ORIGINAL RESEARCH

IJSPT REGIONAL INTERDEPENDENCE OF THE HIP AND

LUMBO-PELVIC REGION IN DIVISON II COLLEGIATE
LEVEL BASEBALL PITCHERS: A PRELIMINARY STUDY
Kathryn Kumagai Shimamura, PT, DPT, NCS, OCS, CSCS, FAAOMPT1, 2
Scott Cheatham, PT, DPT, PhD(c), OCS, ATC, CSCS3
Wendy Chung, PT, DSc1
Daniel Farwell, PT, DPT1
Francisco De la Cruz, PT, DPT, OCS1, 2
Jennifer Goetz, DPT1
Kaleigh Lindblom, DPT1
Darcy Powers, DPT1

ABSTRACT
Background: Pitchers may be at greater risk of injury in comparison to other overhead throwing athletes due to the repetition of the pitching
motion. It has been reported that approximately 30% of all baseball injuries occur in the lower body. This may be related to limited hip mobility,
which can compromise pitching biomechanics while placing excessive stress on the trunk and upper quarter. Hip motion and strength measure-
ments have been reported in professional baseball pitchers but have not been reported in collegiate pitchers.
Purpose: The purpose of this study was to report preliminary findings for passive hip motion and isometric hip muscle strength in collegiate pitch-
ers and compare them to previously published values for professional level pitchers.
Study Design: Cross sectional study
Methods: Twenty-nine collegiate baseball pitchers (age = 20.0 + 1.4 years, height = 1.88 + 0.06 m; weight = 89.3 + 10.7 kg; body mass index =
25.3 + 2.5 kg/m2) were recruited. Subjects were assessed for hip internal rotation (IR) and external rotation (ER) passive motion, hip anteversion
or retroversion, gluteus maximus, gluteus medius, hip internal rotator, hip external rotator strength, and lumbo-pelvic control with the prone active
hip rotation test as described by Sahrmann. Statistical analysis included calculation of subject demographics (means and SD) and use of a two-tailed
t-test (p >0.05).
Results: Fifty-two percent of the right-handed and 50% of the left-handed pitchers demonstrated poor lumbo-pelvic motor control with an inability to
stabilize during active hip IR and ER even though isolated strength deficits were not detected at a significant level. There were no significant differ-
ences in hip passive motion or gluteus medius strength between right and left-handed pitchers. Differences did exist between collegiate data and previ-
ously published values for professional pitchers for IR motion measured in prone and gluteus maximus strength. Hip retroversion was present in 55%
of the pitchers primarily in both limbs with four of the pitchers presenting with retroversion singularly in either the stride or trail limb where the ER
rotation motion was greater than the IR.
Conclusion: Assessing mobility and muscle strength of the lower quarter in isolation can be misleading and may not be adequate to ensure the potential
for optimal pitching performance. These findings suggest that lumbo-pelvic control in relation to the lower extremities should be assessed as one func-
tional unit. This is the first study to explore hip motion, strength, and lumbo-pelvic control during active hip rotation in collegiate baseball pitchers.
Evidence Level: 2
Keywords: Baseball, collegiate, hip, lumbo-pelvic motion

CORRESPONDING AUTHOR
Scott Cheatham PT, DPT, PhD(c), OCS, ATC,
CSCS
1
Department of Physical Therapy, Azusa Pacific University, Assistant Professor
Azusa CA, USA Director Pre-Physical Therapy Program
2
Department of Physical Therapy, Southern California Kaiser
Permanente, Los Angeles CA, USA Division of Kinesiology and Recreation, SAC
3
Division of Kinesiology and Recreation, California State 1138
University Dominguez Hills, Carson, CA USA California State University Dominguez Hills
Acknowledgements: 1000 E. Victoria St. Carson, CA 90747
Marcie Harris Hayes, PT, DPT, MSCI, OCS
Joseph Byrd PT, DPT, OCS office # (310) 243-3794
Bryan Stewart PT, DPT, OCS E-mail: Scheatham@csudh.edu

