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Objectives

• Understand anatomical correlations to adjacent “Over the Top”- Biomechanics of the and distal segments and the influence of regional interdependence concepts on the baseball Overhead Throwing Athlete; thrower. • Be able to communicate basic baseball terms, Baseball language, and elements of baseball throwers. Tyler J. Opitz, DPT, SCS • Learn gross pitching assessment, evaluation, and education principles to correct deviations and 10-14-16 improve outcomes. The Andrews Institute • Identify risk factors for injury. • Determine what are modifiable elements in the throwing motion.

Introduction America’s Pastime • Baseball first referenced in 1755 in England; no • I have no conflicts of interest to disclose… yet. known inventor. • Played 4 years collegiate baseball • Pitching coach at Dickinson State University • Overhead pitching legalized in 1884. • Written multiple shoulder and elbow rehab protocols • Softball originated as “indoor baseball.” • Re-designed Interval Throwing Program here at Andrews • Developed a return to sport criteria for upper extremity • Popularity growing in Latin American and Asian injuries countries

• Goals: • MLB made $9.5 billion in 2016 (www.espn.com) – Determine what is the objective of pitching – Review the different phases – Identify pathologies – Apply knowledge to pitcher assessment

What is Pitching Definition

• Definition : In baseball, a pitch is the act of throwing a baseball towards home plate to start a play. The term • Baseball throwing biomechanics can be comes from the Knickerbocker Rules; originally, the ball had defined or described as a coordinated to be “pitched” underhand, as with pitching horseshoes. Overhead pitching was not allowed till 1884. (MLB rule sequence of body movements and muscular book) forces that have an ultimate goal of high ball • What it really is: series of complex movements used in coordination gradually increasing from low threshold to velocity and target accuracy (Calabrese, 2013) high threshold patterns, using combined body movements of the upper and lower extremities in open and closed chain positions, working agonist and antagonist muscle groups in concert to create a repeatable pattern for delivery with maximal effort in order to achieve peak ball velocity and accuracy to throw a strike.

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What is the number What is the best 1 job for pitchers??? pitch in baseball???

To GET OUTS (21-27) while allowing 1 less STRIKE 1!! run than the other team

Pitching Shapes and Sizes

Sling Shot Mechanism Terminology

Muscule, fascia, ligament tension (Hip/Trunk Separation) Anatomical Sport Related Throwing arm Scapula • Stance leg vs stride leg • Pitch type • Arm slot • Mound, rubber (pitcher’s plate) Ball – Mound = 10 inches high, 60’ 6’’ to • Handedness- refers to home plate throwing arm • Training: Drive leg – PFP- Pitcher’s fielding practice Stride leg • Valgus torque – elbow – Long toss- throwing for distance in • Stride length hopes to enhance arm strength – Flat ground – practicing pitching from – Long, short, open, closed flat surface (based off hip position and – BP- Batting practice release point) • Linear separation vs rotational • Trunk positioning separation- hip separation • Stretch vs wind-up • Deceleration • Batter side- refers to which side of plate batter hits on when viewing from pitcher’s mound

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Anatomy

Anatomy- Elbow Anatomy- Regional Interdependence • “The premise that unrelated impairments in remote regions anatomically contribute and are associated with a patient’s primary report of symptoms; Relationships existing between seemingly unrelated segments of the body.” – Wainner et al., 2001, Wainner et al., 2007, Sueki et al., 2013

Anatomy- Regional Interdependence Epidemiology

• Every year in the USA, Approximately 15 million children and adults play organized baseball • 5.7 million children in eight grade or lower • Up to 30-40% of child and adolescent accidents occur during sports (ASMI, 2013) • Over 3.5 million children under the age of 14 are seen annually for sports-related injuries (ASMI, 2013) • 1 in 20 youth pitchers will end up with serious injury (ASMI, 2013) • From 1994-1999 to 2000-2004 Dr. James Andrews saw a 4 fold increase in the number of elbow surgeries in college baseball players and a 6 fold increase in High School players

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History Pitching Phases & Terminology

