Single-Leg Squat and Reported Pain in Collegiate Softball Pitchers.

Background: Single-leg squat (SLS) performance is related to altered mechanics related to injury during the windmill softball pitch; however, it is unknown if SLS kinematics differ between softball pitchers with and without upper extremity pain. Purpose/Hypothesis: The purpose of this study was to compare knee valgus, trunk rotation, trunk lateral flexion, and trunk flexion during an SLS in collegiate softball pitchers with and without self-reported upper extremity pain. It was hypothesized that those who reported upper extremity pain would show increased compensatory trunk and knee kinematics compared with those without pain. Study Design: Controlled laboratory study. Methods: A total of 75 collegiate softball players (mean age, 20.4 ± 1.7 years; mean height, 173.3 ± 7.7 cm; mean weight, 79.1 ± 11.6 kg) participated and were placed in pain (n = 20) or no-pain (n = 55) groups. Participants performed an SLS once per side. Kinematic data were collected at 100 Hz using an electromagnetic tracking system. A 2 (pain vs no pain) × 2 (descent vs ascent) × 2 (drive leg vs stride leg) mixed-design multivariate analysis of variance with Wilks lambda distribution was used to determine differences in drive-leg and stride-leg lower body mechanics between the descent and ascent phases of the SLS between the pitchers in the current study with and without pain. Results: There was no significant effect in the 3-way interaction between upper extremity pain, side, and phase (Λ = 0.960; F[4, 70] = 0.726; P = .577; η2 = 0.04). However, there were large effects for the phase × side interaction (Λ = 0.850; P = .021; η2 = 0.150). There was a main effect of phase (Λ = 0.283; P < .001; η2 = 0.717). Conclusion: Study findings indicated that SLS mechanics do not differ between collegiate softball pitchers with and without reported upper extremity pain. Drive-leg mechanics showed more stability in the SLS than stride-leg mechanics. Clinical Relevance: Softball pitchers are at risk of upper extremity injury. It is important to identify mechanisms that may lead to pain in order to mitigate the risk of injury.

Preliminary Analysis of Closed Kinetic Chain Upper Extremity Stability Test Differences Between Healthy and Previously Injured/In-Pain Baseball Pitchers.

BACKGROUND: A comprehensive examination of the kinetic chain during an overhead athlete's upper extremity assessment, such as the closed kinetic chain upper extremity stability test (CKCUEST), may help clinicians identify potential upper extremity dysfunction. HYPOTHESIS: Body position observed on dominant and nondominant hand touch during a CKCUEST trial differs between players with previous injury/pain history compared with healthy counterparts. STUDY DESIGN: Descriptive laboratory study. LEVEL OF EVIDENCE: Level 5. METHODS: Seventeen baseball pitchers were recruited to participate (18.03 ± 2.01 years; 185.40 ± 6.57 cm; 83.92 ± 13.87 kg). A medical history questionnaire was used to separate participants into groups, either previous injury/pain or healthy. Kinematic and kinetic data were collected on the participants performing the CKCUEST with an electromagnetic tracking system. Kinematics were analyzed using a pair of 1-way multivariate analyses of variance (MANOVAs). RESULTS: The MANOVA for nondominant hand touch in the CKCUEST revealed a significant difference in lumbopelvic-hip complex (LPHC) kinematics between previously injured/pain group and healthy group (Λ = 0.37; F4,12 = 5.12; P = 0.01). CONCLUSIONS: The previously injured/pain group displayed less pelvic axial rotation and dominant hip abduction during the nondominant touch indicating more LPHC stability during the nondominant touch. In conclusion, differences were observed in LPHC kinematics during the CKCUEST nondominant touch between a healthy and previously injured/pain group perhaps due to the increased awareness provided through rehabilitative programs for the previously injured/pain group. CLINICAL RELEVANCE: Clinicians can use this information to help address kinetic chain movement efficiency within baseball pitchers. This study provides evidence of LPHC kinematic differences during the nondominant touch of baseball pitchers and may enhance the use of the CKCUEST as a return-to-play assessment.

Are Core Stability Tests Related to Single Leg Squat Performance in Active Females?

