Tuesday, March 24, 2009

Windmill pitching shows risk of injury to biceps

Contrary to common belief, softball pitching subjects the biceps to high forces and torques when the player's arm swings around to release the ball, according to an analysis of muscle firing patterns conducted at Rush University Medical Center.

Published in the current issue of the American Journal of Sports Medicine, the study of the "windmill" pitching motion appears to explain the high incidence of anterior shoulder pain seen in female softball players.

"The conventional belief has been that the underhand throwing motion of softball places little stress on the arm," said Dr. Nikhil Verma, lead author and a specialist in sports medicine at Rush. "But that is not the case."

In the study, seven women – three collegiate and four professional pitchers – underwent motion analysis and surface electromyography to evaluate the muscle firing pattern of their biceps in the course of a windmill pitch. Electromyography detects electrical potential generated by muscle cells when they contract.

The researchers found that even though the upper arm movement in both baseball and fast-pitch softball gives the ball about the same velocity, muscle force during the windmill pitch was much higher.

Moreover, the maximum force, or maximum contraction, occurred not when the arm was cocked, as in baseball's overhand pitching, but when the arm circled around from the 9 o'clock position, almost fully extended back, to the 6 o'clock position, perpendicular with the ground, completing its windmill motion to release the ball. Consequently, the biceps took the majority of the stress, not the elbow.

"The greatest impact is on the biceps, as the muscle first accelerates the arm and then puts on the brakes, after transferring force to the ball," Verma said.

Fast-pitch softball is one of the most popular female athlete team sports in America. In 2008, roughly 2.5 million adolescents competed in the game, and about 1.3 million players were registered with the Amateur Softball Association.

Despite the game's immense popularity at the high school and collegiate levels, Verma said, there is a dearth of sports medicine research on the game's most notable activity: the windmill pitch. Many have assumed that injury is rare with the underhand throw.

Verma launched his study in Rush's human motion laboratory when he found that female softball players from the local professional team were coming into his practice complaining of pain in the front of their shoulders. He was able to localize the pain to the biceps tendon. In one case, a pitcher had ruptured her tendon during play, which implicated the long head of the biceps tendon as the source of stress.

The study findings correlated with these clinical observations.

According to Verma, female softball pitchers are prone to overuse injury not only because of windmill pitching dynamics, but also because they pitch so many games.

"Competitive female pitchers often pitch in every game during a weekend tournament – the equivalent of 1,200 to 1,500 pitches in as little as three days." Verma said. "This is the opposite of the baseball world, where pitchers receive three to four days of rest before returning to the mound."

"Previous studies have shown that shoulder problems cause a significant amount of lost game time among windmill pitchers, with anterior shoulder pain being the common culprit," Verma added. "This study helps explain the etiology of that shoulder pain, and may help doctors devise better treatment and prevention strategies."

Saturday, February 28, 2009

Elbow Ligament Reconstruction

Elbow Ligament Reconstruction Appears Not to Effect Future Professional Advancement in Baseball

New research to be presented at the 2009 American Orthopaedic Society of Sports Medicine Specialty Day in Las Vegas suggests that elbow ulnar collateral ligament (UCL) reconstruction prior to selection in the Major League Baseball (MLB) draft does not increase the risk of future injury or affect the rate of professional advancement.

“Our study showed no statistical difference between athletes who had undergone UCL reconstruction prior to the draft and a matched control group in terms of advancement in professional baseball” said Gregory F. Carolan, MD, lead author and Director of Orthopaedic Sports Medicine at St. Luke’s Hospital in Bethlehem, PA. Dr. Carolan is a former fellow at the San Diego Arthroscopy & Sports Medicine Program and The Scripps Clinic, San Diego, CA where the research was conducted in conjunction with the San Diego Padres Baseball Club.Other doctors involved in the project included Jan Fronek, MD, Christopher Geary, MD, James Koziol, MD, Daniel Keefe, MD and Heinz Hoenecke, MD.

The researchers reviewed the medical records of all players selected during the five MLB drafts held from 1999 through 2003 and identified 30 players (all but 3 were pitchers) who had undergone UCL reconstruction (RUCL) prior to entering the draft. The data analyzed included the highest level of professional advancement, the number of times players were placed on the disabled list (DL), the type of injury responsible for placement on the DL and game statistics for those players that advanced to the Major Leagues. There was no statistically significant difference in any of these areas between the RUCL group and the control group.

