title: Relationship Between Tightness of the Hip Joint and Elbow Pain in Adolescent Baseball Players.
abstract: BACKGROUND
  Repetitive tensile stresses from valgus torque can induce elbow injury in adolescent baseball players. Insufficient hip range of motion (ROM) can change throwing mechanics, reducing the transfer of energy from the lower to the upper extremities. Thus, hip ROM limitations may force the upper extremities to bear the burden of a strong throw. Improper pitching mechanics caused by insufficient hip ROM are thought to increase valgus torque on the elbow when throwing, increasing the risk of elbow injury.
  
  
  OBJECTIVE
  To investigate the relationship between elbow pain and hip ROM in adolescent baseball players.
  
  
  METHODS
  Cross-sectional study; Level of evidence, 3.
  
  
  METHODS
  A total of 122 adolescent baseball players with a mean age of 12.0 years (range, 6-14 years) participated in this study. Elbow pain, hip flexion angle, and the internal rotation angles of the hip at 0° and 90° of flexion were assessed. Participants were divided into a pain group and a normal group based on the pain assessment, and each hip angle was compared between groups using Student t tests. P values <.05 were considered statistically significant.
  
  
  RESULTS
  Thirty-one of 122 players had elbow pain. The hip flexion angle of the trail leg was 121.9° ± 12.3° for the normal group and 111.2° ± 11.3° for the pain group (P = .0001). The plant leg hip flexion angles were 122.0° ± 12.4° and 113.6° ± 11.3° (P = .0014) for the normal and pain groups, respectively. The internal rotation angle at 0° of hip flexion of the trail leg was 49.4° ± 12.6° and 45.6° ± 8.8° (not significant), and of the plant leg was 49.1° ± 12.5° and 48.7° ± 11.5° (not significant), for the normal and pain groups, respectively. The internal rotation of the trail leg at 90° of hip flexion was 46.9° ± 13.3° in the normal group and 36.1° ± 15.7° in the pain group (P = .0005). In the plant leg, the internal rotation angle at 90° of hip flexion was 46.9° ± 12.2° and 36.4° ± 18.1° for the normal and pain groups, respectively (P = .0013).
  
  
  CONCLUSIONS
  Limitations to hip flexion and internal rotation at 90° of hip flexion were risk factors for elbow injury. Differences in internal rotation angles between 0° and 90° of hip flexion may be important criteria for identifying adolescent baseball players at risk of elbow pain.
authors.affiliation: Division of Rehabilitation, Matsudo Orthopaedic Hospital, Chiba, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Saito
authors.affiliation: Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Kenmoku
authors.affiliation: Division of Rehabilitation, Matsudo Orthopaedic Hospital, Chiba, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kameyama
authors.affiliation: Division of Orthopaedic Surgery, Matsudo Orthopaedic Hospital, Chiba, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Murata
authors.affiliation: Division of Rehabilitation, Matsudo Orthopaedic Hospital, Chiba, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yusa
authors.affiliation: Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Ochiai
authors.affiliation: Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Kijima
authors.affiliation: Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Naonobu
authors.initials: N
authors.lastname: Takahira
authors.affiliation: Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Fukushima
authors.affiliation: Division of Orthopaedic Surgery, Matsudo Orthopaedic Hospital, Chiba, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Ishige
authors.affiliation: Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Takaso
keywords: hip range of motion; pitching mechanics; prevention; throwing elbow