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Baseball Throwing: Fundamentals and Biomechanics

Coaches at all levels often overlook the fundamentals and mechanics of the baseball throw. Many believe that good throwing athletes are born with natural ability. Others feel that almost anyone can improve his or her throwing by understanding and practicing proper mechanics.

The act of throwing requires synchronized movements performed in this sequence: stride, hip rotation, trunk rotation, and arm movement. These synchronized motions allow for maximal hand, and thus ball, velocity (speed).

• The stride is a step in the direction of the throw. The length of the stride should be approximately 80 percent of the athlete’s height. The foot should land within two to three inches of the midline of the direction.
• Hip rotation follows foot contact. The hips rotate to open up towards the target against a stable front side while the back knee drives forward and inward.
• Trunk rotation follows proper hip rotation. A common fault among young or unskilled throwers is that the back hip does not come around to square the body off, and the back knee does not drive forward. Inexperienced throwers will improperly rotate the hips and trunk at the same time. The correct sequence of hip to trunk rotation allows for a pre-loading or stretching of the trunk muscles which gives these muscles an increased contraction force.
• Proper arm movement during acceleration depends upon sequenced hip and trunk rotation. As the trunk starts its rotation, the arm should lag slightly behind. This lagging serves to pre-stretch the shoulder muscles allowing increased acceleration of the arm.
• The elbow height should be in line with the shoulders; and should be outside of elbow with the thumb in front and the fingers behind the ball. Some believe the wrist snap is the secret of throwing hard. However, high speed photography clearly shows that the ball is released from the hand prior to most of the wrist flexion.

The reason to break down throwing into phrases is to help understand the process. In reality, throwing is a continuous activity of sequences of body motions. Coaches can help athletes understand throwing mechanics and give ample practice time to form and technique.

Basketball is one of the most common and widely played sports in the United States. It can be both fun and a good cardiovascular workout.

However, due to the fast-paced nature of this contact sport, basketball players are at risk for a variety of injuries. Three of the most common injuries are ankle sprains, finger sprains, and patellar tendinitis.

When injured, it is important to follow the R.I.C.E (Rest, Ice, Compression, Elevation) treatment routine. Controlling inflammation, assessing the severity of your injury, and deciding if you need to see a doctor are also critical steps to consider when you are injured on the basketball court.

When dealing with any injury, it is essential to apply ice to the injured and swollen area. By applying ice to an injury, you help the body by reducing pain and swelling.

Utilizing a compression wrap will give the injured area the support it needs, as well as help to control any troublesome inflammation. Elevation, or putting the injured area above the heart, will also help you by decreasing the affects of swelling.

If at any time during the injury you felt a snap, a pop, or feel a sensation of "grinding" in the joint, the next logical step should be to see a physician. Some injuries can be so severe that your doctor may need to prescribe a splint or cast to help in the healing process and protect you from further injury.

The fingers and the wrist are common areas that are injured when playing basketball. The ball can strike an extended finger or wrist and cause an injury ranging from a simple sprain to a fracture.

If you suspect a fracture, obtain an emergency room x-ray or seek the opinion of your doctor. If the pain from any injury lasts longer than 2 to 3 days, a medical evaluation should be obtained before you attempt to return to play.

The application of ice and a compression wrap to the injured area will help to reduce the swelling until you can get to see your doctor. Injuries to the hand and wrist are sometimes traumatic in nature and can at times, cause severe disability if left unnoticed.

Lower back discomfort is a condition that is commonly suffered by basketball players. Running and jumping on the hardwood court or on the concrete playground can produce a large amount of stress on the lower back.

Lower back pain may be the result of weak abdominal muscles, which assist the back muscles when moving around on the court. If the abdominal muscles are not in shape or are de-conditioned, then the lower back muscles will have to compensate.

Treatment for a lower back strain may include rest to allow the injured area to heal and by stretching before, during, and after the game to maintain flexibility. Keeping a good muscular balance between your abdominal muscles and your low back muscles will help reduce your chances of low back pain when you are active.

Knee injuries are also a common problem to face when playing basketball. Inflammation on the patellar tendon (known as Jumper's Knee) can cause pain and swelling and result in time away from the court. The pain of Jumper's knee is characterized by pain in the patellar tendon, an area just below the kneecap.

