Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, UK; Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, UK; Department of Orthopaedic Surgery, Wake Forest School of Medicine, USA.
Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, UK; Brasenose College, University of Oxford, UK.
J Sci Med Sport. 2021 Jan;24(1):13-20. doi: 10.1016/j.jsams.2020.06.015. Epub 2020 Jul 1.
To investigate the relationship between baseball pitching biomechanics and pain, injury, or surgery, in pitchers of all ages and competition levels.
Systematic review.
This study was registered on Prospero (CRD42019137462). Four online databases (MEDLINE, SPORTDiscus, CINAHL, and Embase) from inception to June 13, 2019 were systematically searched. Risk of bias was assessed through the modified Downs and Black.
967 titles/abstracts were screened with 11 studies (1376 pitchers) included. Four studies used 3D biomechanical analyses, five studies video analysis, and two studies evaluated EMG activity. Level 1b evidence suggests that injured pitchers had greater elbow valgus torque at late arm cocking (injured: 91.6Nm, non-injured: 74.7Nm, p=0.013) and early trunk rotation was predictive of increased upper extremity surgical risk (Hazard Ratio: 1.69 (95% CI 1.02-2.80)). Level 3b evidence observed pitchers with upper extremity surgical history had greater lateral trunk tilt at release (surgery: 29.3°, controls: 23.4°, p=0.035), and flexor carpi ulnaris EMG activity was decreased (injured: 68% MMT, controls: 103% MMT) in pitchers with elbow injury.
Increased elbow valgus torque and early trunk rotation were injury risk factors, and elbow injured pitchers displayed diminished forearm muscle activity. Due to the low power of many of these studies, and the lack of prospective 3D biomechanical studies, other pitching biomechanical variables cannot be ascertained as injury risk factors. Future studies are needed to prospectively assess pitching injury risk through 3D biomechanical methods.
研究所有年龄段和竞技水平的投球手中棒球投球生物力学与疼痛、损伤或手术之间的关系。
系统评价。
本研究在 Prospero（CRD42019137462）上进行了注册。从建库到 2019 年 6 月 13 日，系统地检索了 4 个在线数据库（MEDLINE、SPORTDiscus、CINAHL 和 Embase）。通过改良的 Downs 和 Black 评估偏倚风险。
共筛选出 967 篇标题/摘要，其中纳入 11 项研究（1376 名投手）。4 项研究采用 3D 生物力学分析，5 项研究采用视频分析，2 项研究评估肌电图活动。1b 级证据表明，受伤投手在晚期手臂扣球时的肘外翻扭矩更大（受伤：91.6Nm，未受伤：74.7Nm，p=0.013），早期躯干旋转与上肢手术风险增加相关（风险比：1.69（95%CI 1.02-2.80））。3b 级证据观察到上肢手术史的投手在投球时的外侧躯干倾斜更大（手术：29.3°，对照组：23.4°，p=0.035），肘部受伤的投手中屈肌肌皮神经肌电图活动减少（受伤：68%MMT，对照组：103%MMT）。
增加的肘外翻扭矩和早期躯干旋转是受伤的危险因素，肘部受伤的投手显示前臂肌肉活动减少。由于这些研究的功率较低，以及缺乏前瞻性 3D 生物力学研究，其他投球生物力学变量不能确定为受伤的危险因素。需要进一步的前瞻性研究通过 3D 生物力学方法评估投球受伤的风险。
