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What Can a Jump Tell Us About Elbow Injuries in Professional Baseball Pitchers?

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What Can a Jump Tell Us About Elbow Injuries in Professional Baseball Pitchers? What Can a Jump Tell Us About Elbow Injuries in Professional Baseball Pitchers? John Mayberry,*y PhD, Scott Mullen,z MD, and Scott Murayama§ Investigation performed at University of the Pacific, Stockton, California, USA Background: The incidence rate of elbow injuries has been rising in recent years among professional baseball pitchers. Deter- mining valid screening procedures that allow practitioners to identify pitchers at an increased risk of such injuries is therefore of critical importance. Purpose: To validate the use of countermovement jump (CMJ) tests as a diagnostic tool for pitcher conditioning. Study Design: Case-control study; Level of evidence, 3. Methods: More than 500 pitchers at a single professional baseball organization performed preseason CMJ assessments on a force plate before the 2013 to 2018 seasons. Three measurements were extracted from ground-reaction force data during the test: eccentric rate of force development (ERFD), average vertical concentric force (AVCF), and concentric vertical impulse (CVI). Athletic trainers at the organization collected detailed information on elbow and shoulder injury rates as well as workload (pitch count) throughout the rest of the season. Poisson regression models were fit to investigate the dependency of injury rates on CMJ test performance. Results: ERFD, CVI, and AVCF were all significant predictors of elbow injury risk after accounting for pitcher age, weight, and workload. The analysis identified 3 specific indicators of heightened risk based on the results of a CMJ scan: low ERFD, a com- bination of low AVCF and high CVI, and a combination of high AVCF and low CVI. In contrast, shoulder injury risk was roughly independent of all 3 CMJ test measurements. Conclusion: This study supports the hypothesis of the entire kinetic chain’s involvement in pitching by establishing a link between CMJ test performance and elbow injury risk in professional baseball pitchers. CMJ assessment may be a powerful addition to injury risk alert and prevention protocols. Pitchers in high-risk groups can be prescribed specific exercise plans to improve move- ment imbalances. Keywords: elbow injuries; countermovement jump test; vertical ground-reaction forces; Poisson regression Professional baseball pitchers have experienced a signifi- risk factors for UCL injuries,9,34 injury rates have contin- cant rise in elbow injury rates over the past 3 decades.10 ued to increase since 2010, and the situation has been The increase in ulnar collateral ligament (UCL) injuries described as a UCL injury ‘‘epidemic.’’4,34 UCL injuries has been particularly alarming, with only 33 pitchers are most common in pitchers,29 occurring with repetitive requiring UCL reconstruction in the 1990s, compared high valgus torque across the elbow joint during throwing with 101 UCL reconstructions between 2000 and 2009.34 motions. The majority of this stress is concentrated on the Despite considerable research efforts to identify modifiable anterior band of the UCL.11 Previous studies have shown that high one-time or long term pitch volumes,20 pitch speed,3 and fatigue15 may *Address correspondence to John Mayberry, PhD, University of the increase the risk of UCL injury. One posited explanation Pacific, 3601 Pacific Ave, Stockton, CA 95211, USA (email: jmayberry for these results is that repetitive pitching motions cause @pacific.edu). y an accumulation of microtraumas to the elbow and shoul- University of the Pacific, Stockton, California, USA. 1 zUniversity of Kansas Medical Center, Kansas City, Kansas, USA. der, leading to an increased risk of ligament injuries. §Colorado Rockies, Denver, Colorado, USA. The microtraumas occur because the UCL approaches or Submitted June 26, 2019; accepted December 12, 2019. exceeds cadaveric failure loads with certain arm positions The authors declared that they have no conflicts of interest in the common to throwing motions in baseball.11,24 authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has Unfortunately, workload can be difficult to control for not conducted an independent investigation on the OPD and disclaims professional pitchers under the demands of competitive any liability or responsibility relating thereto. regular season schedules. Ideally, one would like to develop preventive measures that target throwing The American Journal of Sports Medicine mechanics in addition to managing workload. Efficient 1–6 DOI: 10.1177/0363546520905543 operation of the kinetic chain, which transfers force toward 2 Ó 2020 The Author(s) the distal segments of the body in throwing movements, 1 2 Mayberry et al The American Journal of Sports Medicine may reduce injury risk by decreasing valgus forces placed TABLE 1 on the UCL.8 Previous research has demonstrated an asso- Number of Elbow and Shoulder Injuries in the Sample ciation between deficiency in full activation of the kinetic With Counts in Terms of Player-Seasonsa chain and elbow injury risk2 and