The International Journal of Sports Physical Therapy | Volume 10, Number 1 | February 2015 | Page 1
INTRODUCTION hip compared to the trailing limb.3 Biomechani-
The repetition of the pitching motion combined with cal changes that result from mal-alignment of the
strenuous training schedules place baseball pitch- lower extremities can have an influence on joint
ers at a greater risk of injury in comparison to other loading, mechanical efficiency of muscles, and pro-
overhead throwing athletes.1 Although the majority prioceptive orientation and feedback from the hip
of injuries occur in the upper extremity, Posner et al and knee. These adaptations ultimately result in
found that approximately 30% of all injuries in base- altered neuromuscular function and control of the
ball pitchers occur in the lower body.2 Increasing lower extremities.10 The resulting faulty movement
evidence indicates that baseball pitchers are suscep- patterns can further perpetuate irritation to the sur-
tible to femoroacetabular impingement, sports her- rounding tissues of the hip and low back which can
nias, and groin injuries.3 The development of these occur with increased frequency of accessory and
conditions are often related to limited hip mobil- physiologic movements seen with poor lumbo-pel-
ity as proposed by Verrall et al who suggest that vic control.11
hip stiffness is associated with later development
of chronic groin injury and may be a risk factor for To date, it is unknown whether collegiate level play-
development of future pathology.4 Abnormal hip ers display the same hip asymmetries as professional
mobility can also predispose other body regions by level players.3 The presence of a retroversion defor-
compromising normal pitching biomechanics which mity places the femoral neck in a position of poste-
may induce excessive forces through the glenohu- rior rotation in the frontal plane with the end result
meral joint. This can affect the velocity of the pitch of increased external rotation ROM of the hip and
as well as increase the potential risk for injury in the associated decrease in hip internal rotation.11 It is
upper quarter.5, 3 Specifically, altered hip rotational often assumed that adequate strength and ROM auto-
range of motion has a direct effect on the amount matically ensures efficient performance.12 Although
of external rotation torque and horizontal adduction movement patterns are partially dictated by anatom-
range of motion of the shoulder that occurs during ical and biomechanical variables, the neurological
the throwing motion.6 control necessary to coordinate smooth movement
is often overlooked.12,13 During a baseball pitch, it
In addition to rotational mobility, it is critical for the is essential to control the trunk from a position of
pitcher to have adequate strength of both the trailing greatest rotation at arm cocking through the position
limb (leg on same side as throwing arm) and stride when the ball is released.14 The greatest demand
limb (leg opposite side of throwing arm) in order to for stability of the trunk occurs at stride limb foot
effectively transfer power through the lower quarter contact before ball release.15 The amount of poste-
and trunk into the pitching arm.7 Adequate strength rior lumbo-pelvic rotation that exists over the stride
of the hip abductor muscles demonstrated by good limb at foot contact is important since excessive
peak hip abductor muscle activity in the trail limb motion can reduce the maximum kinetic values of
is necessary during the wind-up and early cocking the pitch.16 It is therefore necessary to assess trunk
phases in order to stabilize the pelvis and enable stability relative to the rotation in the hip in order to
optimal stride length for optimal acceleration from ensure that a pitcher can maintain adequate trunk
the lower quarter.7,8 control as the trunk rotates over the stride limb at
ball release.
Over time, the loading patterns specific to indi-
vidual pitchers that lead to asymmetric patterns In a previous study by Sung et al, the increase in
can contribute to the development of sport-specific axial rotation of the trunk relative to the hip was
and extremity specific adaptations in hip range of identified as a significant risk factor for development
motion.9 McCulloch et al found that hip rotation in of low back pain and can occur in conjunction with
pitchers at the professional level can be asymmetri- stiffness in the hip.17 Van Dillen et al also found that
cal, showing significantly greater internal rotation individuals with low back pain often have limited
in the trailing hip compared to the stride limb and and asymmetrical passive hip rotation.18,19 Although
significantly greater external rotation in the stride this has not been assessed in baseball pitchers, the

The International Journal of Sports Physical Therapy | Volume 10, Number 1 | February 2015 | Page 2
assessment of hip rotation in relation to the trunk Table 1. Subject Demographics
has been a useful screening tool for other rotational
sports such as golf.20

