scholarly journals Serratus Anterior Stretch: A Novel Intervention and Its Effect on the Shoulder Range of Motion

2020 ◽  
pp. 1-4
Author(s):  
Keramat Ullah Keramat ◽  
Mohammad Naveed Babar
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
External Rotation ◽  
Scapular Dyskinesis ◽  
Serratus Anterior ◽  
Shoulder Dysfunction ◽  
Shoulder Range Of Motion ◽  
Before And After ◽  
Movement Screening ◽  
Shoulder Range

Context: Serratus anterior tightness is associated with scapular dyskinesis and overall shoulder dysfunction, which affects the range of motion. The most effective intervention to stretch the serratus anterior is unknown. Objective: To evaluate the effect of a therapist-administered novel serratus anterior stretch (SAS) on shoulder range of motion. Method: This study recruited 30 healthy subjects of age 21.20 (1.69) years, height 1.65 (0.11) m, and weight 60.90 (10.36) kg in equal ratio of males and females who scored 1 or 2 on the shoulder mobility test of functional movement screening. A single intervention of a novel SAS was applied to the shoulder. Outcome variables before and after the SAS included the following: shoulder ROM (flexion, abduction, internal rotation, and external rotation) and functional movements of reaching up behind the back and reaching down behind the neck. Results: A paired t test was used to analyze the data. Following the acute SAS intervention, all shoulder ROM improved significantly (P < .000). The change in internal rotation was 6.00° (7.47°), external rotation was 5.66° (9.35°), abduction was 13.50° (11.82°), flexion was 20° (13.33°), reaching up behind the back was 5.10 (2.21) cm, and reaching down behind the neck was 5.41 (2.89) cm. The most marked improvement was in reaching up behind the back (24.48%) and reaching down behind the neck (22.78%). A very large effect size (>1) was observed across most of the variables. Conclusion: An acute SAS intervention improves shoulder mobility in healthy individuals. It is recommended for the trial on the prevention and rehabilitation of shoulder pathologies with restriction in shoulder mobility.

scholarly journals The Relationship Between Shoulder Range of Motion and Arm Stress in College Pitchers: A MOTUS Baseball Study

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0040
Author(s):  
Caleb Gulledge ◽  
Toufic Jildeh ◽  
Joseph Tramer ◽  
Fabien Meta ◽  
Kevin Taylor ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Upper Extremity ◽  
Internal Rotation ◽  
External Rotation ◽  
Outcome Measurement ◽  
Overhead Athletes ◽  
Shoulder Range Of Motion ◽  
Patient Reported ◽  
The Relationship ◽  
Shoulder Range