• Alexander Hubert Preparation Stride Acceleration Follow through Provience Leuf, M.D. Recovery -Wind up -Early Cocking -Late cocking -Deceleration • 1888 • Earliest document to specifically discuss biomechanics as it pertains to performance • First document to discuss exercise specific to Baseball

Pitching Mechanics Phase I - Preparation • LOW THRESHOLD position Preparation Stride Acceleration Follow Through Recovery • Involves proper foot placement, posture, contact with pitching rubber, & hand position • This is a pitcher’s chance to intimidate the hitter • Wind-Up & Stretch are two different initial positions – Stretch pitching mechanics utilizes same mechanics but speed of movements, height of leg lift are all accelerated – Pitching from stretch is used to hold base runners and limit stolen bases by decreasing time to deliver ball to home plate

Phase I – Wind-up Wind-up • Varies based on: – Individual – Situation- runners on base etc. • Goal : – To position body in preparation to pitch ball in most advantageous position with optimal force and outcome. – Build potential energy • Movements : – Accessory vs. deficient – Minimal force through shoulder & arm – Weight transferred to drive leg (back leg) stride foot raising to form balance point – Concludes at the top of the leg lift – Leg lift height varies – Culminates at INITIATION OF STRIDE* • Balance is imperative to optimize later phase efficiency

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Phase I – Wind-up Pathokinematics- Wind-up • Pathokinematics: – Weakness of hip extensors, abductors, poor proprioception, core stabilizer muscles, and or weakness of stance leg quadriceps, poor active stride leg – Leads to: • Loss of or absent balance point • Weakness leads to unstable base resulting in later segments of body motion to speed up and compensate.

Phase II- Stride/Arm Cocking Phase II: Stride/Arm Cocking • Height dependent • Movements: • Directional – Starts with stride leg advancing towards home with ball hand simultaneously separating from glove moving posteriorly. – Open vs closed – Stance limb driving towards home plate • Goals: – Upright trunk posture – To stride as close to home – HIP SEPARATION : as possible while • OPEN & ROTATE WITH STRIDE SO PELVIS IS FACING HOME PLATE maintaining efficiency to • MAINTAIN CLOSTED TORSO CREATING COILING EFFECT WITH TORSO release ball as hard and POINTED PARALLEL TO PITCHING MOUND – 2 types: close to batter as possible » Linear – Pre-load muscles and » Rotational ligaments (rubber band – Arm action starts below shoulder, circumducts/rotates upward to be in effect) abducted and ER position at foot contact. – Generate as much force • As arm circumducts ball should be above rear shoulder level at foot from drive leg to increase contact arm/ball velocity – Terminates at foot contact and throwing arm advancing towards home plate – EARLY ARM COCKING STARTS AT FOOT CONTACT***

Points of Interest Hip -> Shoulder Separation Foot contact(FC)-lower body and • Decreased stress on arm with linear (increased trunk FC-upper body trunk/hip separation) (Wright et al., 2004) Parameter Target Range Parameter Target Range Stride length ratio 78-87% Shoulder abduction 82-104⁰ • Rotational separation decreases linear drive (% height) Shoulder horizontal 13-34⁰ • Studies show that a more rotational throw limits Lead foot position 6-13in abduction Lead foot angle 8-25⁰ Shoulder external 36-78⁰ pitching velocity and puts more stress on the arm . rotation (ER) (Fleisig et al., 2011) Knee flexion angle 35-52⁰ Elbow flexion 75-105⁰ Pelvis rotation 22-43⁰

Trunk separation 41-58⁰ www.topvelocity.net

Side trunk tilt -3-11

Chu et al, 2009

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Separation Hip - Torso Separation

Linear Separation Rotational Separation

Torso – Hip Separation Phase II- Stride/Arm Cocking

• Pathokinematics- – Decreased: drive limb flexibility, thoracic rotation, pelvic rotation, stride limb adductor/hamstring flexibility, core strength – Lateral trunk lean – Open/closed foot positioning – Arm delay -> Inverted “W” • Leads to arm lagging behind – Increased joint reaction forces through shoulder and elbow during later phases (Kibler et al., 2013)

