How to Predict Baseball Shoulder Injuries | EBC Podcast Ep. 388

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with more research. A study that was shared to me by my friends over at jtech and it is all around preseason shoulder strength measurements in professional baseball pitchers identifying players at risk for injury. This was a really cool study and if you fancy yourself a sports chiropractor, there is a lot of take home messages from this study that in my opinion can be applied across young athletes, college athletes, high school athletes. And this study was devised of course, by and from pro athletes. A lot of great information. We're going to dive into it and more on today's episode. Before we get started, I want to say a few words about Patient Pilot by the smart chiropractor. Patient Pilot is the number one reactivation automation software within Chiropractic we for every 100 email list subscribers, our average doc has two plus click to call and click to schedule reactivations each and every month. The money is in your list. If you have an email list of more than three or 400 people and you're not doing anything with it or you're touching it every now and again, you're just leaving sheer opportunity on the table. Let us help you schedule a demo over at thesmartchiropractor.com again, that is thesmartchiropractor.com, schedule a demo. Click the link down in the show notes and get hooked up so you can start generating consistent reactivations. Because if your net new patients plus reactivations exceeds your inactivations each month, you have an infinitely sustainable practice. As my friend Dr. Steven Fransen says, and I could not agree more. But on today's episode we're talking research again. This study came out a little while back and I am gonna drop a link down in the show notes so you can access it if you so choose. It was in the American Journal of Sports Medicine. I'll repeat the title one more time as well. Preseason shoulder strength measurements in professional baseball pitchers identifying players at risk for injury. Talk about an important study. I mean, I look at baseball salaries and I literally scratch my head. I've never heard of these people and they're making tens if not hundreds of millions of dollars and good for them. But there's a lot of money line at the highest level now. It's almost impossible to go to the highest level and but if you do make it there, there is in our rewards and those rewards are vast. That means people are invested in These athletes performing and their ability to perform not only directly correlates with their ability to earn, but it also really is the life cycle of their career. If somebody is injured, especially a baseball pitcher that gets injured, this can become a really devastating aspect to their career. It can become a bad investment from a business point of view, from the team's perspective. So anything possible to be able to predictively assess whether or not somebody might be at risk for injury is of excessively high value. Again, an injury to professional athlete, it doesn't only affect the player, it can really affect the team. It can affect the, the fan base, it could affect profitability and the entire outcome of a season. You know, in many cases, and we've seen this across many sports and baseball pitchers are a really, really key component. I think of it like a quarterback on a team. It's really difficult, it's practically impossible to be a great professional baseball team without having great pitching. So there's an inordinate amount of leverage, so to speak, that a pitcher has on, on that team. They, it's, it's a big deal. In a team focused game, the pitcher is quite frankly going to be the most important individual relative to whether the team succeeds or not. So keeping that person on the mound and uninjured, super, super important. Previous investigations have shown that throwing mechanism does place a considerable stress on the glenohumeral and elbow joint. All you have to do is look at a throwing motion in slow motion and you're like, I didn't know an arm could bend that way. There is unquestionably a ridiculous amount of stress and strain that happens, which is why there are so many injuries. Now compressive forces occur at the glenohumeral joint. There's internal rotation, torque, horizontal abduction torque and elbow varus torque. Have all, all of those motions or stresses have been identified as possible sources of overuse injuries in the shoulder and elbow. The lower extremities also play a really, really big role. Strength and conditioning in the lower extremity and that transfer of energy, we see this with Onbase U, which is the baseball version of tpi. Great, great program out there headed up by Greg Rose. But the lower extremity, strength and conditioning, transferring of torque, transferring of power. Think about just the size of a quad compared to an arm in most cases, most of the time the power delivered to the upper extremity and the sort of the whipping motion that transfer, the physics of that create, create an unbelievable amount of stress and strain at pretty much what I'm going to call the most unstable joint in the body, which is the shoulder. So this is a really, really big deal. And it ties directly, of course, into a pitcher's ability to do their job, which