Objectives: Overuse injuries in overhead athletes are becoming more prevalent, with an unclear relationship between shoulder biomechanics and medial elbow symptoms and injury. The purpose of this study was to investigate the relationship of shoulder range of motion to torque across the medial elbow in college pitchers using a validated MOTUS sensor baseball sleeve. Methods: Pitchers were recruited from three local university baseball teams. Exclusion criteria included injury or restricted activity due to pain. They were evaluated in the preseason, within two weeks before their first game of the season. Pitchers completed workload questionnaires and patient reported outcome measurement information system (PROMIS) pain interference (PI), physical function (PF), and upper extremity (UE) surveys. Shoulder range of motion and upper extremity lengths were measured bilaterally. After adequate warm-up, pitchers were fitted with a MOTUS sensor baseball sleeve (Motus Global, Massapequa, NY) and instructed to throw 5 fastballs in a standardized manner off the mound at game-speed effort. The sensor placed at the medial elbow reported elbow torque, arm speed, arm slot, and shoulder rotation for each pitch, while a radar gun measured peak ball velocity. The primary outcome was to evaluate the relationship between shoulder range of motion and increased stress across the medial elbow. Additional outcomes evaluated pitcher characteristics, demographics, and outcome scores. Outcomes were assessed via a multivariable model, which controlled for possible covariates. Results: Twenty-eight pitchers were included in the preseason analysis with an average (SD) age of 20.1 (1.3) years and playing experience of 15.3 (1.8) years, 2.5 (1.2) of those years at collegiate level. The dominant shoulder demonstrated decreased internal rotation (54.5+/-10.6 vs 65.8+/-9.1) and increased external rotation (ER, 94.1+/-10.4 vs 88.4+/-9.2) relative to the non-dominant side (p < 0.001), while total rotational range of motion (TRROM) was significantly decreased in the dominant arm (148.6+/-12.4 vs 154.1+/-10.6, p < 0.001). The average glenohumeral internal rotation deficiency (GIRD) was 11.3 (9.87) and average external rotation gain (ERG) was 5.71 (8.8). External rotation was found to be a predictor of arm stress, with an increase in 0.35 Nm of elbow torque for every degree increase in ER (beta = 0.35+/-0.06, p = 0.003); there was moderate correlation between ER and arm stress (r = .45, P<.001). Pitchers demonstrated significantly greater arm stress with the following shoulder ROM measurements: GIRD < 20 as compared to greater than 20 degrees (46.6 +/- 0.5 versus 43.5 +/- 1.1, P=.011), ERG greater than 5 as compared to < 5 degrees (47.4 +/- 0.7 versus 45.1 +/- 0.6, P=.014), and loss of total rotational ROM less than 5 as compared to > 5 degrees (46.6 +/- 0.5 versus 43.6 +/- 1.1, P=.013). Multivariate analysis demonstrated significant predictors of PROMIS PF and UE scores were arm stress, ERG, and GIRD (p<0.05), while increased PROMIS PI scores were predicted by increased ERG and GIRD (p<0.05). Conclusion: We found medial elbow stress, arm speed, arm slot, and shoulder rotation as measured by the MOTUS baseball sensor sleeve were influenced by rotational adaptations of the pitching shoulder in collegiate throwing athletes prior to their season. Likewise, arm stress and shoulder rotational adaptations were reflected as predictors of PROMIS PF, UE, and PI scores.

scholarly journals A comparative study on the effectiveness of Mulligan mobilization versus Positional release therapy technique in patients with Adhesive capsulitis

2021 ◽  
Vol 12 (1) ◽  
pp. 1-5
Author(s):  
Chandrasekaran K ◽  
Sundaram M S ◽  
Senthil Selvam P ◽  
Viswanath Reddy A ◽  
Senthilkumar S ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Functional Activity ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Shoulder Range Of Motion ◽  
Release Technique ◽  
Group A ◽  
Group B ◽  
Shoulder Range

Adhesive capsulitis is a painful condition in which the movement of the shoulder becomes limited and functional activity is affected. Adhesive capsulitis occurs when the shoulder joint capsule become thick, stiff and inflamed. The aim of the study is to compare the effectiveness of Mulligan movement with mobilization versus Positional release technique on shoulder range of motion and functional activity in patients with adhesive capsulitis. 30 patients were randomly divided into two groups. Group A (N = 15) received Mulligan mobilization technique and Group B (N = 15) received positional release therapy. The shoulder range of motion (Abduction, External rotation, Internal rotation) was measured by goniometer, the functional activity by SPADI questionnaire. The results showed that significant differences in shoulder ROM Abduction (t = 14.18, p = 0.000), Internal rotation (t = 13.80, p = 0.000), External rotation (t = 15.87, p = 0.000) and SPADI questionnaire (t = 13.94, p = 0.000) were observed in group A patients when compared to group B. In conclusion the Mulligan mobilization technique was effective to improve the shoulder ROM and reduce functional disability in patients with adhesive capsulitis compared to Positional release technique.

