demographic information, alcohol use, and alcohol education. I analyzed the questionnaires descriptively (frequencies, percentages, and means) and collectively, on the total population, and separately, on all teams. To validate and further understand information gained from the questionnaires, I conducted multiple face-to-face interviews with forty (11%) of the participants.
Almost 79% of the subjects consumed alcohol, with light beers being the most popular beverage. Most started using alcohol before 18 years of age. More softball (89.1%) and volleyball (88.9%) athletes reported drinking than did basketball (63.2%) athletes. Quantity and frequency of alcohol use decreased during the competitive sport season but increased out of season. Almost 60% (55.9%) of the participants engaged in binge drinking (defined as four or more drinks per drinking episode) out of season and 35% in season. Female athletes who lived off campus drank more frequently than those who lived in residence halls, but athletes living in residence halls reported drinking in larger quantities. The most common reasons subjects chose not to use alcohol included the effects alcohol has on health and sports performance, coaches' rules, dislike of the taste of alcohol, and concerns about weight gain. Those who chose to use alcohol did so mostly for social purposes. Most subjects received 4 to 8 hours of alcohol education in lecture sessions during their college careers. The majority wanted additional education, especially with regard to the effects of alcohol on sports performance.
Based upon the results of this study, alcohol education has little impact on alcohol use among NCAA Division I female basketball, softball, and volleyball players, particularly out of season. Most choose to use alcohol simply to have fun. Because alcohol affects athletic performance, female athletes tend to use less alcohol in season. Future studies should address the types of alcohol prevention and intervention methods used during out-of-season and in-season periods. Correlation studies should investigate relationships between these programs and alcohol use among female athletes. A broader population of athletes from various sports (eg, field hockey, golf, gymnastics, tennis, soccer, and swimming) should also be investigated.
drugs; substance abuse; binge drinking
A database describing the range of normal rotator cuff strength values in uninjured high school pitchers has not been established. Chronologic factors that contribute to adaptations in strength also have not been established.
To establish a normative profile of rotator cuff strength in uninjured high school baseball pitchers and to determine whether bilateral differences in rotator cuff strength are normal findings in this age group.
Baseball playing field.
Patients or Other Participants:
A total of 165 uninjured male high school baseball pitchers (age = 16 ± 1 years, height = 1.8 ± 0.1 m, mass = 76.8 ± 10.1 kg, pitching experience = 7 ± 2 years).
Main Outcome Measure(s):
Isometric rotator cuff strength was measured bilaterally with a handheld dynamometer. We calculated side-to-side differences in strength (external rotation [ER], internal rotation [IR], and the ratio of ER:IR at 90° of abduction), differences in strength by age, and the influence of chronologic factors (participant age, years of pitching experience) on limb strength.
Side-to-side differences in strength were found for ER, IR, and ER:IR ratio at 90° of abduction. Age at the time of testing was a significant but weak predictor of both ER strength (R2 = 0.032, P = .02) and the ER:IR ratio (R2 = 0.051, P = .004) at 90° of abduction.
We established a normative profile of rotator cuff strength for the uninjured high school baseball pitcher that might be used to assist clinicians and researchers in the interpretation of muscle strength performance in this population. These data further suggested that dominant-limb adaptations in rotator cuff strength are a normal finding in this age group and did not demonstrate that these adaptations were a consequence of the age at the time of testing or the number of years of pitching experience.
shoulder; muscle physiology; throwing
The shoulder is one of the most commonly injured body sites among athletes. Little previous research describes shoulder injury patterns in high school athletes.
To describe and compare shoulder injury rates and patterns among high school athletes in 9 sports (football, soccer, basketball, baseball, and wrestling for boys and soccer, volleyball, basketball, and softball for girls).
Prospective injury surveillance study.
Injury data were collected from 100 nationally representative US high schools via High School Reporting Information Online.
Patients or Other Participants:
Athletes from participating high schools injured while involved in a school-sanctioned practice or competition in 1 of the above sports during the 2005–2006 and 2006–2007 school years.
Main Outcome Measure(s):
Shoulder injury rates, diagnoses, severity, and mechanisms.
During the 2005–2006 and 2006–2007 school years, athletes in this study sustained 805 shoulder injuries during 3 550 141 athlete-exposures (AEs), for an injury rate of 2.27 shoulder injuries per 10 000 AEs. This corresponds to an estimated 232 258 shoulder injuries occurring nationwide during this time. Shoulder injuries were more likely to occur during competition than practice (rate ratio = 3.01, 95% confidence interval = 2.62, 3.46). Shoulder injury rates per 10 000 AEs were highest in football (5.09), wrestling (4.34), and baseball (1.90). Common shoulder injury diagnoses included sprains/strains (39.6%), dislocations/separations (23.7%), contusions (11.5%), and fractures (6.6%). Although 44.8% of athletes sustaining a shoulder injury returned to play in less than 1 week, 22.9% were out of play for more than 3 weeks, and 6.2% of shoulder injuries required surgery. Common mechanisms of shoulder injury included player-to-player contact (57.6%) and contact with the playing surface (22.8%).
