Are UCL Injuries a Matter of Bad Luck? The Role of Variability and Fatigue Quantified

Trigt, Bart van; Leenen, A. J. R.; Hoozemans, M.J.M.; Helm, F.C.T. van der; Veeger, H.E.J.

doi:10.3390/proceedings2020049107

Cited by 5 publications

(9 citation statements)

References 17 publications

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“…The individual association of elbow load magnitude and within-individual variability with repetitive pitching emphasize the importance of an individual approach in relation to the quanti cation of load and overload. This individual approach seems essential in relation to overuse injuries because it is hypothesized that pitchers who have a higher load magnitude and within-individual variability are at higher risk for sustaining an injury 27 . This, in combination with the mechanical fatigue phenomenon, where an increase in loading cycles (pitch count) and loading magnitude (valgus torque) increases the chance of damage, are important factors in overuse injuries.…”

Section: Discussionmentioning

confidence: 99%

Potential injury mechanisms in ulnar collateral ligament injuries; magnitude and variability of elbow load in repetitive baseball pitching

Trigt

Hogerwou

Leenen

et al. 2023

Preprint

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A common overuse injury in baseball pitching is the Ulnar Collateral Ligament (UCL) injury, due to high and repetitive loading of the medial side of the elbow. This repetitive loading (i.e. external valgus torque), caused by pitching a high number of balls in a practice session or during a game, is resisted by the UCL and counteracted by the elbow muscles. The elbow muscles have the potential to shield the UCL from the full external load and were active in all fifteen participants during pitching. To understand the injury mechanisms, we investigated the effect of repetitive pitching on the elbow load magnitude and variability. In addition, we explored whether repetitive pitching affects elbow muscle activation during pitching. On a group level, the linear mixed models showed no significant associations of repetitive pitching with valgus torque magnitude and variability and elbow muscle activity. Significant large differences exist between pitchers in their individual courses in elbow valgus torque and muscle activity with repetitive pitching. This shows the importance of individuality in relation to repetitive pitching. To arrive at effective elbow injury prevention in baseball pitching, individual characteristics of changes in elbow load and muscle activity in relation to the development of UCL injuries should be investigated.

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Section: Discussionmentioning

confidence: 99%

Potential injury mechanisms in ulnar collateral ligament injuries; magnitude and variability of elbow load in repetitive baseball pitching

Trigt

Hogerwou

Leenen

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…The valgus torque magnitude on its own cannot completely explain this percentage, as all professional pitchers show high valgus torques. To explain this prevalence, the within-individual load variability and the injury threshold are both important metrics to include [13]. The injury threshold in this model is the maximal load the UCL can sustain before it strains or tears.…”

Section: Discussionmentioning

confidence: 99%

“…The demonstrated within-individual valgus torque variability and the fact that this differs between subjects is a step towards validating the injury model of van Trigt et al (2020). However, it is suggested that pitchers who throw with a higher magnitude and within-individual variability of valgus torque might have-but do not necessarily have-a higher chance of sustaining an injury, because the injury threshold is also of importance [13] (Figure 2). It is important to mention that we did not investigate the relationship between valgus torque variability and injuries.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the aforementioned studies analyzed a single pitch [10] or the average of the fastest three-five pitches [11,12], neglecting to consider the withinindividual variability in ball speed and elbow load. Assuming that reaching a critical (peak) value of valgus torque is a major determinant in UCL injury, this magnitude will depend on the average torque level as well as the within-individual variability of this torque [13]. Information on both parameters is therefore necessary.…”

Section: Introductionmentioning

confidence: 99%

“…A simple explanatory computational model illustrates that a higher within-individual (elbow) load variability increases (elbow) injury risk [13]. We modeled the load as a Gaussian distribution with an average, standard deviation, and different numbers of pitches as inputs.…”

Section: Introductionmentioning

confidence: 99%

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Quantifying Within-Individual Elbow Load Variability in Youth Elite Baseball Pitchers and Its Role in Overuse Injuries

et al. 2022

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Medial elbow overuse injuries are rising in baseball. The external valgus torque magnitude is a possible risk factor for medial elbow injuries. The magnitude on its own cannot explain why one pitcher sustains an injury and another does not. Therefore, the aim of this study is to describe the within-individual external valgus torque variability and to determine whether the within-individual external valgus torque variability can be described by a Gaussian distribution. Eleven youth elite baseball pitchers threw twenty-five fastball pitches. Body kinematics were measured with VICON motion capture at 400 Hz. Elbow valgus torques of the total 270 pitches were calculated with a custom-made inverse dynamic model in Python. Visual inspection and the Shapiro–Wilk test were performed to test for the within-individual elbow valgus torque normality. The results showed that within-individual valgus torque variability was present in pitchers and differed among pitchers. Furthermore, it was shown that the within-individual valgus torque variability was normally distributed in nine out of eleven subjects. In conclusion, the presence of and differences in within-individual elbow load variability among baseball pitchers can be useful variables as they might be related to overuse elbow injuries.

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Magnitude and variability of individual elbow load in repetitive baseball pitching

van Trigt,

van Hogerwou,

Leenen

et al. 2023

Sci Rep

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In baseball pitchers the elbow is exposed to high and repetitive loads (i.e. external valgus torque), caused by pitching a high number of balls in a practice session or game. This can result in overuse injuries like the ulnar collateral ligament (UCL) injury. To understand injury mechanisms, the effect of repetitive pitching on the elbow load magnitude and variability was investigated. In addition, we explored whether repetitive pitching affects elbow muscle activation during pitching. Fifteen pitchers threw each 60 to 110 balls. The external valgus torque and electromyography of three elbow muscles were quantified during each pitch. Linear mixed model analyses were performed to investigate the effect of repetitive pitching. On a group level, the linear mixed models showed no significant associations of repetitive pitching with valgus torque magnitude and variability and elbow muscle activity. Significant differences exist between pitchers in their individual trajectories in elbow valgus torque and muscle activity with repetitive pitching. This shows the importance of individuality in relation to repetitive pitching. In order to achieve effective elbow injury prevention in baseball pitching, individual characteristics of changes in elbow load and muscle activity in relation to the development of UCL injuries should be investigated.

show abstract

Are UCL Injuries a Matter of Bad Luck? The Role of Variability and Fatigue Quantified

Cited by 5 publications

References 17 publications

Potential injury mechanisms in ulnar collateral ligament injuries; magnitude and variability of elbow load in repetitive baseball pitching

Potential injury mechanisms in ulnar collateral ligament injuries; magnitude and variability of elbow load in repetitive baseball pitching

Quantifying Within-Individual Elbow Load Variability in Youth Elite Baseball Pitchers and Its Role in Overuse Injuries

Magnitude and variability of individual elbow load in repetitive baseball pitching

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