Acute Effects of 2 Consecutive Simulated Badminton Matches on the Shoulder Range of Motion and Isometric Strength of Elite Youth Players

2020 ◽  
pp. 1-7
Author(s):  
Jaime Fernandez-Fernandez ◽  
Alejandro Lopez-Valenciano ◽  
Jose Vicente Garcia-Tormo ◽  
David Cabello-Manrique ◽  
Juan García-López
Keyword(s):  
Range Of Motion ◽  
External Rotation ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Shoulder Range Of Motion ◽  
Recovery Strategies ◽  
Before And After ◽  
Shoulder Strength ◽  
Shoulder Range ◽  
Dominant Side

Purpose: To analyze the influence of playing 2 consecutive prolonged badminton matches on the shoulder strength and range of motion (ROM) of young players. Methods: Sixteen elite junior badminton players (12 males and 4 females; mean (SD): age 16.2 [0.8] years, body mass 63.5 [6.6] kg, height 173.2 [6.3] cm) participated in a cross-sectional study. Shoulder internal (IR)/external rotation (ER) ROM and IR/ER strength measures were conducted before and after 2 consecutive prolonged (ie, 35 min) matches and 12 hours after the second match. Results: After consecutive matches, IR strength of the dominant side and ER strength of the dominant and nondominant sides (effect size [ES] = 0.20–0.57) were reduced. Shoulder total ROM of the dominant side was decreased (ES = 0.80), while on the nondominant side, IR (ES = 0.66) was also decreased. After 12 hours, results showed decreased values in the IR/ER strength of the dominant side (ES = 0.36–1.00), as well as ER of both dominant and nondominant sides (ES = 0.30–0.59). IR ROM of the nondominant side (ES = 0.69) was also decreased. Conclusion: Present results showed that 2 consecutive matches on the same day with brief rest periods led to significant impairments in shoulder strength and ROM levels. These data can potentially elucidate the need for shoulder-specific training and recovery strategies prior to or during competitions.

scholarly journals Differences in Passive Shoulder Range of Motion Between Baseball Players With Neurogenic Thoracic Outlet Syndrome and Matched Healthy Controls

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712110007
Author(s):  
J. Craig Garrison ◽  
Joseph P. Hannon ◽  
John E. Conway
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Thoracic Outlet Syndrome ◽  
External Rotation ◽  
Limited Information ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Shoulder Range Of Motion ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
Shoulder Range

Background: Neurogenic thoracic outlet syndrome (nTOS) is becoming more recognized as a diagnosis in the throwing athlete. Currently, there is limited information on the clinical presentation and development of nTOS in baseball players. Purpose: To compare passive shoulder range of motion (ROM) and anatomic humeral retrotorsion (HRT) of baseball players diagnosed with nTOS with a group of healthy, matched controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 53 adolescent baseball players diagnosed with nTOS (age, 17.2 ± 2.3 years; height, 180.9 ± 10.1 cm; weight, 80.0 ± 13.3 kg) were compared with 53 healthy baseball players (age, 17.2 ± 2.4 years; height, 183.9 ± 9.0 cm; weight, 83.8 ± 11.5 kg). Participants were measured for shoulder internal rotation (IR) and external rotation (ER) ROM and HRT. All measurements were taken bilaterally, and the differences (throwing to nonthrowing arm) were used to calculate mean values for glenohumeral internal rotation difference, glenohumeral external rotation difference (GERD), total rotational motion difference (TRMdiff), and anatomic humeral retrotorsion difference. Group comparisons were made between the nTOS and control players using multivariate analysis of variance, and descriptive comparisons were made with independent t tests. Results: There were no significant differences between groups in age, height, weight, or years of experience. Players in the nTOS group had significantly less throwing arm ER compared with controls (103.4° ± 10.4° vs 109.6° ± 7.5°, respectively; P = .001) and GERD (3.0° ± 9.2° vs 8.8° ± 9.2°, respectively; P = .002). TRMdiff was significantly greater in nTOS (–11.1° ± 11.1°) than in controls (–3.7° ± 9.4°) ( P < .001). Conclusion: In the current study, adolescent baseball players diagnosed with nTOS were evaluated with shoulder ROM differences when compared with a matched healthy cohort. A loss of throwing arm ER appeared to be the main factor behind shoulder ROM changes in the nTOS group.