Currently there are no studies exploring range of

motion (ROM), strength and motor control of the
lumbo-pelvic region during active hip rotation in Pacfic University, and 14 participants were from the
Division II collegiate level baseball pitchers. Clinical pitching roster at California State University San Ber-
assessment of the hip for passive ROM and strength nardino. Subjects were between the ages of 18 and 30
performed in this study has been used previously in years with a mean age of 20.0 + 1.4 years. The aver-
similar populations of young healthy adults.21 Hand age height of the participants was 1.9 + .06 m, average
held dynamometry and digital goniometery have weight was 89.3 + 10.7 kg, average body mass index
been determined to be efficient and reliable assess- was 25.3 + 2.5 kg/m2. Both right and left-handed
ments for muscle strength and range of motion.21,22 pitchers were accepted into the study including 23
Although there are no previous studies validating the right-handed pitchers and six left-handed pitchers.
use of this test, stability of the lumbo-pelvic area in Subjects had to be asymptomatic in both hips at the
relation to the hip has also been previously explored time of testing and clear of any known hip pathology.
in rotational athletes by Harris-Hayes.27 Exclusion criteria included previous hip surgery or
any other medical problem that would have limited
The purpose of this study was to report preliminary their ability to participate in full activity during the
findings for passive hip motion and isometric hip regularly scheduled 2013-2014 baseball season.
muscle strength in collegiate pitchers and compare
them to previously published values for professional Instruments
level pitchers. Additionally, this study explores the For range of motion measurements, a hand held
relationship between lumbo-pelvic motor control digital goniometer (MicroFet 3, Hoggan Health
and active hip rotation by assessing movement of Industries, West Jordan, UT) was used to measure
the lumbar spine and pelvis during prone active hip the subjects hip range of motion. Hand held digital
rotation. goniometers have shown good reliability when com-
pared to a standard goniometer and inclinometer.23
METHODS For manual muscle testing (MMT), a digital dyna-
This study was approved by the university Inter- mometer (MicroFet 3, Hoggan Health Industries,
nal Review Board. Eligible participants read and West Jordan, UT) was used on each subject. The dig-
signed an informed consent prior to enrollment in ital hand dynamometer has shown good intra-rater
this study. This cross sectional study involved the reliability with intraclass correlation coefficient
assessment of pelvic girdle and hip function of Divi- (ICC) ranging from 0.81 to 0.96.24
sion II baseball pitchers. Each pitcher was assessed
for hip passive ROM, isometric strength, Craig’s test, Pilot Testing
and lumbo-pelvic motor control during active hip Prior to data collection, a three session pilot training
rotation during one data collection session. Com- test was conducted using the two examiners involved
parisons were made between right and left handed in the data collection process. One examiner recorded
pitchers and previously established normative val- all results and one examiner performed all of the tests
ues from professional pitchers. and was blinded to the recording of the data outcomes.
The tests were performed on 29 subjects. The intra-
Subjects rater reliability for hip range of motion, strength, and
Instrumented hip examinations were performed Craig’s test was good with a range of ICC(3,3) = 0.90
with a digital goniometer and digital dynamometer to 0.92 and the lumbo-pelvic motor control tests also
on a total of 29 collegiate baseball pitchers during showed good reliability ICC(3,1) =0.93. These values
the onset of spring training (Table 1). Participants met or exceeded the recommended minimal reliabil-
included 15 from the active pitching roster of Azusa ity of 0.90 for clinical measurements.25

The International Journal of Sports Physical Therapy | Volume 10, Number 1 | February 2015 | Page 3
Assessment Procedures
Sitting: Passive Hip IR and ER Passive ROM and Man-
ual Muscle Testing (MMT)
For all of the assessments, the subjects were exam-
ined in their home team training facility and all pro-
cedures were explained in detail and demonstrated
by the examiners.

Hip IR ROM: For measurement of the hip ROM

tests, the subjects were sitting with their legs hang-
ing off the edge of the plinth. The examiner placed
one hand at the lateral aspect of the distal thigh and
the other on the medial malleoli. The subject was
passively moved into hip internal rotation by mov-
ing the foot laterally to the end of the available range.
The examiner then stabilized the subject’s thigh at
the point where the hip could no longer be passively
moved without inducing movement at the lumbo-
pelvic region and measured with a hand held digital
goniometer placed at the lateral malleolus.

