Shoulder External Over Internal Rotation Ratio Is Related to Biomechanics in Collegiate Baseball Pitching.

Altering baseball pitching mechanics affects both performance and the risk of injury. The purpose of this study is to investigate the relationships of shoulder external over internal rotation ratio (SEIR) and other shoulder rotational properties during physical exam and biomechanics of pitching for 177 collegiate baseball pitchers. The shoulder range of motion was quantitatively measured using a custom-made wireless device. Pitching motion data were collected at 240 Hz, and a custom program was created to calculate the throwing arm motion and loading during baseball pitching. Linear regression and analysis of variance tests were performed to investigate the relationships between the shoulder physical exam outcomes and throwing arm biomechanics. SEIR had significant correlations with shoulder horizontal adduction angle at foot contact, maximum shoulder external rotation angle, maximum shoulder linear velocity, and elbow angle at ball release. SEIR groups had significant differences in shoulder proximal force, adduction torque, internal rotation torque, and horizontal adduction torque, and in elbow medial force and varus torque. Glenohumeral internal rotation deficit and total rotational motion deficit had no relationships with throwing arm motions or joint loadings. Shoulder health should be monitored to improve understanding of pitching mechanics in collegiate baseball pitchers.

Open Foot Stance Reduces Lead Knee Joint Loading During Golf Swing.

Foot stance and club type's relationship with lead knee joint biomechanics and possible involvement with injury incidences in amateur golfers have not been evaluated. This study included 16 male right-handed amateur golfers who performed golf swings with 2 different foot stances (straight and open) using 4 different club types (driver, 3 iron, 6 iron, and 9 iron) while standing on 2 force plates in a motion capture laboratory. A custom program calculated the kinematics and kinetics of the lead knee. Overall, the open stance reduced most translations, rotations, forces, and torques of the lead knee in all 4 club types when compared with the straight stance. The open stance reduced the rotation motion (-28%), compressive force (-5%), and rotation torque (-9%) when compared with the straight stance, which are the highest contributors to grinding of cartilage. The driver club had significantly larger values in most translations, rotations, forces, and torques when compared among the 4 club types. The open stance reduced the rotation motion, compressive force, and rotation torque in the lead knee joint compared with the straight stance. Lead knee joint biomechanics should be monitored to reduce injury in amateur golfers.

Shoulder External Rotational Properties During Physical Examination Are Associated With Injury That Requires Surgery and Shoulder Joint Loading During Baseball Pitching.

BACKGROUND: Throwing arm injuries are common because of the demand on the shoulder. The shoulder is qualitatively checked regularly by team physicians. Excessive instability and joint loading in baseball pitching are risk factors for throwing arm injuries. Knowledge of shoulder flexibility, range of motion, and joint loading may provide new insights for treatments to reduce the likelihood of injury incidence. PURPOSE: To investigate the relationship among injuries, shoulder external rotational properties, and shoulder joint loading in baseball pitchers. STUDY DESIGN: Descriptive laboratory study. METHODS: Pitching kinetics, shoulder rotational tests, and self-reported injury questionnaires were used to study 177 collegiate baseball pitchers. Pitching motion data were collected at 240 Hz using a motion capture system. A custom program calculated the shoulder joint loading. The shoulder rotational test quantitatively records shoulder range of motion and flexibility using a custom-made wireless device. Self-reported injury questionnaires were filled out during tests and yearly follow-ups. The total length of the study was 5 years. Analysis of variance, chi-square, and regression tests were performed to compare differences among groups and detect correlations with surgery and shoulder joint loadings. RESULTS: There were significant differences in shoulder flexibility among surgery groups. Shoulder external rotational properties during physical examination were significantly associated with shoulder joint loading in baseball pitching. High shoulder external rotation was associated with 14% to 36% lower shoulder posterior force and adduction, internal rotation, and horizontal adduction torque (P < .05). High shoulder flexibility was associated with 13% higher anterior force (P < .05). High shoulder external rotation before external rotation torque was applied was associated with 13% to 33% lower shoulder inferior force and adduction, internal rotation, and horizontal adduction torque (P < .05). There were no significant differences in shoulder joint loading among the surgery groups. CONCLUSION: Shoulder injuries that require surgery were associated with shoulder external rotation flexibility. High shoulder external rotation may be advantageous because it lowers the force and torque on the shoulder joint. CLINICAL RELEVANCE: The ability to understand shoulder external rotational properties, joint loading, and injury during baseball pitching helps further our understanding of injury mechanisms. The shoulder rotational test should be used as a screening tool to identify players at risk.

Very-low-dose twice-daily aspirin maintains platelet inhibition and improves haemostasis during dual-antiplatelet therapy for acute coronary syndrome.

Higher aspirin doses may be inferior in ticagrelor-treated acute coronary syndrome (ACS) patients and reducing bleeding risk whilst maintaining antithrombotic benefits could improve outcomes. We characterized the pharmacodynamics of a novel dual-antiplatelet-therapy regimen consisting of very-low-dose twice-daily (BD) aspirin with standard-dose ticagrelor. A total of 20 ticagrelor-treated ACS patients entered a randomized crossover to take aspirin 20 mg BD (12-hourly) during one 14-day period and 75 mg once-daily (OD) in the other. After 14 days of treatment, serum thromboxane (TX)B2 and light-transmittance aggregometry were assessed pre- and 2 h post-morning-dose, bleeding time was measured post-dose, and TXA2 and prostacyclin stable metabolites were measured in urine collected 2 h post-morning-dose. Data are expressed as mean ± SD. After 14 days treatment, serum TXB2 levels were significantly greater 2 h post-dosing with aspirin 20 mg BD vs. 75 mg OD (3.0 ± 3.6 ng/mL vs. 0.8 ± 1.9 ng/mL; p = 0.018) whereas pre-dosing levels were not significantly different (3.5 ± 4.1 ng/mL vs. 2.5 ± 3.1 ng/mL, p = 0.23). 1-mmol/L arachidonic acid-induced platelet aggregation was similarly inhibited by both regimens pre-dose (8.5 ± 14.3% vs. 5.1 ± 3.6%, p = 0.24) and post-dose (8.7 ± 14.2% vs. 6.6 ± 5.3%; p = 0.41). Post-dose bleeding time was shorter with 20 mg BD (680 ± 306 s vs. 834 ± 386 s, p = 0.02). Urinary prostacyclin and TX metabolite excretion were not significantly different. In conclusion, compared to aspirin 75 mg OD, aspirin 20 mg BD provided consistent inhibition of platelet TXA2 release and aggregation, and improved post-dose hemostasis, in ticagrelor-treated ACS patients. Further studies are warranted to assess whether this regimen improves the balance of clinical efficacy and safety.

Perceived Perfectionism from God Scale: Development and Initial Evidence.

In this study, the Perceived Perfectionism from God Scale (PPGS) was developed with Latter-day Saints (Mormons) across two samples. Sample 1 (N = 421) was used for EFA to select items for the Perceived Standards from God (5 items) and the Perceived Discrepancy from God (5 items) subscales. Sample 2 (N = 420) was used for CFA and cross-validated the 2-factor oblique model as well as a bifactor model. Perceived Standards from God scores had Cronbach alphas ranging from .73 to .78, and Perceived Discrepancy from God scores had Cronbach alphas ranging from .82 to .84. Standards from God scores were positively correlated with positive affect, whereas Discrepancy from God scores was positively correlated with negative affect, shame and guilt. Moreover, these two PPGS subscale scores added significant incremental variances in predicting associated variables over and above corresponding personal perfectionism scores.