Recent biomechanical evidence suggests that shoulder impingement syndrome (SIS) is closely linked with altered core-shoulder kinetic chain, resulting pain, altered external shoulder muscle activation, and external muscle weakness. We aimed to compare the effects of conventional isolated shoulder exercise (ISE) and core-shoulder chain exercises (CCE) during isokinetic shoulder rotation in baseball pitchers with SIS. Forty male college baseball pitchers with SIS were randomly allocated to ISE and CCE groups and they performed the exercises 3 times a week for 6 weeks. The standardised numerical pain rating scale (NPRS), shoulder pain and disability index (SPADI), electromyography (EMG) amplitude, and concentric (CON) and eccentric (ECC) torques were measured. Substantial improvements in NPRS and SPADI scores were observed after CCE compared to ISE (p ≤ 0.046). Internal oblique/transversus abdominis, rectus abdominis, external oblique, serratus anterior, and infraspinatus muscle activation were significantly higher after CCE than ISE (p ≤ 0.033). CON and ECC torques were higher after CCE than ISE (p ≤ 0.002). The present findings demonstrated superior therapeutic effects of CCE in improving pain, disability level, shoulder muscle activation, and torque (muscle strength) in baseball pitchers with SIS compared to the conventional ISE, highlighting the importance of the chain exercise concept.

Mindfulness-related practices (e.g., yoga) appear aligned with the field of athletic performance in developing sport-related capacities such as attention regulation, volition, perception, and coping. The purpose of the present narrative study was to explore the experiences of professional baseball players who interacted with the ideas and practices of mindfulness presented in classes featuring yoga and Mindfulness-Acceptance-Commitment (MAC). Participants were seven Minor League Baseball players who learned mindfulness practices in off-season instructional classes and then completed semi-structured episodic interviews on how their mindfulness practices were perceived and utilized in training and competition during the baseball season. Data were analyzed using the three-dimensional space approach to examine participants\' subjective accounts of experience, behavior, environmental conditions, and external events. Individual narratives were re-storied and themed. Results indicated various themes across settings, from players\' experiences in the yoga/MAC classes (effect of breath regulation on coping strategies; self-awareness and the mind-body connection), on the baseball field (confidence and self-efficacy; self-regulation; resilience and positive coping strategies), and off the baseball field (everyday life and activities; stigma of mental training). Overall, participants appeared to be accepting of mindfulness integrated into their training and provided perspectives supporting the benefits of yoga/MAC classes. This study has research and practice implications in incorporating yoga and mindfulness-based practices in athletic performance among young professional athletes.

BACKGROUND: The forearm flexor-pronator muscles act as a dynamic elbow stabilizer against elbow valgus load during baseball pitching. The elasticity of these muscles increases with pitching. However, it is unclear whether increased muscle elasticity is associated with greater elbow valgus torque during pitching. This study aimed to determine the relationship between the elasticity of the forearm flexor-pronator muscles and elbow valgus torque during pitching in young baseball pitchers.
METHODS: We recruited 124 young baseball pitchers aged 9 to 12 years. The exclusion criteria included current pain with pitching, history of surgery on the tested extremity, or injuries on the tested extremity within the past 12 months. Before the examination, participants completed a questionnaire about their age, height, weight, dominant arm, and practice time per week. The strain ratios of flexor carpi ulnaris (FCU), flexor digitorum superficialis (FDS), and pronator teres as the index of muscle elasticity were measured using ultrasound strain elastography. Participants pitched 3 fastballs at a distance of 16 m (52 ft 6 in) with maximum effort while wearing a sensor sleeve that recorded the elbow valgus torque. A multiple linear regression analysis was conducted to examine the association between muscle elasticity and elbow valgus torque, adjusting for age, height, weight, and practice time.
RESULTS: The final analysis included 107 pitchers. After adjusting for covariates, increased strain ratio of the FCU was significantly associated with greater elbow valgus torque (coefficients = 0.038, 95% confidence interval, 0.016-0.059, P < .001). Similarly, increased strain ratio of the FDS was significantly associated with greater elbow valgus torque (coefficients = 0.027, 95% confidence interval, 0.013-0.042, P < .001).
CONCLUSIONS: The high elasticities of the FCU and FDS were associated with greater elbow valgus torque during pitching in young baseball pitchers. The high elasticity of these muscles is a protective response and may be necessary for young baseball pitchers with greater elbow valgus torque during pitching. Among young baseball pitchers with greater elbow valgus torque, those who are unable to produce the higher elasticities of these muscles could have greater elbow valgus load during pitching and be at a higher risk for elbow injuries. The measurement of the elasticities of the FCU and FDS may be useful for identifying young baseball pitchers at risk of sustaining elbow injuries.

