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Laura Miele, Carl W. Nissen, Kevin Fitzsimmons, Trudy Lerer and Garry Lapidus

Injury prevention programs have a positive effect on performance and the reduction of risk in most studies and reviews. However, not all teams and coaches utilize them. In order to better understand this, a 19-item survey was conducted to assess high school coaches’ perceptions, attitudes, and current practices regarding knee injury prevention among adolescent athletes during a mandatory Connecticut certification/re-certification course. The results of the survey show that high school coaches report a wide variability in their attitudes and utilization of training programs related to knee injury prevention. Coaches reported several barriers to employing the programs; the leading issue being time. Future education and outreach efforts should address the barriers in order to increase use of injury prevention training.

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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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Matthew D. Milewski, Sylvia Õunpuu, Matthew Solomito, Melany Westwell and Carl W. Nissen

Documentation of the lower extremity motion patterns of adolescent pitchers is an important part of understanding the pitching motion and the implication of lower extremity technique on upper extremity loads, injury and performance. The purpose of this study was to take the initial step in this process by documenting the biomechanics of the lower extremities during the pitching cycle in adolescent pitchers and to compare these findings with the published data for older pitchers. Three-dimensional motion analysis using a comprehensive lower extremity model was used to evaluate the fast ball pitch technique in adolescent pitchers. Thirty-two pitchers with a mean age of 12.4 years (range 10.5–14.7 years) and at least 2 years of experience were included in this study. The pitchers showed a mean of 49 ± 12° of knee flexion of the lead leg at foot contact. They tended to maintain this position through ball release, and then extended their knee during the follow through phase (ball release to maximal internal glenohumeral rotation). The lead leg hip rapidly progressed into adduction and flexion during the arm cocking phase with a range of motion of 40 ± 10° adduction and 30 ± 13° flexion. The lead hip mean peak adduction velocity was 434 ± 83°/s and flexion velocity was 456 ± 156°/s. Simultaneously, the trailing leg hip rapidly extended approaching to a mean peak extension of –8 ± 5° at 39% of the pitch cycle, which is close to passive range of motion constraints. Peak hip abduction of the trailing leg at foot contact was –31 ± 12°, which also approached passive range of motion constraints. Differences and similarities were also noted between the adolescent lower extremity kinematics and adult pitchers; however, a more comprehensive analysis using similar methods is needed for a complete comparison.