Hurd, Wendy J.

Background: There is an assumption that baseball athletes who reside in warm-weather climates experience larger magnitude adaptations in throwing shoulder motion and strength compared with their peers who reside in cold-weather climates. Hypotheses: (1) The warm-weather climate (WWC) group would exhibit more pronounced shoulder motion and strength adaptations than the cold-weather climate (CWC) group, and (2) the WWC group would participate in pitching activities for a greater proportion of the year than the CWC group, with the time spent pitching predicting throwing shoulder motion and strength in both groups. Study Design: Cross-sectional study; Level of evidence, 3. Methods: One hundred uninjured high school pitchers (50 each WWC, CWC) were recruited. Rotational shoulder motion and isometric strength were measured and participants reported the number of months per year they pitched. To identify differences between groups, t tests were performed; linear regression was used to determine the influence of pitching volume on shoulder motion and strength. Results: The WWC group pitched more months per year than athletes from the CWC group, with the number of months spent pitching negatively related to internal rotation motion and external rotation strength. The WWC group exhibited greater shoulder range of motion in all planes compared with the CWC group, as well as significantly lower external rotation strength and external/internal rotation strength ratios. There was no difference in internal rotation strength between groups, nor a difference in the magnitude of side-to-side differences for strength or motion measures. Conclusion: Athletes who reside in cold- and warm-weather climates exhibit differences in throwing shoulder motion and strength, related in part to the number of months spent participating in pitching activities. The amount of time spent participating in pitching activities and the magnitude of range of motion and strength adaptations in athletes who reside in warm-weather climates may make these athletes more susceptible to throwing-related injuries.

Context: Interval sports programs are a critical rehabilitation element when preparing the injured athlete for a return to preinjury activities. There is currently no published interval hitting program to guide a return to unrestricted play for the volleyball athlete. Therefore, data-based, position-specific overhead hitting programs that control for intensity, time, and number of ball strikes were developed for female college volleyball players. Evidence Acquisition: Records from a single Division I varsity women’s volleyball team were examined for all matches during 7 consecutive years of team play. Data were collected for number of hitting and service attempts per game for each position and the number of games per match. Results: Per game, middle hitters averaged 4.51 attacks and 2.77 service attempts; right-side hitters, 3.58 attacks and 1.26 service attempts; outside hitters, 6.37 attacks and 3.44 service attempts; and setters and defensive specialists, 0.17 attacks and 1.78 service attempts. Conclusion: The interval hitting program can provide rehabilitation specialists with a data-based approach that may facilitate a return to play and minimize the risk of reinjury for volleyball athletes.

Context: Baseball throwing injuries are common. Emphasis on injury prevention and rehabilitation is made in an attempt to keep athletes on the field of competition. Interval throwing programs are an integral part of training, conditioning, and returning an injured baseball player to the game. Evidence Acquisition: Development of data-driven programs was based on the number, type, distance, and intensity of throws during games, across the spectrum of ages and positions for baseball athletes at all levels of play. Statistical analysis by age, position, and level of play determined the need for separate throwing programs. Means, the high range, game rules, and practical considerations were used to develop each data-based interval throwing program. Results: Data-based age and level-of-play interval throwing programs for pitchers, catchers, infielders, and outfielders have been developed, tested, and implemented for more than 10 years. Progression is based on type and location of injury, symptoms in response to throwing, and preinjury performance profile. Although the throwing programs are highly structured, there is ample opportunity to modify them to meet the needs of individual athletes. Conclusion: Data-based interval throwing programs for baseball athletes are an integral training and conditioning element for both injured and uninjured athletes who are preparing for sports participation. Medical team members should equip themselves with an understanding of how to use the programs for safe training, conditioning, and return to play.

Background: Identification of highly active individuals early after acute anterior cruciate ligament deficiency who are good candidates for nonoperative management is a clinical challenge. The University of Delaware has developed and validated a treatment algorithm and screening examination to distinguish between nonoperative and surgical candidates. Study Design: Review. Evidence Acquisition: A description of the decision-making rules and rehabilitation protocol for highly active individuals with anterior cruciate ligament deficiency is provided. Results from clinical trials, outcome studies, and biomechanical investigations conducted using the treatment algorithm and screening examination are also reviewed. Results: Patients identified as nonoperative rehabilitation candidates using these clinical guidelines have a far greater success rate than what has been reported when patients self-select nonoperative management. Furthermore, nonoperative outcomes are improved when patients participate in a perturbation-enhanced rehabilitation protocol. Divergent lower extremity movement patterns are consistent with the different functional abilities of the dichotomous patient groups identified with the screening examination. Conclusion: Given the differential patient response to anterior cruciate ligament injury, implementation of the decision-making guidelines discussed in this review offers clinicians the opportunity to provide individualized patient care rather than continuing with a blanket surgical treatment strategy.