Does High Medial Elbow Stress During Pitching Compromise the Dynamic Stabilizers of The Elbow?

# Background The flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) are thought to provide dynamic stability to the medial elbow, with a lesser contribution from the pronator teres (PT). # Hypothesis/Purpose The purpose of this study was to determine if baseball pitchers with higher valgus elbow torque experience greater FCU and FDS strength loss. # Study Design Controlled Laboratory Study # Methods A pilot study was performed to determine if middle and ring finger flexion strength tests preferentially activated the FCU and FDS versus the PT (10 men age 36±12 yr). EMG amplitudes, expressed as percent of maximal voluntary contraction (MVC) were compared between tests and muscles. In a field study of college baseball pitchers, middle finger, ring finger and grip strength were tested prior to, immediately after, and one day after 14 pitching performances in 10 pitchers (21±2 yr). Elbow valgus torque was measured from an inertial measurement unit, housed in a compression sleeve and pitchers were categorized as having high or low valgus torque. # Results For the pilot study EMG activations were 74% FDS, 66% FCU and 35% PT for the middle finger test (muscle effect p=0.032) and 93% FCU, 61% FDS and 23% PT for the ring finger test (muscle effect p=0.005). In the field study, pitchers with high valgus torque showed marked post-game middle finger fatigue (88% of baseline) and incomplete recovery the following day (95%), while pitchers with low valgus torque showed no strength loss (107% post game, 106% a day later; group x time p=0.022). Results were similar for ring finger strength (high torque: 94% post game 96% a day later; low torque: 114% post game 107% a day later; group x time p=0.048). By contrast, grip strength was not different between pitchers with high versus low valgus torque (p=0.143). # Conclusion High medial elbow stress during pitching fatigues the dynamic stabilizers of the medial elbow. # Level of Evidence Level 3 ©The Author(s

Adductor Strains in Athletes

Acute adductor injuries are a common occurrence in sport. The overall incidence of adductor strains across 25 college sports was 1.29 injuries per 1000 exposures, with men's soccer (3.15) and men's hockey (2.47) having the highest incidences. As with most muscle strains there is a high rate of recurrence for adductor strains; 18% in professional soccer and 24% in professional hockey. Effective treatment, with successful return to play, and avoidance of reinjury, can be achieved with a proper understanding of the anatomy, a thorough clinical exam yielding an accurate diagnosis, and an evidence-based treatment approach, including return to play progression

Accelerated muscle recovery in baseball pitchers using phase change material cooling

Purpose: The purpose of this study was to document recovery following a pitching performance and determine if prolonged post-game phase change material (PCM) cooling of the shoulder and forearm accelerates recovery. Methods: Strength, soreness and serum creatine kinase (CK) activity were assessed prior to, and on the two days following pitching performances in 16 college pitchers. Pitchers were randomized to receive either post-game PCM cooling packs on the shoulder and forearm, or no cooling (control). PCM packs were applied inside compression shirts and delivered cooling at a constant temperature of 15°C for 3 hours. Strength was assessed for shoulder internal rotation (IR), external rotation (ER), empty can test (EC) and grip. Results: Total pitch count was 60±16 for 23 PCM cooling games and 62±17 for 24 control games (P=.679). On the days following pitching IR strength (P=.006) and grip strength (P=.036) were higher in the PCM cooling group versus control. One day after pitching IR strength was 95±14 of baseline with PCM cooling versus 83±13 for control (P=.008, effect size d 0.91) and 107±9 versus 95±10 for grip strength (P=.022, effect size d 1.29). There was a trend for greater ER strength with PCM cooling (P=.091, effect size d 0.51). The EC strength was not impaired after pitching (P=.147) and was therefore unaffected by PCM cooling (P=.168). Elevations in soreness and CK were not different between treatments (Treatment by Time CK P=.139, shoulder soreness P=.885, forearm soreness P=.206). Conclusion: This is one of the first studies to document impairments in muscle function on the days following baseball pitching, and the first study showing a novel cryotherapy intervention that accelerates recovery of muscle function in baseball pitchers following a game

Influence of a montmorency cherry juice blend on indices of exercise-induced stress and upper respiratory tract symptoms following marathon running—a pilot investigation