Effectiveness of arthroscopic management of idiopathic shoulder stiffness: A meta-analysis

2021 ◽  
pp. 1-8
Author(s):  
Ya-Dong Wang ◽  
Yu-Xiang Ming ◽  
Yong-Hua Pang ◽  
Wei-Nan Chen ◽  
Xu-Hua Zong ◽  
...  
Keyword(s):  
Range Of Motion ◽  
External Rotation ◽  
Meta Analysis ◽  
Eligibility Criteria ◽  
Shoulder Stiffness ◽  
Capsular Release ◽  
Shoulder Range Of Motion ◽  
Arthroscopic Capsular Release ◽  
Shoulder Range

BACKGROUND: Persisting shoulder stiffness adversely affects quality of life by causing pain and motion restrictions especially in patients with diabetes. OBJECTIVE: The aim of this study was to evaluate the outcomes of arthroscopic capsular release in patients with idiopathic shoulder stiffness. METHOD: A literature search was conducted in electronic databases and studies were selected by following precise eligibility criteria. Random-effects meta-analyses were performed to estimate the changes at latest follow-up in scores of the Constant, American Shoulder and Elbow Surgeons (ASES), and University of California at Los Angelis (UCLA) scales, Visual Analogue Scale (VAS), and shoulder range of motion. RESULTS: Nineteen studies were included. The follow-up duration was 42 months [95% confidence interval (CI): 32, 51]. Improvements in scores of the Constant, ASES, UCLA scales, and VAS were 48.3 [95% CI: 38.0, 58.6], 44.6 [95% CI: 24.6, 64.6], 19.3 [95% CI: 16.6, 22.0], and -6.1 [95% CI: -6.9, -5.4] respectively (P< 0.05 all). Improvements in the shoulder range of motion were: abduction 82.0 [95% CI: 65.0, 98.9]; forward flexion 75.9 [95% CI: 59.7, 92.1]; external rotation 43.2 [95% CI: 37.5, 49.0]; and internal rotation 25.4 [95% CI: 15.2, 35.5] degrees; P< 0.05 all). CONCLUSION: Arthroscopic capsular release effectively improves shoulder function in patients with idiopathic shoulder stiffness.

Influence of a Pre-throwing Protocol on Range of Motion and Strength in Baseball Athletes

2020 ◽  
Author(s):  
Jessica Downs ◽  
Kyle Wasserberger ◽  
Gretchen D. Oliver
Keyword(s):  
Range Of Motion ◽  
External Rotation ◽  
Isometric Strength ◽  
Intervention Teams ◽  
Shoulder Range Of Motion ◽  
Hip Range Of Motion ◽  
Control Team ◽  
Overhand Throwing ◽  
Intervention Team ◽  
Shoulder Range

AbstractThough chronic overhand throwing is known to result in range of motion and strength adaptations, there is limited research regarding interventions for maintenance of these characteristics. Therefore, the purposes of this study were to explore the use of a pre-throwing protocol focusing on lumbopelvic-hip complex musculature in high school baseball players and examine its effects on shoulder and hip range of motion and isometric strength over the course of a season. Four exercises were added to the intervention team’s warm-up routine. The control and intervention teams’ passive bilateral hip and shoulder range of motion and isometric strength were assessed pre/post-season. A multivariate analysis of variance revealed significant differences in delta scores between the teams for multiple shoulder and hip range of motion and isometric strength variables. Key results were the intervention team lost significantly more stride hip external rotation but gained more isometric strength than the control team. The intervention team was also able to better maintain shoulder range of motion than the control team. Practitioners should use the results of this study and consider incorporating exercises that target lumbopelvic-hip complex musculature into their current training program.

Shoulder Range of Motion and Strength Characteristics in Circus Acrobats

2020 ◽  
Vol 35 (3) ◽  
pp. 145-152
Author(s):  
Carlie Huberman ◽  
Melissa Scales ◽  
Srikant Vallabhajosula
Keyword(s):  
General Population ◽  
Range Of Motion ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Hand Dominance ◽  
Cross Sectional ◽  
Shoulder Range Of Motion ◽  
Shoulder Strength ◽  
Shoulder Complex ◽  
Shoulder Range