Phase III- Acceleration/Early ->Late Points of Interest Cocking • Goals: – Generate as much force and Arm Cocking velocity as possible to execute Parameter Target Range pitch • Movements: Max pelvis rotation 515-667 – Completion of drive with drive limb velocity (MPRV) with full weight shift to stride leg Percent of time 17-37% – Trunk forward lean, stride knee starts to extend to act as rigid MPRV catapult for arm and body Max upper trunk 1,068-1,224⁰/sec – Scapula provides stable base for rapid acceleration into IR from rotation velocity maximal ER (MUTRV) – Greatest torque to shoulder Percent of time 39-56% • Transition from max ER to forceful IR MUTRV – Shoulder maximal ER, max valgus load to elbow – Unwinding of myofascial tension to generate ball velocity – Torso rotation Chu et al, 2009 – Terminates with ball release

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Phase III – Acceleration/Early ->Late Joint Forces on UCL- Acceleration Cocking • Pathokinematics: • Failure Load 80 N – Weakness of lumbothoracic musculature, throwing arm • 64 N valgus load (Eygendaal et al, 2007) scapular stabilizers, stride leg • 300 N medial shear hip stabilizers and quadriceps and/or flexibility deficits • 900 N compressive force – Leads to: • Shoulder loads are minimal • loss of elbow height during acceleration • Shoulder Rotates at 9,000 deg/sec (Calabrese, 2013) • Lateral tilt with increased valgus • Elbow rotates internally at velocities greater than 2,300 deg/sec . loading of elbow and anterior (Ellenbecker et al., 2009, Wilk et al., 2012) shear at GH joint – Peel back mechanism* • Tennis is 982 deg/se c (Eygendaal et al., 2007). • Poor hip/knee positioning • Fastest human movement in sports! altering trunk tilt and subsequent increased arm joint reaction forces Meister, 2000, Anz, 2010, Werner et al., 2001 (Kibler et al., 2013)

Phase IV- Deceleration/ Follow- Points of Interest Through • Goals: Maximum ER – Release ball as hard and accurately as possible Parameter Target Range – Begin deceleration of arm and prepare Maximum shoulder 174-190⁰ for fielding ER • Movements: Maximum shoulder 9-22⁰ – Most violent phase of pitching horizontal – Greatest eccentric and distraction forces on shoulder abduction – Ball release occurs at bill of hat or Elbow flexion 91-113⁰ farther – Neutral spine, forward trunk lean, head over shoulders and vertical, shoulders and torso in line with lead leg – Lead leg continues to extend – Contralateral UE performing antagonistic contraction Chu et al, 2009 (Seroyer et al., 2010)

Phase IV- Deceleration/Follow- Points of Interest Through • Pathokinematics: Ball Release – Decreased rotator cuff Parameter Target Range strength Lead knee flexion 22-47⁰ – Lateral trunk tilt – Excessive torso rotation Forward trunk tilt 29-43⁰ – Lead leg hyperextension Side trunk tilt 13-32⁰ – Trunk recoil Shoulder abduction 86-102⁰ – Lack of using body and Shoulder internal 6,658-8,360⁰/sec One of the fastest measured natural soft tissue tensions to decelerate arm rotation (IR) human joint motions • Leads to: velocity 20 full revolutions per sec – Increased rotator cuff forces Elbow flexion 19-28⁰ to decelerate arm over shorter distance Elbow extension 2,220-2681⁰/sec – Abnormal release angle leading to abnormal elbow velocity joint forces – Hip pathology Chu et al, 2009 – Inconsistent release ؞ inconsistent performance

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Points of Interest Phase V- Recovery

• Goals: Force and Torques – Recover to balance point to Parameter Target Range be in optimal fielding position Shoulder anterior 280-399N • Movements : force – Allow throwing arm to Shoulder proximal 1,099-1,446N Avg. pitcher body weight = 920N decelerate against body. force – Find center of gravity with leg Elbow proximal 1,024-1,446N counter balancing to head force (similar to SL hip Shoulder horizontal 90-133N-m hinge/golfer’s lift) adduction torque – Max hip flexion and IR of Shoulder IR torque 84-118N-m stride leg with relative torso rotation maximally to same Elbow varus torque 82-16N-m Rienold et al, stance limb side Elbow flexion 41-63N-m 2010 torque

