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      The Impact of Workload on the Evolution of Hip Internal and External Rotation in Professional Baseball Players Over the Course of the Season

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          Abstract

          Background:

          Although restricted hip range of motion (ROM) is associated with an increased risk for injuries in baseball players, the evolution of hip ROM over the season remains undefined.

          Hypothesis:

          Hip ROM profiles would be symmetric between hips and positions (pitchers vs position players) but would decrease from preseason to postseason. Additionally, it was hypothesized that this decrease in motion would correlate with workload.

          Study Design:

          Cohort study; Level of evidence, 2.

          Methods:

          Bilateral hip ROM was assessed in 96 professional baseball players (54 pitchers, 42 position players) preseason and postseason. ROM comparisons were made between lead and trailing hips, pitchers and position players, and preseason and postseason measures. The change from preseason to postseason was correlated with player demographics and measures of workload for pitchers and position players.

          Results:

          Preseason hip ROM was symmetric between hips; however, pitchers demonstrated increased preseason lead hip internal rotation (IR) ( P = .018) and bilateral hip total ROM (TROM) ( P < .020) compared with position players. From preseason to postseason, position players lost 7° of external rotation (ER) ( P ≤ .005 ). In pitchers, the loss of IR correlated with increased pitches ( P = .016) and innings ( P = .037), while the loss of ER ( P = .005 ) and TROM ( P = .014) correlated with increasing mean fastball velocity. Workload for position players did not correlate with motion loss.

          Conclusion:

          Symmetric hip ROM profiles should be anticipated in baseball players; however, pitchers may have increased preseason IR and TROM and postseason ER and TROM relative to position players. Although loss of motion correlated with workload in pitchers, this was not the case for position players. Hip motion should be monitored over the course of the season. This is particularly true for pitchers who lose IR as workload increases, which may place them at a greater risk for injuries.

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          Most cited references30

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          Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers.

          Glenohumeral internal rotation deficit (GIRD) indicates a 20° or greater loss of internal rotation of the throwing shoulder compared with the nondominant shoulder.
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            Epidemiology of Major League Baseball Injuries

            Little is known about the injury rates in Major League Baseball (MLB) players, as a formal injury surveillance system does not exist. The goal of this study was to characterize the epidemiology of MLB injuries over a 7-year period.
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              Correlation of torque and elbow injury in professional baseball pitchers.

              During the pitching motion, velocity is generated by the upper extremity kinetic chain on internal rotation of the shoulder and trunk translational/rotational motion. This generation of power places significant forces and torques on the elbow and shoulder. Elbow valgus torque and shoulder rotational torque are theoretically linked to elbow injury. Pitchers experiencing higher levels of elbow valgus torque and shoulder external rotation torque throughout the pitching motion are more likely to suffer elbow injury than pitchers with lower levels of torque. Cohort study; Level of evidence, 3. With an established biomechanical analysis model, 23 professional baseball pitchers were videotaped during spring training games and followed prospectively for the next 3 seasons for elbow injury. A mixed statistical model using differences of least squares means and analysis of variance was used to analyze the association between elbow injury and torque levels throughout the pitching motion as well as at each major event within the pitching motion. There were overall statistical trends relating elbow injury with both higher elbow valgus torque (P = .0547) and higher shoulder external rotation torque (P = .0548) throughout the entire pitching motion. More importantly, there was an individual significant correlation of elbow injury with both higher elbow valgus torque (P = .0130) and higher shoulder external rotation torque (P = .0018) at the late cocking phase (pitching event of maximum external rotation of the shoulder). This study provides information that supports existing theories about how and why certain injuries occur during the throwing motion in baseball. The late cocking phase appears to be the critical point in the pitching motion, where higher levels of torque at the shoulder and elbow can result in increased risk of injury. Manipulation of pitching mechanics to alter these torque levels or using these measures to identify pitchers at risk may help decrease injury rates.
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                Author and article information

                Journal
                Orthop J Sports Med
                Orthop J Sports Med
                OJS
                spojs
                Orthopaedic Journal of Sports Medicine
                SAGE Publications (Sage CA: Los Angeles, CA )
                2325-9671
                02 February 2018
                February 2018
                : 6
                : 2
                : 2325967117752105
                Affiliations
                []Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.
                []Sports Medicine Center, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
                [§ ]New York Mets, New York, New York, USA.
                [4-2325967117752105] Investigation performed at the Hospital for Special Surgery, New York, New York, USA
                Author notes
                [*] [* ]Christopher L. Camp, MD, Sports Medicine Center, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA (email: camp.christopher@ 123456mayo.edu ).
                Article
                10.1177_2325967117752105
                10.1177/2325967117752105
                5802643
                29435468
                94c401cc-8592-4787-b92c-b3f64c90f2ab
                © The Author(s) 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License ( http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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                professional baseball,hip range of motion,pitchers,position players,workload

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