Spine Alignment in Standing and Maximal Upper Limb Elevation in Baseball Players with Lumbar Spondylolysis and Those without Low Back Pain.

The changes in lumbar lordosis angle (LL) and sacral slope angle (SS) related to upper limb elevation and thoracic kyphosis angle (TK) in baseball players with spondylolysis remain unclear. Herein, we investigated baseball players with spondylolysis and those without low back pain, comparing LL and SS with upper limb elevation within and between groups and TK between groups. Baseball players with spondylolysis were enrolled as subjects, and baseball players without low back pain were enrolled as controls (n = 8 each). X-rays were obtained in the standing position and with maximal elevation position of the upper limb (elevation position). LL and SS were measured in the standing and elevated positions, and TK was measured in the standing position. LL was significantly larger in individuals with spondylolysis than controls. The SS of the control group was significantly larger in the elevated position than in the standing position, while the SS of the spondylolysis group was not significantly different between positions. SS was significantly larger in the spondylolysis group than in the control group, only in the standing position. Physical therapy for spondylolysis should focus on hyperlordosis alignment in the standing and maximal elevation positions of both upper limbs, sacral hyper-slope alignment in the standing position, and decreased sacral slope motion.

Comparison of alignment and spondylolysis fracture angle in bilateral and unilateral spondylolysis.

OBJECTIVES: Spondylolysis occurs bilaterally or unilaterally and bilateral spondylolysis increases the risk of developing isthmic spondylolisthesis. The characteristics of the lumbar lordosis angle (LLA), sacral slope angle (SSA), and spondylolysis fracture angle (SFA) in bilateral spondylolysis compared with those in unilateral spondylolysis have not been clarified. The purpose of this study was to compare the LLA, SSA, and SFA of bilateral and unilateral spondylolysis. MATERIALS AND METHODS: Thirty-eight patients with lumbar spondylolysis who visited our clinic for an initial visit and 15 age-matched patients with a chief complaint of low back pain were included as controls. Computed tomography films were used to classify all spondylolysis patients into two groups: those with bilateral fractures (bilateral) and those with unilateral fractures (unilateral). The LLA and SSA were measured using lateral X-ray films and the SFA was measured using computed tomography films. RESULTS: The LLA was significantly higher in all spondylolysis patients than in the control group (p = .026). There was no significant difference in SSA between the spondylolysis and control groups (p = .28). The LLA was significantly higher in the bilateral group than in the unilateral group (p = .018). There was no significant difference in SSA between the bilateral and unilateral groups (p = .15). The SFA was significantly lower in the bilateral group than in the unilateral group (p = .024). CONCLUSIONS: This study suggests that physical therapy for spondylolysis may be considered bilaterally and unilaterally.

Relationship between Standing Trunk Extension Angle and Medial Elbow Injuries in Young Baseball Pitchers.

Purpose: The purpose of this study was to investigate the relationship between the standing trunk extension angle and medial elbow injuries. Subjects and methods: The study participants were 90 male baseball pitchers (10−12 years) belonging to youth baseball teams. Pitching elbow injuries were evaluated by an orthopedic surgeon using ultrasound scans and physical examination findings. A single optical three-dimensional motion analysis system was used for the trunk extension measurements, with three-dimensional coordinates captured. The overall, upper, and lower trunk angles were then analyzed. Results: Trunk extension angle during standing trunk extension was significantly smaller among participants who were positive for medial elbow injuries on ultrasound scans (positive: 71.4° ± 10.3°; negative: 75.7° ± 9.2°; t = 2.05, p < 0.05). The upper trunk extension angle was significantly smaller than the lower trunk extension angle among participants who were positive for medial elbow injuries on physical examination (upper: 33.0° ± 6.9°; lower: 41.2° ± 8.2°; t = −2.42, p < 0.05). Conclusions: Trunk extension angle during standing trunk extension is associated with medial elbow injuries. Evaluating the trunk extension angle as multiple segments rather than a single rigid body is valuable.

Significant reduction of patellar height affected lower clinical outcomes and knee flexion over five-year follow-up after total knee arthroplasty.

AIMS: This study aimed to investigate the relationship between changes in patellar height and clinical outcomes at a mean follow-up of 7.7 years (5 to 10) after fixed-bearing posterior-stabilized total knee arthroplasty (PS-TKA). METHODS: We retrospectively evaluated knee radiographs of 165 knees, which underwent fixed-bearing PS-TKA with patella resurfacing. The incidence of patella baja and changes in patellar height over a minimum of five years of follow-up were determined using Insall-Salvati ratio (ISR) measurement. We examined whether patella baja (ISR < 0.8) at final follow-up affected clinical outcomes, knee joint range of motion (ROM), and Knee Society Score (KSS). We also assessed inter- and intrarater reliability of ISR measurements and focused on the relationship between patellar height reduction beyond measurement error and clinical outcomes. RESULTS: The ISR gradually decreased over five years after TKA, and finally 33 patients (20.0%) had patella baja. Patella baja at the final follow-up was not related to passive knee ROM or KSS. Interestingly, when we divided into two groups - patella baja and patella normal-alta (ISR ≥ 0.8) - the patella baja group already had a lower patellar height before surgery, compared with the patella normal-alta group. The ISR measurement error in this study was 0.17. Both passive knee flexion and KSS were significantly decreased in the group with a decrease in ISR of ≥ 0.17 at final follow-up. CONCLUSION: Patellar height gradually decreased over five years of follow-up after TKA. The reduction in patellar height beyond measurement error following TKA was associated with lower clinical outcomes. Cite this article: Bone Jt Open 2021;2(12):1075-1081.

