By: Hillary Plummer, PhD, ATC
It is no secret that elbow injuries have become exceedingly prevalent in baseball pitchers. Specifically, ulnar collateral ligament (UCL) tears continue to increase. UCL injuries that require reconstruction result in significant time-loss from baseball participation and rates of return to competition range from 68% to 94%.1-6 Despite increased awareness in injury prevention and load management measures for pitchers, injury rates do not appear to be decreasing.
Altered lumbo-pelvic control may be a contributing factor to upper extremity injuries. Pitching is a dynamic movement that requires coordinated sequencing of the kinetic chain. Optimal sequencing in which force is generated by the legs during the wind-up and transferred to the trunk, upper extremity to maximize ball velocity. Altered force transfer up the kinetic chain can result in compensations at the shoulder and elbow to make up for any lost force and may contribute to injury.7-10 Chaudhari et al11 examined the role of lumbo-pelvic control during a single-leg raise task on injury in MiLB pitchers. Anterior-posterior deviation of the pelvis was measured using a Level Belt. Pitchers rated as having poor lumbo-pelvic control had a high likelihood of missing more than 30 days during the season (p = 0.023). Anterior-posterior deviation scores were also divided into tertials and pitchers in the highest tertial were 3 times more likely to miss at least 30 days than those in the lowest tertial. It is possible that pitching biomechanics contributed to injury in their sample of pitchers. Recent work by Laudner and colleagues12 examined lumbo-pelvic control during a single-leg balance test and shoulder and elbow kinetics during pitching. No significant relationships with the stride leg lumbo-pelvic control and kinetics were observed. A relationship between lumbo-pelvic control on the drive leg and maximum shoulder abduction torque (r= 0.44, p= .003) and elbow varus torque (r= 0.46, p= .002) were observed. Over time, greater shoulder and elbow kinetics may contribute to injury.
There is also evidence to suggest that lumbo-pelvic control is related to pitching performance. Chaudhari et al13 used the same single-leg raise task to assess the role of lumbo-pelvic control on pitching performance. Pitchers with better lumbo-pelvic control (score of <7° of lumbo-pelvic movement) had lower walks plus hits per inning pitched (1.4 ± 0.3 vs. 1.6 ± 0.36, ES = 0.79, p = 0.013) and a greater number of innings pitched during the season (78.9 ± 38.7 vs. 53.4 ± 42.5, ES = 0.64, p = 0.043) compared to pitchers poor lumbo-pelvic control.
These studies highlight the role of lumbo-pelvic control on injury and performance in baseball pitchers. Prospective studies examining lumbo-pelvic control and pitching biomechanics and injury throughout a season are needed. Clinicians who work with pitchers should monitor and target any deficits in lumbo-pelvic control in pitchers to improve performance and reduce injury.
1. Thompson WH, Jobe FW, Yocum LA, Pink MM. Ulnar collateral ligament reconstruction in athletes: Muscle-splitting approach with transposition of the ulnar nerve. J Shoulder Elbow Surg. 2001;10(2):152-157.
2. Dodson CC, Thomas A, Dines JS, Nho SJ, Williams RJ, Altchek DW. Medial ulnar collateral ligament reconstruction of the elbow in throwing athletes. Am J Sports Med. 2006;34(12):1926-1932.
3. Rohrbough JT, Altchek DW, Hyman J, Williams RJ, Botts JD. Medial collateral ligament reconstruction of the elbow using the Docking Technique. Am J Sports Med. 2002;30(4):541-548.
4. Dines JS, ElAttrache NS, Conway JE, Smith W, Ahmad CS. Clinical outcomes of the DANE TJ Technique to treat ulnar collateral ligament insufficiency of the elbow. Am J Sports Med. 2007;35(12):2039-2044.
5. Paletta GA, Wright RW. The modified docking procedure for elbow ulnar collateral ligament reconstruction: 2-year follow-up in elite throwers. Am J Sports Med. 2006;34(10):1594-1598.
6. Erickson BJ, Bach BR, Jr., Cohen MS, et al. Ulnar Collateral Ligament Reconstruction: The Rush Experience. Orthop J Sports Med. 2016;4(1):2325967115626876.
7. Chu SK, Jayabalan P, Kibler WB, Press J. The kinetic chain revisited: New concepts on throwing mechanics and injury. Physical Medicine and Rehabilitation. 2016;8(35):S69-77.
8. Davis JT, Limpisvasti O, Fluhme D, et al. The effect of pitching biomechanics on the upper extremity in youth and adolescent baseball pitchers. Am J Sports Med. 2009;37(8):1484-1491.
9. Kibler WB, Chandler JB, Shapiro R, Conuel M. Muscle activation in coupled scapulohumeral motions in the high performance tennis serve. Br J Sports Med. 2007;41:745-749.
10. Lintner D, Noonan TJ, Kibler WB. Injury patterns and biomechanics of the athlete’s shoulder. Clin Sports Med. 2008;27(4):527-551.
11. Chaudhari AM, McKenzie CS, Pan X, Onate JA. Lumbopelvic control and days missed because of injury in professional baseball pitchers. Am J Sports Med. 2014;42(11):2734-2740.
12. Laudner KG, Wong R, Meister K. The influence of lumbopelvic control on shoulder and elbow kinetics in elite baseball pitchers. J Shoulder Elbow Surg. 2019;28(2):330-334.
13. Chaudhari AM, McKenzie CS, Borchers JR, Best TM. Lumbopelvic control and pitching performance of professional baseball pitchers. J Strength Cond Res. 2011;25(8):2127-2131.