High school shoulder injury rates and patterns varied by sport. Continued surveillance is warranted to understand trends and patterns over time and to develop and evaluate evidence-based preventive interventions.
epidemiology; injury surveillance
Medial elbow injuries are common among baseball pitchers. Easily accessed methods to assess medial elbow stress may be useful in identifying individuals with increased injury risk.
Pitch velocity (PV) is positively associated with higher medial elbow adduction moments.
Cohort study; Level of evidence, 2.
Participants included 26 uninjured high school pitchers, 15 to 18 years in age. Three-dimensional data and PV were collected as athletes threw 10 fastballs for strikes to a regulation-distance target. Variables of interest were the normalized peak internal elbow adduction moment and peak PV. Linear regression was performed to evaluate the influence of PV on the adduction moment.
For the group, mean PV was 71 mph (range, 58-81 mph), and the adduction moment was 0.558 Nm/Ht × mass (range, 0.378-0.723). PV was positively associated with the adduction moment (P < 0.01, R2= 0.373).
Talented young pitchers may be more susceptible to elbow injuries as a consequence of a biomechanical coupling between PV and upper extremity joint moments.
PV may be measured easily and serve as an indicator of medial elbow stress.
biomechanics; throwing; upper extremity; adolescent; injury risk
Repetitive overhead throwing motion causes motion adaptations at the glenohumeral joint that cause injury, decrease performance, and affect throwing mechanics. It is essential to define the typical range of motion (ROM) exhibited at the glenohumeral joint in the overhead thrower.
We (1) assessed the glenohumeral joint passive range of motion (PROM) characteristics in professional baseball pitchers; and (2) applied these findings clinically in a treatment program to restore normal PROM and assist in injury prevention.
From 2005 to 2010, we evaluated 369 professional baseball pitchers to assess ROM parameters, including bilateral passive shoulder external rotation (ER) at 45° of abduction, external and internal rotation (IR) at 90° abduction while in the scapular plane, and supine horizontal adduction.
The mean ER was greater for the throwing and nonthrowing shoulders at 45° of abduction, 102° and 98°, respectively. The throwing shoulder ER at 90° of abduction was 132° compared with 127° on the nonthrowing shoulder. Also, the pitcher’s dominant IR PROM was 52° compared with 63° on the nondominant side. We found no statistically significant differences in total rotational motion between the sides.
Although we found side-to-side differences for rotational ROM and horizontal adduction, the total rotational ROM was similar.
The clinician can use these PROM values, assessment techniques, and treatment guidelines to accurately examine and develop a treatment program for the overhead-throwing athlete.
Little is known about pitching performance or lack of it among Major League Baseball (MLB) pitchers who undergo operative treatment of rotator cuff tears.
To assess pitching performance outcomes in MLB players who needed operative treatment of rotator cuff tears and to compare performance in these athletes with that in a control group of MLB players.
Publicly available player profiles, press releases, and team injury reports.
Patients or Other Participants:
Thirty-three MLB pitchers with documented surgery to treat rotator cuff tears and 117 control pitchers who did not have documented rotator cuff tears were identified.
Main Outcome Measure(s):
Major League Baseball pitching attrition and performance variables.
Players who underwent rotator cuff surgery were no more likely not to play than control players. Performance variables of players who underwent surgery improved after surgery but never returned to baseline preoperative status. Players who needed rotator cuff surgery typically were more experienced and had better earned run averages than control players.
Pitchers who had symptomatic rotator cuff tears that necessitated operative treatment tended to decline gradually in performance leading up to their operations and to improve gradually over the next 3 seasons. In contrast to what we expected, they did not have a greater attrition rate than their control counterparts; however, their performances did not return to preoperative levels over the course of the study.
pitching; clinical outcome; shoulder
To estimate the economic cost of injuries in a population of US high school varsity athletes.
Design and Setting
The North Carolina High School Athletic Injury Study, conducted from 1996 to 1999, was a prospective cohort study of injury incidence and severity. A two‐stage cluster sampling technique was used to select athletic teams from 100 high schools in North Carolina. An injury cost model was used to estimate the economic cost of injury.
