Research Review #3: Movement Screens and Overuse Symptoms in College Baseball Players

Busch AM, Med DRC, Onate JA, Ramsey VK, Cromartie F. Relationship of preseason movement screens with overuse symptoms in collegiate baseball players. Int J Sports Physical Ther. 2017;12(6):960-966. doi:10.16603/ijspt20170960.

Background

Throwing-related overuse injuries are common at all levels of organized baseball.   Risk factors for these types of injuries include sport-specific adaptations (osseous and soft tissue), throwing velocity, overuse, muscle imbalances, and previous injury.

Purpose

The purpose of this study was to determine if preseason Functional Movement Screen (FMS) shoulder mobility or Selective Functional Movement Assessment (SFMA) upper extremity pattern performance could accurately identify college baseball players at increased risk for in-season overuse symptoms.

Study Population

Inclusion

  • Active participation in pre-season Division III baseball team activities (n=135) from 4 different universities.

Exclusion

  • Actively being treated for shoulder or elbow injury
  • Reported any upper extremity injury at the time of testing

Research Methods

The same FMS and SFMA certified examiner performed all testing on players two weeks prior to the official start of team practices.  FMS shoulder mobility scores were dichotomized as “good” (score of 2 or 3) or “poor” (score of 0 or 1).  SFMA scores were dichotomized as “good” (functional non-painful) or “poor” (dysfunctional painful, dysfunctional non-painful, and functional painful).  Participants completed a weekly questionnaire during the preseason and competitive season which inquired about shoulder or elbow complaints and time loss from practice or competition.

Key Results

  •  Poor FMS performance was associated with an increased likelihood of experiencing overuse symptoms in the preseason (OR = 5.14, p = 0.03) when controlling for position and grade level (freshman, sophomore, etc)
  • Poor FMS performance was not associated with experiencing overuse symptoms during the competitive season.
  • Poor SFMA performance was associated with an increased likelihood of experiencing overuse symptoms during the preseason season (OR = 6.10, p = 0.03) and competitive season (OR = 17.07, p = 0.03) when controlling for grade and position.

Study Limitations

  • Research participants were a convenience sample of 4 area college teams.
  • Due to missing data, only 60 research participants were included in the chi-square and logistic regression analyses.
  • Underpowering may have contributed to some insignificant findings.
  • Fatigue, pitch counts, throwing velocities and other risk factors were not analyzed.
  • Confidence intervals for all significant findings were wide suggestion imprecision of data: SFMA performance and competitive season risk (OR 17.07, 95% CI 1.39, 210.20)

Practical Implications & Additional Thoughts

Preseason movement screens may help identify college baseball players at an increased risk for shoulder and elbow overuse symptoms.  The SFMA upper extremity patterns appear to be most useful for identifying an increased risk during the preseason and competitive season.  Despite the methodological shortcomings of this study, the findings are applicable to professionals who conduct pre-participation screenings and physicals.  The SFMA upper extremity patterns are extremely quick and easy to assess as part of any pre-season player assessment.

Glenohumeral internal rotation deficit (GIRD) is frequently encountered in overhead athletes at all levels1.  It is always important to consider GIRD along with the athlete’s total arc of rotation motion (total internal and external rotation motion).  The SFMA upper extremity pattern 1 assesses the ability to reach behind the back which includes internal rotation as one component of the combined movement.  Loss of passive external rotation range of motion has also been associated with an increased risk for injury in professional baseball players2.   The SFMA upper extremity pattern 2 includes some contributions of glenohumeral external rotation as part of this combined movement.  Therefore, both these quick screening tests possess face validity and some research support for inclusion in a preseason assessment.

It is extremely important that we keep in mind the two SFMA upper extremity patterns are not isolated tests for glenohumeral joint range of motion deficits.  Contributions from the spine, rib cage, scapulothoracic joint and adjacent soft tissues must be considered.  Addressing any thoracic spine and rib cage impairments with manual therapy or exercise often clears dysfunctional upper extremity patterns in overhead athletes without directing treating the glenohumeral joint.  Clearing proximal impairments with a regional interdependence approach is probably the best approach before any aggressive stretching protocols are employed.  My clinical experience suggests thoracic spine manipulation, gentle soft tissue techniques, and movement retraining is enough to correct the dysfunctional SFMA patterns.  It might be premature to jump directly into the sleeper stretch with these athletes.  The SFMA upper extremity patterns offer a method to quickly screen the athlete but a more detailed assessment is needed before choosing the most appropriate corrective strategy.

References

  1. Wilk KE, Macrina LC, Fleisig GS, et al. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39(2):329-335. doi:10.1177/0363546510384223.
  2. Wilk KE, Macrina LC, Fleisig GS, et al. Deficits in glenohumeral passive range of motion increase risk of shoulder injury in professional baseball pitchers. Am J Sports Med. 2015;43(10):2379-2385. doi:10.1177/0363546515594380.

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