“Our data shows that UCL reconstruction prior to selection in the MLB draft does not appear to increase the chances of a future injury to the throwing arm or impact a player’s professional prospects when compared to a matched control group. Our analysis is sufficiently powered to detect large differences between the two groups; however our ongoing research will continue to add confidence that we are not missing more subtle differences. As more athletes undergo the procedure and enter the MLB draft, we hope to be able to accomplish this goal. With the increase in UCL reconstructions being performed, it is heartening to see that the procedure can be successful in allowing future professional athletes to the reach the highest level of competition on par with their peers,” said Carolan.

Wednesday, January 28, 2009

Soccer Hasn't Changed

Researchers from the University of the Basque Country (UPV/EHU) have found that football has changed so little during recent World Cups that, if shown action from matches, we would be incapable today of differentiating between a France ’98 game and another from Germany ’06.

The stars, the ball and the champions have all changed – but the game itself has hardly varied over the past three football World Cups, according to the results of a study by researchers from the University of the Basque Country and published in the magazine Psycothema. “Our study provides a look forward at how football will be played in the South Africa 2010 World Cup,” Julen Castellano, one of the report’s authors, tells SINC.

The study analyses how football has evolved over the World Cups and looks at up to 48 settings from five parts of the pitch, as well as seven potential scores throughout a match. The sports scientists have confirmed that football is based on a linear model, which can be extrapolated to society at large and, above all, that it has remained essentially unchanged over the past three World Cups – France 1998, Japan-Korea 2002 and Germany 2006.

Castellano says this is the result of ten years of research focused on just one area – “to describe, explain and, over time, predict how a game of football will develop”. The researcher, whose thesis dealt with the ’98 World Cup, worked with Abigail Perea and Antonio Hernández to create a retrospective view based on observing, codifying and recording the action in a game. “By using an observational lens we aimed to reflect all the relevant information about the interactions between the two teams competing against each other.”

Football as a dynamic system

The study encompasses so-called “contexts of interaction”, in other words the position of the ball in relation to the players in the two teams. This makes it possible to evaluate levels of balance and imbalance between the players in the teams, which make up ‘dynamic systems of interaction’.

Castellano tells SINC: “We carried out different analyses, both in the most descriptive area – game patterns – and in the area of inferences – analysis of variation and generalised factors – although only the latter was explicitly recorded.”

In this study, each game of football was broken down and organised according to seven momentary results categories: (1) when the team is leading, the other team scores a goal and equalises, (2) it is leading and actually wins, (3) it is losing, scores and equalises, (4) it is losing and ends up losing the game, (5) the teams are drawing, and the team scores a goal and wins, (6) they are drawing, a goal is scored against the team and it loses, and (7) they are level pegging and the game ends in a draw.

The main conclusion is that the way in which the teams play has not varied over the three World Cups studied. “Today we would not be able to distinguish between a game played by teams in the France ’98 World Cup and one played in Germany ’06,” the researchers point out.

Moreover it does not seem as though there will be any significant changes in the way of playing the game in future international fixtures. According to Castellano, “if we carried out the same studies on future World Cups these would be the same, unless there are any significant changes to the regulations that change how the players and teams act throughout the match”.

Saturday, September 27, 2008

Engineer: Head-first slide is quicker

Base running and base stealing would appear to be arts driven solely by a runner's speed, but there's more than mere gristle, bone and lung power to this facet of baseball — lots of mathematics and physics are at plWith baseball playoffs heating up and the World Series right around the corner, it's guaranteed that fans will see daring slides, both feet-first and head-first, and even slides on bang-bang plays at first.

Who gets there faster, the head-first slider or the feet-first?

The head-first player, says David A. Peters, Ph.D., the McDonnell Douglas Professor of Engineering at Washington University in St. Louis, and big-time baseball fan. He says it's a matter of the player's center of gravity.

Peters is a mechanical engineer who specializes in aircraft and helicopter engineering. He sees "fields of dreams" a bit differently than most — he sees them as playgrounds of math and physics.

Peters says that dynamics equations can determine which slide gets you there more quickly, and that there are three important mathematical issues at play.

"There's momentum — mass of the body times how fast the player is moving," he says. "There's angular momentum (mass movement of inertia times the rotational rate). If it's feet-first and you're starting to slide, your feet are going out from you and you're rotating clockwise; if it's head-first, as your hands go down, you're rotating counterclockwise."

"On top of this is Newton's Law," Peters explains. "Force is mass times acceleration. Then moments of inertia times your angular acceleration."

So, who gets there faster?