Varsity athletes from 12 sports: football, girls' and boy's soccer, girls' and boys' track, girls' and boy's basketball, baseball, softball, wrestling, volleyball, and cheerleading.
Main outcome measures
Descriptive data were collected at the time of injury. Three types of costs were estimated: medical, human capital (medical costs plus loss of future earnings), and comprehensive (human capital costs plus lost quality of life).
The annual statewide estimates were $9.9 million in medical costs, $44.7 million in human capital costs, and $144.6 million in comprehensive costs. The mean medical cost was $709 per injury (95% CI $542 to $927), $2223 per injury (95% CI $1709 to $2893) in human capital costs, and $10 432 per injury (95% CI $8062 to $13 449) in comprehensive costs. Sport and competition division were significant predictors of injury costs.
Injuries among high school athletes represent a significant economic cost to society. Further research should estimate costs in additional populations to begin to develop cost‐effective sports injury prevention programs.
Throwing is a whole-body motion that requires the transfer of momentum from the lower extremity to the upper extremity via the trunk. No research to date examines the association between a history of shoulder or elbow injury and trunk flexibility in overhead athletes.
To determine if injury history and trunk-rotation flexibility are associated and to compare trunk-rotation flexibility measured using 3 clinical tests: half-kneeling rotation test with the bar in the back, half-kneeling rotation test with the bar in the front, and seated rotation test in softball position players with or without a history of shoulder or elbow injury.
University softball facilities.
Patients or Other Participants:
Sixty-five female National Collegiate Athletic Association Division I softball position players.
Trunk-rotation flexibility was measured with 3 clinical tests. Recent injury history was obtained using a questionnaire and verified by the certified athletic trainer.
Main Outcome Measure(s):
Binomial regression models were used to determine if injury history was associated with flexibility categories (high, normal, or limited tertiles) for each of the 6 (3 tests × 2 directions) trunk-rotation flexibility measures. Trunk-rotation flexibility measures from 3 clinical tests were compared between participants with and without a history of shoulder or elbow injury using analysis-of-variance models.
When measured using the half-kneeling rotation test with the bar in the back and the seated rotation test, injury history and forward trunk-rotation flexibility were associated. However, no mean group differences were seen in trunk-rotation flexibility between participants with and without a history of shoulder or elbow injury.
Limited forward trunk-rotation flexibility may be a risk factor for shoulder or elbow injuries. However, further study is needed to confirm the study finding.
overhead athletes; throwing; range of motion
There is an assumption that baseball athletes who reside in warm-weather climates experience larger magnitude adaptations in throwing shoulder motion and strength compared with their peers who reside in cold-weather climates.
(1) The warm-weather climate (WWC) group would exhibit more pronounced shoulder motion and strength adaptations than the cold-weather climate (CWC) group, and (2) the WWC group would participate in pitching activities for a greater proportion of the year than the CWC group, with the time spent pitching predicting throwing shoulder motion and strength in both groups.
Cross-sectional study; Level of evidence, 3.
One hundred uninjured high school pitchers (50 each WWC, CWC) were recruited. Rotational shoulder motion and isometric strength were measured and participants reported the number of months per year they pitched. To identify differences between groups, t tests were performed; linear regression was used to determine the influence of pitching volume on shoulder motion and strength.
The WWC group pitched more months per year than athletes from the CWC group, with the number of months spent pitching negatively related to internal rotation motion and external rotation strength. The WWC group exhibited greater shoulder range of motion in all planes compared with the CWC group, as well as significantly lower external rotation strength and external/internal rotation strength ratios. There was no difference in internal rotation strength between groups, nor a difference in the magnitude of side-to-side differences for strength or motion measures.
Athletes who reside in cold- and warm-weather climates exhibit differences in throwing shoulder motion and strength, related in part to the number of months spent participating in pitching activities. The amount of time spent participating in pitching activities and the magnitude of range of motion and strength adaptations in athletes who reside in warm-weather climates may make these athletes more susceptible to throwing-related injuries.
glenohumeral joint; rotational motion; rotator cuff; throwing; youth athlete
Optimal baseball throwing mechanics require a significant contribution of thoracolumbar motion, particularly in the sagittal and transverse planes. This motion is key for proper transmission of forces from the lower to upper extremity, thereby minimizing a throwing athlete's risk of injury and maximizing athletic performance.
To define the active‐assisted thoracolumbar ROM of both baseball pitchers and position players and to compare these motions both within and between groups.
Fifty‐six asymptomatic, collegiate and minor league baseball pitchers and 42 position players volunteered to participate. Active‐assisted thoracolumbar flexion, extension, and bilateral rotation ROM, were measured in a standing position, using two bubble inclinometers. Two‐tailed t tests were used to determine differences in ROM between and within the pitchers and position players.
