Objectives: The incidence of shoulder and elbow overuse injury continues to rise in youth baseball players. Several throwing programs designed to reduce stress on the elbow have been described, but most are not evidence-based. The aim of this study was to compare the kinetics and kinematics between mound and flat-ground pitching at two different distances with the goal of developing evidenced-based injury prevention and recovery guidelines for youth throwers. Methods: Fifteen healthy, high school varsity-level baseball pitchers (mean age 16.7 ± 0.7 yrs; height 182.2 ± 6.2 cm; weight 76.0 ± 9.4 kg;) participated in the study. Players were fitted with a motusBASEBALLTM sensor and sleeve (Motus Global, Rockville Centre, NY), which has been shown to have good reliability and correlation with in-laboratory measures. Each pitcher was asked to pitch 5 fastballs to a catcher under each of the 4 conditions: mound at 60.5 ft (regulation distance), flat ground at 60.5 ft, mound at 50.5 ft, and flat ground at 50.5 ft. For each pitch, the sensor recorded arm speed, arm slot, shoulder rotation, and elbow varus torque. Ball velocity was tracked with a radar gun (Stalker Radar, Richardson, TX). Linear mixed-effects models were used to account for both within and between-subject variability. A multivariable model was used to evaluate the association of mound pitching (vs flat ground), distance (50.5 vs 60.5 ft), and their interaction on each of the following outcomes: arm speed, arm slot, shoulder rotation, elbow varus torque, and ball velocity. Results: There were no statistically significant effects of mound vs flat ground or distance variation on both arm speed or shoulder rotation. Arm slot was significantly higher on pitches from the mound at 60.5 ft [+4.58 (95% CI: 1.26, 7.90), p=0.007]. Elbow varus torque was significantly lower on throws from the mound [-1.88 (95% CI: -3.56, -0.20), p=0.03] and from a longer distance [-2.21 (95% CI: -3.89, -0.53), p=0.01]. Pitches thrown from the mound were significantly faster compared to flat ground at both distances, with throws at 60.5 ft of greater velocity than at 50.5 ft [+1.03 (95% CI: 0.66, 1.40), p<0.001]. Please see the Table for full results. Conclusion: The findings suggest that throwing from the mound may not be higher risk compared to flat ground, contrary to long-standing notions. The lower elbow varus torque and higher arm slot, which has previously been shown to be associated with reduced stress, from throwing from the mound may even indicate a protective effect. Compared to 50.5 ft, there was lower elbow varus torque and faster ball velocity at the longer distance, indicating that elbow stress and ball velocity may not correlate perfectly, and radar guns may not be an appropriate surrogate measure of elbow varus torque. A better understanding of the kinetic and kinematic implications of various throwing programs will allow for designing programs that are based on objective data to achieve the goal of preventing injuries in young baseball players. [Table: see text]
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