Context Inadequate hip range of motion (ROM) and isometric strength (ISO) may interfere with energy flow through the kinetic chain and result in increased injury susceptibility. Objective To examine the relationship of hip ROM and ISO with energy flow through the trunk and pitching-arm segments during the windmill softball pitch in youth athletes. A subsequent purpose was to examine the relationship between energy flow and pitch speed. Design Descriptive laboratory study. Setting University research laboratory. Patients or Other Participants A sample of 29 youth softball pitchers (age = 11.2 ± 1.3 years, height = 155.0 ± 10.4 cm, mass = 53.2 ± 12.6 kg). Main Outcome Measure(s) Bilateral hip internal-rotation and external-rotation (ER) ROM and ISO were measured. Net energy outflow and peak rates of energy outflow from the distal ends of the trunk, humerus, and forearm were calculated for the acceleration phase of the windmill softball pitch, and pitch speed was measured. Results Regression analysis revealed an effect of drive-hip ER ISO on the net energy flow out of the distal ends of the trunk ( P = .045) and humerus ( P = .002). Specifically, increased drive-hip ER ISO was associated with increased net energy outflow from the trunk to the humerus and from the humerus to the forearm. No significant effects of hip ROM or other hip ISO measures were observed. Additionally, pitchers who achieved higher peak rates of distal outflow tended to achieve higher pitch speeds. Conclusions An association was present between drive-hip ER ISO and the net energy flow out of the distal ends of the trunk and humerus during the acceleration phase of the windmill softball pitch, emphasizing the importance of hip and lower body strength in executing the whole-body windmill pitch. Overall, energy-flow analysis is an interesting new way to analyze pitching mechanics and will aid in furthering our understanding of performance and injury risk in windmill softball pitching.

Context: Inadequate hip range of motion (ROM) and isometric strength (ISO) may interfere with energy flow through the kinetic chain and result in increased injury susceptibility. Objective: To examine the relationship of hip ROM and ISO with energy flow through the trunk and pitching arm segments during the windmill softball pitch in youth athletes. A subsequent purpose was to examine the relationship between energy flow and pitch speed. Design: Descriptive laboratory study. Setting: University research laboratory. Participants: A sample of 29 youth softball pitchers (11.2±1.3 yrs.; 155.0±10.4 cm; 53.2±12.6 kg). Main Outcome Measure(s): Bilateral hip internal rotation (IR) and external rotation (ER) ROM and ISO were measured. Net energy outflow and peak rates of energy outflow from the distal ends of the trunk, humerus, and forearm were calculated for the acceleration phase of the windmill softball pitch, and pitch speed was measured. Results: Regression analysis revealed a significant effect of drive hip ER ISO on the net energy flow out of the distal ends of the trunk (p=0.045) and humerus (p=0.002). Specifically, increased drive hip ER ISO was associated with increased net energy outflow from the trunk to the humerus and from the humerus to the forearm. No significant effects of hip ROM or other hip ISO measures were observed. Additionally, pitchers who achieved higher peak rates of distal outflow tended to also achieve higher pitch speeds. Conclusions: There is an association between drive hip ER ISO and the net energy flow out of the distal ends of the trunk and humerus during the acceleration phase of the windmill softball pitch, emphasizing the importance of hip and lower body strength in the execution of the whole-body windmill pitch. Overall, energy flow analysis is an interesting new way to analyze pitching mechanics and will aid in further understanding of performance and injury risk in windmill softball pitching.

Context Previous research has indicated that throwing sports expose athletes to overuse injuries and that specialization in sport is linked to injury. However, the effect of overexposure to a throwing sport on a dynamic movement task is unknown. Objective To determine if sport specialization in youth throwing athletes affected performance on the single-legged squat (SLS). Design Descriptive laboratory study. Setting University research laboratory. Patients or Other Participants A total of 49 youth baseball and softball athletes (23 baseball, 26 softball; age = 12.96 ± 2.32 years, height = 165.01 ± 13.05 cm, mass = 61.42 ± 13.04 kg) were recruited. Main Outcome Measure(s) Participants were grouped into 3 categories based on specialization definitions: (1) 8 months or longer in season, (2) 8 months or longer in training, or (3) 8 months or longer in season and previously quit another sport. We measured SLS kinematics and used a set of 1-way multivariate analyses of variances to determine if trunk kinematics differed by group. Results Athletes who spent 8 months or more in sport-specific training exhibited significantly more trunk control, revealed by less trunk lateral flexion (Λ = 0.69, F 6,38 = 2.89, P = .020) and less trunk flexion (Λ = 0.69, F 6,38 = 2.88, P = .021) throughout an SLS. Conclusions These results agree with the principle of specific adaptation to imposed demands. Surprisingly, athletes who spent 8 months or more playing a unilateral sport showed no differences in SLS performance. Clinicians should emphasize that neuromuscular adaptations of the lumbopelvic-hip complex for dynamic movement, such as an SLS, may be achieved through training instead of strict sport participation. Future researchers should consider how much of the training protocol is actually specialized for sport training.

Objective To present a case of bilateral subtalar joint coalition in a National Collegiate Athletic Association Division I basketball player and the treatment plan that was used to manage the coalition from the beginning of conference play through the postseason. Background A 20-year-old male basketball athlete (height = 182.8 cm, mass = 83.4 kg) presented with bilateral subtalar joint tarsal coalition that became symptomatic in 2006 and resulted in constant pain with any form of activity. Differential Diagnosis Traumatic injury of the talocalcaneal joint. Treatment Nonsurgical intervention of conservative therapy was elected. Uniqueness Less than 13% of the overall population is affected with tarsal coalition, so it is safe to assume that very few athletes competing at the collegiate or elite level suffer from this condition. This is the first report in the literature to document conservative manual therapies used to manage the symptoms of subtalar joint tarsal coalition in a Division I basketball player. Conclusions After the intensive treatment program for tarsal coalition was implemented, the patient experienced pain relief and was able to continue to compete at a competitive level. This case represents the need to further explore and document a conservative treatment protocol for tarsal coalition.

Objective: To present the case of surgical treatment and rehabilitation of a midshaft clavicular fracture in a National Collegiate Athletic Association Division I football athlete. Background: While attempting to catch a pass during practice, the athlete jumped up and then landed on the tip of his shoulder. On-the-field evaluation was inconclusive, with a sideline evaluation diagnosis of clavicular fracture. Postinjury radiographs revealed a midshaft clavicular fracture. Differential Diagnosis: Spiral oblique midshaft clavicular fracture. Treatment: The sports medicine staff discussed surgical and nonsurgical options. A surgical procedure of internal fixation with an 8-hole plate was performed. Uniqueness: Surgical treatment for clavicular fractures is becoming increasingly common. This is the first report of an advanced rehabilitation protocol for surgical repair. We suggest that new rehabilitation protocols for clavicular repairs be investigated now that surgical treatment is being pursued more frequently. Conclusions: More aggressive treatment procedures and rehabilitation protocols for clavicular fractures have evolved in recent years. With these medical advancements, athletes are able to return to play much more quickly without compromising their health and safety.