OBJECTIVES: To begin to establish normative data for shoulder range of motion (ROM) and strength in the circus acrobats and to compare these values based on age, sex, hand dominance, and acrobatic subgroup. METHODS: Active (AROM) and passive (PROM) of the full shoulder complex and PROM of the isolated glenohumeral joint were measured in 193 circus acrobats using standardized techniques for anterior elevation (flexion), posterior elevation (extension), lateral elevation (abduction), and external and internal rotation. Shoulder strength was measured using a hand-held dynamometer in all planes of motion. Measurements were taken twice and averaged. Mixed ANOVA were performed. One-sample t-tests were used to compare with general population. RESULTS: Several significant differences were noted between dominant and non-dominant sides, but not between the sex or age groups tested. Acrobats who did both aerial and ground acrobatics had significantly greater full shoulder complex flexion AROM than the aerial group, and AROM extension than the ground group. Circus acrobats had significantly greater AROM full shoulder complex extension, abduction, internal and external rotation, and shoulder strength than the general population. CONCLUSION: Overall, results from this cross-sectional study revealed that circus acrobats had greater shoulder strength and ROM than the general population, which could affect the way these patients should be treated in a clinical setting. Age and sex seemed to have minimal effects, but there was clearly an effect of hand dominance. Acrobats who train both aerial and ground acrobatics may have greater ROM in certain planes than those who train in only one type of discipline.

scholarly journals Correlation of 3-Dimensional Shoulder Kinematics to Function in Subjects With Idiopathic Loss of Shoulder Range of Motion

2005 ◽  
Vol 85 (7) ◽  
pp. 636-647 ◽  
Author(s):  
Peter J Rundquist ◽  
Paula M Ludewig
Keyword(s):  
Range Of Motion ◽  
Multiple Regression ◽  
External Rotation ◽  
Regression Equation ◽  
Multiple Regression Equation ◽  
3 Dimensional ◽  
Shoulder Range Of Motion ◽  
Shoulder Kinematics ◽  
And Function ◽  
Shoulder Range

AbstractBackground and Purpose. People with idiopathic loss of shoulder range of motion (ROM) have difficulty completing activities of daily living. This investigation was performed to determine the association between active glenohumeral ROM and function and to develop a multiple regression equation to explain variation in function in people with idiopathic loss of shoulder motion. Subjects and Methods. This was a comparative study of 21 subjects (18 female, 3 male), using measurements of shoulder kinematics and administration of the Shoulder Rating Questionnaire (SRQ). Electromagnetic tracking sensors monitored the 3-dimensional position of the scapula and humerus throughout active shoulder motions. Correlations were performed between the active ROMs of interest and various demographic factors and the SRQ. A multiple regression equation was generated. Results. A multiple regression equation including scapular-plane abduction, external rotation at the side, external rotation at 90 degrees of abduction, and weight explained 69% of the variation in the SRQ scores. Discussion and Conclusion. The results suggest that active ROM can be used to predict function in people with idiopathic loss of shoulder ROM.

Shoulder Range of Motion Deficits in Baseball Players With an Ulnar Collateral Ligament Tear

2012 ◽  
Vol 40 (11) ◽  
pp. 2597-2603 ◽  
Author(s):  
J. Craig Garrison ◽  
Mollie A. Cole ◽  
John E. Conway ◽  
Michael J. Macko ◽  
Charles Thigpen ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Ulnar Collateral Ligament ◽  
Control Group ◽  
Elbow Extension ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Elbow Injury ◽  
Shoulder Range Of Motion ◽  
Shoulder Range

