Tyler Timothy F, Mullaney Michael J, Mirabella Michael R, Nicholas Stephen J, McHugh Malachy P
Pro Sports Physical Therapy, Scarsdale, New York, USA Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA.
Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA.
Am J Sports Med. 2014 Aug;42(8):1993-9. doi: 10.1177/0363546514535070. Epub 2014 Jun 3.
Shoulder strength and motion deficits in high school baseball pitchers have been implicated in injury risk.
PURPOSE/HYPOTHESIS: To prospectively determine if preseason strength and range of motion (ROM) are predictive of injury in high school baseball pitchers. It was hypothesized that ROM asymmetries and weakness would be predictive of injury.
Case-control study; Level of evidence, 3.
Preseason strength and ROM measurements were made on 101 pitchers from 4 different high schools over 4 seasons (total 166 pitcher-seasons: 25 freshman, 46 junior varsity, and 95 varsity player-seasons). Glenohumeral internal rotation (IR), glenohumeral external rotation, and posterior shoulder ROM were measured bilaterally. Strength in IR, external rotation, supraspinatus (empty-can test), and scapular retraction was measured bilaterally (handheld dynamometer). Injury incidence (injuries per 1000 pitches) was computed for players categorized as above normal (≥1 SD above the mean), normal (within 1 standard deviation of the mean), and below normal (≤1 SD below the mean) for each potential risk factor. Injury was defined as a missed game or practice because of shoulder or elbow problem.
There were 28 upper extremity injuries (19 shoulder, 9 elbow; incidence, 0.58 injuries/1000 pitches). There was a trend for supraspinatus weakness to be associated with increased injury risk (relative risk [RR], 3.60; 95% CI, 0.75-17.32; P = .09). When analyzing major injuries only (>3 missed games), preseason supraspinatus weakness was significantly associated with increased injury risk (RR, 4.58; 95% CI, 1.40-15.01; P = .02). Paradoxically, pitchers with no IR loss were at increased risk compared with pitchers with ≥20° loss (RR, 4.85; 95% CI, 1.01-23.29; P = .04). Other ROM and strength measures were unrelated to injury risk.
Although excessive loss of IR ROM is thought to be a risk factor for injury, the opposite was the case in this study. The absence of IR ROM loss in high school pitchers may indicate inadequate prior exposure to pitching, resulting in increased injury risk. Preseason supraspinatus weakness was associated with increased risk for a major injury, and preventative supraspinatus strengthening may be beneficial.
高中棒球投手的肩部力量和运动功能缺陷与受伤风险有关。
目的/假设：前瞻性地确定季前赛的力量和活动范围（ROM）是否可预测高中棒球投手的受伤情况。假设ROM不对称和力量薄弱可预测受伤情况。
病例对照研究；证据等级，3级。
在4个赛季中，对来自4所不同高中的101名投手进行了季前赛力量和ROM测量（总共166个投手赛季：25个新生赛季、46个初中校队赛季和95个校队球员赛季）。双侧测量盂肱关节内旋（IR）、盂肱关节外旋和后肩部ROM。双侧测量IR、外旋、冈上肌（空罐试验）和肩胛后缩的力量（手持测力计）。计算每个潜在风险因素分类为高于正常（≥均值1个标准差以上）、正常（在均值1个标准差范围内）和低于正常（≤均值1个标准差以下）球员的受伤发生率（每1000次投球的受伤次数）。受伤定义为因肩部或肘部问题错过比赛或训练。
有28例上肢受伤（19例肩部，9例肘部；发生率，0.58次受伤/1000次投球）。冈上肌力量薄弱有与受伤风险增加相关的趋势（相对风险[RR]，3.60；95%可信区间，0.75 - 17.32；P = 0.09）。仅分析严重受伤情况（错过3场以上比赛）时，季前赛冈上肌力量薄弱与受伤风险增加显著相关（RR，4.58；95%可信区间，1.40 - 15.01；P = 0.02）。矛盾的是，与内旋损失≥20°的投手相比，内旋无损失的投手受伤风险增加（RR，4.85；95%可信区间，1.01 - 23.29；P = 0.04）。其他ROM和力量指标与受伤风险无关。
尽管内旋ROM过度损失被认为是受伤的风险因素，但本研究情况相反。高中投手内旋ROM无损失可能表明之前投球经历不足，导致受伤风险增加。季前赛冈上肌力量薄弱与严重受伤风险增加相关，预防性的冈上肌强化训练可能有益。
