Throwing-related injuries are becoming an epidemic in youth baseball with a fivefold increase in the number of serious elbow and shoulder injuries in the U.S. since 2000 (1). Upper extremity injuries account for more than half of all injuries occurring in baseball across all competition levels, with shoulder- and elbow-related injuries comprising 32-35% and 17-58% of injuries respectively (2). Possible modifiable factors leading to shoulder and elbow injuries include: throwing biomechanics, movement proficiency, strength, coordination, and throwing volume. Consequences of upper extremity injuries in baseball players can be surgery, prolonged time loss from sports, decreased quality of life, financial loss, and ultimately retirement from baseball (3).
Injury prediction and prevention is notoriously challenging in the throwing athlete as there are many variables across several different domains that can influence injury and reinjury risk. In collaboration with UBC sports medicine resident, Dr. Kaila Holtz, we have created an injury screening tool to help better identify athletes at risk of injury and assist currently injured athletes in their rehabilitation. Our comprehensive screen includes a subjective questionnaire, physical assessment, workload assessment, and biomechanics assessment. Data collected in each phase is used to create an individualized summary for each athlete to maximize performance and prevent injury.
Initially, we intended to trial the screen with only the pitchers of the UBC varsity baseball team, but later opened the screen to any athlete (pitcher or position player) that was identified as “at-risk” for developing a throwing injury as per the subjective questionnaire. After identifying “at-risk” athletes, we then took each of them through the physical assessment, testing them in different domains such as joint range of motion, functional movement capacity, scapular strength and control, and core strength. Finally, with data gained from the physical assessment, we compared each athlete’s results to age-matched normative values to develop a list of key findings and provide individualized recommendations to help direct their training. In collaboration with the UBC Strength & Conditioning coaches, we were able to implement some of these recommendations into the strength training programs of each athlete. Also, with help of the UBC Baseball coaching staff, we had each athlete undergo a biomechanical review to further identify any technical issues with their pitching mechanics and allow them to decrease their risk of injury.
The 5 phases of the UBC Baseball injury Prevention & Screening Program:
Phase 1: Subjective Questionnaire – Kerlan-Jobe Orthopaedic Clinic (KJOC) Questionnaire
The KJOC is a 10-item questionnaire focused on the upper extremity in overhead athletes. It has been validated and shown to have reliability as a functional assessment tool in the overhead athlete. The KJOC is being used by many professional baseball teams from the major leagues through the minor leagues to identify athletes at-risk for developing a throwing injury.
Phase 2: Physical Assessment
After reviewing the research and identifying physical criteria associated with an increased risk of injury in the overhead throwing athlete, we created a physical assessment screening tool. Our screening tool is comprised of a hypermobility assessment, functional movement assessment, range of motion and strength measurements.
Phase 3: Workload Assessment
In collaboration with UBC Baseball coaches and UBC Strength & Conditioning coaches, we discussed throwing loads and the concept of periodization for the overhead throwing athlete.
Phase 4: Biomechanics Assessment
We deferred most of the biomechanics assessment to the UBC Baseball coaching staff and technical coaches. Biomechanical norms have been established in both baseball and softball and our understanding of proper kinetic linking continues to evolve. Improper kinetic linking is a modifiable risk factor that stresses the spine, shoulder, and elbow in throwing athletes.
Phase 5: Summary & Recommendations
We compiled the data collected in each phase of the screen to create an individualized summary of key findings and provide recommendations to help direct each athlete’s training.
This project would not have been possible without the support of the UBC varsity baseball program and the help of the integrated services team comprising of UBC Strength & Conditioning, UBC Athletic Therapy, UBC Student Athletic Therapists and the expertise of Dr. Kaila Holtz.
For more information or if you, or an athlete you work with, would like to have a screen performed, please contact firstname.lastname@example.org
Eric Lowe, MPT, BKin, IMS, CAFCI
Registered Physiotherapist, Intramuscular Stimulation, Acupuncture Certified
Plaza of Nations – B103-750 Pacific Blvd, Vancouver, BC, V6B 5E7
T: (604)642-6761 | F: (604)642-6762
- Paterno, M et al. Prevention of Overuse Sports Injuries in the Young Athlete. Orthop Clin North Am. 2013 Oct; 44(4):553-564.
- Oyama, S. Baseball pitching kinematics, joint loads, and injury prevention. Journal of Sport and Health Science. 2012 Sept; 1(2):80-91.
- Bohne, C et al. Knowledge of injury prevention and prevalence of risk factors for throwing injuries in a sample of youth baseball players. Int J sports Phys Ther. 2015 Aug; 10(4):464-475.