Background: Shoulder range of motion (ROM) deficits are associated with elbow injury in baseball players. Purpose: To compare the ROM characteristics of baseball players with a diagnosed ulnar collateral ligament (UCL) tear with those of a group of age-, activity-, and position-matched healthy controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Sixty male competitive high school and collegiate baseball players participated. Thirty athletes (age [mean ± standard deviation], 18.20 ± 1.56 years) with a diagnosed UCL tear were compared with 30 (age, 18.57 ± 0.86 years) age-, activity-, and position-matched players without a UCL injury. Of the 60 participants, there were 44 pitchers, 4 catchers, 5 infielders, and 7 outfielders. Participants were measured for shoulder internal rotation (IR), external rotation (ER), and horizontal adduction (HA) at 90° of shoulder elevation. Participants were also measured for elbow extension in a seated position. Group comparisons were made between participants with and without a UCL injury using independent t tests with an α level set at P < .05. All measurements were taken bilaterally, and the differences (involved to uninvolved) were used to calculate means for all variables, including glenohumeral internal rotation deficit (GIRD), total rotational motion (TRM), HA, and elbow extension. Results: Baseball players with a UCL tear (UCLInj) exhibited significantly greater deficits in TRM compared with the control group of healthy baseball players (NUCLInj) (UCLInj = −6.67° ± 11.82°, NUCLInj = 0.93° ± 9.91°; P = .009). No group differences were present for GIRD (UCLInj = −12.53° ± 5.98°, NUCLInj = −13.63° ± 5.90°; P = .476), HA (UCLInj = −3.00° ± 5.01°, NUCLInj = −3.23° ± 5.15°; P = .860), or elbow extension (UCLInj = −2.63° ± 7.86°, NUCLInj = −1.17° ± 2.76°; P = .339). Pitchers with a UCL tear had significantly greater deficits in TRM (UCLInjPitch = −6.96° ± 11.20°, NUCLInjPitch = 1.29° ± 8.33°; P = .0087) and dominant shoulder ER (UCLInjPitch = 112.04° ± 14.35°, NUCLInjPitch = 121.85° ± 9.46°; P = .011) than pitchers without a UCL tear. Conclusion: A deficit in TRM is associated with a UCL tear in baseball players. Although GIRD may be prevalent in throwers, it may not be associated with a UCL injury. When examining ROM in baseball players, it is important to assess both TRM and GIRD.

Infraspinatus Cross-Sectional Area and Shoulder Range of Motion Change Following Live-Game Baseball Pitching

2019 ◽  
Vol 28 (3) ◽  
pp. 236-242 ◽  
Author(s):  
Brett S. Pexa ◽  
Eric D. Ryan ◽  
Elizabeth E. Hibberd ◽  
Elizabeth Teel ◽  
Terri Jo Rucinski ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Athletic Training ◽  
Repeated Measures ◽  
External Rotation ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Shoulder Range Of Motion ◽  
Posterior Shoulder ◽  
Before And After

Context: Following a baseball pitching bout, changes can occur to glenohumeral range of motion that could be linked to injury. These effects are in part due to the posterior shoulder’s eccentric muscle activity, which can disrupt muscle contractile elements and lead to changes in muscle cross-sectional area (CSA), as measured by ultrasound. Objective: To assess changes in muscle CSA, and range of motion immediately before and after pitching, and days 1 to 5 following pitching. Design: Repeated measures. Setting: Satellite athletic training room. Patients: Ten elite college baseball pitchers participating in the fall season (age: 18.8 [1.2] y, height: 189.2 [7.3] cm, mass: 93.1 [15.3] kg, 8 starters, 2 long relievers). Intervention: A pitching bout of at least 25 pitches (63.82 [17.42] pitches). Main Outcome Measures: Dominant and nondominant infraspinatus CSA, as measured by ultrasound, and glenohumeral range of motion including internal rotation (IRROM), external rotation (ERROM), and total rotation range of motion (TROM) before pitching, after pitching, and days 1 to 5 following the pitching bout. Results: Dominant limb CSA significantly increased day 1 after pitching, and returned to baseline on day 2 (P < .001). Dominant and nondominant TROM did not change until day 5 (4.4°, P < .001) and day 3 (4.5°, P < .001), respectively, where they increased. Dominant IRROM was significantly decreased for 3 days (day 1: 1.9°, P < .001; day 2: 3.1°, P < .001; day 3: 0.3°, P < .001) following pitching and returned to baseline on day 4, with no such changes in the nondominant limb. Dominant external rotation significantly increased immediately post pitching (4.4°, P < .001) but returned to baseline by day 1. Conclusions: The results of the study demonstrate that infraspinatus CSA does not recover until 2 days following pitching, and IRROM does not recover until 4 days following pitching. Baseball pitching elicits damage to the posterior shoulder muscle architecture, resulting in changes to physical characteristics that last up to 4 days following pitching.

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