Hip ER ROM: The measurement for external rota- Figure 1. Hip ROM measured with digital goniometer
tion was then performed. The examiner placed one
hand at the medial aspect of the distal thigh and the The examiner placed a stabilizing belt around the
other on the lateral malleoli. The subject was pas- hand held digital dynamometer placed at the medial
sively moved into hip external rotation by moving malleolus. The subject was asked to move their foot
the foot medially to the end of the available range. inward, externally rotating against the resistance of
The examiner then stabilized the subject’s leg and the stabilizing belt attached to the leg of the plinth
measured with a hand held goniometer placed at the and digital dynamometer. The force generated by the
medial malleolus (Figure 1). subject was recorded as the external rotator muscle
force. Two trials were recorded for each extremity.
MMT for Hip Internal Rotators: While seated, the
subject’s leg was placed in a neutral position of hip Prone: Passive HIP IR, ER, lumbopelvic control
rotation and abduction and adduction by the exam- and Gluteus maximus MMT
iner. The examiner placed a stabilizing belt around
the hand held digital dynamometer which was Passive Hip IR and ER: Passive hip ROM testing
placed at the lateral malleolus. The subject was was also conducted using the methods defined by
asked to move their foot outward, internally rotating Sahrmann.26,27 To assess hip passive rotation, the
against the resistance of the stabilizing belt attached subject was placed in the prone position on the
to the leg of the plinth and digital dynamometer. plinth, with the femur placed in neutral position by
The force generated by the subject was recorded as the examiner. The subject flexed the knee to 90 de-
the internal rotator muscle force in kilograms (Fig- grees. The subjects thigh was abducted 15 degrees to
ure 2). Two trials were recorded and averaged for place the Tensor Fascia Lata (TFL) on slack. The ex-
each extremity. aminer placed one hand on the pelvis of the test leg.
The examiner’s opposite hand was used to move the
MMT for Hip External Rotators: While seated, the subject’s leg into an internally rotated position by
subject’s leg was placed in a neutral position of hip moving the subject’s foot laterally. Once the exam-
rotation and abduction and adduction by the examiner. iner felt the anatomic block or movement of the

The International Journal of Sports Physical Therapy | Volume 10, Number 1 | February 2015 | Page 4
 lateral position, confirmed with manual palpation.
The amount of femoral internal rotation was mea-
sured by placing a digital goniometer along the tibia.
Two trials were performed and recorded. An angle
less than 8 degrees was determined to be a posi-
tion of retroversion and an angle greater than 15
degrees was determined to be a position of antever-
sion.28 Intra-tester reliability is high for the Craig’s
test and is reported in the literature to range from
0.80–0.90.29-31

Prone lumbopelvic control test: Testing was con-

ducted using the methods defined by Sahrmann.26,27,32
To assess prone active rotation, the subject was
placed in a prone position on the plinth with the fe-
mur placed in neutral position in regards to IR/ER
or abduction or adduction by the examiner. The sub-
ject flexed the knee to 90 degrees. The examiner pal-
pated the pelvis at the level of the anterior superior
iliac spine (ASIS) and the posterior superior iliac
Figure 2. MMT Measured with digital dynamometer spine (PSIS) bilaterally to assess whether the pelvis
and lumbar spine maintained a neutral position
throughout the test. The subject was asked to main-
pelvis, maximal passive internal rotation mobility of
tain the 90-degree position of the knee and to ac-
the hip was measured using a digital goniometer
tively perform femoral IR through their full avail-
placed parallel to the tibia. The measurement was
able ROM (which was visually compared to the pas-
recorded and averaged between two trials. The same
sive measurements taken earlier) while maintaining
position was used for the measurement of external
the knee at 90 degrees of knee flexion. As the sub-
rotation. The examiner kept one hand on the pelvis
ject actively rotated the femur the examiner assessed
and the other hand was used to move the foot medi-
the pelvis for any superior or inferior movement or
ally while maintaining the 90 degree flexed position
the ASIS or PSIS. The subject then performed active
of the knee. The examiner continued to move the
femoral ER through their full available ROM while
foot until the examiner felt the pelvis move. Once
the examiner assessed for movement in the pelvis
the examiner felt the anatomic block or movement
exactly as was performed for IR. This was performed
of the pelvis, maximal passive external rotation mo-
on both lower extremities. A negative test was de-
bility of the hip was measured with a digital goniom-
fined as the subject independently performing ac-
eter placed parallel to the tibia. The measurement
tive femoral IR and ER throughout their full avail-
was recorded, with two trials performed, and the av-
able ROM without simultaneous movement in the
erage of the two trials was used for data analysis.
pelvis or trunk (Figure. 3). Criteria for a positive test
Craig’s Test included early or excessive pelvic or low back rota-
Further testing for femoral anteversion and retrover- tion with active rotation of either hip (Figure 4).11
sion was conducted using the Craig’s test. The sub- Reliability of the MSI exam has been substantiated
ject was in the prone position with the knee flexed by Harris-Hayes and Van Dillen where inter-tester
to 90 degrees. The examiner palpated the same side reliability of classification of patients with LBP when
greater trochanter. The femur was passively rotated therapists used the MSI classification system was
through hip internal rotation and external rotation substantial.33 The Movement System Impairment
until the position at which the trochanter was par- (MSI) exam, which encompasses the prone rotation
allel to the plinth placing it in the most prominent test, has demonstrated good reliability with a kappa