is to create as much torque as possible to throw the ball with a velocity that's as high as possible, while creating torsional motions in many cases to throw a specific pitch, a curveball splitter, et cetera. So the ability to identify players who are more likely to be injured over course of a season is of extreme value to the players, to the trainers, to the teams themselves. And the purpose of this study was to analyze the predictive value of preseason shoulder strength measurements to see how that impacted, if at all, the rate of injury during the season. So over a five year period between 2001 and 2005, 144 major and minor league baseball pitchers were, they participated in this. And preseason strength testing was performed between February and March and spring training. Over those five years, 207 total players and data points were collected. Excuse me, let me rephrase that.207 total distinct player and season data points were collected from 144 total players. Pitchers were not excluded. Again, pitchers were not excluded for prior injury or surgery. So this was active players. Right. It didn't matter if they had a previous injury or surgery. All strength measurements were taken in an isometric manner according to a specific protocol. And there were a couple things that they measured. Strength was assessed using jtech devices in the throwing arm for prone internal rotation, prone external rotation, seated external rotation, and suprasprinatus strength. So all of that is what was measured to analyze. Okay, Is there any correlation causation? Are there any variables that we can isolate in terms of strength relative to injury? So these patients or pitchers were subsequently followed during the course of the seasons for any occurrences of a throwing related injury. They sort of bracketed these in terms of zero, no injury. Number one was an injury not requiring surgery or number two was injury requiring surgery. So they split it up into those three camps. And an injury was defined very, very specifically. It was an athlete that had to go onto the disabled list or missed at least one game because of that condition. So really, really specific criteria there. And a throwing related injury was defined as any condition that could be linked to the kinematic chain or kinetic chain of the throwing motion. So very, very specific in terms of what they were analyzing. And what they found was a total of 70 injuries and 50 players with 10 having suffered injuries in multiple seasons. There were 41 shoulder injuries and 28 elbow injuries. 12 of the shoulders and 16 of the elbows were treated operatively. So what does that mean? Long story short, I guess is an injury to a professional athlete clearly results in loss of income and a decreased career length. Directly correlated. There's causation there. If there's an injury, it is going to cause you very likely most of the time to. To have less earning potential and a decreased career length. So on the other side of that, I'll kind of pause here and take a little bit of a step to the side in the conversation because I think it's important to note this is not only about finding out who's likely to be injured, but it's really about then being able to take proactive steps. If there's imbalances between strength that there's a correlation to injury on, well, that's a really great thing to know because during the off season, during the preseason, or before somebody even makes it to the professional leagues, being able to create a balance that decreases that coefficient. Gosh, that sounds technical, but decreasing that likelihood through specific training would be a really good idea, especially if you think about that training requires such little time and investment comparatively to the potential outcome of an elongated career or a career to begin with, because this was just professional players. Think about all of these kids that are struggling in high school, in college, in the minors, with recurrent injuries of all types in all sports, but definitely relating to pitching in baseball. This is a really, really big deal. And as kids play more and more, 12 months out of the year on 17 different. I don't understand it whatsoever, but that's neither here nor there. People are playing a lot of sports and they're playing a lot of sports a lot of times with a lot of reps, with minimal cross training. That increases the likelihood of injury. Now, it also develops that skill, don't get me wrong, but it dramatically increases the likelihood that you could be injured. So knowing at the highest level what is causing professional athletes or leading them to be more likely to injure themselves due to imbalances in strength, addressing that 10 years before, five years before, as you are coaching, training and getting up to hopefully becoming a pro athlete, this is super, super impactful all the way down the chain and all the way up the chain from youth to professional levels and everything in between. So baseball pitchers are particularly susceptible to these types of injuries, of course, because of the repetition and the demanding nature of the overhead throwing motion. So. And the shoulder is just an inherently unstable joint due to the large size of the humeral head, relatively Small glenoid fossa. The glenohumeral joint relies on dynamic