This overuse-type injury responds well to icing after activity and to flexibility before and after the game in the hamstrings and quadriceps muscles. Making sure that all the muscles in the lower body are flexible and strong will help to lessen the effects of Jumper's knee.

A more disabling injury involving the knee is a tear of either the meniscus (cartilage) or the ACL (anterior cruciate ligament). This injury is the result of a twisting motion at the knee and is characterized by a "pop" or a large amount of swelling and disability. If you suspect one of these two injuries, your next logical step is to see your physician for further evaluation.

Ankle injuries are among the most common ailments suffered by basketball players and account for close to 1/4th of all basketball related injuries. There are two common types of ankle sprains that a basketball player may encounter while participating.

The most common type of ankle sprain involves an injury to the lateral ligaments (outside ligaments) of the ankle and is caused by an inversion or a turning of the foot inwards and towards the body. The inversion ankle sprain typically involves stepping or coming down on another player's foot and twisting the ankle inwards.

The second type of ankle sprain involves the medial (or the inside ligaments) of the ankle. With an eversion sprain the foot turns away from the body or towards the outside. The eversion sprain can also be the result of stepping on another player's foot or coming down awkwardly on the ankle.

The treatment of an ankle sprain involves applying ice to the injured area and a compression wrap to control the swelling. If the injury is severe enough or you suspect a fracture, you may need to utilize crutches to assist in walking and a visit to your doctor for an x-ray may be necessary.

By maintaining good strength levels in your muscles and utilizing good flexibility practices, you can reduce your chances of suffering an injury. Making sure that you have the right equipment and good shoes is also a must when you decide to take to the basketball court.

Remember an ounce of prevention is worth a pound of cure.

Although most people would agree that golf is not considered a strenuous sport, the mechanics of the golf swing and the nearly 25 million participants sets the stage for a certain percentage of golf related injuries. Golf, unlike most other sports, is played by people of all ages, body types, and can be played throughout one's life.

A wide range of musculoskeletal injuries is associated with these factors in both the professional and amateur golfer. The motion of the golf swing requires large forces generated in trunk rotation and shoulder motion through a wide range of motion at high speed.

Comparison studies between the professional and amateur golfer indicate a high incidence of hand and wrist injuries in the professional golfer and elbow and back injuries in the amateur golfer. Differences between the groups may be related to conditioning, differing swing mechanics and an older average of the amateur golfer as compared to the professional golfer.

Training error or too much play or practice all contribute to the repetitive microtrauma (wear and tear) that leads to overuse injuries. The hand and wrist are susceptible to injuries from excessive ground contact combined with increased grip strength. The constant impact of the club to the ground can lead to ligament injury (sprains) in the wrist and potential stress fractures.

To avoid injury while participating in golf, there are several key things you can do:

• Warm up fully before playing by lightly hitting balls with your short irons.
• Be sure to stretch. Golf requires a fine balance of strength and flexibility in all muscle groups to produce a smooth and coordinated swing.
• Overall fitness will make a better golf score and decrease risk of injury.

The sport of hockey is a physically demanding sport that utilizes not only speed but also fitness and physical contact. Participants in hockey compete on skates with a razor edge and at very fast speeds so it goes without saying that injuries can be a huge part of the game.

The areas of the body that are injured the most in hockey are the shoulders and the knees. The shoulders can become bruised, dislocated, or a bone can be broken as a result of contact with the boards, other players, and even the playing surface. The knee is also a victim of a possible contusion, sprain, and in some extreme cases, a ligament can tear as the result of contact or a collision.

Common Injuries:

• Blisters develop as a result of repetitive friction against the skin.
• Contusions/Bruises develop as a result of falls, collisions, direct hit from sticks.

Treatment:

Blisters

• Keep area clean and dry.
• Keep blistered area well padded.

Contusions/ Bruises

• Apply ice to affected area to minimized swelling.
• X-ray of injured limbs if you feel or hear a "grinding" sensation.

Methods to Reduce the Risk of Injury:

• Utilize a good warm up
• Maintain good equipment
• Check the Arena
• Promote fair play
• If you are injured see your doctor

The aim of aerobic conditioning is to improve the cardiovascular system. To be effective, exercise must be of intensity great enough to reach 75-80% of the individual's maximum heart rate and be maintained at that rate for no less than 25 minutes.

