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Predictors of Throwing Velocity in Youth and Adolescent Pitchers

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Predictors of Throwing Velocity in Youth and Adolescent Pitchers J Shoulder Elbow Surg (2015) -, 1-7 1 56 2 57 3 58 4 59 www.elsevier.com/locate/ymse 5 60 6 61 7 62 8 63 9 64 10 Predictors of throwing velocity in youth and 65 11 66 12 adolescent pitchers 67 13 68 14 69 15 Q2 Terrance Sgroi, DPT, MTCa, Peter N. Chalmers,MDb,*, Andrew J. Riff,MDb, 70 16 Matthew Lesniak, DPTa, Eli T. Sayegh,BSc, Markus A. Wimmer, PhDb, 71 17 b b b 72 18 Nikhil N. Verma,MD, Brian J. Cole, MD, MBA , Anthony A. Romeo,MD 73 19 74 20 75 Q1 a 21 Accelerated Rehabilitation Centers Ltd, Chicago, IL, USA 76 bDepartment of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA 22 c 77 23 College of Physicians and Surgeons, Columbia University, New York, NY, USA 78 24 79 25 80 Background: Shoulder and elbow injuries are a common cause of pain, dysfunction, and inability to play 26 in overhead throwers. Pitch velocity plays an integral part in the etiology of these injuries; however, the 81 27 demographic and biomechanical correlates with throwing velocity remain poorly understood. We hypoth- 82 28 esized that pitchers with higher velocity would have shared demographic and kinematic characteristics. 83 29 Methods: Normal preseason youth and adolescent pitchers underwent dual-orthogonal high-speed video 84 30 analysis while pitch velocity was collected with a radar gun. Demographic and pitching history data 85 31 were also collected. Kinematic data and observational mechanics were recorded. Multivariate regression 86 32 analysis was performed. 87 33 Results: A total of 420 pitchers were included, with a mean pitching velocity of 64 Æ 10 mph. After multi- 88 < 34 variate logistic regression analysis, the most important correlates with pitch velocity were age (P .001; 89 2 ¼ < 2 ¼ < 2 ¼ 35 R 0.658), height (P .001; R 0.076), separation of the hips and shoulders (P .001; R 0.027), 90 and stride length (P < .001; R2 ¼ 0.016); in combination, these 4 variables explained 78% of the variance 36 91 in pitch velocity. Each year of age was associated with a mean 1.5 mph increase in velocity; each inch in 37 height, with 1.2 mph; separation of the hips and shoulders, with 2.6 mph; and a 10% increase in stride 92 38 length, with 1.9 mph. 93 39 Conclusion: Pitch velocity is most strongly correlated with age, height, separation of the hips and shoul- 94 40 ders, and stride length. 95 41 Level of evidence: Basic Science Study, Kinesiology. 96 42 Ó 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. 97 43 Keywords: Baseball; injury prevention; pitching; overhand throwing; motion analysis; ulnar collateral 98 44 ligament tear; superior labral anterior-posterior tear 99 45 100 46 101 47 102 48 103 This study was approved by the Institutional Review Board of Rush Overhead throwing places substantial forces and torques 49 104 University Medical Center: Protocol No. 13090101, Expedited Review on the shoulder and elbow, with forces regularly exceeding 50 105 Initial Approval Notification. 390 N and torques regularly exceeding 1000 Nm in pro- 51 *Reprint requests: Peter N. Chalmers, MD, Department of Orthopaedic 106 fessional pitchers.13 These forces have been implicated in 52 Surgery, Rush University Medical Center, 1611 W Harrison St, Chicago, 5 107 IL 60612, USA. the pathogenesis of shoulder and elbow injuries, which are 53 24,25 108 E-mail address: [email protected] (P.N. Chalmers). common in baseball pitchers. For example, superior 54 109 55 1058-2746/$ - see front matter Ó 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. 110 http://dx.doi.org/10.1016/j.jse.2015.02.015 FLA 5.2.0 DTD YMSE3140_proof 16 March 2015 7:05 am ce RMK 2 T. Sgroi et al. 111 labral anterior-posterior tears are a common cause of completeness with participants. A standardized physical exami- 166 112 shoulder discomfort in pitchers and remain an unsolved nation was performed. Passive glenohumeral rotation was 167 113 measured by a goniometer with the subject supine and the scapula 168 problem, with rates of return to a preinjury level of play of 114 8,15,19,22 stabilized at neutral shoulder flexion, 90 shoulder abduction, and 169 22% to 60%. 115 The neuromuscular and biomechanical factors that 90 elbow flexion. Total arc of motion, glenohumeral internal 170 rotation deficit, and glenohumeral external rotation excess were 116 correlate with injury during overhead pitching have been 171 117 24,25,28 then calculated from these measurements. These measurements 172 previously studied, and velocity has been identified were performed in both upper extremities. 