Injury Prevention Related to Pitching

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ASMI American Sports Medicine Institute mPreventib Pitching 8۳ E. David Osinski M.A. Glenn S. Fleisig, Ph.D. 

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Biomechanics of ‏تا‎ ¢ Adult pitchers (college & pro) - ASMI 18 studies published in last ten 2 - 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) 

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74 Knee @ FC B 95 i 3 ee acne) 3 

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Results - 120106 a ۳ Youth HS ااوی 39 350 290 فاك 770 630 ‎107C‏ 910 750 ‎39C‏ 350 280 Sh Anterior 210 Elb Proximal 400 ٩ ‏امت:۲۳0‎ 480 Sh Posterior 160 Significant relationship between kinetic forces at shoulder & elbow joints for variables for pitching mechanics for youth through professional pitchers. 

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Results - Force (% 222 ۱ Youth HS Col Pw ۱ 9 39 39 44 un Elb Proximal 14 85 9% 102 Sh Proximal 89 101 113 PAL Sh Posterior 30 38 44 un Significant relationship between forces at shoulder & elbow joints for pitching mechanics variables when adjusted for physical differences. 

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Wind Up Commencement Mo THE 16:24:49 061 59 

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111011 001 Foot Contact tobe ‏كك‎ OATE 12727799 Upper Torso < ۴ closed Shoulder: Abduction = 90 Rotation = 65° ۱۰۱۱۰ ‏یره‎ 

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111011 01 SAL LiL 9 Max. Rotation me 16:24:51 DATE 12727799 ‏ات‎ 5 Rotation = 175° Elbow: ‏نیت‎ ‎256 ‎Flexion = 100° 

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111011 01 Shoulder: TRE 16:24:51 ‏لل اران‎ Anterior Force=290N IR Torque = 51 ۱۹ ۱۰۱۱۰ ‏یره‎ ‎Varus ‎Torque=48Nm (Weight = 740 N : = 170 lb) -244|__> Piny 58[ 2۲-9 

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111011 01 SAL LiL ee Arm Acceleration tre 16:24:51 ‏لل اران‎ lone 1 ‏ع‎ ‎Extension = 2200/5 5-5 ‏نت‎ ‎Shoulder: 25 2598 Rotation = 6800°/s -244] + ۴۷ _ 58[ 2۲ 9 

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11101 01 FAL LLL Accel Shoulder: ۲۷۴ ۱6: 24: 1 08 ۱2۸ ‏وومج2‎ Proximal Force = 750N 10۳: Proximal Force = 630N 46 1 ‏الال‎ ‎= 170 lb) 

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- ثانا )11( 1 ع9 1/11 04 1)21 نايا نا لك 7 ۱۳ OATE 12727799 

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vaccine ‏اب‎ 3 ا 2 35 

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سد ل 7 * 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 

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AGOLESCEML 1 ‏)را‎ OLLOULGEL ee ۰ Typically males, 12 - 15 years of age ° 14 y/o more prone due to rapid growth and ‏ات۱۱۵۹‎ ¢ 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 

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YSEAL INJURY -- 

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Elbow - Anatomy/Mechanics i A Posterior Bundle Anterior Bundle Transverse Ligament ¢ Anterior Band of ۱0 ‏ا‎ ‎valgus ‎stabilizer) ‎attaches to the medial epicondyle 2100101117515 

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Elbow - Anatomy/Mechanics ° Increased bone plasticity ° Hyperelasticit 7 ‏عاتصتو‎ ‎excessive ‎۱9۹ ‎translation 

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Elbow Injuri Skeletally immature athletes are susceptible to unique injuries secondary to: SOC Ua Sn BC en Nie) EORTC Even * Inadequate dynamic strength / stability to resist high biomechanical forces 

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* Most common injury seen in the adolescent throwing athlete * Caused by acute valgus overload و ‎normal‏ 

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1996 Survey (USA Baseball News, 6) * Survey for USA 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) 

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1997-96 Study (Med Sci Sport 3 1) ¢ 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 

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1999 Study (AmJ Sports Se * Funded by USA Baseball ۰ 500 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 

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Conclusions - woe ° Successful youth and adult pitchers use similar kinematics. * Relationship between poor mechanics and risk of injury unproven 

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بت Se * Correlation between pitch count and pain in youth pitchers * College/Pros use pitch counts to protect pitchers. Youth pitchers should do as well. 

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] 9 ‏ار‎ - £Ltels ۹ 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 احضو جضن يو ون ا تر ا ‎Pa eT‏ 

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American Baseball Foundation Thank you 

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) – Kinematic (angular displacements and velocities) and kinetic (forces & torques) comparison of baseball pitching among various levels of development. (F leisig et al, J Biomechanics, 1999) Results - Position (°) Youth Stride 85 Ext Rot@ FC 67 Elbow @ FC 74 Knee @ FC 43 Max Elbow 95 Max Hor Add 21 Max Ext Rot 177 Elbow @ Rel 24 Hor Add @ Rel 11 Trunk @ Rel 32 Knee @ Rel 36 Hor. Add 910 HS Coll 85 85 64 55 82 85 50 48 100 99 20 20 174 173 23 23 10 9 31 33 43 39 890 820 Pro 86 58 87 46 98 17 175 23 9 33 38 830 Results - Force (Newtons) Sh Anterior Elb Proximal Sh Proximal Sh Posterior Youth 210 400 480 160 HS 290 630 750 280 Coll 350 770 910 350 Pro 390 910 1070 390 Significant relationship between kinetic forces at shoulder & elbow joints for variables for pitching mechanics for youth through professional pitchers. Results - Force (%Weight) Sh Anterior Elb Proximal Sh Proximal Sh Posterior Youth 39 74 89 30 HS 39 85 101 38 Coll 44 96 113 44 Pro 44 103 121 44 Significant relationship between forces at shoulder & elbow joints for pitching mechanics variables when adjusted for physical differences. Wind Up Commencement Movements High School Foot Contact Pelvis = 25° open Upper Torso = 20° closed Shoulder: Abduction = 90° Rotation = 65° Elbow: Stride High School Max. Rotation Shoulder: Rotation = 175° Elbow: Flexion = 100° Arm Cocking High School Shoulder: Anterior Force=290N IR Torque = 51 Nm Elbow: Varus Torque=48Nm (Weight = 740 N = 170 lb) Arm Cocking Arm Acceleration High School Arm Acceleration Elbow: Extension = 2200°/s Shoulder: Rotation = 6800°/s Arm Acceleration High School Shoulder: Proximal Force = 750 N Elbow: Proximal Force = 630 N (Weight = 740 N = 170 lb) Deceleration & FollowThrough Pathomechanics PHYSEAL INJURY Little 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 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 PHYSEAL INJURY Little Leaguer’s Shoulder Elbow - Anatomy/Mechanics • Anterior Band of UCL (main valgus stabilizer) attaches to the medial epicondyle apophysis Elbow - Anatomy/Mechanics • Increased bone plasticity • Hyperelasticit y permits excessive joint translation 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 Medial Epicondyle Apophysitis / Avulsion • Most common injury seen in the adolescent throwing athlete • Caused by acute valgus overload • X-rays may appear normal 1996 Survey (USA Baseball News, 1996) • Survey for USA 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) 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 1999 Study (Am J Sports Med, 2002) • Funded by USA 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 Conclusions - Mechanics • Successful youth and adult pitchers use similar kinematics. • Relationship between poor mechanics and risk of injury unproven 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. 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 American Baseball Foundation Thank you ABF BASIC Program at Rickwood Field