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Program seen as effective for medial elbow injury prevention in baseball players
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A prevention program that improves physical function was effective in the prevention of medial elbow injury in youth baseball players, according to a recently published study.
Researchers identified 305 youth baseball players who did not have a history of elbow and shoulder pain. One hundred thirty-six players underwent the Yokohama Baseball-9 program, which included nine stretching and strengthening exercises, and 169 players were placed in the control group. Investigators performed a clinical assessment of the elbow and shoulder joint, an ultrasonography assessment of the elbow and a physical function assessment. The incidence of medial elbow injury was the primary endpoint for efficacy. Other outcomes included absolute measures of physical function and change in these outcomes after 1 year.
Results showed players who participated in the intervention program had a significantly lower rate of medial elbow injury compared with controls. Investigators noted improvements in the intervention group regarding total range of motion of the shoulder rotation, hip internal rotation, shoulder internal rotation deficit, lower trapezius muscle strength and the thoracic kyphosis angle. Predictive factors of a lower rate of medial elbow injury included increased total shoulder rotation, increased hip internal rotation of the nondominant side and decreased thoracic kyphosis angle. – by Monica Jaramillo
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Peter N. Chalmers, MD
A great deal of research has focused upon the increasing incidence of and risk factors for injury in youth baseball players. However, little evidence exists to guide injury prevention strategies. Sakata and colleagues performed a prospective comparative study. There were 275 baseball players age 8 to 11 [years who] were divided into a control group and a group that was instructed in a combination of nine stretching and nine strengthening exercises that included the wrist, elbow, shoulder, core and hips. An a priori power analysis suggested 304 subjects would be necessary. Players were asked to complete the program at least once a week and compliance was 57.4% via self-report.
At 1-year, the exercise group had significantly lower rates of medial elbow injury and significantly better total range of shoulder rotation. In a multivariate analysis, increased shoulder total rotation, increased nondominant hip internal rotation and decreased thoracic kyphosis predicted lower rates of medial elbow injury.
The study is weakened by selection bias — 28% of the original group was excluded due to prior shoulder or elbow pain and an additional 15% were excluded due to loss to follow-up. The study is not blinded or randomized. Given cultural differences between Japan and the United States, it remains unclear whether these findings will be generalizable and thus the findings will need to be confirmed before this program can be recommended. Overall, the study is innovative and provides an exciting new potential avenue for injury prevention.
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