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Overhead Throwing: Biomechanics and Pathology

Overhead Throwing: Biomechanics and Pathology

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Published by rapannika
Narrative review on the biomechanics and pathology of the overhead throwing motion with implications for physical therapy management
Narrative review on the biomechanics and pathology of the overhead throwing motion with implications for physical therapy management

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Published by: rapannika on May 07, 2009
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throwing motion and discuss the pathology associatedwith this motion. Discussion of treatment strategies isoutside of the scope of this article, but based on theinformation presented here, the therapist should be ableto make an appropriate choice from the many conserva-tive protocols available
1-3
.
Methods for motion analysis
Throwing is part of many athletic activities, but thethrowing motion most extensively researched is withouta doubt the overhead baseball pitching motion. Whenreviewing literature on the mechanics of the overheadthrowing motion, one can distinguish three differentapproaches for describing the mechanics of this motion:1. electromyographic data,2. kinematic analysis,3. kinetic analysis.A vast body of research exists on the electromyo-graphic activity of glenohumeral and scapulothoracic
P
ain and decreased function of the shoulder are com-mon complaints for which a patient may be referredto a physical therapist. Dealing with shoulder problemsin the non-athletic population can be quite challenging,but any problem the therapist might have with manag-ing of this population pales compared to the difficultiesone may experience in trying to return the throwing athleteto a previous level of function. The purpose of this ar-ticle is to increase the therapist’s understanding of thepathology associated with the throwing motion in orderto facilitate interpretation of evaluation findings and tohelp determine appropriate management strategies. I willdescribe the mechanics of the well-researched overhead
Address all correspondence and request for reprints to:Peter Huijbregts, PT, MSc, MHSc, MTC, CSCSSouth Haven Community HospitalRehab Department955 South Bailey AvenueSouth Haven, MI 49090USA
Biomechanics and Pathology of the Overhead Throwing Motion:A Literature Review
 Abstract:
This article describes the electromyographic, kinematic and kinetic analysis of theoverhead throwing motion. Pathology associated with this motion is described, based on aliterature review and inferred from data of said analysis. The goal of this article is to improve thetherapist’s understanding of the biomechanics of the overhead throwing motion to facilitateevaluation and treatment decisions.
Key Words:
Throwing, Shoulder, Biomechanics, Pathology
Peter Huijbregts, PT, MSc, MHSc, MTC, CSCS
Biomechanics and Pathology of the OverheadThrowing Motion: A Literature Review / 17
The Journal of Manual & Manipulative TherapyVol. 6 No. 1 (1998), 17 - 23
 
musculature during the overhead throwing motion. Theelectrical activity measured during the dynamic motion(usually) by way of intramuscularly placed electrodes isdescribed as a percentage of the electrical activity mea-sured during a maximal isometric contraction (MVC ormaximal voluntary contraction) of the same muscle, priorto dynamic testing
4,5
.A second way of analyzing the throwing motion iskinematics, the branch of mechanics that deals with themotion of a body without reference to force or mass
6
.Researchers will use high-speed camera systems and markerson the athletes’ bodies to get information regarding measuressuch as joint range of motion, angular velocity, and angularacceleration of the motion studied
7,8,9
.The kinematic data play an important role in cal-culating the kinetic data
9
. Kinetics is the branch of mechanicsthat deals with the motion of a body under the action of given forces and/or moments
6
. Simply put, kinematicssupplies data in terms of joint angles, velocities andacceleration, whereas kinetics is expressed as forces andtorques.
Total body kinematics of the overhead throw
All too often overlooked in rehabilitating the throwingathlete is the fact that the overhead-throwing motion isa total body motion with a possibility of causative fac-tors for injury in any place throughout the kinematicchain. We will, therefore, start by reviewing the totalbody kinematics of the overhead throw of the baseballpitcher.In general, literature distinguishes five distinct phasesin the overhead throw: wind-up, early cocking, late cocking,acceleration and follow-through (see figure 1). Becauseof the differences found in muscular activity and magni-tudes of deceleration, some authors
4,7,9
distinguish adeceleration phase as the first part of follow-through.The wind-up phase in the overhead baseball pitchis a preparatory phase, centered around flexion. A right-handed thrower has a flexion pattern of the left lowerextremity with considerable hip and knee flexion. Therealso will be a flexion movement of the spine. Both handsare in contact with the ball, and the shoulders are in aninternal rotation-adduction position with bilateral elbowflexion. The pitcher is facing the batter with the left sideof the body
7,10
.Early cocking starts when the left hand loses con-tact with the ball. The right shoulder moves from adduc-tion and internal rotation to abduction and external rotation.The pitcher steps with the previously flexed left leg inthe direction of the batter, and the trunk moves intoextension, right rotation and left sidebending
10
.The late-cocking phase starts when the left foot of the pitcher hits the ground
10,11
. This is the start of a derotationmovement of trunk and legs that will contribute to ac-celerating the ball. The right arm and ball still move inthe same direction of horizontal abduction and externalrotation.Acceleration starts with the switch-over from shoulderexternal to shoulder internal rotation. This rotation isthe most important movement of the acceleration phase.In this phase, the shoulder also moves from horizontalabduction to horizontal adduction and back in the direc-tion of horizontal abduction, just prior to ball release
7,8
.Ball release by the right hand marks the end of acceleration. The arm, which has been immensely accel-erated for the throwing motion, now has to be deceler-ated. One sees a flexion of the left lower extremity andflexion with a left rotation of the trunk. The shouldergoes from a minimal abduction movement to adduction
Fig.1:
 