Benefits of jogging or distance running include increasing aerobic capacity and muscular endurance, prevention or postponement of coronary artery disease, personal gratification and the low cost of the sport.

Causes of Running Injuries

• Shoe problems
• Training errors
• Environmental factors
• Anatomic abnormalities

Shoes should:

• Provide shock absorption
• Provide motion control and stability
• Be well fitted for comfort
• Last at least 500 miles or 9-12 months

Trainer Errors:

• Too much - too fast, too soon
• Mileage on runs should be gradually increased or decreased based upon needs of the individual
• Over distancing without adequate stretching
• Rapid changes in mileage
• Interval training (going from slow speeds over long distances to fast speeds covering less ground)
• Insufficient rest between training sessions

Anatomic Abnormalities:

Pre-existing structural problems such as:

• High foot arch
• Flat feet
• Leg length differences
• Scoliosis

Figure Skating Injuries

Competitive figure skating requires speed, agility, flexibility, strength, endurance and power. Over the years the level of difficulty has steadily increased creating a need for off-ice training to facilitate on-ice performance and prevent injuries.

Injuries

Injuries can be classified as either overuse or acute. The most common types of injury seen in figure skaters result from overuse. Overuse injuries result from microtrauma or a small force placed on a structure (such as muscle, tendon or bone) over a long period of time.

These consist of such injuries as tendonitis, bursitis, stress fractures and shin splints. Acute injuries result from a large force placed on a structure(s) over a very short time, resulting in immediate damage to the structure. These injuries may be ligament sprains, muscle strains, cartilage tears and fractures.

Off-ice Training and Injury Prevention

Overuse injuries are often preventable with an off-ice conditioning program. The goals of an off-ice training program are to increase body awareness for proper alignment, eliminate imbalances between muscles with respect to strength and flexibility, and to prevent injuries. Off-ice training should consist of stretching, strengthening and endurance with emphasis on anaerobic conditioning.

Figure skaters are prone to developing muscle imbalances. These muscle imbalances are caused by decreased flexibility and muscle weakness, which lead to abnormal or poorly controlled movements. The deviations may often be subtle, especially to the untrained eye. Deviations from "normal" biomechanical movements of the body caused by muscle imbalances create a need for a strengthening program and a daily stretching program.

It has been reported that a marked decrease in flexibility often occurs in the quadriceps muscle (in front of the thigh) and in the gastrocnemius muscle complex (the calf). Reports have also indicated that there is a significant difference in the force output between the quadricep and hamstring (back of the thigh) muscles between the take-off and landing legs.

Overuse injuries can also occur from a sudden increase in training time and/or intensity, which is often the case when transitioning from the academic school year to the summer skating schedule. It is recommended that the transition be gradual depending on the change in training time.

Off-ice training should be performed under the supervision of a qualified professional, such as a certified strength and conditioning coach, exercise physiologist, physical therapist or athletic trainer. Exercises which are performed incorrectly can lead to unnecessary injury.

It is preferred that many of the drills be as sport specific as possible; thus, an off-ice training professional possessing knowledge of figure skating is beneficial. The frequency of exercise should be individualized depending on goals, age, ability, and phase of the competitive year.

Utilization of body weight rather than weights or machines is a safe and excellent way to increase strength and endurance, especially in younger skaters.

Plyometrics and Pilates

Many off-ice programs incorporate plyometrics, jumping exercises which train inborn strength reflexes within the muscle to respond powerfully and quickly. Plyometric exercises are an excellent way to increase explosive jumping power. However, they can often lead to injury when moderate or advanced plyometric exercise is performed incorrectly or when the participating skater does not have adequate strength and flexibility.

Low intensity plyometric exercise such as jumping rope, skipping or hopping are safe and appropriate exercises. Pilate exercise is becoming increasingly popular with figure skaters. These exercises teach skaters muscle control and body awareness which are vital skills for skaters to master.

In case of a skater who experiences repeated injuries, analysis of the training schedule, body mechanics, strength, flexibility and skating boots should be performed by a qualified professional. Careful coaching, a gradual increase in training time and intensity, and a structured off-ice training program that incorporates strength and flexibility are the best way to prevent overuse injuries.

Cleveland Clinic Sports Health provides care and off-ice training to skaters at all levels from early beginnings to national and world level figure skating competitors.

