CHAPTER 31 Biomechanics of the Shoulde

During Sports

Glenn S. Fleisig, Shouchen Dun, and David Kingsle

Before studying prevention and treatment of shoulder injuries, it is vital to understand the anatomy of the shoulder complex and shoulder biomechanics during various athletic motions. Shoulder biomechanics are particularly important for chronic and overuse injuries, because the cumulative effect of repetitive motions and forces may be paramount in the pathology. The vast majority of overuse shoulder injuries treated in sports medicine result from overhead throwing or striking. An especially large portion of the patient population comes from baseball pitchers. In this chapter, the biomechanics of overhand throwing and striking will be explained. The rapid, forceful biomechanics of baseball pitching are described rst and serve as a basis for the general understanding of all overhand throws. Specic characteristics of other types of overhand throws are then described, followed by the biomechanics of various striking and swinging motions in sports. The overall biomechanics of these activities are quantied and described, but shoulder biomechanics are emphasized. For the sake of brevity, approximate values for the kinematic and kinetic parameters are often included in this text without standard deviation or ranges.

preparation for raising the lead leg (Fig. 31-1A). The lea leg is lifted by concentric contractions of the hip exo (rectus femoris, iliopsoas, sartorius, pectineus).5 When th knee has reached its maximum height, the pitcher shou be in a balanced position with the lead side (left sid for right-handed pitcher) facing toward home plate an the left knee and both hands anterior to the chest (se Fig. 31-1B). The stance leg bends, slightly controlled b eccentric contractions from the quadriceps muscle, an remains in a fairly xed position due to isometric contra tions of the quadriceps until a balanced position is achieved The hip abductors (gluteus medius, gluteus minimis, an tensor fascia latae) of the stance leg must also contract iso metrically to prevent a downward tilting of the opposi side pelvis, and the hip extensors of the stance leg contra both eccentrically and isometrically to control and stabiliz hip exion.5

The shoulders are partially exed and abducted, an they are held in this position by the anterior and medi deltoids, supraspinatus, and the clavicular portion the pectoralis major.6,7 In addition, elbow exion is main tained by isometric contraction8 of the elbow exo (biceps brachii, brachialis, and brachioradialis).7,8

BASEBALL PITCHING
Normal Biomechanics
Of all sports motions, the greatest shoulder angular velocity and greatest incidence of shoulder injuries occur during baseball pitching. Even though a baseball pitch is a continuous motion, it can be divided into different phases to help understand the mechanics involved.1-4 A summary of shoulder kinematics (motions) and shoulder kinetics (forces and torques) during these phases is presented in Table 31-1 and in the text. A pitch is broken into six phases: 1. Wind-up 2. Stride 3. Arm cocking 4. Arm acceleration 5. Arm deceleration 6. Follow-through Wind-up The purpose of the wind-up phase is to put the athlete in a good starting position to pitch. The wind-up begins as the pitcher plants the back foot against the rubber in 365

Wind-up ends with the pitcher in a good balanced pos tion. Except for the potential energy from lifting the lea leg, very little energy is generated in the wind-up phas Electromyographic (EMG) studies have shown that upp extremity muscle activity during this phase is minimal.6-

Stride The stride phase begins at the end of the wind-up, whe the lead leg begins to fall and move toward the targ and the hands separate. The stride ends when the lea foot rst contacts the ground (see Fig. 31-1C to F). Eccen tric contraction of the hip exors controls the lowerin of the lead leg, and concentric contraction from the h abductors of the stance leg help lengthen the stride.5 I pitching, the forward movement is probably initiated some degree by hip abduction, followed by knee and h extension from the stance leg. As the lead leg fal downward and forward, the lead hip begins to external rotate, while the stance hip begins to internally rotate The stance hip also extends due to concentric contra tions from the hip extensors.13 Throughout the strid phase the trunk is tilted slightly sideways, away from th target.

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