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A Thesis Entitled Upper Extremity Muscle Activation and Motion In A Thesis entitled Upper Extremity Muscle Activation and Motion in Active Males by Yoshitomo Saito Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Master in Science Degree in Exercise Science with a Concentration in Athletic Training _________________________________________ Christopher Ingersoll, PhD, AT, ATC, Committee Chair _________________________________________ Amanda Murray, PT, DPT, PhD, Committee Member _________________________________________ Neal Glaviano, PhD, AT, ATC, Committee Member _________________________________________ Amanda Bryant-Friedrich, PhD, Dean College of Graduate Studies The University of Toledo May 2018 Copyright 2018, Yoshitomo Saito This document is copyrighted material. Under copyright law, no parts of this document may be reproduced without the expressed permission of the author. An Abstract of Upper Extremity Muscle Activation and Motion in Active Males by Yoshitomo Saito Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Master in Science Degree in Exercise Science With a Concentrated in Athletic Training The University of Toledo May 2018 Context: Elbow injuries consist of more than half of all baseball related injuries reported in the NCAA from 1998 to 2004. Specifically, injuries to the UCL are common among baseball pitchers. During baseball pitching, mean torque on the UCL of the elbow is around 65Nm; however, mean load to cause a UCL to fail is 35Nm. In addition to stabilization from UCL, flexor-pronator muscle group provides stabilization during baseball pitching. It is shown that pitch fatigue increases injury rate by 36 times. However, there is a limited amount of research done focusing on muscle fatigue during a simulated baseball game. Objectives: The purpose of this study is to assess muscle activation in pitchers using surface EMG during a simulated baseball game, and to compare changes in velocity and self-reported fatigue during a simulated game. Design: descriptive laboratory study Patients: 9 healthy males. Inclusion: healthy 18-24-year-old male, currently active or former (within 2-3 years from retirement) high school or collegiate baseball pitcher. Exclusion: Current elbow or/and shoulder injury. Current restriction from sports participation. Previous surgery to the throwing elbow or shoulder. Intervention(s): Participation will complete a maximum 120 pitches Outcome Measures: iii Video was assessed with 12 camera 3D analysis. Surface EMG data was assessed using a wireless surface EMG system. Results: No statistical significance in both FCU and FCR muscle activity across a game. Our result shows that FCU muscle activity increased, and FCR muscle activity decreased across a simulated game. On the other hand, there was a statistical significance in biceps muscle activity with decreased data across a simulated game. Our data shows that pitching velocity did not change drastically, however, participants continued to increase self-reported perceived fatigue. Conclusion: Baseball pitchers experienced increase in self-reported fatigue with small changes in muscle activities and velocity during a simulated game. Word Count: 298 words iv Table of Contents Abstract iii Table of Contents v List of Figures vii List of Abbreviations viii I. Manuscript 1 A. Introduction 1 B. Methods 4 a. Design 4 b. Participants 4 c. Procedures 5 d. Data Processing 7 e. Statistical Analysis 8 C. Results 8 D. Discussion 9 E. Conclusion 12 References 18 Appendices A. The Problem 21 B. Literature Review 26 C. Additional Methods 41 D. Additional Results 71 E. Back Matter 73 v F. Bibliography 77 vi List of Figures Figure 1 Participation set-up for EMG and Motion Capture Assessment ......................13 Figure 2 FCU Muscle Activity Across a Simulated Baseball Game ............................14 Figure 3 FCR Muscle Activity Across a Simulated Baseball Game .............................15 Figure 4 BB Muscle Activity Across a Simulated Baseball Game ................................16 Figure 5 Perceived Fatigue Across a Simulated Baseball Game ...................................17 vii List of Abbreviations BB ..............................Biceps Brachii EMG ...........................Electromyography FCR ............................Flexor Carpi Radialis FCU ............................Flexor Carpi Ulnaris UCL............................Ulnar Collateral Ligament UCLR ........................Ulnar Collateral Ligament Reconstruction viii Chapter One Manuscript Introduction Ulnar collateral ligament (UCL) injuries have become commonly recognized as a baseball injury within many upper extremity injuries that exist. Upper extremity injuries account for more than half of all baseball injuries in many different competitive