stabilization provided by the rotator cuff and all of that surrounding musculature as well to support it. The best, the best we can. Yet we maximize and we tax it so heavily during these motions. That's the balance. So that's okay. But you have to understand that balance so you know what proactive steps you can take and should take in order to minimize the risk of injury. So critical points of maximal stress on the shoulder interestingly have been identified as the late cocking motion and during arm deceleration. And arm deceleration is an interesting point here because it seems to lead to a lot of injury potential, which you think of it during the throwing motion and then when the ball gets released, everything takes care of itself. But it's actually that deceleration motion after release that can really wreak havoc when you have imbalances in strength. So deceleration incidentally is the most vigorous phase of the rotator cuff muscle activation, so higher risk of injury there. So this study did find, long story long, they did find a statistically significant association between preseason external rotation weakness and throwing related injury requiring surgical intervention. So if you want to decrease the risk of having surgical intervention due to a throwing injury, it is a really good idea to have external rotation strength. You do not want external rotation weakness. They also noted a statistically significant association between preseason supraspinatus weakness and incidence of throwing related injury requiring surgical intervention. So you want to strengthen supraspinatus, you want to strengthen external rotation. Absolutely critical. Those are really the big take home messages here. And because of the role of the external rotators in arm deceleration, coming back around to deceleration, evaluation of their strength in relation to internal rotators is essential for this injury prevention and rehab. You want external and internal rotators to have balance. We tend to have. Pitchers tend to have. Maybe I won't conclude myself there. We pitchers tend to have great internal rotation strength, weakness on external rotation, that is trouble territory. You want balance there. So the bottom line is the shoulder and elbow are subjected to ridiculous stress during the pitching motion, resulting in a number of injuries. And to the knowledge of the individuals writing this study, none have shown a previous. No studies have shown a previous relationship. So they demonstrated a significant association between shoulder, external rotator and supraspinatus weakness and and injury requiring surgical intervention. And they also noted that the ratio of external to internal rotator strength was associated with shoulder injury and trended toward association with overall incidence of injury bottom line is supraspinatus strength good thing. External rotation strength a good thing. Weakness on either of those increases the likelihood of surgical intervention for baseball pitchers. And that is the take home message you could start utilizing with pediatric patients in youth baseball right now. High school athletes, college athletes, and if you are treating pro or semi pro, super critical information to know. Love this study. Thanks to the guys over at jtech for sharing it with me. I am happy to share it here. Now before we wrap up, I want to say a few words about Kairo Spring. A few of you took advantage of Kairo Spring's incredible offer. They have an awesome AI iterative ehr. I've never seen anything like it. You should check it out. They're willing to hook you up with a hundred dollar Amazon gift card just for checking it out. Kyrospring.com offer kyrospring.com offer I'll drop that link down in the show notes and this was a I did a episode of maybe a month ago with the founder of Kiro Spring. I'm a big fan. They support this podcast. You just support them. They have some really interesting tools at their disposal in the EHR space that I've not seen anywhere else. That makes it higher likelihood that you are going to bill appropriately, code appropriately and get paid appropriately. Those three things are very good and they'll hook you up with $100Amazon gift card just for giving them the opportunity to showcase it. Kairospring.com offer be sure to go over there and check it out. And additionally, if you have not picked up your set or pair of orthotics from Power Step, please do so. They are what I use, what my dad uses. I cannot recommend it enough. Developed by a podiatrist over 30 years ago, power Step Orthotics. They are awesome and they want to hook you up with a free sample pair for being a listener of this podcast pro powerstep.com sample use the code EBC evidence based chiropractor and they will hook you up. I will drop links to all of that and more down in the show notes and if you have not left us a rating or review, I would greatly appreciate it if you take a moment and do so. That helps more and more docs find out about this podcast. Thank you for listening. Thank you for tuning in. Thank you for being a chiropractor. Hope you have a great week and I will talk to you soon. Thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice. Come back for next week's episode. If you want to grow faster, visit theevidencebasedchiropractor.com and join our MD Marketing membership today.