UNASSIGNED: Tremblay, M, Anderson Sirois, S, Verville, W, Auger, M, Abboud, J, and Descarreaux, M. Acute upper-body and lower-body neuromuscular fatigue effect on baseball pitchers\' velocity: A pilot study. J Strength Cond Res 38(8): 1447-1452, 2024-The purpose of this pilot study was to explore the acute effect of upper-body and lower-body neuromuscular fatigue protocols on baseball pitchers\' velocity. Sixteen baseball pitchers were recruited, and a crossover design was used to meet the study purpose. Pitchers were tested twice, 7 days apart, with their upper-body and lower-body explosiveness, pitching velocity, and muscle soreness perception of their throwing arm (forearm flexors, biceps, anterior deltoid, and upper trapezius muscles) assessed before and after an upper-body and lower-body neuromuscular fatigue protocol. Two-way analysis of variances and paired t tests ( p < 0.05) were used to identify and compare prescores and postscores. Following both fatigue protocols, results revealed a significant decrease in time for pitching velocity ( p = 0.005, ηp 2 = 0.462), and increases in muscle soreness perception of the forearm flexors ( p = 0.005, ηp 2 = 0.470), anterior deltoid ( p = 0.045, ηp 2 = 0.274), and upper trapezius ( p = 0.023, ηp 2 = 0.339) muscles. Paired t test results showed a significant decrease in preneuromuscular and postneuromuscular fatigue protocol in the upper-body ( p < 0.01) and lower-body ( p < 0.01) explosiveness scores. These pilot study results show the impact of different exercise protocols on pitchers\' explosiveness, velocity, and muscle soreness perception emphasizing the need for further investigation into the acute effect of exercise targeting the upper or lower-body on pitching performance, specifically at the pitcher\'s position.

Prevalence of impaired foot function among baseball players with and without a disabled throwing shoulder/elbow was investigated. The study included 138 male players. Players who had previously complained of shoulder/elbow pain during throwing motion were defined as the players with a history, and those who experienced shoulder/elbow pain during the examination were defined as having the injury. Foot function was evaluated by foot \"rock paper scissors\" movements and floating toes. Their prevalence was assessed and the relationships between players with and without the injuries were statistically analyzed. The prevalence of players with a history and injury was 27% and 7%, respectively. The prevalence of impaired foot function on the non-throwing side among players with injury was significantly higher than those without (60% vs. 28%, P < 0.001) and higher tendency on the throwing side than those without (60% vs. 32%). Regarding floating toes, players with a relevant history showed a significantly higher prevalence on the throwing side than those without (49% vs 28%, P < 0.001) and higher tendency on the non-throwing side than those without (49% vs 32%). Players with disabled throwing shoulder/elbow have a significantly higher prevalence of impaired foot function and floating toes than players without it.