Motion Analysis Focusing on Rotational Movements of Professional Female Baseball Pitchers: Comparison with Male University Baseball Pitchers.

PURPOSE: The purpose of this study was to compare pitching motion of the professional female baseball pitchers with the male university baseball pitchers focused on the pelvic and thoracic movements. SUBJECTS AND METHODS: The participants were 15 healthy professional female baseball pitchers (11 right-handers and 4 left-handers; age, 21.7 ± 3.2 years; height, 162.5 ± 5.1 cm; weight, 59.0 ± 6.6 kg) and 14 healthy male university baseball pitchers (12 right-handers and 2 left-handers; age, 19.9 ± 0.8 years; height, 176.4 ± 3.0 cm; body mass, 73.1 ± 3.0 kg). Throwing motion was captured by three-dimensional motion analysis system. Kinematic data of the lead hip, pelvis, thorax, and dominant shoulder were collected and the joint angle at maximum external rotation phase and ball release phase were compared. RESULTS: The female baseball pitchers rotated pelvis and thorax more than the male at the maximum external rotation phase and ball release phase (p < 0.05). At the same, the pelvis and thorax of the female baseball pitchers were tilted significantly closer to horizontal plane than the male (p < 0.05). The pelvis and thorax of the male baseball pitchers was tilted to non-dominant lateral side. CONCLUSIONS: The results of this study indicate that the pelvic and thoracic movements of the professional female baseball pitchers was different from male university pitchers.

Relationship Between Physical Fitness at the End of Preseason and the Inseason Game Performance in Japanese Female Professional Baseball Players.

Watanabe, Y, Yamada, Y, Yoshida, T, Matsui, T, Seo, K, Azuma, Y, Hiramoto, M, Miura, Y, Fukushima, H, Shimazu, A, Eto, T, Saotome, H, Kida, N, and Morihara, T. Relationship between physical fitness at the end of preseason and the inseason game performance in Japanese female professional baseball players. J Strength Cond Res 33(6): 1580-1588, 2019-This study examined anthropometric and fitness profiles of Japanese female professional baseball players and investigated the relationship between players' physical fitness and inseason game performance. Fifty-seven players who were registered in the Japan Women's Baseball League (JWBL) participated. Height, body mass, grip strength, back strength, knee extension and flexion strength, hamstring extensibility, vertical jump height, and horizontal jump distance were measured at preseason (February and March) in 2013. Game performance during the 2013 season (March-November) was obtained from official JWBL statistics. Vertical jump height showed significant positive correlations with individual performance records (e.g., total bases [r = 0.551], slugging percentage [r = 0.459], and stolen bases [r = 0.442]). Similar relationships were observed between horizontal jump distance and performance statistics in most cases. By contrast, grip, back, and lower-limb strength, as well as hamstring extensibility were not significantly correlated with game performance. Stepwise regression analysis selected vertical jump height as an independent variable, significantly correlating with several game performance measures (e.g., total bases: adjusted R = 0.257). Also, vertical jump height and body mass index were identified as independent variables significantly associated with stolen bases (adjusted R = 0.251). Maximal jump performance, rather than simple isometric muscle strength or flexibility, is a good performance test that can be used at the end of preseason to predict inseason batting and stolen base performance. Our findings demonstrate the importance of constructing preseason training programs to enhance lower-limb muscular power that is linked to successful inseason performance in female baseball players.

Hip, Trunk, and Shoulder Rotational Range of Motion in Healthy Japanese Youth and High-school Baseball Pitchers.

OBJECTIVE: The rotational range of motion (ROM) in the upper extremities, trunk, and lower extremities is important for throwing motion. However, unlike for the shoulders, the differences relating to age and throwing-side in trunk and lower extremity ROMs in baseball pitchers are unknown. This study examined the effects of age and dominance on the ROMs of the trunk and upper and lower extremities. METHODS: The study included 356 young baseball pitchers aged 9-17 years who participated in off-season baseball camps. The subjects comprised 155 youth pitchers (aged 9-14 years) and 201 high-school pitchers (aged 15-17 years) who were able to throw at full force without pain. The neck, shoulder, trunk, and hip rotational ROMs on the dominant and non-dominant side were measured by well-trained physical therapists. The differences between throwing sides and between age groups were examined using two-way analysis of variance. RESULTS: Shoulder external rotation on the dominant side was greater than that on the non-dominant side. Shoulder external and internal rotational ROMs were maintained regardless of age, whereas the trunk rotational ROM significantly increased with age. CONCLUSIONS: The effects of age and dominance on ROMs of the neck, trunk, and upper and lower extremities in Japanese youth and high-school baseball pitchers were clarified. These data could be used as a specific reference and as target values for the rehabilitation of throwing injuries in young athletes.