points out the important role played by other physiological structures in stress sta- Shoulder 12 bilization during repetitive throwing. For example, inter- Elbow 0 1 2 3 nal rotation of the shoulder results in a protective varus force against the valgus force at the elbow. Thus, deficien- 0 426 48 5 1 cies in internal rotation of the shoulder can increase elbow 1 35300 injury risk as well.8,14 2 5 000 The neuromuscular system functions to ensure proper 3 1 000 activation, coordination, and transfer of forces through aFor example, there were 426 player-seasons with no shoulder the kinetic chain. Consequently, assessing neuromuscular or elbow injuries, 35 player-seasons with 1 elbow and no shoulder performance may help diagnose injury risk. Garrison injuries, 48 player-seasons with no elbow and 1 shoulder injury, 13 et al established a link between lower extremity balance and so on. performance and elbow injuries with a Y balance test, showing that participants with a UCL tear demonstrated decreased performance in their lower extremity balance stored in a force acquisition software (Sparta software). test as compared with an uninjured control group. Alterna- Athletic trainers and coaches at the organization provided tively, a countermovement jump (CMJ) test is among the injury data throughout this 5-year period with injury loca- most reliable and valid forms of jump tests for predicting tions classified based on the Orchard Sports Injury Classi- athletic performance,21,23 lifting ability,6 and strength.26 fication System (OSICS-10). This included all injuries The meta-analysis by Claudino et al7 further highlighted assessed by athletic trainers or coaches throughout this the utility of the CMJ test as a tool for monitoring neuro- time. Randomly generated athlete identification numbers muscular status. The authors surveyed the efficacy of 63 de-identified athlete information from both force plate tri- CMJ performance variables from 151 studies and found als and injury data. Counts of elbow and shoulder injuries that several kinematic and kinetic variables exhibited for each player-season in the data set were used as moderate sensitivity to detect supercompensation effects, response variables in Poisson regression models with inter- while average jump height was also moderately sensitive actions between the 3 CMJ measurements of ERFD, to fatigue levels. AVCF, and CVI as explanatory variables. Pitcher age These meta-analyses and the studies therein suggest and weight at the start of the season were included as that simple lower body assessments such as the Y balance covariates in the model, while pitch count was used as an and CMJ test are valid procedures for monitoring athlete offset to standardize for workload. wellness. Several companies have started to take advan- tage of this relationship to design diagnostic and prescrip- Participants tive tools for injury prevention. This article focuses on analyzing the validity of 1 specific tool, the ‘‘best 3 of 6’’ The participants for this study consisted of professional CMJ scan employed by Sparta Science. This scan consists baseball pitchers from a single Major League Baseball of a sequence of 6 CMJ trials. Three measurements are organization. Overall, the analysis included 524 player- extracted from each jump’s ground-reaction force data: seasons of data from 274 different pitchers. Table 1 sum- the eccentric rate of force development (ERFD), the aver- marizes the sample sizes for all injury groups considered age vertical concentric force (AVCF), and the concentric in the study. Athletes completed the CMJ testing as vertical impulse (CVI). At the end of a scan, ERFD, a part of their routine preseason training and were free AVCF, and CVI scores are assigned to the athlete based of injuries at the time of their CMJ testing. The study on their average values over the 3 jumps of maximum did not record previous years of pitching experience or height. Nibali et al25 established the reliability of scores injury history. All participants were over the age of 18 obtained during this scanning procedure. The aim of this years with a mean age of 24.40 6 3.59 years and provided work is to investigate their validity as a tool for determin- consent before testing, data collection, and the publication ing injury risk in professional baseball pitchers. of results as part of their agreement with their team. In addition, the institutional review board at the correspond- ing author’s university approved the use of CMJ and injury METHODS data for research purposes. Experimental Approaches to the Problem Procedures This study retroactively examined 5 seasons (2013-2018) of Participants performed a preseason scan consisting of 6 CMJ scans and injury data from pitchers in a single profes- CMJs on a commercially available piezoelectric force plate sional baseball organization (both major and minor with a sampling frequency of 1000 Hz (9260AA6; Kistler leagues). Athletes in the organization performed preseason Instruments). Each participant stood on the force plate CMJ scans on a force plate with the results recorded and before waiting for an auditory cue, indicating a 2-second AJSM Vol.
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