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Injury Prevention Related to Pitching

Injury Prevention Related to Pitching E. David Osinski M.A. Glenn S. Fleisig, Ph.D. Biomechanics of Pitching Adult pitchers (college & pro) ASMI 18 studies published in last ten years All levels (youth thru pro)

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Injury Prevention Related to Pitching

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  1. Injury Prevention Related to Pitching E. David Osinski M.A. Glenn S. Fleisig, Ph.D.

  2. Biomechanics of Pitching • Adult pitchers (college & pro) • ASMI 18 studies published in last ten years • All levels (youth thru pro) • Kinematic (angular displacements and velocities) and kinetic (forces & torques) comparison of baseball pitching among various levels of development. (Fleisig et al, J Biomechanics, 1999)

  3. Results - Position (°)

  4. Results - Force (Newtons) Significant relationship between kinetic forces at shoulder & elbow joints for variables for pitching mechanics for youth through professional pitchers.

  5. Results - Force (%Weight) Significant relationship between forces at shoulder & elbow joints for pitching mechanics variables when adjusted for physical differences.

  6. Wind Up Commencement Movements

  7. High School Stride Foot Contact Pelvis = 25° open Upper Torso = 20° closed Shoulder: Abduction = 90° Rotation = 65° Elbow: Flexion = 80°

  8. High School Arm Cocking Max. Rotation Shoulder: Rotation = 175° Elbow: Flexion = 100°

  9. High School Arm Cocking Shoulder: Anterior Force=290N IR Torque = 51 Nm Elbow: Varus Torque=48Nm (Weight = 740 N = 170 lb)

  10. High School Arm Acceleration Arm Acceleration Elbow: Extension = 2200°/s Shoulder: Rotation = 6800°/s

  11. High School Arm Acceleration Shoulder: Proximal Force = 750 N Elbow: Proximal Force = 630 N (Weight = 740 N = 170 lb)

  12. Deceleration & Follow-Through

  13. Pathomechanics

  14. PHYSEAL INJURYLittle Leaguer’s Shoulder • First by Dotter described in 1953 • Described in literature as • osteochondrosis of the proximal humeral epiphysis • proximal humeral epiphyseolysis • stress fracture of proximal humeral epiphyseal plate • rotational stress fracture

  15. Adolescent Pitcher Shoulder Injury • Typically males, 12 - 15 years of age • 14 y/o more prone due to rapid growth and more skilled • Average duration of symptoms before treatment is approximately 7 months • Associated with quantity and intensity of pitching, age at which pitching started, use of curveball

  16. PHYSEAL INJURYLittle Leaguer’s Shoulder

  17. Elbow - Anatomy/Mechanics • Anterior Band of UCL (main valgus stabilizer) attaches to the medial epicondyle apophysis

  18. Elbow - Anatomy/Mechanics • Increased bone plasticity • Hyperelasticity permits excessive joint translation

  19. Elbow Injuries Skeletally immature athletes are susceptible to unique injuries secondary to: • Relatively weak growth plates (physes) • Ligamentous laxity • Inadequate dynamic strength / stability to resist high biomechanical forces

  20. Medial Epicondyle Apophysitis / Avulsion • Most common injury seen in the adolescent throwing athlete • Caused by acute valgus overload • X-rays may appear normal

  21. 1996 Survey (USA Baseball News, 1996) • Survey forUSA Baseball • 28 Orthop. Surgeons & Baseball Coaches • number of pitches more important than innings • Increase pitch count limits with age Examples: 8-10: 50 pitches. 17-18: 90 pitches • Start using pitches at different ages • Fastball (8), Change (10), Curve (14), Slider (16)

  22. 1997-98 Study (Med Sci Sport Exerc, 2001) • 200 pitchers each Spring (300 total subjects) • 8-12 years old pitchers in Birmingham • 50% of pitchers had elbow/shoulder pain during study • Increased pitches  Increased pain risk • 75 pitches/game recommended limit • 600 pitches/season recommended limit

  23. 1999 Study (Am J Sports Med, 2002) • Funded byUSA Baseball • 500 pitchers in Spring • 9-14 years old pitchers throughout Alabama • Increased pitches  Increased pain risk • 75 pitches/game recommended limit (15 batters) • 600 pitches/season recommended limit (120 batters) • No relation found between mechanics - pain risk • Curveballs/Sliders  Increased pain risk

  24. Conclusions - Mechanics • Successful youth and adult pitchers use similar kinematics. • Relationship between poor mechanics and risk of injury unproven

  25. Conclusions - Pitch Quantity • Correlation between pitch count and pain in youth pitchers • College/Pros use pitch counts to protect pitchers. Youth pitchers should do as well.

  26. Conclusions - Pitch Quantity USA Baseball Medical Committee Recommendations 2003 Age Workload Limit in Pitches Game Week Season Year 9-10 50 75 1000 1000 11-12 75 100 1000 3000 13-14 75 125 1000 3000

  27. American Baseball Foundation Thank you ABF BASIC Program at Rickwood Field

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