Regional Interdependence and the Role of the Lower Body in Elbow Injury in Baseball Players: A Systematic Review

Abstract

Background: Elbow injuries are exceedingly common in baseball players. Previous studies have identified that upper extremity strength and range of motion deficits pose a risk for these injuries, but few studies have examined the effect of lower extremity deficits. Given the role of the lower extremity in the kinetic chain of the baseball throwing motion, lower body deficits may affect the kinematics of the upper extremity and play a role in the elbow injury of baseball players. Purpose: To systematically review the current literature investigating the association of trunk and lower extremity deficits with elbow pain or injury in baseball players. Study Design: Systematic review. Methods: A systematic review of the literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines to identify and analyze all previous studies focused on the association of elbow pain and/or injury with functional deficits of the trunk and lower extremities. Results: A total of 14 studies met inclusion criteria, examining a range of baseball players extending from youth to professional athletes. One of the 14 studies examined other types of overhead throwing athletes alongside baseball players. Lower extremity–related risk factors for elbow pain and injury in these athletes were found and stratified per level of play. Factors included specific hip range of motion, lower extremity injury or pain, balance, and foot arch posture. Associations were also found with lower extremity injury and noncompliance with primary prevention programs. Conclusion: Specific lower extremity deficits were found to be independent risk factors for elbow pain and injury in throwing athletes at certain levels of play. Additionally, prevention programs designed to correct deficits in identified risk factors were effective in reducing the incidence of elbow injury in youth athletes. These results highlight the potential of screening and subsequent intervention to reduce the incidence of elbow injury in certain subsets of baseball players.

Ankle dorsiflexion deficit in the back leg is a risk factor for shoulder and elbow injuries in young baseball players

“…While this study cannot definitively determine why a ROM deficit in ankle dorsiflexion in the back leg increases the risk of injury, there are some potential explanations. First, as shown in a previous study involving the trunk and hip joint 30 , functional deficiencies in the ankle joint significantly affected kinetic changes in the adjacent segment or beyond. This finding supports the understanding that a transfer of force and energy occurs along the kinetic chain during the throwing motion 22,23,31 .…”

“…A recent systematic review 30 investigated the relationship between lower body function and elbow injury in baseball players and reported on several independent risk factors for elbow injuries in baseball players [8][9][10][11][12][13][14][15][16][17][18][19][20][21] . However, no study has investigated the relationship between ankle joint ROM and shoulder and elbow injuries in baseball players.…”

Lumbopelvic Control and the Development of Upper Extremity Injury in Professional Baseball Pitchers

“…Laudner et al 16 found that lumbopelvic control of the drive leg has a negative relationship with both shoulder and elbow torque during the pitching motion, meaning pitchers with less lumbopelvic control created more horizontal shoulder and elbow valgus torque. In a systematic review, Deal et al 6 noted that several lower extremity deficiencies, including decreased balance, were independent risk factors for elbow pain in throwing athletes. The results of the current study support these previous investigations, indicating that pitchers with less lumbopelvic control are more likely to develop upper extremity injury.…”

Beyond the Shoulder: A Case Report of Regional Interdependence Treatment Approach in an Elite Level Tennis Player

“…Specifically, a recent systematic review analyzed the role of regional interdependence within baseball athletes. Not only were lower extremity deficits risk factors for upper extremity injury and/or pain, but improvements to these deficits reduced the incidence of upper extremity pain and dysfunction in young baseball athletes 14 . Similarly, a cross-sectional study of 2,215 overhead athletes found that upper extremity pain was more prevalent in young athletes that had concomitant back, hip, knee and foot pain 15. Prior to treatment, our patient demonstrated a break in the kinetic chain (lower extremity deficits) which may have been associated with the indicated supraspinatus tear.…”