118 6,28 173 as a primary factor. However, the demographic and ki- All subjects then underwent video motion anal- 119 nematic factors that correlate with velocity remain only ysis.3,7,16,18,24,25,29-31,33,36-39 With use of high-definition orthog- 174 120 partially understood. Multiple prior kinematic and electro- onal video cameras from the frontal and lateral views, subjects 175 121 myographic analyses have been performed examining were filmed at 210 Hz while pitching from a regulation practice 176 122 normal youth, collegiate, and professional mound appropriate for the subject’s level of play. Throwing ve- 177 123 pitchers.1,2,6,10,12-14,17,21,32,36-39 These studies have focused locity was measured with a radar gun (JUGS Sports, Tualatin, OR, 178 124 on correlations between kinematic and kinetic fac- USA), which per the manufacturer has an accuracy of Æ0.5 mph. 179 125 tors.1,2,10,13,14,32,36-39 Very few studies have identified ki- Filming took place after a full warm-up and once subjects felt 180 126 nematic and demographic correlates with velocity. Those ready to pitch at 100% velocity. All subjects pitched fastballs from 181 the wind-up position over a regulation distance for their age at a 127 studies that have been performed were conducted on small 182 128 strike zone target appropriately positioned and sized for their age. 183 groups of pitchers and did not incorporate demographic For each pitcher, the single pitch most representative of the 129 4,11,14,26,27,34,35,40 184 factors, which limits their generalizability. pitcher’s best effort was recorded for analysis. 130 A better understanding of the demographic and kinematic 185 131 186 factors that correlate with velocity could provide therapists Data analysis 132 and pitching coaches with areas on which to focus in 187 133 188 training and pitcher development. A standardized protocol was used to extract kinematic data from 134 189 Our overarching goal was to perform a demographic and video footage using commercial software (Dartfish Inc., Alphar- 135 biomechanical analysis of the correlates with velocity in etta, GA, USA). Only those kinematic variables shown previously 190 136 overhead youth and adolescent pitchers. Our primary aim to correlate with kinetic variables, as identified a priori, were 191 137 with this study was to determine the demographic and recorded (Table I). Observational mechanics were recorded once 192 138 biomechanical factors that predict throwing velocity. We for each pitch, with 2 study authors performing the measurements. 193 139 hypothesized that pitchers with higher velocity would have These were assigned a binary yes vs. no as previously described.9 194 140 shared demographic and kinematic characteristics. These included whether the subject (1) led with the hips, (2) had 195 141 the hand on top of the ball during the stride phase, (3) had the arm 196 142 in the throwing position at front foot contact, (4) had closed 197 143 Methods shoulders at the hand-set position, (5) had a closed foot orientation 198 144 at front foot contact, (6) had separation of rotation in the hips and 199 shoulders, and (7) was in the fielding position at follow-through.9 145 This is a single-episode cross-sectional study. As many youth and 200 Separation of rotation in the hips and shoulders was defined as a adolescent overhand baseball pitchers as possible within our 146 binary yes in those pitchers in whom, during the cocking phase, a 201 geographic area were recruited, and no a priori power analysis was 147 period could be identified during which the pelvis rotated to face 202 conducted. All subjects were currently in preseason training and 148 home plate while the shoulders continued to face third base (for a 203 underwent a standardized evaluation. Exclusion criteria included 149 right-handed pitcher). Pitchers in whom no such period could be 204 age <9 years; sidearm or ‘‘submarine’’ style pitching motion, as 150 identified were recorded as having a binary no for separation of 205 the kinematic data obtained were thought to be incomparable to rotation of the hips and shoulders. All analyses were performed in 151 the rest of the cohort; those who were not planning to pitch for 206 Excel X (Microsoft, Redmond, WA, USA) and SPSS 21 (IBM 152 their team that year; and those pitchers who did not think they 207 Inc., Armonk, NY, USA). An independent observer who was not 153 would be able to throw because of excess discomfort at the time of 208 aware of the study hypothesis entered all data. Continuous data 154 the evaluation. Pitchers who thought they were able to throw and 209 normality was evaluated with the Kolmogorov-Smirnov test. Ve- 155 who had been throwing in practice were included even if they had 210 locity was compared between discrete groups by Student t test or 156 a history of injury or current discomfort within their arm.
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