BACKGROUND: Baseball pitching requires fast and coordinated motions of the whole body to reach high ball speeds, putting considerable strain on the musculoskeletal system, particularly the shoulder and elbow.
METHODS: Descriptive epidemiology study.
OBJECTIVE: To describe musculoskeletal symptoms and the functional status of the shoulder and elbow in male high school baseball pitchers.
METHODS: Dutch baseball talent academies.
METHODS: 125 male high school baseball pitchers aged 12 to 18 years, who participated in one of the six Dutch baseball talent academies and the Dutch National U-18 team were recruited and enrolled.
METHODS: Musculoskeletal symptoms, functional status of the shoulder and elbow were registered for each player every six months over two consecutive baseball seasons through self-assessment questionnaires, including the Kerlan-Jobe Orthopaedic Clinic (KJOC) and the Western Ontario Shoulder Instability Index (WOSI) questionnaires.
RESULTS: 570 musculoskeletal (MSS) symptoms in 93 of the 125 players were reported. The average six-month prevalence for symptoms of the throwing shoulder was 37% (95% CI: 33% - 41%), and for the elbow 37% (95% CI: 31% - 42%), followed by the lower back with 36% (95% CI: 26% - 45%). The baseball pitchers who experienced only shoulder symptoms had an average KJOC score of 80.0 (95% CI: 75.3-84.7) points, while those with only elbow symptoms reported a score of 90.2 (95% CI: 89.2-95.3). On the WOSI questionnaire, baseball pitchers scored an average of 421.2 (95% CI: 200.1 - 642.4) points.
CONCLUSIONS: In a cohort of Dutch high school baseball pitchers, one-third reported shoulder and elbow symptoms on the throwing side, with reduced functional status and lower back symptoms. Future efforts should focus on developing preventive strategies through early symptom detection, aiming to prevent symptom progression and, ultimately, the development of severe injuries.

UNASSIGNED: This study evaluated treatment modality (surgical vs nonoperative) of medial ulnar collateral ligament (UCL) injuries in nonprofessional throwing baseball athletes by comparing type, severity, and location of UCL injury.
UNASSIGNED: Baseball players with closed medial epicondyle physes and concomitant throwing-related UCL injury will be more likely to undergo surgical intervention than players with open medial epicondyle physes.
UNASSIGNED: Retrospective.
UNASSIGNED: Level 5.
UNASSIGNED: A total of 119 baseball players with a mean age of 16.9 ± 2.5 years (range, 11-25 years) were included in the study. Datapoints included sex, age at time of injury, severity, and location of UCL injury, growth plate status, operative versus conservative management, and concomitant flexor forearm injury.
UNASSIGNED: A total of 75 players were treated conservatively; 43 underwent UCL reconstruction (UCL-R), and 1 had an unknown treatment outcome. No significant difference was found for age related to treatment type, UCL-R (17.2 ± 2.2) versus conservative treatment (16.8 ± 2.6). Athletes with closed medial epicondylar growth plates were more likely to undergo UCL-R than athletes with open medial epicondylar growth plates (P = 0.02). There were no significant differences between UCL injury location (42 distal, 37 proximal, 18 combined tear locations, 11 complete tears, and 11 intact UCLs with inflammation) by treatment type (P = 0.09). There was a significant difference for UCL severity (11 complete tears, 96 partial tears) by treatment type (P = 0.03).
UNASSIGNED: Nonprofessional athletes with closed medial epicondylar growth plates and throwing-related UCL injuries were more likely to be treated surgically. Baseball athletes with partial tears, if skeletally immature, require further long-term evaluation.
UNASSIGNED: Continued knowledge gains in this area of throwing medicine will further improve our treatment algorithms in nonprofessional baseball players.

UNASSIGNED: Many studies have described hamate hook fractures resulting from direct force from sporting tools. However, several authors have reported fractures that did not occur during swing-related activities. This study aimed to understand the injury mechanism of fractures by investigating their morphologies.
UNASSIGNED: We selected patients with hamate hook fractures and collected data on computed tomography scans, injury causes, and how athletes handled sporting tools.
UNASSIGNED: We investigated 50 patients, and the study cohort included 32 patients who sustained injuries during sports: 24 during baseball (group A) and 8 during other sports (group B). Sixteen patients sustained injuries from falls (group C), and 2 had their hands crushed while using an industrial press machine (group D). In group A, most patients had a fracture line starting from the middle section of the radial side, accompanied by osteosclerotic changes in their lower hand. In group B, most patients had fracture morphologies similar to those of most patients in group A. The main morphology of fractures in group C was a transverse fracture at the base. Two patients in group D had minimal fragments at the tip of the hooks.
UNASSIGNED: Our results question the theory that most hamate hook fractures in athletes are caused by direct force exerted on the palm because the fracture morphology was different from that of patients injured by acute trauma from direct force. Instead, these fractures likely stem from an indirect mechanism involving repetitive force generated by the tendons and muscles acting on the hook.

