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

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          Abstract

          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.

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          Most cited references30

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          Risk factors for shoulder and elbow injuries in adolescent baseball pitchers.

          There is little evidence supporting current safety recommendations for adolescent pitchers. Pitching practices of adolescent pitchers without history of arm injury will be significantly different from those of adolescent pitchers who required shoulder or elbow surgery. Case control study; Level of evidence, 3. Ninety-five adolescent pitchers who had shoulder or elbow surgery and 45 adolescent pitchers who never had a significant pitching-related injury completed a survey. Responses were compared between the 2 groups using t tests and chi(2) analyses. Multivariable logistic regression models were developed to identify the risk factors. The injured group pitched significantly more months per year, games per year, innings per game, pitches per game, pitches per year, and warm-up pitches before a game. These pitchers were more frequently starting pitchers, pitched in more showcases, pitched with higher velocity, and pitched more often with arm pain and fatigue. They also used anti-inflammatory drugs and ice more frequently to prevent an injury. Although the groups were age matched, the injured group was taller and heavier. There were no significant differences regarding private pitching instruction, coach's chief concern, pitcher's self-rating, exercise programs, stretching practices, relieving frequency, pitch type frequency, or age at which pitch types were first thrown. Pitching practices were significantly different between the groups. The factors with the strongest associations with injury were overuse and fatigue. High pitch velocity and participation in showcases were also associated with increased risk for injury. New recommendations were made based on these results. Adherence to the recommendations may reduce the incidence of significant injury to adolescent pitchers.
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            Longitudinal study of elbow and shoulder pain in youth baseball pitchers.

            Previous studies among young pitchers have focused on the frequency and description of elbow injuries. The purpose of this study was to evaluate the frequency of elbow and shoulder complaints in young pitchers and to identify the associations between pitch types, pitch volume, and other risk factors for these conditions. A prospective cohort study of 298 youth pitchers was conducted over two seasons. Each participant was contacted via telephone after each game pitched to identify arm complaints. Generalized estimating equations were used to assess associations between arm complaints and independent variables. The frequency of elbow pain was 26%; that of shoulder pain, 32%. Risk factors for elbow pain were increased age, increased weight, decreased height, lifting weights during the season, playing baseball outside the league, decreased self-satisfaction, arm fatigue during the game pitched, and throwing fewer than 300 or more than 600 pitches during the season. Risk factors for shoulder pain included decreased satisfaction, arm fatigue during the game pitched, throwing more than 75 pitches in a game, and throwing fewer than 300 pitches during the season. Arm complaints are common, with nearly half of the subjects reporting pain. The factors associated with elbow and shoulder pain were different, suggesting differing etiologies. Developmental factors may be important in both. To lower the risk of pain at both locations, young pitchers probably should not throw more than 75 pitches in a game. Other recommendations are to remove pitchers from a game if they demonstrate arm fatigue and limit pitching in nonleague games.
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              Ulnar collateral ligament reconstruction in high school baseball players: clinical results and injury risk factors.

              The incidence of ulnar collateral ligament injury has increased in baseball, especially at the high school level. Ulnar collateral ligament injury in high school baseball players is associated with overuse, high-velocity throwing, early throwing of breaking pitches, and improper warm-ups. Retrospective cohort study. Follow-up physical examination and questionnaire data were collected at an average of 35 months after ulnar collateral ligament reconstruction from 27 former high school baseball players. Six potential risk factors were evaluated: year-round throwing, seasonal overuse, event overuse, throwing velocity more than 80 mph, throwing breaking pitches before age 14, and inadequate warm-ups. Overall, 74% returned to baseball at the same or higher level. Patients averaged 3 potential risk factors, and 85% demonstrated at least one overuse category. Of the pitchers, the average self-reported fastball velocity was 83 mph, and 67% threw breaking pitches before age 14. The success rate of ulnar collateral ligament reconstruction in high school baseball players is nearly equal to that in more mature groups of throwers. Overuse of the throwing arm and throwing breaking pitches at an early age may be related to their injuries. Special attention should be paid to elite-level teenage pitchers who throw with high velocity. Copyright 2004 American Orthopaedic Society for Sports Medicine
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                Author and article information

                Journal
                Orthop J Sports Med
                Orthop J Sports Med
                OJS
                spojs
                Orthopaedic Journal of Sports Medicine
                SAGE Publications (Sage CA: Los Angeles, CA )
                2325-9671
                10 December 2020
                December 2020
                : 8
                : 12
                : 2325967120969245
                Affiliations
                []Research and Development, Motus Global, Rockville Centre, New York, USA.
                []Sports Medicine and Shoulder Service, Ringgold 25062, Hospital for Special Surgery; , New York, New York, USA.
                [§ ]Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
                [4-2325967120969245] Investigation performed at Motus Global, Rockville Centre, New York, USA
                Author notes
                [*] [* ]Brittany Dowling, MS, Motus Global, 200 Sunrise Highway, Rockville Centre, NY 11570, USA (email: dowlingb86@ 123456gmail.com ).
                Article
                10.1177_2325967120969245
                10.1177/2325967120969245
                7734513
                33354584
                d60cec9a-9cba-4676-b377-7057a8aaf15a
                © The Author(s) 2020

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License ( https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 29 June 2020
                : 7 July 2020
                Categories
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                Custom metadata
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                elbow,torque,workload
                elbow, torque, workload

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