title: The Impact of Fatigue on the Kinematics of Collegiate Baseball Pitchers.
abstract: BACKGROUND
  Many factors are believed to contribute to throwing injuries in baseball pitchers, in particular overuse and poor throwing mechanics. The impact of fatigue on pitching biomechanics in live-game situations is not well understood.
  
  
  OBJECTIVE
  Pitchers will demonstrate significant deviation in their pitching motions with increasing levels of fatigue.
  
  
  METHODS
  Descriptive laboratory study.
  
  
  METHODS
  Eleven National Collegiate Athletic Association (NCAA) Division I collegiate baseball pitchers were filmed in multiple live-game situations throughout a single season using 2 orthogonal high-speed cameras at 120 Hz. The first fastball of each inning and, when available, the fastball subsequent to the 15th and 30th pitch of each inning were recorded and analyzed for 26 kinematic parameters. Pitch count and velocity were recorded. Kinematic differences were assessed for association with pitch count and subjective fatigue measures over the course of each inning and game through the season.
  
  
  RESULTS
  Twenty-six games were recorded. Pitchers had a mean of 97.2 ± 16.1 pitches per start and 1079 ± 251 pitches per collegiate season. Increased hip lean at hand separation, elbow height at foot contact, and hip flexion and shoulder tilt at maximum external rotation were seen in innings lasting longer than 15 pitches. Maximum external rotation of the shoulder and elbow height at foot contact decreased over the course of a game. Hip lean at hand separation and elbow height at foot contact increased over the course of the season. Season pitch count was weakly correlated with increased shoulder external rotation and shoulder alignment at maximum external rotation and with shoulder abduction at ball release. Elbow flexion decreased with greater season pitch counts.
  
  
  CONCLUSIONS
  Hip lean, elbow height, and shoulder external rotation were the most sensitive kinematic parameters to inning, game, and season fatigue. Pitch count and fatigue have a significant impact on live-game pitching kinematics.
  
  
  CONCLUSIONS
  Fatigue likely alters pitching mechanics. Recognition of kinematic alterations may better demonstrate fatigue-related injury risk and may assist injury prevention in addition to standardized limitations of innings and pitches thrown.
authors.affiliation: Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA. ; Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: W Jeffrey
authors.initials: WJ
authors.lastname: Grantham
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Byram
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Molly C
authors.initials: MC
authors.lastname: Meadows
authors.affiliation: Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ahmad
keywords: baseball; biomechanics; fatigue; injury; pitching; throwing