For further information, call Cleveland Clinic Sports Health and Orthopaedic Rehabilitation at 877.440.TEAM.

Soccer is the most popular sport in the world with more kids playing it than any other sport. Soccer, like American football, is considered a collision sport and each year more than 71,000 soccer related injuries in youth under the age of 15 are treated in the emergency department.

The most common sites of the injuries are the knees, ankles, and feet.

Type of Injuries

Ankle Sprains

Ankle injuries are generally caused by a twisting motion. Ninety percent of all ankle injuries are of the inversion sprain (the foot turns or rolls inward). Severity of the sprain is dependent upon how much the ligaments are stretched or torn.

Turf Toe

A sprain of the great toe can be the result of a combination of artificial playing surfaces and flexible types of footwear. It can be the result of hyper extension of the great toe.

Knee Injuries

Sprain or torn Anterior Cruciate Ligament (ACL), one of the main stabilizing forces in the knee. The athlete may feel or hear a "pop" and experience episodes of instability or "giving out".

Treatment

R.I.C.E.

• Rest
• Ice
• Compression
• Elevation of injured extremity

Prevention

Although there is no one "miracle exercise" to prevent any of these injuries, a sound program of lower extremity strengthening, stretching, and proprioceptive exercises can help to reduce one's risk.

Wading Through Swimming Injuries and Prevention

The repetitive and unique nature of swimming can cause specific injuries, some severe enough to send even the fastest swimmer to the doctor.

Shoulder Injuries

Swimming as a competitive sport puts a great amount of stress on the shoulder. A swimmer relies heavily on the flexibility and strength in the shoulder joint and its surrounding structures. Many shoulder injuries are the result of repetitive overuse and may occur when the shoulder is pushed beyond its capacity.

Swimmer’s shoulder, the most common shoulder injury, is the result of an inflammation of the supraspinatus and/or the biceps tendon and may be the result of an overall shoulder instability. The repetitive irritation can cause pain, swelling and a decrease in performance. Paying attention to technique and making sure that training volumes progress at a normal pace with proper rest are great ways to prevent this injury.

Elbow Injuries

With its various strokes combined with poor mechanics, swimming can equal elbow injuries. Many elbow injuries involve the medial or the inside of the elbow and produce symptoms of pain during the pull phase of a stroke. Other injuries to the elbow include triceps tendonitis and elbow bursitis. Other injuries to the elbow may be the result of poor musculature and/or bad mechanics involving the shoulder.

Knee Injuries

A large number of knee injuries in swimmers are associated with the whip kick during the breaststroke. This injury, called swimmer’s knee, is an overuse injury that involves the medial or the inside ligament of the knee and is the result of the forceful leg activity required to finish the specific stroke. Pain that develops in the front of the knee, patellar tendonitis, is the result of repetitive stress and is usually the result of poor mechanics when pushing off the wall after a flip turn.

Foot and Ankle Injuries

The most common injury for swimmers involving the foot and ankle is when tendonitis develops due to the repetitive up and down movements of the feet when performing a flutter or a dolphin kick. This injury usually presents pain in the front of the leg, but soreness can also develop at the back of the leg.

Repetitive stress when kicking or poor mechanics when pushing off the wall after a flip turn may cause the ankle and lower leg to become irritated and inflamed.

Swimmers can also be affected by swimmer’s heel, which is a condition that develops when the heel strikes the side of the pool during an improper kick turn leaving the heel bruised from the impact.

Back Injuries

Swimmers can also suffer from injuries to the back, especially the lower back. Repetitive stress from performing too many flip turns and the position of the body and the head while moving through the water can contribute to low back problems.

Adolescent swimmers can suffer from swimmer’s back, also known as Scheuermann’s kyphosis, which is a condition caused by repetitive flexion of the thoracic spine while performing specific strokes. Most of the time it is the breaststroke that aggravates this injury.

