Studies Finds Poor Hip Mobility Leads To Higher Rate Of Throwing Injuries
Athletic hip injuries in Major League baseball pitchers associated with ulnar collateral ligament tears (1)
Many athletes do not produce the amount of power and force that they are capable of because they leak force and power through broken positions. The body is a kinetic chain from the ankles, knees, hips, shoulders, elbows and wrists. If you are missing range of motion, strength or motor control in any of these joints the whole system will compensate to pick up the slack. This not only makes your performance suffer, but it leads to injury as well. Hip range of motion in baseball is extremely important to efficiently transfer energy from the ground up through the kinetic chain. Missing range of motion through the hips has been found to hinder performance and increase the risk of injury in baseball athletes.
As overhand throwing is a sequence of role-specific events in the kinetic chain coordinated to produce force on the ball, a deficiency of the hips to generate power during the wind-up and early cocking phases may result in overcompensation of the upper extremities during the late cocking and early acceleration phases. This phenomenon has been previously documented in the shoulder, in which the majority of overhand throwers with superior labral from anterior to posterior (SLAP) tears were found to have significant deficits in internal rotation ROM of the hips. If kinetic overcompensation instead manifests at the elbow, it may lead to repetitive microtrauma to the UCL. This can result in the gradual development of chronic changes, including heterotopic calcification and ligamentous attenuation, and ultimately ruptures requiring reconstructive surgery. - Athletic hip injuries in Major League baseball pitchers associated with ulnar collateral ligament tears. (1)
A study called, Athletic Hip Injuries in Major League Baseball Pitchers Associated With Ulnar Collateral Ligament Tears by David Kantrowitz looked at 247 professional baseball players and had some pretty significant findings. Including this discovery:
As the frequency of UCL reconstructions continues to rise in professional baseball, understanding the factors that predispose athletes to UCL tears is increasingly important. The pivotal finding of this study is that players who underwent UCL reconstruction were 74% more likely to have sustained a hip, groin, or hamstring injury within 4 years before or after surgery compared with matched controls (P = .049). Specifically, the incidence of hip injuries in pitchers who required UCL reconstruction was significantly higher than the injury incidence of matched controls (P = .027). Additionally, nearly twice the number of hip injuries occurred before UCL reconstruction compared with after, indicating that pitchers who have undergone UCL surgery are more likely to have sustained a hip injury before their surgery. These data support our hypothesis that hip injuries, specifically FAI and labral lesions, may lead to overcompensation at the elbow during overhand throwing, potentially leading to the development of UCL tears.- Athletic hip injuries in Major League baseball pitchers associated with ulnar collateral ligament tears. (1)
74% of Players that underwent UCL surgery sustained a hip, groin or hamstring injury within 4 years before or after surgery! That is tremendous evidence that throwing arm injuries tend to be a downstream issue. That means that a deficiency in your lower half to efficiently transfer force up the kinetic chain leads to overcompensation that results in higher chances of throwing arm injuries. Another investigation called, The disabled throwing shoulder. Spectrum of pathology: 10-year update. Had very similar findings:
Prior investigations support the notion that decompensation of the proximal lower extremity can lead to overcompensation in the upper extremity. In a 10-year review of throwers, Kibler et al noted that 50% of elite overhand throwers with SLAP tears had significant deficits in internal rotation of the hips and in hip abductor and extensor strength. The authors also found that the majority of these patients had kinetic chain deficits. It is speculated that insufficient hip internal rotation ROM impairs the transfer of energy from the lower to upper extremity, precipitating kinetic chain alterations and increasing stress loads at the shoulder, resulting in injuries. The current investigation is the first to make a similar connection to UCL injuries and is supported by previous research concluding that insufficient hip internal rotation is a risk factor for elbow pain and injuries. -( 1,2)
The bottom line is this. Every baseball coach and athlete needs to understand that arm pain and injury is oftentimes a downstream issue in the kinetic chain. Somewhere along the chain there is deficiency that is disrupting a smooth transfer through the kinematic sequence. This leads to overcompensation of the upper body which leads to arm injuries. For a great visual of how the hips not being used properly in the pitching delivery disrupts the kinetic chain watch this video.
The next question is what is the solution? The answer comes from self awareness for the athlete. Every baseball athlete needs to know his mobility restrictions, biomechanics deficiencies and speed/ strength/power deficiencies. From there it is up to the athlete to address these deficiencies specifically in their offseason training. This is why it is so important to take 3-4 months of the year off from throwing so that time can be spent “building the athlete” with strength & conditioning, mobility & movement training, biomechanics drills and nutrition. This will not only pay dividends for health purposes, but also performance enhancement. Here is a great outline from The disabled throwing shoulder. Spectrum of pathology: 10-year update. (I would also add specific biomechanics drills to reinforce the proper sequencing of the kinetic chain.)
The primary aim of this rehabilitation approach is to emphasize evaluating and treating the entire body. Often, the source of the problem may not be only at the site of pain; therefore evaluating and treating the entire system are necessary and beneficial for the outcome of the patient. The rehabilitation program addresses 3 primary focus points: kinetic chain, shoulder mobility, and shoulder strengthening. The rationale and evidence, when available, for the interventions are then integrated into the 3-phase exercise program.
1. Kinetic chain
a. Leg drive and lower extremity strength
b. Hip mobility
c.Proximal core stability
d.Dynamic core strength/power
e.Scapular stabilization
2. Shoulder mobility
a. Restoring internal and external rotation deficits to achieve safe total ROM
b. Addressing joint restrictions in the spine and shoulder complex
c. Addressing muscular flexibility imbalances in the spine and scapula
3. Arm strength and endurance
a. Restoring scapular motor control for functional and pain-free motion
b. Facilitating inhibited or weak scapular musculature
c. Integrating scapular exercises with functional tasks
d. Facilitating endurance and eccentric control by advanced shoulder and scapular exercises
e. Strengthening forearm, wrist, and hand
- The disabled throwing shoulder. Spectrum of pathology: 10-year update. (2)
Remember, never guess! Always assess. The assessments will give you the self awareness to both improve performance and reduce your risk of injury. From that assessment have a plan to address the low hanging fruit. Take a 3-4 month offseason to work on your deficiencies. Be consistent and disciplined and good things will happen.
If you want to learn more please follow us on social media (Twitter, Instagram, Facebook,) @stevenguadagni (Youtube) @5toolsportsscience and feel free to send in video of your pitching or hitting mechanics for a free analysis. If you want to train with us we have several options. Come down for Long Term Training at our facility, Remote 1 on 1 Online Training from home or The 5 Tool Prospect Manual and Nutrition Manual. Learn how to optimize your mechanics and perform at the highest level possible! Hope you guys enjoyed the article. Please don’t hesitate to reach out if you have any questions.
References
1) Kantrowitz, David E., et al. "Athletic hip injuries in Major League baseball pitchers associated with ulnar collateral ligament tears." Orthopaedic journal of sports medicine 6.10 (2018): 2325967118800704.
2) Kibler WB, Kuhn JE, Wilk K, et al. The disabled throwing shoulder. Spectrum of pathology: 10-year update. Arthroscopy. 2013;29:141–161.