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Speaker: Overhead throwing injuries are multifactorial in athletes
PHILADELPHIA — When assessing injuries in overhead-throwing athletes, orthopedists need to consider multiple factors, including core stability, as well as player status and competition level, according to results presented at the Advances in Throwing Symposium: Latest on Injury Treatment and Performance Optimization.
Despite the popularity of core stability training with injury prevention through rehabilitation, Marisa Pontillo, PT, DPT, SCS, noted there is little evidence that supports the relationship between core stability and upper extremity injuries in the athletic population. Previous published studies using static and dynamic testing and clinical and biomechanical core stability testing have shown no correlation between poor core stability or poor lower extremity postural control and athletes with non-traumatic shoulder injuries.
“To throw another wrench in, we know that hip range of motion deficits exist. We know that asymmetries exist in our throwers, and it has been thought that decreased hip range of motion is thought to alter throwing mechanics,” Pontillo said in her presentation here. “However, a number of colleagues have recently found that there is no difference in stance of lead leg internal or external range of motion in baseball players with an [ulnar collateral ligament] UCL injury when compared with a healthy cohort.”
Pontillo noted muscle capacity, strength, endurance and neuromuscular control need to be assessed to truly assess core stability. However, she added that current clinical tests of core stability, including flexor extensor endurance test, side plank test, double leg lowering test, only focus on strength and endurance.
“I think we can all agree that core stability is a factor [of injury risk], but it is multifactorial,” Pontillo said.
This includes taking into account player status, competition level, player position, pitch mechanics and the types of pitches being thrown, she continued.
Shoulder-specific risk factors, such as internal rotation and external rotation deficits, total arc differences and horizontal adduction deficits, have also been found to be injury risks in overhead athletes, according to Pontillo. She added differences have been found in humeral retrotorsion in pitchers with shoulder and elbow injuries vs. healthy pitchers.
Strength factors are also injury risks, Pontillo noted, with a link between elbow pain and increased rotator cuff strength among young athletes.
“In our high school athletes, supraspinatus weakness and decreased overall rotator cuff strength has been associated with upper extremity injury risk,” Pontillo said. “In our professional athletes, our [external rotation:internal rotation] ER:IR strength ratio and our supraspinatus weakness has been found to be injury risks as well.” – by Casey Tingle
Reference:
Pontillo M. The role of core stability in evidence-based injury prevention. Presented at: Advances in Throwing Symposium: Latest on Injury Treatment and Performance Optimization; March 2, 2019; Philadelphia.
Disclosure: Pontillo reports no relevant financial disclosures.
Perspective
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Overhead throwing injuries have become focal points of research and discussion among many of us who are team physicians. The author makes excellent points in that a myriad of factors contribute to injuries in these athletes including strength and range of motion deficits (shoulder and hip). I believe core strength plays an extremely important role in injury prevention in overhead athletes based on several studies in youth athletes (pitchers opening up more when they become fatigued). Unfortunately, the challenge we face is accurately defining core strength so it can be measured and studied properly. Further work is needed in this area.
New York