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  • Author: Mark Lee x
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Hardeep Singh, Mark Lee, Matthew J. Solomito, Christian Merrill and Carl Nissen

Symptomatic spondylolysis/spondylolisthesis is thought to be caused by repetitive lumbar extension. About 8.9% of baseball pitchers that experience back pain will be diagnosed with spondylolysis. Therefore, this study aims to identify and quantify lumbar extension experienced during baseball pitching. It was hypothesized that young pitchers would exhibit less lumbar extension than older pitchers. A total of 187 healthy pitchers were divided into 3 age groups: youth, adolescent, and college. Kinematic data were collected at 250 Hz using a 3-D motion capture system. Lumbar motion was calculated as the difference between upper thoracic motion and pelvic motion over the pitching cycle. Lumbar “hyperextension” was defined as ≥20° past neutral. College pitchers had significantly greater lumbar extension compared with youth and adolescent pitchers at the point of maximum external rotation of the glenohumeral joint during the pitch cycle (−25° [13°], P = .04). For all age groups, lumbar hyperextension was present during the first 66% of the pitch cycle. Most pitchers spent 45% of pitch cycle in ≥30° of lumbar extension. Understanding that lumbar extension and hyperextension are components of the complex, multiplanar motions of the spine associated with baseball pitching can potentially help in both the prevention and management of symptomatic spondylolysis/spondylolisthesis.

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Katherine Lee, James Onate, Samar McCann, Tamerah Hunt, Wilbert Turner and Mark Merrick

Clinical Scenario:

In wrestling, athletes often support a large amount of weight on their heads or are forced into extreme ranges of motion. These suboptimal movement conditions lead to a high prevalence of neck injuries in wrestlers. A large portion of the work done by the cervical musculature in wrestling is theorized to be eccentric or isometric types of contractions. Strengthening of these cervical muscles is clinically considered to play a vital role in being competitive on the wrestling mat. The cervical stability provided by strengthening these muscles may also play a part in injury prevention among wrestlers.

Focused Clinical Question:

Does increased cervical strength lead to a decreased risk of injury in wrestling?

Summary of Search, “Best Evidence” Appraised, and Key Findings:

The literature was searched for studies of level 4 evidence or higher using the Oxford Centre for Evidence-Based Medicine level of evidence system that investigated the relationship between cervical strength and injury risk in wrestling. No studies were found comparing cervical strength to injury risk in wrestling, but 2 related studies were found and have been included in this critically appraised topic.

Clinical Bottom Line:

There is poor evidence to support a relationship between cervical strength and injury risk in wrestling.

Strength of Recommendation:

There is grade C evidence to indicate that increased cervical strength decreases the risk of injury in wrestling.