The overhead throwing motion (with permission from Huijbregts PA, Clarijs JP. Krachttraining in revalidatie en sport. Utrecht: DeTijdstroom BV, 1995)
18 / The Journal of Manual & Manipulative Therapy, 1998
 
with internal rotation. Especially in the first part of thefollow-through (the deceleration phase) the shouldercomplex muscles are very active in decelerating the throwingarm
7
. Fleisig et al
9
define the deceleration phase as thetime between ball release and attaining maximal inter-nal rotation. The second part of the follow-through isthe body follow-through: the trunk and lower extremitymotion already described decrease the force requirementsabout the shoulder and, thus, the potential for injury
12
.The overhead throw is a very fast activity. Braatz etal
10
mention a time frame of 110 to 280 (ms) for late cockingand acceleration. Fleisig et al
9
measured an average timeof 0.139
±
0.017 (s) from foot contact to ball release, aperiod which, as we have seen, corresponds to the latecocking and acceleration phases combined.
 Electromyographic analysis
Both in the wind-up, and in the (body) follow-through,the demands on the musculoskeletal system are relativelyminor. This becomes evident when considering the maximalmuscular activity measured about the shouldergirdle duringboth phases
4
: in the wind-up phase, no muscle exceeds21% of the electrical activity of the maximum voluntarycontraction (MVC), and in the follow-through phase, noneof the muscles exceeds 42% MVC.During early cocking, mainly the serratus anteriorand the upper trapezius are active in their role as lateralrotators of the scapula
4
. In doing so, they support thevery active deltoid and supraspinatus (which provideglenohumeral abduction) in abducting and elevating theshoulder complex
4
.During late-cocking, the abduction elevation remainsrelatively constant, possibly explaining the observeddecreased activity of the deltoid and supraspinatus
4
. Theposterior rotator cuff muscles, the infraspinatus and theteres minor, are very active in producing external rota-tion of the humerus; and they contribute significantly toanterior glenohumeral stability by controlling anteriortranslation of the humeral head
11,13
. The scapulothoracicmuscles, especially the trapezius, the levator scapulae andthe serratus anterior are very active in stabilizing thescapula. They produce a slight protraction-lateral rota-tion movement, which, by increasing the subacromialspace with the relatively constant angle of abductionelevation decreases the chance of impingement in thisphase
14
. The greatest amount of activity during this phaseis found in the internal rotators of the shoulder. Thepectoralis major, the latissimus dorsi, and especially thesubscapularis are all highly active
4
. These muscles con-stitute the main ventral stabilizing factor in this phaseof the movement, and their eccentric action during theextreme external rotation is the eccentric phase of thepliometric contraction or short stretch-shortening-cycle(SSC)
15
that will accelerate the ball in the upcomingacceleration phase.Internal rotation is the main movement duringacceleration, as witnessed by the high activity in all in-ternal rotators, and especially the subscapularis. Scapu-lar muscles are highly active in order to provide a stablebase for this high-speed internal rotation
4
. The teres minorand the posterior deltoid are two other important muscleswith high electromyographic activity. The triceps brachiicontracts very strongly in this phase, but appears mainlyto have a function in the elbow joint
4
.In the deceleration phase, the scapular muscles areagain all very active in eccentrically slowing down thearm
14
. The total deltoid, teres minor, subscapularis andlatissimus dorsi are also very active. The biceps brachiishows strong activity in eccentrically decelerating elbowextension
4
.
Kinematic analysis
As discussed earlier, the overhead throwing motionis truly a total body movement. We will however, limitourselves now to discussing the kinematics of the shoul-der complex. During the cocking phases of the overheadthrow the frontal plane movement of abduction-eleva-tion increases to a range of motion in the order of 90 to110 degrees, then stays constant until the beginning of follow-through, where for a very short period it slightlyincreases and promptly decreases again
7,8
. The greateramount of abduction one would expect in this throw isthe result of the trunk movements described earlier.In the transverse plane during early cocking hori-zontal abduction increases to between 30 and 50 degrees.This is followed by 14 to 20 degrees of horizontal adduc-tion during late cocking. Horizontal adduction decreasesagain to approximately zero degrees with the upper armin the frontal plane at the beginning of follow-through
7,8
.The rotational movement is the main movement of the acceleration phase
7,16
. There is a maximal excursioninto external rotation of up to 175 degrees
7,16
. However,this is measured in relation to the ground; and exclud-ing the contribution of the trunk, only 140 degrees wasfound to truly originate in the shoulder
8
. Ball release occursin a position in which the forearm is almost vertical inrelation to the ground but in which the shoulder is still100 to 110 degrees externally rotated
7
. Angular speedsduring acceleration of up to 7,000 degrees per secondoccur during the internal rotation movement, whereasangular decelerations of up to 500,000 degrees per sec-ond-squared clearly illustrate the demands placed uponactive and passive structures of the shoulder in havingto decelerate this internal rotation
4,7,17
.In addition to the overhead throw, the literaturealso mentions the three-quarter-throw, the side-arm throwand the underhand throw. The name of the specific throworiginates in the position of the upper arm relative tothe ground
10
. Dillman et al
7
state there is no differencein the amount of abduction with most throwing or racket
Biomechanics and Pathology of the OverheadThrowing Motion: A Literature Review / 19

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