Core stability (CS) deficits can have a significant impact on lower limb function. The aim of this study was to investigate the relationship between two dynamic core exercise assessments and dynamic knee valgus during single-leg squats. In total, 20 physically active female students participated in this study. The OCTOcore smartphone application assesses CS during two dynamic exercise tests, the partial range single-leg deadlift (SLD) test and the bird-dog (BD) test. A two-dimensional assessment of a single-leg squat test was used to quantify participants' hip frontal angle (HFASLS) and knee frontal plane projection angle (FPPASLS). Ankle dorsiflexion was evaluated through the weight-bearing dorsiflexion test. The correlational analyses indicated that the HFASLS was significantly related to the partial range single-leg deadlift test (r = 0.314, p < 0.05) and ankle dorsiflexion (r = 0.322, p < 0.05). The results showed a significant difference (p < 0.05) in the CS test between cases categorised as dynamic knee valgus (>10°) and normal (≤10°). The CS deficit may influence the neuromuscular control of the lumbopelvic-hip complex during single-leg movements. The link between CS and kinematic factors related to knee injuries was only observed when CS was measured in the SLD test but not in the BD test.

Relationship of pelvis and torso angular jerk to hand velocity in female softball hitting.

The purpose of this study was to determine the influence of pelvis and torso angular jerk on a performance indicator of hitting, specifically hand velocity. Eighteen softball athletes were analysed (20.3 ± 1.6 years; 164.9 ± 24.9 cm; 74.4 ± 14.0 kg). Participants were instructed to execute 3 maximum effort swings off a stationary tee at the middle "strike-zone" location. Angular jerk data were analysed during the acceleration phase of the swing, the time between foot contact and ball contact. Quadratic regression analyses were conducted to examine the relationship of minimal pelvis angular jerk and minimal torso angular jerk to angular hand velocity at ball contact. No significant relationship was found between pelvis angular jerk and angular hand velocity at ball contact (r = 0.192, p = 0.754). The curvilinear regression model for pelvis angular jerk produced: R2 = 0.037; F (2, 17) = 0.288; p = 0.754. Lack of significant findings suggests a relationship between jerk and angular hand velocity does not exist within female softball hitting. Future research should investigate the timing of minimal jerk through the acceleration phase as a predictor of angular hand velocity, rather than the value of jerk itself.

Test-retest reliability of a smartphone app for measuring core stability for two dynamic exercises.

BACKGROUND: Recently, there has been growing interest in using smartphone applications to assess gait speed and quantify isometric core stability exercise intensity. The purpose of this study was to investigate the between-session reliability and minimal detectable change of a smartphone app for two dynamic exercise tests of the lumbopelvic complex. METHODS: Thirty-three healthy young and active students (age: 22.3 ± 5.9 years, body weight: 66.9 ± 11.3 kg, height: 167.8 ± 10.3 cm) participated in this study. Intraclass correlation coefficient (ICC), coefficient of variation (%CV), and Bland-Altman plots were used to verify the reliability of the test. The standard error of measurement (SEM) and the minimum detectable difference (MDD) were calculated for clinical applicability. RESULTS: The ICCs ranged from 0.73 to 0.96, with low variation (0.9% to 4.8%) between days of assessments. The Bland-Altman plots and one-sample t-tests (p > 0.05) indicated that no dynamic exercise tests changed systematically. Our analyses showed that SEM 0.6 to 1.5 mm/s-2) and MDD (2.1 to 3.5 mm/s-2). CONCLUSION: The OCTOcore app is a reliable tool to assess core stability for two dynamic exercises. A minimal change of 3.5 mm/s-2 is needed to be confident that the change is not a measurement error between two sessions.

Using the single leg squat as an assessment of stride leg knee mechanics in adolescent baseball pitchers.

OBJECTIVES: Lack of control of the lower extremity or trunk during single leg tasks is often associated with pathomechanic adaptations during the pitching motion which may increase the risk of pain and injury to the upper extremity. The objectives of the study were to determine the amount of variability in stride knee mechanics accounted for by compensations during a common movement assessment, the single leg squat (SLS) and to establish the usefulness of SLS as a screening tool for at-risk athletes. DESIGN: Cross-sectional design. METHODS: Sixty-one adolescent baseball pitchers performed a SLS on each leg. Participants performed three fastball pitches to a catcher at a regulation distance. Kinematic data were collected at 100Hz using an electromagnetic tracking device. RESULTS: MANOVAs with follow-up one-way ANOVAs were used to examine the amount of variance in pitching knee mechanics explained by SLS compensations. At stride foot contact, there was a significant effect of SLS valgus angle on knee valgus angle (F1,51=23.16, p<0.001, ηp2=0.31) and valgus moment (F1,51=8.28, p=0.006, ηp2=0.14). At ball release (BR), there was a significant effect of SLS valgus angle on flexion angle (F1,51=9.37, p=0.004, ηp2=0.16) and valgus angle (F1,51 = 26.93, p<0.001, ηp2=0.35). Examination of the average values occurring between SFC and BR, revealed a significant effect of SLS valgus angle on knee valgus angle (F1,51=30.91, p<0.001, ηp2=0.38). CONCLUSIONS: SLS compensations are potentially a useful screening tool for stride knee mechanics in adolescent baseball pitchers.