Whole-body and segmental muscle volume are associated with ball velocity in high school baseball pitchers.

The aim of the study was to examine the relationship between pitching ball velocity and segmental (trunk, upper arm, forearm, upper leg, and lower leg) and whole-body muscle volume (MV) in high school baseball pitchers. Forty-seven male high school pitchers (40 right-handers and seven left-handers; age, 16.2 ± 0.7 years; stature, 173.6 ± 4.9 cm; mass, 65.0 ± 6.8 kg, years of baseball experience, 7.5 ± 1.8 years; maximum pitching ball velocity, 119.0 ± 9.0 km/hour) participated in the study. Segmental and whole-body MV were measured using segmental bioelectrical impedance analysis. Maximum ball velocity was measured with a sports radar gun. The MV of the dominant arm was significantly larger than the MV of the non-dominant arm (P < 0.001). There was no difference in MV between the dominant and non-dominant legs. Whole-body MV was significantly correlated with ball velocity (r = 0.412, P < 0.01). Trunk MV was not correlated with ball velocity, but the MV for both lower legs, and the dominant upper leg, upper arm, and forearm were significantly correlated with ball velocity (P < 0.05). The results were not affected by age or years of baseball experience. Whole-body and segmental MV are associated with ball velocity in high school baseball pitchers. However, the contribution of the muscle mass on pitching ball velocity is limited, thus other fundamental factors (ie, pitching skill) are also important.

Etiology of cervical myelopathy induced by ossification of the posterior longitudinal ligament: determining the responsible level of OPLL myelopathy by correlating static compression and dynamic factors.

STUDY DESIGN: Retrospective study. OBJECTIVE: To determine the responsible level of cervical myelopathy induced by ossification of the posterior longitudinal ligament (OPLL). This was achieved by correlating the intervertebral range of motion (ROM) as the dynamic factor with the space available for spinal cord (SAC) as the static compression factor. SUMMARY OF BACKGROUND DATA: The association between spinal canal stenosis and the occurrence of the myelopathy has previously been reported for OPLL patients, but not the detailed relationship between SAC, ROM, and myelopathy. METHODS: We investigated OPLL type, SAC, and ROM in relation to the responsible level of cervical OPLL myelopathy in 27 cases. SAC and ROM were measured at each vertebral and intervertebral levels. The responsible level was diagnosed using spinal cord-evoked potentials and classified as group A, whereas the nonresponsible level was classified as group B. RESULTS: Spinal cord-evoked potentials revealed 21 cases with a single responsible level and 6 cases with 2 responsible levels. The mean ROM of group A (8.9 degrees) was significantly higher (P<0.01) than that of group B (5.7 degrees). The mean SAC of group A (8.2 mm) was significantly lower (P<0.01) than that of group B (12.4 mm). Using discriminate analysis, significant differences for both SAC and ROM were observed between groups A and B [Box's M test: chi=3.31

Distal-type cervical spondylotic amyotrophy: assessment of pathophysiology from radiological findings on magnetic resonance imaging and epidurally recorded spinal cord responses.

STUDY DESIGN: Six cases with distal-type cervical spondylotic amyotrophy are reported. OBJECTIVE: To investigate the pathophysiology of distal-type cervical spondylotic amyotrophy from magnetic resonance imaging and intraoperative evoked spinal cord responses. SUMMARY OF BACKGROUND DATA: Cervical spondylotic amyotrophy had a characteristic clinical symptom of severe muscular atrophy with no or insignificant sensory deficit. Selective ventral root lesions or intrinsic spinal cord lesions have been proposed as the pathophysiology of cervical spondylotic amyotrophy, but they have not been well understood. METHOD: Six patients with distal-type cervical spondylotic amyotrophy were described, and their magnetic resonance imaging and evoked spinal cord potentials after median nerve, motor cortex, and spinal cord stimulation were investigated. RESULTS: Sagittal T2-weighted magnetic resonance imaging showed high signal intensity change within the spinal cord at C4-C5, C5-C6, and C6-C7. All patients underwent laminoplasty. The attenuation of postsynaptic potentials with preserved presynaptic potentials at C4-C5, C5-C6, and C6-C7 was characteristic in the evoked spinal cord potentials after median nerve stimulation. The amplitude of the evoked spinal cord potentials after median nerve stimulation was preserved at C2-C3. This means that lateral posterior column in the spinal cord had less or no involvement in distal-type cervical spondylotic amyotrophy. Concomitant hyperactivity of the patellar tendon reflex was correlated with the abnormality in the evoked spinal cord potentials after transcranial electric stimulation. CONCLUSIONS: The results suggest a longitudinal gray matter lesion as one pathophysiologic feature, and that less damage to the lateral posterior column is the reason for the preservation of sensory function in the patients with distal-type cervical spondylotic amyotrophy described in this study.