baseball levels.1 There were 72 medial elbow injuries in a single professional baseball organization consisting of six minor league teams and 1 major league team from the years 2006 to 2011.2 There are many cases of medial elbow injuries reported not only at the professional level but at the collegiate level as well. According to Dick el at3, 5.78 injuries/1000 athlete exposures (AEs) of college athletes were exposed to injuries from 1988 to 2003. UCL sprains are the most common non-contact injuries among baseball players, with over 25% accounting for severe injuries defined by missing participation for more than 10 days.3,4 As the statistics shows, UCL injuries has been a relevant problem of baseball and Affecting a large number of baseball players’ participation status in many different levels of competitions. Baseball related medial elbow pathologies often present with significant symptoms such as medial elbow pain, numbness and tingling sensations, and a decrease in pitching velocity and control.5 During throwing, the medial elbow static stabilizing structures can only withstand 40Nm of valgus torque.6 While the UCL provides significant stabilization to the medial elbow joint; however, previous studies support that valgus forces acting on the elbow cannot be withstood by the UCL on its own.6 In addition to static stabilization from the ligament itself, flexor-pronator muscles groups have proven to provide dynamic 1 stabilization to the medial elbow to withstand the generated torque7, especially flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS). Previous research8 hypothesize that pitching mechanics may be altered when pitchers experience muscle fatigue. When muscle fatigue is experienced, mechanical compensations may be present that may lead to unwanted stress and microtrauma to elbow and shoulder joints during ball delivery that may predispose to injuries.8 Medial elbow tends to decrease the ability of the muscle to absorb energy.8 Limited current evidence has shown that muscle fatigue does not affect significantly in throwing mechanics, elbow forces and torque.9 However, the relationship between muscle fatigue and throwing mechanics, elbow forces or torque has not been fully supported by previous evidences. During ball delivery, there is 65Nm of valgus torque created in the involved elbow, and with UCL’s capacity to stand only 40Nm of the torque, significant valgus torque that was applied at maximum internal rotation torque is said to be a critical point for the elbow injury to occur.10 At maximum external rotation of the shoulder, torque and forces that are acting on elbow were measured by existing studies.11 Previous research shows that there is no increase in torque or force on the elbow as muscles experience fatigue. It is also seen that biomechanics remain unchanged through 7 to 9 innings of pitching.8 Ulnar collateral ligament and medial elbow pathologies in overhead athletes have been studied extensively12 and ulnar collateral ligament reconstruction (UCLR) continues to increase its numbers performed drastically over years especially in younger population.13,14 Public perception of UCLR is positive that generally it is believed to increase athletes’ performance level.14 While the widespread popularity and demand for the UCLR procedure is at an all-time high, the success rate of professional baseball 2 players returning to sport following UCLR seems to vary in existing studies with the reported ranges of 53-90%.15-18 A prior study9 documented those who underwent UCLR did not show significant differences in pitching biomechanics including forward trunk tilt, timing in shoulder rotation, shoulder abduction, and lateral trunk tilt. Knowledge of normal pitching mechanics and activation of flexor-pronator muscle is essential to understand the neuromuscular response to fatigue. Gaining insight into fatigue during realistic sporting demands would provide clinicians and coaches information that could be used as a strategy to decrease UCL injuries. Although activities of muscles surrounding the elbow have been examined extensively as a part of UCL injury studies,8,9,11 there is little research on assessing muscle activation in pitchers during a simulated game with comparison of changes in velocity and self-reported perceived fatigue during a simulated game.8 Previous research supports the idea that pitching biomechanics remains strikingly similar between collegiate starting pitchers, and muscle fatigue does not change in shoulder and elbow forces and torque8. However, these previous studies evaluate throwing biomechanics in a controlled manner, which limits the generalizability to how fatigue may alter upper extremity kinematics and muscle activity during a real game situations. While these studies
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