10/3/2016 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. 1 10/3/2016 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 2 10/3/2016 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 3 10/3/2016 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 4 10/3/2016 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 5 10/3/2016 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 6 10/3/2016 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,