Comparison of the "Tall and Fall" Versus "Drop and Drive" Pitching Styles: Analysis of Major League Baseball Pitchers During a Single Season.

Background: Previous research has documented the proportion of "tall and fall" (TF) and "drop and drive" (DD) pitching styles among Major League Baseball (MLB) pitchers who underwent ulnar collateral ligament reconstruction (UCLR). The proportion of these 2 styles among all MLB pitchers remains unknown. Purpose: To determine the proportion of the TF and DD pitching styles in all rostered MLB pitchers during a single season as well as the proportion of TF and DD pitchers who sustained an upper extremity (UE) injury and those who underwent UCLR. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Pitcher demographic characteristics from the 2019 MLB season and pitching information were obtained via open-access sources. Two-dimensional video analysis was used to categorize the included pitchers into TF and DD groups. Statistical comparisons and contrasts were made using 2-tailed t tests, chi-square tests, and Pearson correlation analyses as appropriate. Results: Of the 660 MLB rostered pitchers in 2019 (age, 27.39 ± 3.51 years; body mass index, 26.34 ± 2.47 kg/m2; fastball velocity, 150.49 ± 3.99 kph [93.51 ± 2.48 mph]), 412 (62.4%) pitchers used the TF style and 248 (37.6%) pitchers used the DD style. Significantly more UE injuries were seen in the TF group compared with the DD group (112 vs 38 injuries, respectively; P < .001). Twelve pitchers underwent UCLR (TF, 10; DD, 2), representing a 1.8% UCLR rate among all pitchers. This was a second surgery for 2 pitchers, both of whom used the TF pitching style. Significantly more pitchers in the TF group than the DD group had undergone UCLR before 2019 (135 vs 56 pitchers, respectively; P = .005). Conclusion: The results of the present study demonstrated a higher prevalence of both UE injury and prior UCLR in TF pitchers. Further research is needed to explore the potential association between pitching style and UE injury.

Knowledge and Perceptions of Ulnar Collateral Ligament Injuries in Baseball Players: A Survey of NCAA Head Baseball Coaches.

Background: There is growing concern among sports medicine professionals regarding the increasing prevalence of ulnar collateral ligament (UCL) surgery in baseball players. At this time, it is unclear whether collegiate head baseball coaches possess adequate knowledge of UCL injuries. Purpose/Hypothesis: The purpose of this study was to assess the knowledge and perceptions of UCL injury among National Collegiate Athletic Association (NCAA) head baseball coaches. It was hypothesized that NCAA head baseball coaches would demonstrate misconceptions and knowledge disparities regarding UCL injury. Study Design: Cross-sectional study. Methods: An online 35-question survey was designed to assess NCAA head baseball coaches' knowledge of UCL injury. The survey included questions related to participant characteristics, UCL injury, biometric performance and pitching variables, throwing fatigue, surgical variables/performance outcomes, and collegiate athlete recruitment. A total of 788 NCAA head baseball coaches were asked to participate. Responses were analyzed and reported using descriptive statistics where appropriate. Statistical comparisons and contrasts were made using chi-square and Fisher exact tests. Results: A total of 103 NCAA head baseball coaches participated in the survey, representing a 13.1% response rate. Only 31% of respondents could correctly identify all UCL injury symptoms, and 93% recommended <8 weeks off from overhead throwing during the off-season. Previous elbow injury observation was associated with UCL symptom identification (χ2 = 10.614; P = .005). Regular access to an athletic trainer (P = .015) and regular access to a strength and conditioning coach (P = .004) were both associated with NCAA division status, with Division I programs having the most access. Neither sports medicine physician (P = .656) nor athletic trainer (P = .611) access was associated with the geographic location of the baseball program; however, strength and conditioning coach access was associated with geographic location (χ2 = 6.696; P = .010). Conclusion: This study demonstrates that limited UCL injury knowledge and various misconceptions exist among NCAA baseball head coaches. The majority of responding coaches recommended an amount of time off from overhead throwing during the off-season that may be inadequate and were unable to identify all symptoms associated with UCL injury, representing the most concerning findings of the present study.