AOSSM 2009:棒球球季開打前的肩膀強度掃描可以對潛在的投手受傷提供警訊


  July 13, 2009 (科羅拉多州Keystone) — 根據美國整形外科運動醫學協會第35屆年會中發表的研究,棒球球季開打前,對特定部位進行強度掃描,有助於辨識哪些投手在球季中有較高的受傷風險,且可加強訓練,以避免這些潛在傷害。
  
  主要作者、田納西州那什維爾Vanderbilt醫學中心第4年整形外科住院醫師Ian Robert Byram表示,運動整形外科醫師通常會觀察一些強度及虛弱程度與後續傷害之間的關係,但是之間的關聯性文獻並不多。
  
  他解釋,理論上,相對過度強化的內轉肌群與相對較弱的外轉肌群之間的失衡,會造成肩膀和手肘的傷害。但是就我們所知,沒有探討球季前的強度與職業球季中傷害之間的前溯研究結果。
  
  為了進行這項研究,Byram醫師等人在2001至2005年間,蒐集科羅拉多落磯球團所有投手的季前肩膀強度資料,包括了大聯盟和小聯盟的144名投手。
  
  在這五個球季開始時,選手們檢測以下四種強度:俯臥內旋、俯臥外旋、坐姿外旋,以及棘上肌強度。
  
  之後在這幾個球季中追蹤選手的投球相關傷害事件,根據沒有受傷、保守治療的傷、手術治療的傷進行分類。使用「Spearman等級相關係數」以分析選手測量的強度與傷害之間的關係。
  
  Byram醫師表示,我們希望將每個球季視為測量投手個人強度的一個新的時間點,之後蒐集任何受傷的資料。
  
  結果顯示,需要手術的傷害與俯臥外旋強度(P= .003)、坐姿外旋強度(P= .048)、棘上肌強度(P= .006)之間分別有顯著關係。
  
  Byram醫師表示,俯臥外旋強度和俯臥內旋強度之比值,傾向與傷害之間有關,但是沒有顯著關聯。
  
  他解釋,研究的一些限制,包括有許多因素未納入,例如投球量、球種、選手體型和投球速度,事實上,級距型的傷害量表可能不能將無法以手術治療的有害傷害納入考量。
  
  Byram醫師表示,這些發現有助於對稍後球季的傷害提出警訊,對於球隊有極高價值,也有助於球季前訓練。
  
  我們希望此研究可以運用在球季前的測量,以辨識那些有風險的選手,之後對這些高風險者進行復健。
  
  他指出,合併其他資料後,這項發現可能有更多好處。如果我們可以彙整多個機構的資料,將可提供更有力的結論,而可以運用到其他運動類型。
  
  紐約島民曲棍球隊的整形外科醫師Brian R. Neri表示,其他機構的確指出動作範圍和強度-傷害之關聯的趨勢,季前掃描的觀念獲得支持。Neri醫師未參與本研究。
  
  他解釋,整形外科醫師治療高手運動員,特別是棒球選手,開始探討與動作範圍喪失有關的類型,例如內旋,以及後續和肩膀或手肘有關的問題。我們致力於季前檢查以及結果評估工具,使我們可以在開始就知道有運動範圍和強度問題的選手,可以幫助我們預測後續問題和介入。
  
  他表示,我們檢測全弧動作,評估會讓他們的肩膀產生問題的明顯內旋不佳,例如內夾擊、關節唇病變、或過度拉傷,導致手肘問題。
  
  Byram醫師的研究未接受商業補助。Byram醫師和Neri醫師宣告沒有相關財務關係。
  
  美國整形外科運動醫學協會(AOSSM)第35屆年會:摘要8363。發表於2009年7月10日。
  

AOSSM 2009: Baseball Preseason Shoulder Strength Screening Can Offer Red Flags for Potential Pitcher Injuries

By Nancy A. Melville
Medscape Medical News

July 13, 2009 (Keystone, Colorado) — Measurements of specific areas of strength during the baseball preseason can help identify pitchers who are most at risk for injury later in the season and allow for focused training to prevent those potential injuries, according to a study presented here at the American Orthopaedic Society for Sports Medicine 35th Annual Meeting.

Sports orthopaedists often observe associations between certain strengths and weaknesses and the potential for subsequent injuries, but the literature is lacking in solid evidence linking the 2, said Ian Robert Byram, MD, lead author and fourth-year orthopaedic surgery resident at Vanderbilt Medical Center in Nashville, Tennessee.

"It's been theorized that an imbalance between the relatively overstrengthened internal rotators and relatively weakened external rotators could cause damage to the shoulder and elbow, resulting in injury," he explained. "But to our knowledge, there has been no prospective outcome study trying to link a preseason strength variable and injury variable in professional baseball players."

For the study, Dr. Byram and his colleagues collected preseason shoulder strength data for all pitchers on the Colorado Rockies baseball team, including 144 major- and minor-league pitchers, between 2001 and 2005.

At the beginning of each of the 5 seasons, players were tested in 4 strength areas: prone internal rotation, prone external rotation, seated external rotation, and supraspinatus strength.

The players were then tracked through the respective season for incidents of throwing-related injury and were categorized as either having no injury, injury treated conservatively, or injury resulting in surgery. The Spearman rank correlation coefficient was used to analyze the association between the players' strength measurements and injury.

"We wanted to look at each individual season as a new snapshot in gauging the pitchers' individual strengths and then correlate that data with any injuries," Dr. Byram said.

The results showed a significant association of injury requiring surgery with prone external rotation strength (P?= .003), seated external rotation strength (P?= .048), and supraspinatus strength (P?= .006).

The ratio of prone external rotation to prone internal rotation strength trended toward an association with injury, but the ratio was not statistically significant, Dr. Byram said.

Some limitations for the study included various factors that were not accounted for, such as player pitch counts, pitch type, player size and pitch velocity, and the fact that the ordinal injury scale could fail to pick up considerations such as potentially deleterious injuries that were not treated surgically, he explained.

The findings, by helping to raise red flags for potential injury later in the season, could be highly valuable to a team and help to focus training during the preseason, Dr. Byram said.

"We hope this study can have some application in identifying at-risk players via preseason measurements and then focusing rehabilitation efforts to those in a higher-risk group."

In combination with additional data, the findings could have broader-reaching benefits, he added. "If we can pool data from multiple organizations, this would provide stronger conclusions that could possibly be applied to other sports organizations."

Other organizations have indeed been spotting trends in range-of-motion/strength-injury associations, and the idea of preseason screening for such patterns is gaining favor, said Brian R. Neri, MD, the team orthopaedist for the New York Islanders hockey club. Dr. Neri was not involved in the study.

"Orthopaedists who treat overhead athletes, baseball players in particular, have started to see a pattern in regards to a loss in range of motion, such as internal rotation, and a set-up for later problems either with the shoulder or elbow," he explained. "We've tried to come up with a preseason examination and outcome-assessment tool that gives us a baseline for where the athlete is in terms of things like range of motion and strength that may help us predict future problems and intervene.

"We're testing things like total arc of motion and evaluating for significant internal rotation deficits, which could potentially set them up to have shoulder issues, such as internal impingement, labral pathology, or excessive stress, leading to elbow problems," he said.

Dr. Byram's study did not receive commercial support. Dr. Byram and Dr. Neri have disclosed no relevant financial relationships.

American Orthopaedic Society for Sports Medicine (AOSSM) 35th Annual Meeting: Abstract 8363. Presented July 10, 2009.

    



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