Detection of Gluteal Changes Using Ultrasound Imaging During Phases of Gait in Individuals With Medial Knee Displacement.

Context: Medial knee displacement (MKD) is a common risk factor for lower-extremity injury and is related to altered gluteal muscle activity. Ultrasound imaging (USI) is a reliable means to explore mechanical muscle activity; however, no information exists regarding USI of the gluteals during gait in an MKD population. Objective: To determine differences in USI gluteal muscle activity during gait in individuals with and without MKD. Design: Descriptive laboratory study. Setting: University research laboratory. Participants: Out of 28 participants, 14 exhibiting MKD unilaterally during a single-leg squat (19.36 [1.51] y, 169.73 [7.50] cm, and 62.01 [10.57] kg; 10 females) and 14 matched non-MKD subjects (20.29 [1.73] y, 167.24 [9.07] cm, and 67.53 [16.03] kg). Interventions: Bilateral B-mode USI of the gluteus maximus (Gmax) and gluteus medius (Gmed) muscles during quiet stance, heel strike, and a 10-second treadmill walking clip. Main Outcome Measures: Gluteal thickness measures normalized to quiet stance yielded activity ratios, and percentage of muscle thickness change was assessed between heel strike and quiet stance. Differences between groups were assessed with Cohen's d effect sizes with 95% confidence intervals. Activity ratios with 90% confidence intervals plotted on 10% intervals from 0% to 100% of gait were used to compare groups and limbs. A subsample of images was measured to determine intertester reliability. Results: USI revealed decreased Gmax and Gmed percent change at heel strike (%change = -9.57% [7.15%] and -8.76% [4.26%], respectively). The MKD limb compared with the contralateral limb exhibited decreased Gmed activity ratio at 30% of gait (MKD = 0.89 [0.056]; non-MKD = 1.01 [.052]). Intertester reliability was excellent for gluteus maximus (intraclass correlation coefficient = .987 [.014]) and Gmed (intraclass correlation coefficient = .989 [.013]) measurements. Conclusions: USI highlighted gluteal activity differences of MKD limbs during gait, which may contribute to inadequate hip stabilization during this daily repetitive task. These findings potentiate the use of USI as an intervention- or screening-based visual tool.

Effects of Hip Abduction Fatigue on Trunk and Shoulder Kinematics During Throwing and Passive Hip Rotational Range of Motion.

Context: Hip abductor musculature contributes to the stability of the pelvis, which is needed for efficient energy transfer from the lower-extremity to the upper-extremity during overhead throwing. Objective: The purpose of this study was to examine the effects of a bilateral hip abduction fatigue protocol on overhead-throwing kinematics and passive hip range of motion. Design: Prospective cohort study. Setting: Controlled laboratory setting. Participants: A convenience sample of 19 collegiate female softball players (20.6 [1.9] y; 169.3 [9.7] cm; 73.2 [11.2] kg). Main Outcome Measures: Repeated hip abduction to fatigue was performed on an isokinetic dynamometer for 3 consecutive days. Trunk and shoulder kinematics during throwing and hip internal and external rotation range of motion were analyzed prior to fatigue on day 1 (prefatigue) and following fatigue on day 3 (postfatigue). Results: Repeated-measures analysis of variances revealed no statistically significant differences in trunk and shoulder kinematics prefatigue and postfatigue. A statistically significant time × side × direction interaction (F2,36 = 5.462, P = .02, ηp2=.233 ) was observed in hip passive range of motion. A decrease in throwing-side hip internal rotation prefatigue to postfatigue (mean difference = -2.284; 95% confidence interval, -4.302 to -0.266; P = .03) was observed. Conclusions: The hip abductor fatigue protocol used in this study did not significantly alter trunk and upper-extremity throwing kinematics. The lack of changes may indicate that fatigue of the hip abductors does not contribute to trunk and shoulder kinematics during throwing or the protocol may not have been sport-specific enough to alter kinematics.

Reliability of two functional clinical tests to evaluate trunk and lumbopelvic neuromuscular control and proprioception in a healthy population.