"It turns out your center of gravity is where the momentum is," Peters says. "This is found half way from the tips of your fingers to the tips of your toes. In the headfirst slide, the center of gravity is lower than halfway between your feet and hands, so your feet don't get there as fast. It's faster head-first."

For a long time — until roughly the Pete Rose era of the '60s and '70s — players shunned the headfirst slide to protect their hands and faces. Spikes, evoking the Ty Cobb days, were weapons on the diamond. In the past few decades, players who prefer the head-first slide have taken to running while holding onto their batter's gloves to prevent their hands from opening up and being exposed to injury. While the percentage of players who slide one way or the other is not actually known, Peters estimates it's about 50-50.

Peters notes a growing number of players who will slide into first base, despite conventional wisdom that running through first is the faster way.

"Mathematically, you might think there's an advantage, but leaving your feet is actually a detriment because you're no longer pulsing (pumping your legs) and you start to decelerate," he says. "When you're running, your get your feet out in front of the center of gravity, so you're getting maybe three or four steps of an advantage."

Peters says the only advantage of any slide into first base is to avoid the first baseman's tag when he has to come off the base to spear an errant throw.

"In general, most agree to run through first, but you'll find people who will swear it's better to do it the other way.

Thursday, July 10, 2008

Soccer Concussions: Men and Women

Men and women with history of concussion mend differently, study finds

Concussion treatment needs to be more individualized, authors urge

Female soccer players and soccer players who have had a previous concussion recuperate differently from males or players without a history of concussion, new research released today at the 2008 American Orthopaedic Society for Sports Medicine Annual Meeting at the JW Marriott Orlando Grande Lakes shows. The study found that prior history of concussion and gender account for significant differences in test results following the injury. Because of these differences, the authors urge physicians and coaches to take an individualized approach to treating concussion patients.

"The results of this study suggest that physicians should not be taking a one-size-fits-all approach to treating concussions," said co-author Alexis Chiang Colvin, MD, Sports Medicine Fellow for the Department of Orthopaedics at the University of Pittsburgh Medical Center. "Our study shows that patients with a history of a previous concussion perform worse than patients without a previous history on neurocognitive tests taken after they sustain a concussion. Furthermore, females perform worse than males on post-concussion testing, as well."

The authors chose to examine concussion recovery patterns in soccer players due to the popularity of the sport among both genders. Also, it is a non-helmeted sport with identical rules for all participation levels for both genders. In the United States, there are between 1 and 4 million estimated sports-related concussions each year. The most common causes of concussion in soccer include, head-to-head contact, head contact with other body parts and head-to-ground contact.

A concussion is an injury to the brain that results in temporary loss of normal brain function, usually caused by a blow to the head. Concussions can affect memory, judgment, reflexes, speech, balance and coordination.

The study had 234 soccer players (61 percent female, 39 percent male) ranging in age from 8 to 24 years old, who were given neuropsychological tests that measured attention, memory, processing speed and reaction time after their concussion. The results of the tests were analyzed to see if there were group differences in performance between male and female participants and those with a previous history of concussion.

The study found that females performed significantly worse than males on tests of reaction time. Females were also significantly more symptomatic than males. Additionally, there was a trend, although not significant, towards females testing poorly regarding verbal memory and processing speed when compared to males.

Soccer players with a history of concussion performed significantly worse on verbal memory testing after another concussion, the study found.

"There's a theory that males typically have a stronger neck and torso that can handle forces better," said Dr. Colvin. "But when we accounted for Body Mass Index in this study, we still found a difference between males and females. Therefore, there are differences in recovery between genders that cannot simply be attributed to size difference. More studies are needed to determine the reason for differences in recovery between males and females."

Tuesday, July 8, 2008

Male cyclists risk sexual problems

Men who take up cycling in an effort to stay fit, do their bit for the environment or avoid spiralling motoring costs, could be harming their health if they don't choose the right bicycle. That's the stark warning from consultant urological surgeon Mr Vinod Nargund from St Bartholomew's and Homerton Hospitals, London, in the urology journal BJU International.

He says that the problems to look out for include genital numbness, erection problems and soreness and skin irritations in the groin area.

Men who cycle a lot can also experience changes to their sperm function, because of the excessive heat generated in the pelvic area. No general link between cycling and male infertility has been established, but it is still recognised as a possible side effect and has been noted in a number of male cyclists.

Regular cyclists also run a higher risk of testicular damage and impaired testicular function.

Mountain bikers run a particular risk, says Mr Nargund, as studies have shown that they exhibit higher levels of scrotal abnormalities than on-road cyclists.