The International Journal of Sports Physical Therapy | Volume 10, Number 1 | February 2015 | Page 5
 Figure 4. Positive MSI Exam demonstrating excessive pelvic
or low back rotation with active rotation.
Figure 3. Negative MSI Exam for independent active femo-
ral IR without simultaneous movement in the pelvis or trunk. attached to the leg of the plinth was placed around
the hand held digital dynamometer on the distal
posterior surface of the subject’s femur above the
coefficient of 0.81 for classification using entire knee. The examiner instructed the subject to hold
MSI exam.34,35 The prone hip rotation test has been the position of the leg lifted off the table with the
used by Scholtes et al to identify early lumbo-pelvic knee flexed as maximal resistance was applied by
motion in athletes with low back pain who played the stabilizing belt attached to the leg of the plinth
rotation related sports.36 The presence of greater The maximal force measured by the hand held digi-
lumbo-pelvic roation is frequently associated with tal dynamometer was recorded. Two trials were re-
low back pain, indicating that clinical assessment of corded for each extremity.
early lumbo-pelvic movement in relation to the hip
can be of great importance in individuals who play Sidelying Gluteus Medius Manual Muscle Test
rotaional sports.37
Gluteus Medius MMT: The subject was placed in the
Gluteus Maximus MMT: The subject was positioned sidelying position with the test leg on top. The ex-
prone with bilateral ASIS on the end of the plinth, aminer placed one hand on the pelvis and placed
leaning over the edge of the plinth, while feet main- the other hand under the test leg. The examiner lift-
tained contact with the ground. The knee of the test ed the test leg into hip abduction to assess the
leg was flexed to 90 degrees. The examiner lifted the amount of available ROM that the subject had in hip
test leg with one hand and stabilized the pelvis with abduction. The examiner’s other hand stabilized the
the other hand to assess the amount of available pelvis to avoid the subject from rolling forward or
ROM the subject had in hip extension. The subject’s backward during the test. The subject’s leg was re-
leg was returned to neutral (hip flexion 90 degrees turned to a neutral position. The subject was then
with 90 degrees knee flexion). The stabilizing belt asked to raise their leg off of the table to mid range