OBJECTIVES: The need to accurately assess trunk and lumbopelvic proprioception and neuromuscular control is widely accepted. However, based on current literature, there is a lack of reliable clinical tests to evaluate these aspects in clinical practice. The objective of this study is to investigate intra- and inter-tester reliability of the lateral step down test and the lumbopelvic position-reposition test in a healthy population. METHODS: Protocol and scoring methods were developed for the lateral step down test and lumbopelvic position-reposition test, used to assess trunk and lumbopelvic neuromuscular control and proprioception respectively. Each test was performed once by thirty participants and video analysis for test scoring was performed. Three items on the lateral step down test were scored to evaluate neuromuscular control and, four items on the lumbopelvic position-reposition test were scored to evaluate proprioception. Aggregate scores for each test were calculated based on the separate item scores. Intraclass correlation coefficients and linear weighted kappa coefficients were determined for intra- and inter-tester reliability. RESULTS: Based on the aggregate score, excellent intra- and inter-tester reliability (ICC (2,1)=0.73-0.88) was found for both tests. Moderate/almost perfect intra-and inter-tester agreement (K=0.62-0.91) was found for the separate items of the lateral step down test and fair/substantial agreement (K=0.25-0.76) for the items of the lumbopelvic position-reposition test. CONCLUSION: Current testing protocol and scoring method for the lateral step down test is reliable. Adjustments for the scoring method of the lumbopelvic position-reposition test are warranted to improve reliability.

Is core stability a risk factor for lower extremity injuries in an athletic population? A systematic review.

OBJECTIVES: To research and summarize the literature regarding the role of core stability as a risk factor in the development of lower extremity injuries in an athletic population. METHODS: Pubmed, Web of Science and Embase were searched in August 2016 to systematically review studies, which related core muscle functioning and core stability to lower extremity injuries. RESULTS: Nine articles were included in the systematic review. Various components of core stability were found to be related to lower extremity musculoskeletal injuries in healthy athletic populations. Core strength, core proprioception and neuromuscular control of the core were found to be a risk factor in the development of lower extremity injuries. However, conflicting evidence was found for core endurance as a risk factor for lower extremity injuries. CONCLUSION: This systematic review provides preliminary evidence for the association between impaired core stability and the development of lower extremity injuries in healthy athletes. Deficits in various aspects of core stability were identified as potential risk factors for lower extremity injuries. As such, core stability needs to be considered when screening athletes.

Hip and upper extremity kinematics in youth baseball pitchers.

The purpose of this study was to examine the relationship between dynamic hip rotational range of motion and upper extremity kinematics during baseball pitching. Thirty-one youth baseball pitchers (10.87 ± 0.92 years; 150.03 ± 5.48 cm; 44.83 ± 8.04 kg) participated. A strong correlation was found between stance hip rotation and scapular upward rotation at maximum shoulder external rotation (r = 0.531, P = 0.002) and at ball release (r = 0.536, P = 0.002). No statistically significant correlations were found between dynamic hip rotational range of motion and passive hip range of motion. Hip range of motion deficits can constrain pelvis rotation and limit energy generation in the lower extremities. Shoulder pathomechanics can then develop as greater responsibility is placed on the shoulder to generate the energy lost from the proximal segments, increasing risk of upper extremity injury. Additionally, it appears that passive seated measurements of hip range of motion may not accurately reflect the dynamic range of motion of the hips through the progression of the pitch cycle.

Hip range of motion and scapula position in youth baseball pitching pre and post simulated game.

Lower to upper extremity sequencing of energy and force is linked by virtue of the scapula. It was the purpose of this study to examine the relationship between passive hip rotational range of motion and scapular kinematics during baseball pitching. Nineteen youth baseball players (11.3 ± 0.6 years; 151.8 ± 8.8 cm; 45.9 ± 10.9 kg) with no history of injury participated. Bilateral hip passive rotational range of motion was measured pre and post pitching a simulated game. Scapular kinematics at the position of shoulder maximum external rotation during the pitching cycle were recorded in the first and last innings of the simulated game. Post simulated game, stance leg hip passive internal rotation revealed significant correlations (r = -0.57, P = 0.01) with scapula anterior/posterior tilt at the pitching event of maximum humeral external rotation. The current study reveals that pitching a simulated game results in alterations throughout the kinetic chain. Specifically, this study strengthens the notion that lumbopelvic-hip complex parameters play a significant role in shoulder motion. With this link identified, it is suggested that clinical focus be directed musculature about the lumbopelvic-hip complex as well as muscles that work to stabilise the scapula during dynamic movement.