UNASSIGNED: Injuries to the medial ulnar collateral ligament (UCL) are common among baseball pitchers due to repetitive stress on the soft tissue stabilizers of the elbow during pitching. Dynamic stress ultrasound (SUS) can be used to evaluate the UCL and ulnohumeral joint to identify anatomic risk factors of those who will require UCL reconstruction (UCLR).
UNASSIGNED: To determine whether any adaptive or morphological changes detectable on SUS can predict injury to the UCL in professional baseball pitchers.
UNASSIGNED: Cohort study; Level of evidence, 3.
UNASSIGNED: A total of 203 professional baseball pitchers who underwent SUS at preseason training sessions over the course of 18 years were categorized into 1 of 2 groups: those without a history of shoulder, arm, elbow, or forearm surgery or injuries (healthy cohort; n = 184) and those who underwent UCLR the same season as SUS (UCLR cohort; n = 19). Ligament thickness, joint spacing, and laxity were compared. An additional matched cohort analysis was conducted using 10 players from each group to detect differences in the progression of UCL and ulnohumeral joint measures in the year before injury.
UNASSIGNED: The UCLR cohort, when compared with the healthy cohort, had higher relative (ie, nondominant-side measurements subtracted from dominant-side measurements) resting ulnohumeral joint space (median, 0.50 vs 0.20 mm, respectively; P = .006) and higher rates of hypoechoic foci (57.9% vs 30.4%, respectively; P = .030). Players of both groups had similar dominant UCL thickness (P = .161), ulnohumeral joint space at rest (P = .321), space under stress (P = .498), and laxity (P = .796). Groups did not differ in terms of relative UCL thickness, ulnohumeral joint space under stress, or relative laxity. In the year before UCL injury, the UCLR cohort, compared with the matched healthy cohort, had a greater increase in mean dominant UCL thickness (0.94 vs -0.60 mm, respectively; P = .038) and a greater increase in relative median UCL thickness (1.35 vs -0.35 mm, respectively; P = .045). Players in the healthy cohort were statistically older than those in the UCLR cohort (23 vs 22 years, respectively; P = .004). No differences in ulnohumeral stress spacing or laxity were detected.
UNASSIGNED: SUS of players who underwent UCLR demonstrated a progressive increase in UCL thickness over 1 year, higher rates of hypoechoic foci, and increased ulnohumeral rest space compared with SUS of uninjured players.

This functional magnetic resonance imaging study delves into the impact of experience and pitcher handedness on the pitch-calling behavior of baseball umpires. Expert and intermediate umpires were asked to make ball/strike calls on videotaped pitches of left- and right-handed pitchers and rate their certainty for the call while undergoing scanning. Behavioral results replicated previous findings that expert umpires were more certain but not more accurate or quicker than intermediate umpires, suggesting that, as sports officials, umpires may learn to project confidence to maintain control of the game. At the neural level, expert umpires exhibited more extensive and pronounced activations within the action observation network, dorsal striatum, and cerebellum. These heightened neural responses were probably associated with their enhanced visual processing abilities for pitching action and ball trajectory, honed over years of officiating. Notably, both expert and intermediate umpires exhibited decreased accuracy when judging pitches from left-handed pitchers compared to right-handed ones. These challenges in accuracy corresponded with weaker neural activations in the aforementioned brain regions, implying difficulties in processing specific visual details of the rarely encountered left-handed pitchers. Moreover, slightly longer reaction times and reduced uncertainty were observed particularly for left-handed ball pitches, as revealed by lower activation in the right premotor cortex, highlighting issues with predictive processing. In summary, our findings shed light on the influence of pitcher handedness on the pitch-calling behavior of baseball umpires and extend the current understanding of the perceptual and decision-making behavior of sports officials.