Abstract

Objectives: The persistent high rates of elbow injuries among professional baseball pitchers indicates a critical gap in our understanding of how a pitch influences load on the elbow. Traditionally, research has examined the maximum value of various kinetics experienced at the throwing arm during a pitch, especially elbow varus torque. The maximum elbow varus torque has been used as a surrogate for potential elbow injury; however, the elbow injury epidemic has still persisted. It is possible that analysis focused on only the maximum value misses the total load experienced on the throwing arm. Therefore, the purpose of this study was to investigate different metrics to evaluate elbow stress, including maximum elbow varus torque, elbow loading rate, and cumulative varus torque between different pitch types. By evaluating these aspects of elbow stress, our study aims to uncover previously overlooked kinetic variables that might be potential contributors to elbow injuries, bridging the gap between existing kinetic analyses and the persistent high injury rates. Methods: Data from a cohort of 41 professional baseball pitchers were utilized for this analysis (188 ± 6 cm; 91.9 ± 8.2 kg). Pitchers threw a series of fastball, changeup, and curveball pitches (fastball: 10 ± 3 pitches, changeup: 3 ± 1 pitches, curveball: 4 ± 1 pitches) captured using a 3D motion capture system (480 Hz). Kinetic variables were calculated for each pitch, including maximum elbow varus torque, loading torque rate (measured as the derivative of the varus torque curve), and cumulative elbow varus torque (measured as the area under the elbow varus torque curve). A linear mixed effects model was employed to examine within player associations between pitch type and ball velocity, maximum elbow varus torque, loading torque rate, and cumulative elbow varus torque. Statistical significance was set at p<0.01. Results: Our findings reveal that the fastball pitch created greater loading on the elbow compared to the change up and curveball pitches (Table 1). Pitchers threw their fastball with increased ball velocity (40.3 ± 0.6 m/s) compared to throwing their changeup (36.6 ± 0.5 m/s) and curveball (33.7±0.5 m/s) (p<0.001). Maximum elbow varus torque was also greater in the fastball pitch (93.7 ± 3.3 N∙m) compared to the changeup pitch (84.1 ± 2.4 N∙m) and curveball (91.0 ± 2.3 N∙m) (p<0.001); the curveball pitch had greater maximum torque compared to changeup pitches (p<0.001). The loading rate was 15% lower for the changeup pitch (690.0 ± 49.4 N∙m/s) (p<0.001) and 6% lower for the curveball (753.6 ± 60.3 N∙m/s) compared to the fastball (820.1 ± 72.2 N∙m/s) (p<0.001). The cumulative elbow varus torque for the fastball was 4% greater than the changeup pitch (2996.9 ± 92.9 vs 2894.1 ± 84.1 N∙m) and 7% greater than the curveball pitch (2996.9 ± 92.9 vs 2797.2 ± 85.8 N∙m) (p<0.001). Conclusions: This study reveals the importance of considering pitch type when evaluating kinetic variables in professional baseball pitchers. The observed differences in elbow varus torque, loading rate, and other kinematic metrics between fastball, changeup, and curveball pitches highlights the need for a comprehensive understanding of biomechanical variations associated with different pitch types. These findings have implications for optimizing pitcher training programs, injury prevention strategies, and player management. By unraveling the intricate connections between kinetic variables and pitch types, this research contributes to advancing the biomechanical knowledge within the field of orthopedics and sports science.

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