Increased Shoulder Distraction Force and Shoulder Horizontal Abduction in Professional Baseball Pitchers With Discordant Torso Rotation Order.

BACKGROUND: Inefficient energy transfer from the pelvis and trunk has been shown to increase compensation at the level of the shoulder. Kinetic chain sequencing of the core segments is underexamined in professional baseball pitchers, especially as it relates to changes in upper extremity kinetics. PURPOSE: To evaluate elbow and shoulder kinetics in a cohort of professional pitchers differentiated by instances of discordant pelvic to upper torso sequencing during the pitch. STUDY DESIGN: Descriptive laboratory study. METHODS: 285 professional baseball pitchers were evaluated using 3D motion capture (480 Hz). Pitchers were divided into "chronological" and "discordant" groups based on whether maximum pelvic rotation velocity occurred before (chronological) or after (discordant) maximum upper torso rotation velocity during the pitch motion. Pelvic, upper torso, and shoulder kinematic parameters, shoulder distraction force, shoulder internal rotation torque, and pitch efficiency (PE) were compared between groups. RESULTS: Pitchers with discordant torso sequencing (n = 30; 110 pitches) had greater shoulder horizontal adduction at maximum external rotation (mean difference, 3.6°; 95% CI, -5.2° to -2.0°; t = -4.5; P < .001) and greater maximum shoulder external rotation (mean difference, 3.7°; 95% CI, 5.7° to 1.5°; t = -3.5; P < .001) than chronological pitchers (n = 255; 2974 pitches). PE did not differ between groups (P = .856), whereas ball velocity was significantly faster in the discordant group (mean difference, 0.6 m/s; 95% CI, -1.1 to -0.3 m/s; t = -3.3; P = .0012). Chronological pitchers had significantly reduced shoulder distraction force (mean difference, -4.7% body weight (BW); 95% CI, -7.9% to -1.5% BW; t = -2.9; P = .004) with no difference in shoulder internal rotation torque (P = .160). These kinematic and kinetic differences were not observed when accounting for interpitcher variability. CONCLUSION: Between pitchers, those who had a discordant pelvic to upper torso sequence experienced significantly greater shoulder distraction forces, potentially compensating by increasing maximum shoulder external rotation and horizontal abduction. Achieving maximal pelvic rotation velocity before maximal rotation velocity may be advantageous in preventing compensation at the upper extremity and excessive throwing arm loading. CLINICAL RELEVANCE: Identifying risk factors for increased upper extremity forces has potential implications in injury prevention. Specifically, mitigating shoulder distraction forces may be beneficial in reducing risk of injury.