Throwing injuries: Biomechanics and mechanism of injury
- Craig Young, MD
Craig Young, MD
- Professor of Orthopaedic Surgery and Family and Community Medicine
- Medical College of Wisconsin
- Section Editors
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Joseph Chorley, MD
Joseph Chorley, MD
- Section Editor — Pediatric Sports Medicine; Adolescent Sports Medicine
- Associate Professor of Pediatrics, Adolescent Medicine, and Sports Medicine
- Baylor College of Medicine
Millions of people throughout the world participate in sports that involve throwing or throwing-like movements. These movements range from classic ball throwing, as performed by baseball pitchers or cricket bowlers, to throwing implements other than balls, such as a javelin, to throwing-like actions that do not involve a ball directly, such as a tennis serve. All such movements involve complex biomechanics and great stresses being placed on the musculoskeletal system. Improper biomechanics, excessive stress beyond the capacity of an individual’s musculoskeletal system, or cumulative trauma from throwing too frequently can cause injury.
This topic will review the biomechanics of throwing and the relationship of these biomechanics to common throwing-related injuries. The clinical presentation and diagnosis of specific injuries are discussed separately. (See "Throwing injuries of the upper extremity: Clinical presentation and diagnostic approach".)
EPIDEMIOLOGY AND RISK FACTORS
While the prototypical throwing athlete in the United States is a baseball player, many athletes use similar motions, including softball players, American football quarterbacks, javelin throwers, cricket bowlers, and water polo players. In addition, athletes involved in sports with repetitive overhead motions such as swimming, tennis, and volleyball often suffer similar injuries.
Based on 2009 census data, it is estimated that there are approximately 11.8 million softball players, 11.5 million baseball players, 10.8 million tennis players, 10.7 volleyball players, and over 50 million swimmers in the United States alone. At the high-school level, 2012 data from the United States National Federation of High School Sports report that there are over 475,000 baseball players, 380,000 softball players, 340,000 tennis players, and 90,000 tennis players, and almost 19,000 water polo players.
Upper extremity injuries are common in the overhead athlete and account for 75 percent of the time missed from sport among collegiate baseball players . A cohort study with 10-year follow-up of 481 youth pitchers revealed that 5 percent experienced serious injury (defined as injury requiring elbow or shoulder surgery or retirement from pitching) over that time . Most of these upper extremity injuries are caused by overuse. Risk factors among baseball players include position (pitchers and catchers are at greatest risk), high number of pitches per game (ie, high pitch counts), high number of innings pitched, higher pitch velocity (pitchers who throw harder are at greater risk of injury), year-round play, and inadequate recovery time between throwing sessions (games or practice) [1-8]. Year-round play in particular is thought to the increase the injury rate among youth baseball pitchers [5,6,9].
- McFarland EG, Wasik M. Epidemiology of collegiate baseball injuries. Clin J Sport Med 1998; 8:10.
- Fleisig GS, Andrews JR, Cutter GR, et al. Risk of serious injury for young baseball pitchers: a 10-year prospective study. Am J Sports Med 2011; 39:253.
- Lyman S, Fleisig GS, Andrews JR, Osinski ED. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med 2002; 30:463.
- Lyman S, Fleisig GS, Waterbor JW, et al. Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc 2001; 33:1803.
- Parks ED, Ray TR. Prevention of overuse injuries in young baseball pitchers. Sports Health 2009; 1:514.
- Petty DH, Andrews JR, Fleisig GS, Cain EL. Ulnar collateral ligament reconstruction in high school baseball players: clinical results and injury risk factors. Am J Sports Med 2004; 32:1158.
- Dennis RJ, Finch CF, Farhart PJ. Is bowling workload a risk factor for injury to Australian junior cricket fast bowlers? Br J Sports Med 2005; 39:843.
- Krajnik S, Fogarty KJ, Yard EE, Comstock RD. Shoulder injuries in US high school baseball and softball athletes, 2005-2008. Pediatrics 2010; 125:497.
- Olsen SJ 2nd, Fleisig GS, Dun S, et al. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med 2006; 34:905.
- Ranson C, Hurley R, Rugless L, et al. International cricket injury surveillance: a report of five teams competing in the ICC Cricket World Cup 2011. Br J Sports Med 2013; 47:637.
- Orchard J, Farhart P, Kountouris A, et al. Pace bowlers in cricket with history of lumbar stress fracture have increased risk of lower limb muscle strains, particularly calf strains. Open Access J Sports Med 2010; 1:177.