Prevention

Stretching, strengthening and proper technique are all factors in preventing and/or recovering from any of these injuries. The following are some recommended stretches to include in a program for swimmers:

• The pectoral stretch will help with the rounding of the shoulders that is commonly seen in swimmers. Lie on back with both shoulders touching the ground. Let knees fall to one side, keeping both shoulders on the ground. Switch.
• Posterior/inferior stretch: Stretch the arm across the body by grasping the elbow with the opposite arm. You can vary the angle at which you pull the arm across the body, which will stretch the different structures in this area.
• Triceps/inferior stretch: Bringing the arm up above the head, let the forearm relax down behind the head and use the opposite arm to pull at the elbow for an increase in the stretch.
• Back stretch: On hands and knees, arch back like a cat.
• Hamstring stretch: Sitting with legs straight out in front, maintain a straight back posture and lean toward the toes to feel the stretch through the hamstrings and low back.
• Quad/hip flexor stretch: Kneeling on the ground with the tops of your feet flat against the floor, lean back to feel the stretch. Or, assume a forward lunge position, one leg back, and lean forward to feel the stretch across the hip of the back leg.

Tennis, Anyone?  Yes, Everyone!

Bjorn Borg, the stoic tennis-playing Swede who won five straight Wimbledon and six French Open singles titles, was famous for his calm, cool demeanor on the court. For a time, he was dubbed “Ice Borg.” His conditioning was legendary, and so was his resting heart rate, a reported 45 beats per minute.

Whether true or not, the story about Borg’s tranquil cardiac tissue underscores an important point about tennis: Playing it on a regular basis is good for your heart. It’s also good for the body and mind.

In fact, playing tennis on a regular basis produces physical, physiologic and psychological benefits.

These benefits include increased burning of calories, reduction in blood pressure and reduced stress. All of these benefits play a role in reducing a person’s risk of developing heart disease, the number-one killing disease among men and women.

Contrary to what you might think, tennis is not a sport played and enjoyed only by the young. In fact, 11.3 million adults aged 25 and up played tennis at least once last year.

Tennis is a sport for women just as much as it is for men. It also makes a great family activity. Playing tennis on a regular basis can help maintain or improve balance, endurance, mobility, agility, strength and fitness. It also helps burn calories.

According to Sydell and Arnold Miller Family Heart Institute exercise physiologist and avid tennis player Gordon Blackburn, Ph.D., research shows that three hours of moderate aerobic exercise every week can cut the risk of developing heart disease by 50 percent.

Cleveland Clinic Sports Health advises off-court strength training to help you improve your game. A strengthening program can help you hit harder and faster, and prevent rotator cuff and tennis elbow injuries. Interval training can be used to increase foot speed.

And, as always, incorporate stretching before you play, he says. Whether you’re a former tennis player ready to take up the sport again, or you’re taking it up for the first time, pre-play stretching is one of the most important pre-cautions you can take to minimize the risk of muscle or limb injury. Stretching prepares the body for physical activity by warming the muscles and joints.

The process takes only a few minutes. Stretching does not guarantee that you won’t be injured during play, but the evidence shows that it can help significantly reduce the risk.

Be sure to stretch both upper and lower body. For some good upper body stretches for tennis, see below.

To keep tennis safe and healthy, always keep these tips in mind:

• Get the body’s muscles and joints properly warmed up by stretching.
• Use water or healthy sports drinks to keep the body properly hydrated before, during and after play. This is particularly important when playing in hot, humid weather, or for longer than an hour per session.
• If you injure yourself or experience chest pain, stop playing immediately and contact your physician.
• Play within your means. Listen to your body.

Cleveland Clinic Heart Center and the United States Tennis Association (USTA) have joined in a collaborative partnership to support each other in researching and promoting the clinical and aerobic benefits of tennis. For more information, go to www.tenniswelcomecenter.com or http://my.clevelandclinic.org/heart/.

Examples of upper body stretches for tennis

Arm Circles

Target muscles: Deltoid muscles and rotator cuff (shoulder)
Hold your arms out to your sides at shoulder height with palms down and rotate them in small forward circles. Perform 10 forward and 10 backward circles.

Then do 10 forward and 10 backward large arm circles, using the shoulders’ full range of motion. You should feel a slight stretch in the shoulders as you perform the exercise.

Posterior Shoulder Stretch

Cross your left arm over the front of your body and pull it toward your body (angling downward) using your right hand. Hold for 15 to 30 seconds. Repeat with other arm.

Shoulder Stretch

With your left hand, hold a racket behind your back by the throat or handle with the head of the racket pointing down.