The pitchers had significantly more rotation to the non‐throwing arm side as compared to the position players (p = .007, effect size = .61). The pitchers also had more rotation to the non‐throwing arm side as compared to their throwing side (p = .006, effect size = .47). There were no other significant differences between the pitchers and the position players (p > .53). Furthermore, the position players did not have a side‐to‐side rotation difference (p = .99).
Pitchers have a greater amount of rotation ROM towards the non‐throwing arm side as compared to position players. Pitchers also have a greater amount of rotation ROM to the non‐throwing arm side as compared to their throwing side rotation. Because pitchers often present with posterior shoulder tightness and subsequent altered shoulder horizontal adduction and internal rotation ROM, the increase in non‐throwing side rotation ROM may occur in response to these adaptations. More specifically, this increase in non‐throwing side trunk rotation ROM may allow such athletes to bring the arm across the body during the follow‐through phase of the throwing motion despite posterior shoulder tightness. However, future research is necessary to investigate this relationship. Based on these results, clinicians should consider these thoracolumbar ROM adaptations in the prevention, evaluation, and treatment of baseball players.
Level of Evidence:
Flexibility; spine; throwing athlete; trunk
Although baseball is a relatively safe sport, numerous reports suggest a rapid rise in elbow injury rate among youth baseball pitchers.
PubMed was searched for epidemiologic, biomechanical, and clinical studies of elbow injuries in baseball (keywords: “youth OR adolescent” AND baseball AND pitching AND “ulnar collateral ligament OR elbow”; published January 2000 – April 2012). Studies with relevance to youth baseball pitchers were reviewed. Relevant references from these articles were also retrieved and reviewed. Original data, insight, and recommendations were added.
The majority of baseball elbow injuries are noncontact injuries to the dominant arm resulting from repetitive pitching. Five percent of youth pitchers suffer a serious elbow or shoulder injury (requiring surgery or retirement from baseball) within 10 years. The risk factor with the strongest correlation to injury is amount of pitching. Specifically, increased pitches per game, innings pitched per season, and months pitched per year are all associated with increased risk of elbow injury. Pitching while fatigued and pitching for concurrent teams are also associated with increased risk. Pitchers who also play catcher have an increased injury risk, perhaps due to the quantity of throws playing catcher adds to the athlete’s arm. Another risk factor is poor pitching biomechanics. Improper biomechanics may increase the torque and force produced about the elbow during each pitch. Although throwing breaking pitches at a young age has been suggested as a risk factor, existing clinical, epidemiologic, and biomechanical data do not support this claim.
Some elbow injuries to youth baseball pitchers can be prevented with safety rules, recommendations, education, and common sense. Scientific and medical organizations have published safety rules and recommendations, with emphasis on prevention of overuse and pitching while fatigued.
Strength-of-Recommendation Taxonomy (SORT):
pitcher; pitch count; ulnar collateral ligament; Tommy John surgery; curveball
The purpose of this study was to assess major and minor league baseball players’ return to professional baseball at a preinjury level or higher after surgery of the shoulder or elbow.
The majority of athletes will be able to return to their preinjury level after surgery.
Over a 4-season period, prospective injury and surgery records were reviewed for one professional baseball club. Forty-four players underwent 51 procedures (28 shoulder and 23 elbow) by multiple experienced surgeons; 7 players underwent more than 1 procedure.
Twenty-eight shoulder surgeries were performed on 27 players: 19 pitchers and 8 position players. The majority of the procedures were labral repairs (n = 21). Nine players returned to their preoperative level; 2 advanced to a higher level; 5 returned to a lower level; and 11 retired from professional baseball. Only 2 of the 12 players at the high professional level (Major League Baseball, triple-A, double-A) returned to the same level. Twenty-three elbow surgeries were performed on 21 players (20 pitchers). The majority of the procedures were ulnar collateral ligament reconstructions (n = 12). Seven players returned to their preoperative level; 4 advanced to a higher level; 4 returned to a lower level; and 6 retired from professional baseball. Of the 12 players at the high professional level, 3 returned to the same or higher level.
Following surgery, 21 of 44 players (48%) returned to the same or higher level of professional baseball. For those players performing at a high professional level, 5 of 22 (23%) returned to the same or higher level. Return to the same or higher level was more likely with elbow surgery than with shoulder surgery.
Elite throwing athletes may not return to the same level at a high rate following shoulder or elbow surgery.
ulnar collateral ligament; superior labral anterior posterior tear; overhead athlete; baseball injuries; shoulder surgery; elbow surgery