Background: Prolonged exercise, such as marathon running, has been associated with an increase in respiratory mucosal inflammation. The aim of this pilot study was to examine the effects of Montmorency cherry juice on markers of stress, immunity and inflammation following a Marathon. Methods: Twenty recreational Marathon runners consumed either cherry juice (CJ) or placebo (PL) before and after a Marathon race. Markers of mucosal immunity secretory immunoglobulin A (sIgA), immunoglobulin G (IgG), salivary cortisol, inflammation (CRP) and self-reported incidence and severity of upper respiratory tract symptoms (URTS) were measured before and following the race. Results: All variables except secretory IgA and IgG concentrations in saliva showed a significant time effect (P < 0.01). Serum CRP showed a significant interaction and treatment effect (P < 0.01). The CRP increase at 24 and 48 h post-Marathon was lower (P < 0.01) in the CJ group compared to PL group. Mucosal immunity and salivary cortisol showed no interaction effect or treatment effect. The incidence and severity of URTS was significantly greater than baseline at 24 h and 48 h following the race in the PL group and was also greater than the CJ group (P < 0.05). No URTS were reported in the CJ group whereas 50 % of runners in the PL group reported URTS at 24 h and 48 h post-Marathon. Conclusions: This is the first study that provides encouraging evidence of the potential role of Montmorency cherries in reducing the development of URTS post-Marathon possibly caused by exercise-induced hyperventilation trauma, and/or other infectious and non-infectious factors

Treatment and prevention of delayed onset muscle soreness.

Eccentric exercise continues to receive attention as a produc-tive means of exercise. Coupled with this has been the heightened study of the damage that occurs in early stages of exposure to eccentric exercise. This is commonly referred to as delayed onset muscle soreness (DOMS). To date, a sound and consistent treatment for DOMS has not been es-tablished. Although multiple practices exist for the treatment of DOMS, few have scientific support. Suggested treatments for DOMS are numerous and include pharmaceuticals, herb-al remedies, stretching, massage, nutritional supplements, and many more. DOMS is particularly prevalent in resistance training; hence, this article may be of particular interest to the coach, trainer, or physical therapist to aid in selection of efficient treatments. First, we briefly review eccentric exercise and its characteristics and then proceed to a scientific and systematic overview and evaluation of treatments for DOMS. We have classified treatments into 3 sections, namely, phar-macological, conventional rehabilitation approaches, and a third section that collectively evaluates multiple additional practiced treatments. Literature that addresses most directly the question regarding the effectiveness of a particular treat-ment has been selected. The reader will note that selected treatments such as anti-inflammatory drugs and antioxi-dants appear to have a potential in the treatment of DOMS. Other conventional approaches, such as massage, ultrasound, and stretching appear less promising

THE REPEATED BOUT EFFECT: DOES EVIDENCE FOR A CROSSOVER EFFECT EXIST?

Individuals undergoing an unaccustomed exercise bout incorporating a high degree of eccentric muscle contractions commonly experience delayed onset muscle soreness. The damage manifests itself via tenderness, loss of strength, swelling, elevated muscle enzyme activity and loss of flexibility. Following an initial 'damage bout,' a repeated bout results in reduced symptoms. This protective effect is known as the repeated bout effect (RBE) and can last up to 24 weeks between bouts. The mechanism for this RBE is unclear and both central and local mechanisms have been suggested. In an attempt to test the central hypothesis, 12 subjects (mean age = 22.5± 4yrs, ht = 167±9cm, mass = 71.5±13.5kg) underwent an exercise protocol whereby one leg was exercised eccentrically and following complete recovery; the contralateral leg was exercised in the same manner. Subjects were required to step on and off a 46-cm step for 20 minutes at a cadence of 15 steps/minute. One leg was used to go up the step (concentric) while the opposite was used to go down (eccentric). Approximately two weeks later and following complete recovery, the protocol was repeated with the concentrically exercise leg now performing the eccentric contraction. Data analyses indicate that muscle damage was induced during both trials on the eccentrically exercised leg as evidenced by a change in tenderness (bout 1 P < 0.05: bout 2 P < 0.01), pain scores (bout 1 P < 0.0001; bout 2 P < 0.01), and strength loss (bout 1 P = 0.001; bout 2 P = 0.001) over the four day follow up period. No tenderness was evident on the concentrically exercised limbs when compared to baseline (Bout 1: P =0.13, Bout 2: P = .06). Pain was significantly lower in bout two versus bout one (P< 0.04), however, we attribute this to a tolerance effect. Neither strength loss nor tenderness were significantly different between bouts. In the current study, damage was induced in both bouts in the eccentrically exercised limbs. This preliminary data does not provide evidence for a central mechanism in that an initial bout of eccentric exercise using one limb did not provide protection against damage from a repeated bout with the contralateral limb two weeks late