With your right hand, slowly pull the racket head down, bringing your left elbow to your ear and pointing it to the ceiling. Then slowly pull up with the left arm, pointing the lower elbow to the floor. Repeat using opposite arms.

Volleyball is a relatively safe and injury-free sport. For instance, consider that 68 percent of all injuries occur during volleyball practice – not during the game. Knee and ankle injuries account for 36 percent of all injuries in volleyball players. To help avoid such injuries, three things are key: leg strength, balance and agility.

Research shows that athletes who participate in a formal jump program experience four times fewer serious knee injuries. Cleveland Clinic’s JUMP RIGHT program utilizes strengthening, agility and balance to help train individual athletes to improve their jumping technique – and as a result decrease injuries.

The program consists of:

• a pre-test
• three phases of exercise/activity progression
• a post test

During the pre and post-test, the athlete’s jumping abilities are video-taped and measured. The first phase educates the athlete on proper jumping technique with double-leg activities and addresses their strength deficits. The second phase incorporates more single-leg techniques since research has found that – due to blocking and spiking requiring landing with bilateral feet – players need more work with single-leg techniques. The final phase involves more balance and agility activities, including grapevine, running and change in direction. As a whole, JUMP RIGHT addresses an athlete’s core and entire lower body.

So when should players begin the program? Ideally, they should start JUMP RIGHT during the transition from middle school to high school, but jumping athletes at any stage may benefit. An athlete who is well developed and demonstrates a more “knock knee” posture may benefit from beginning sooner. Increasing buttock and hip strength, balance and agility will improve his or her jumping technique and prevent injury.

Amanda Gordon, MPT, works with a range of young competitive athletes, as well as “weekend warriors.” She played four years of volleyball at Baldwin-Wallace as a setter and currently coaches JV volleyball at Brecksville/Broadview Heights High School.

Did you know? Knee pain:

• The most common type of knee pain that results in missed practice and/or games is patellar tendonitis, or pain just below the knee cap.
• Knee pain can be caused by repetitive loading of the tendons in the knee during the “slowing down” or eccentric phase of jumping. Therefore, players have difficulty absorbing the energy produced while landing a spike or block in volleyball.
• Research has found that knee pain also can be caused by having a “valgus” knee position, or an unaligned “knock-kneed position.” This posturing can be caused by hip weakness as well as possible hip, knee and foot alignment issues.

Wrestling poses medical and orthopaedic health care problems to the athletic trainer and the team physician. The injury rate is high for two reasons. First, wrestling is a contact sport, with contact occurring virtually 100% of the time. Second, wrestling is a collision sport. Collision occurs when a wrestler attempts a takedown, representing a high-risk situation.

Among the problems the coach may be confronted with are:

Lacerations

• Lacerations of the head and the face are common.
• Stop match until bleeding is controlled using Band-Aids, steri strips or tape.
• Suturing may be necessary.
  

Nosebleeds

• Common during a match.
• Can be controlled by inserting a small roll of gauze into the nose.
• After the match, direct pressure and ice are effective to stop bleeding.
  

Cauliflower Ear

• An accumulation of scar tissue from repeated trauma.
• Could cause the wrestler to miss several days of practice if severe enough.
• To prevent, encourage use of headgear during practice as well as matches.
  

Spine Injuries

• Injuries of the neck can range from minor muscle strains to spinal cord injuries resulting in paralysis.
• Symptoms may include: numbness, tingling, muscle weakness.
• Immobilize immediately and request emergency medical personnel if situation warrants.
  

Upper Extremity Injuries

• Falls or takedowns causing blows to shoulders can result in A - C (acromioclavicular) sprains.
• Shoulder subluxation (shoulder comes out of joint then returns).
• Shoulder dislocation (shoulder that comes out of the joint and remains out).
• Hyperextended elbow (occurs when wrestler attempts to break a fall). Minor hyperextension injuries can be protected by limiting extension using tape. Dislocation results in extreme cases.
• If a dislocation is suspected, the athlete should not be moved. Wait until emergency medical personnel arrive.

Lower Extremity Injuries

• Knee injuries especially to collateral ligament (require immobilization followed by aggressive rehabilitation).
• Hyperflexion or twisting of the knee can tear the menisci. May necessitate arthroscopic surgery.
• Ankle sprains (common but pose limited period of immobilization).