"The bicycle saddle is in direct contact with the perineum and its underlying structures" he explains. "It makes contact just behind the scrotum where the nerves and blood vessels enter the back of the scrotum and penis.

"This area is sensitive, with hair follicles and sweat and sebaceous glands, which are all good breeding grounds for infection.

"Abrasions, chafing, damaged hair follicles and bruising are among the most traumatic cycling injuries. Sweating in this area can also cause soreness and skin problems."

He points out that more than 60 per cent of male cyclists who have taken part in research studies have reported genital numbness.

"Numbness is common because the pressure of the saddle can impair the blood supply to this area and put pressure on the nerves in the penis" says Mr Nargund. "This can also affect the man's ability to get an erection.

"There is a greater incidence of numbness and erectile problems in men who cycle regularly and over longer training distances. That is why it is important to rest intermittently during prolonged and vigorous cycling."

Choosing the right bike is essential, stresses Mr Nargund.

"The male cyclist should know his bicycle well and a proper fit is particularly important for high-performance cycling" he says.

"The level of pedal resistance is also very important, because riding a bike using too much resistance is a major cause of health problems in the groin area.

"Cyclists can also help to ease saddle-related injuries or skin irritations by adjusting the saddle height and fore and aft position.

"Padding in the saddle and shorts are also important if cyclists want to avoid saddle-related problems."

Mr Nargund's comment piece has been published online on the BJU International website in advance of its hard copy publication later this year.

Monday, July 7, 2008

Baseball diamonds: the lefthander's best friend

Baseball diamonds are a left-hander's best friend.That's because the game was designed to make a lefty the "Natural," according to David A. Peters, Ph.D., the McDonnell Douglas Professor of Engineering at Washington University in St. Louis and über baseball fan. Peters is a mechanical engineer who specializes in aircraft and helicopter engineering and has a different approach to viewing America's Favorite Pastime.

First of all, some numbers.

"Ninety percent of the human population is right-handed, but in baseball 25 percent of the players, both pitchers, and hitters, are left-handed," said Peters, a devoted St. Louis Cardinal fan who attended "Stan the Man's" last ball game at Sportsman's Park in 1963. "There is a premium on lefthanders for a number of reasons. For starters, take seeing the ball.

"A right-handed batter facing a right-handed pitcher actually has to pick up the ball visually as it comes from behind his (the batter's) left shoulder. The left-handed batter facing the right-handed pitcher has the ball coming to him, so he has a much clearer view of pitches."

Then, Peters says, consider the batter's box. After a right-hander connects with a ball, his momentum spins him toward the third-base side and he must regroup to take even his first step toward first base. In contrast, the left-hander's momentum carries him directly toward first.

"The left-handed batter has a five-foot advantage over the right-handed batter," says Peters. "And that means the lefty travels the 90 feet to first roughly one-sixth of a second faster than the righty. That translates to more base hits for the left-hander, whether singles or extra base hits because lefties are getting to the bases more quickly."

Even Jim Thome and Jason Giambi?

The left-handed pitcher generally is much more difficult to steal off, as, from his stretch, he peers directly at the runner; the right-hander must look over his shoulder and wheel to first base, giving the runner more of a warning of the pitcher's intent.

Positions advantageous to southpaws are pitching, first base and right field. For the positions, the advantage is the favorable angles lefties get, enabling them to throw the ball more quickly across the diamond to second, third and home. One position a lefty rarely plays is catcher, for the obvious reason that it is difficult for a southpaw catcher to throw over so many right-hand batters.

"It wasn't all that long ago when first basemen were predominantly left-handed and most right fielders were left-handed," Peters says. "That has changed, at least since the late sixties."

There's even a bias toward the lefthander in ballpark design. Right field in most parks (just think of Yankee Stadium and Fenway Park) is usually shorter than left field because of the preponderance of right-handed hitters.

While traditional thinking holds that the right-handed batter has the advantage over the left-handed pitcher, because the breaking ball goes into the batter's power threshold, it's not always the case, says Peters. And it's that familiarity thing again.

"Because only 10 percent of the population is left-handed, kids grow up and mature in baseball seeing a left-hander just 10 percent of the time they bat," he says. "So, it can be hard for both lefties and righties to face a southpaw. It's why some left-handed batters look dreadful matched against a lefty."

Some batters don't like facing southpaws because their ball is purported to have a natural movement away from a right-hander and into a lefty.

"There's no scientific evidence to support this, but I wonder if lefties get that movement from learning to write in a right-hander's world," Peters says.