- Mansingh A, Harper L, Headley S, et al. Injuries in West Indies cricket 2003-2004. Br J Sports Med 2006; 40:119.
- Orchard J, James T, Alcott E, et al. Injuries in Australian cricket at first class level 1995/1996 to 2000/2001. Br J Sports Med 2002; 36:270.
- Lynch JR, Waitayawinyu T, Hanel DP, Trumble TE. Medial collateral ligament injury in the overhand-throwing athlete. J Hand Surg Am 2008; 33:430.
- Gregory B, Nyland J. Medial elbow injury in young throwing athletes. Muscles Ligaments Tendons J 2013; 3:91.
- Abrams GD, Renstrom PA, Safran MR. Epidemiology of musculoskeletal injury in the tennis player. Br J Sports Med 2012; 46:492.
- Agel J, Palmieri-Smith RM, Dick R, et al. Descriptive epidemiology of collegiate women's volleyball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train 2007; 42:295.
- Hangai M, Kaneoka K, Hinotsu S, et al. Lumbar intervertebral disk degeneration in athletes. Am J Sports Med 2009; 37:149.
- Ladenhauf HN, Fabricant PD, Grossman E, et al. Athletic participation in children with symptomatic spondylolysis in the New York area. Med Sci Sports Exerc 2013; 45:1971.
- Maquirriain J, Ghisi JP, Kokalj AM. Rectus abdominis muscle strains in tennis players. Br J Sports Med 2007; 41:842.
- Webster MJ, Morris ME, Galna B. Shoulder pain in water polo: a systematic review of the literature. J Sci Med Sport 2009; 12:3.
- Fleisig GS, Barrentine SW, Escamilla RF, Andrews JR. Biomechanics of overhand throwing with implications for injuries. Sports Med 1996; 21:421.
- Hurd WJ, Kaplan KM, ElAttrache NS, et al. A profile of glenohumeral internal and external rotation motion in the uninjured high school baseball pitcher, part II: strength. J Athl Train 2011; 46:289.
- Wilk KE, Macrina LC, Arrigo C. Passive range of motion characteristics in the overhead baseball pitcher and their implications for rehabilitation. Clin Orthop Relat Res 2012; 470:1586.
- Zheng N, Eaton K. Shoulder rotational properties of throwing athletes. Int J Sports Med 2012; 33:463.
- Dwelly PM, Tripp BL, Tripp PA, et al. Glenohumeral rotational range of motion in collegiate overhead-throwing athletes during an athletic season. J Athl Train 2009; 44:611.
- Thomas SJ, Swanik KA, Swanik C, et al. Change in glenohumeral rotation and scapular position after competitive high school baseball. J Sport Rehabil 2010; 19:125.
- Wyland DJ, Pill SG, Shanley E, et al. Bony adaptation of the proximal humerus and glenoid correlate within the throwing shoulder of professional baseball pitchers. Am J Sports Med 2012; 40:1858.
- Sundaram B, Skn B, Karuppannan S. Glenohumeral rotational range of motion differences between fast bowlers and spin bowlers in elite cricketers. Int J Sports Phys Ther 2012; 7:576.
- Kurtz CA, Humble BJ, Rodosky MW, Sekiya JK. Symptomatic os acromiale. J Am Acad Orthop Surg 2006; 14:12.
- Frizziero A, Benedetti MG, Creta D, et al. Painful os Acromiale: Conservative Management in a Young Swimmer Athlete. J Sports Sci Med 2012; 11:352.
- Morrey BF, An KN. Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med 1983; 11:315.
- Morrey BF, Tanaka S, An KN. Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Relat Res 1991; :187.
- Safran M, Ahmad CS, Elattrache NS. Ulnar collateral ligament of the elbow. Arthroscopy 2005; 21:1381.
- Park MC, Ahmad CS. Dynamic contributions of the flexor-pronator mass to elbow valgus stability. J Bone Joint Surg Am 2004; 86-A:2268.
- Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Med 2006; 36:189.
- Kibler WB, Wilkes T, Sciascia A. Mechanics and pathomechanics in the overhead athlete. Clin Sports Med 2013; 32:637.
- Kibler WB, Ludewig PM, McClure PW, et al. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the 'Scapular Summit'. Br J Sports Med 2013; 47:877.
- Jenkins DB. Hollinshead's Functional Anatomy of the Limbs and Back, WB Saunders, Philadelphia 1991.
- Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF. Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med 1995; 23:233.
- Raasch WG. Baseball. In: Netter’s Sports Medicine, Madden CC, Putukian M, Young CC, McCarty EC (Eds), Saunders, Philadelphia 2010. p.546.
- Whiteley R. Baseball throwing mechanics as they relate to pathology and performance - a review. J Sports Sci Med 2007; 6:1.
- Fleisig GS, Barrentine SW, Zheng N, et al. Kinematic and kinetic comparison of baseball pitching among various levels of development. J Biomech 1999; 32:1371.
- Sabick MB, Torry MR, Lawton RL, Hawkins RJ. Valgus torque in youth baseball pitchers: A biomechanical study. J Shoulder Elbow Surg 2004; 13:349.
- Werner SL, Fleisig GS, Dillman CJ, Andrews JR. Biomechanics of the elbow during baseball pitching. J Orthop Sports Phys Ther 1993; 17:274.
- Escamilla RF, Andrews JR. Shoulder muscle recruitment patterns and related biomechanics during upper extremity sports. Sports Med 2009; 39:569.
- Dun S, Kingsley D, Fleisig GS, et al. Biomechanical comparison of the fastball from wind-up and the fastball from stretch in professional baseball pitchers. Am J Sports Med 2008; 36:137.
- Fleisig GS, Kingsley DS, Loftice JW, et al. Kinetic comparison among the fastball, curveball, change-up, and slider in collegiate baseball pitchers. Am J Sports Med 2006; 34:423.
- Barrentine SW, Fleisig GS, Whiteside JA, et al. Biomechanics of windmill softball pitching with implications about injury mechanisms at the shoulder and elbow. J Orthop Sports Phys Ther 1998; 28:405.
- Werner SL, Guido JA, McNeice RP, et al. Biomechanics of youth windmill softball pitching. Am J Sports Med 2005; 33:552.
- Bartlett RM, Stockill NP, Elliott BC, Burnett AF. The biomechanics of fast bowling in men's cricket: a review. J Sports Sci 1996; 14:403.
- Hussain I, Bari MA. Mechanical analysis of overhead throwing in cricket. Int J Sports Sci Eng 2011; 5:163. http://www.worldacademicunion.com/journal/SSCI/SSCIvol05no03paper05.pdf (Accessed on July 29, 2014).
- Finch CF, Elliott BC, McGrath AC. Measures to prevent cricket injuries: an overview. Sports Med 1999; 28:263.
- Wheeler K, Kefford T, Mosler A, et al. The volume of goal shooting during training can predict shoulder soreness in elite female water polo players. J Sci Med Sport 2013; 16:255.
- Colville JM, Markman BS. Competitive water polo. Upper extremity injuries. Clin Sports Med 1999; 18:305.
- Fleisig G, Nicholls R, Elliott B, Escamilla R. Kinematics used by world class tennis players to produce high-velocity serves. Sports Biomech 2003; 2:51.
- Lintner D, Noonan TJ, Kibler WB. Injury patterns and biomechanics of the athlete's shoulder. Clin Sports Med 2008; 27:527.
- Guidelines for youth and adolescent pitchers. http://m.mlb.com/pitchsmart/pitching-guidelines/ (Accessed on April 07, 2015).
- Thomas SJ, Swanik CB, Kaminski TW, et al. Humeral retroversion and its association with posterior capsule thickness in collegiate baseball players. J Shoulder Elbow Surg 2012; 21:910.
- Myers JB, Oyama S, Rucinski TJ, Creighton RA. Humeral retrotorsion in collegiate baseball pitchers with throwing-related upper extremity injury history. Sports Health 2011; 3:383.
- Popchak A, Burnett T, Weber N, Boninger M. Factors related to injury in youth and adolescent baseball pitching, with an eye toward prevention. Am J Phys Med Rehabil 2015; 94:395.
- EPIDEMIOLOGY AND RISK FACTORS
- CLINICAL ANATOMY
- BIOMECHANICS OF THROWING AND RELATED RISK OF INJURY
- Overview and images
- Windup phase
- Stride (early cocking) phase
- Cocking phase
- Acceleration phase
- Deceleration phase
- Follow-through phase
- BIOMECHANICAL VARIATIONS BY SPORT
- Baseball pitchers
- Baseball fielders
- Softball pitchers
- American football
- - Run-up phase
- - Delivery stride phase
- - Ball release phase
- - Follow-through phase
- Water polo
- YOUTH THROWING ATHLETES