General Information Joint Forces on UCL- Acceleration • The kinetic chain • Failure Load 80 N

– This linkage system can be described as the • 64 N valgus load (Eygendaal et al, 2007) sequential acceleration and deceleration of • 300 N medial shear anatomical segments from the ground up with • 900 N compressive force each transferring its energy to the more distal • Shoulder loads are minimal Fleisig el al, 1995 segment until the point of ball release. • Shoulder Rotates at 9,000 deg/sec (Calabrese, 2013) – “The stronger the links in the chain the faster the • Elbow rotates internally at velocities greater than 2,300 deg/sec . (Ellenbecker et al., 2009, Wilk et al., 2012) pitch.” Fleisig 2014 • Tennis is 982 deg/se c (Eygendaal et al., 2007). • Fastest human movement in sports!

Meister, 2000, Anz, 2010, Werner et al., 2001

Pitchers vs Position Players Fatigue

• “Most alarming was the finding that a pitcher who regularly pitched with his arm fatigued Variable Throwing Mechanics was 36 times as likely to be in the surgery group”

Position Pitchers Players – Fleisig, G. S., & Andrews, J. R. (2012). Prevention of Elbow Injuries in Youth Baseball Pitchers. Sports Health: A Multidisciplinary Approach, 4(5), 419- Stretch Wind-up Fielding Infielder Outfielder Catcher 424.

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Red Flags Yellow Flags

Misconceptions and Myths: Key Items to Look For Perfect Throwing Motion

• Wind-up – Pitcher is balanced • Risk vs. Reward • Stride – When do you make corrections? – Good push off the rubber – Front foot goes down and forward – Where is the player currently in the development process? – Arms separate freely, downward and up • 15% of college-level pitchers say that troubles in their current • FC performance are based on injuries they received when they played – Foot is planted slightly to the 3rd base side (righty) – Front foot is pointed slightly inward youth baseball – Shoulder abd about 90⁰ with 60⁰ of ER – What type of stress does he currently report during or • Arm Cocking – Pelvis rotation, followed by upper trunk rotation after activity? – Shoulder moves further into ER – What can we gain by making adjustments? – Trunk arches or extends • MER – What do we have to lose by adjusting current movement – Shoulder ER is approximately 180 ⁰ patterns? – Elbow flexion is approximately 90 ⁰ Fortenbaugh et al, 2009

Recommendations Recommendations

1. Watch and respond to signs of fatigue 6. Teach good throwing mechanics as soon as possible (caution 1. If a player complains of fatigue or looks fatigued, rest is must be used with gurus) recommended 2. Open lines of communication between player and staff 7. Specialization should not be endorsed in young players 2. No overhead throwing of any kind for at least 2-3 months a 8. If player complains of pain in his elbow or shoulder year (4 is preferred) and no competitive pitching for at least 4 discontinue pitching until evaluated by a sports medicine months out of the year provider 3. Do not pitch more that 100 innings in games in any calendar 9. Change the perception that velocity is more important than year outs and wins come at all cost 4. Follow either pitch counts or innings limits and days rest 10. Long-toss should be done with supervision and it is not 5. Avoid pitching on multiple teams with overlapping seasons recommended for injured or recovering players (Travel teams, showcases) 11. Pitchers should not also be a catcher for the same team

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ALWAYS ALWAYS ALWAYS!!!

• CORRECT FAULTY MOVEMENT PATTERNS!! • Differentiate between faulty movement patterns and normal abnormal movement* • UE and LE • Squat, bridge, push up, throwing mechanics, shoulder IR (GIRD) • Minimize risk factors for re-injury • Mechanics • Establish CONTROL prior to velocity!!!

THANK YOU!!!

GO DAWGS!!

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