The International Journal of Sports Physical Therapy | Volume 10, Number 1 | February 2015 | Page 6
of hip abduction without rotating the pelvis forward trailing and forward limb (p=0.80). For prone IR
or backward. In this position, the examiner placed ROM, the trail limb (left) was 20.5° + 8.4° versus of
the stabilizing belt around the hand held digital dy- forward limb (right) of 17.3°+ 7.9°. There was no
namometer on the lateral mid femur above the significant difference in prone IR ROM between the
knee. The examiner instructed the subject to hold trailing and forward limb (p=0.29).
the position against the resistance of the stabilizing
For sitting ER ROM, the mean trail limb was 43.2° +
belt secured on the underside of the plinth. The
13.6° versus the forward limb 45.2°+ 13.6°. There
maximal force measured by the hand held digital dy-
was no significant difference in seated ER ROM
namometer was recorded. Two trials were recorded
between the trailing and forward limb (p=0.56). For
for each extremity.
prone ER ROM, the mean trail limb was 49.4° + 7.3°
versus the forward limb 48.9°+ 13.6°. There was no
STATISTICAL ANALYSIS
significant difference in prone ER ROM between the
Statistical analysis was performed using SPSS version
trailing and forward limb (p=0.84).
22.0 for Windows® (IBM SPSS, Chicago, IL). Participant
descriptive data was calculated and reported as the
Comparison of Left and Right Handed
mean and standard deviation (SD). During the pilot
Pitchers
test, rater reliability was determined by the ICC model
When comparing the trailing limb of right and left
(3, k). The T-Test was used with a Bonferoni correction
pitchers there were no significant differences in
to measure mean differences between variables. Sta-
seated IR and prone IR ROM measurements (p=0.85
tistical significance was consider to be p<0.05.25
and p=0.79 respectively) (Table 2). For ER ROM,
there were no significant differences in seated ER
RESULTS
and prone ER measurement (p=0.38 and p=0.87
Right Handers respectively) (Table 3). When comparing the forward
For right-handed pitchers, the mean sitting IR ROM limb of right and left pitchers there was no significant
for the trail limb (right) was 33.6° + 9.4° versus the difference in seated IR and prone IR ROM measure-
forward limb of 35.6°+ 8.1°. There was no signifi- ments (P=0.51 and p=0.72 respectively) (Table 2).
cant difference in seated IR ROM between the trail- For ER ROM of the forward limb, there was no signifi-
ing and forward limb (p=0.22). For prone IR ROM, cant difference in seated ER and prone ER measure-
the trail limb (right) was 24.8° + 8.6° versus of for- ment (P=0.31 and p=0.77 respectively) (Table 3).
ward limb (left) of 27.0°+ 8.9°. ° There was no sig-
nificant difference in prone IR ROM between the Comparison of Collegiate Pitchers’ data to
trailing and forward limb (p=0.19). Previously Established Values for
Professional Pitchers
For sitting ER ROM, the mean trail limb was 36.9° +
The trailing limb of the right-handed pitchers sitting
9.8° versus the forward limb 39.4°+ 10.3°. There was
IR ROM was 33.6° + 9.4° as compared to values for
no significant difference in sitting ER ROM between
professional baseball pitchers of 37.7° + 5.70°, dem-
the trailing and forward limb with the seated mea-
onstrating an approximate four degree difference.39
surement (p=0.08). For prone ER ROM, the mean
The trailing limb prone IR ROM was 34.45° + 8.51°
trail limb was 43.2° + 8.0° versus the forward limb
compared to professional values of 34.6°+ 4.0°, dem-
46.3°+ 12.1°. There was no significant difference
onstrating an approximate 0.2 degree difference.38
in sitting ER ROM between the trailing and forward
limb with the prone measurements (p=0.11). The stride limb of the right-handed pitchers sitting
IR ROM was 35.6°+ 8.1° compared to values for pro-
Left Handers fessional baseball pitchers of 37.0° + 5.60°, demon-
For left handed pitchers, the mean sitting IR ROM strating an approximate one degree difference. The
for the trail limb (left) was 33.0° + 9.5° versus of stride limb prone IR ROM was 27.0°+ 8.9° compared
forward limb (right) of 32.1° + 7.4°. There was no to professional values of 34.4° + 6.0°, demonstrat-
significant difference in seated IR ROM between the ing an approximate seven degree difference.38

The International Journal of Sports Physical Therapy | Volume 10, Number 1 | February 2015 | Page 7
Table 2. Comparison of hip internal rotation ROM of the trail limb and forward limb in Right and Left Handed Pitchers

Table 3. Comparison of hip external rotation ROM of the trail limb and forward limb in right and left handed pitchers

Force measures were combined for right and left- limb and 42.90 kg + 10.23 for the trailing limb. These
handed pitchers. MMT outcomes for the internal were the only values that were able to be compared to
rotators were 55.33 kg + 13.62 for the stride limb and previously established values for professional baseball
49.17 kg + 13.24 for the trailing limb (Table 4). MMT players of 41.9 kg + 7.2 for the stride limb and 41.4 kg
outcomes for the external rotators were 38.10 kg + + 6.3 for the trailing limb (Table 4). This represents a
8.45 for the stride limb and 36.45 kg + 8.80 for the difference of 1.32 kg and 1.50 kg respectively.
trailing limb. MMT outcomes for the gluteus maximus
were 90.55 kg + 20.32 for the stride limb and 90.93 kg Craig’s Test
+ 24.60 for the trailing limb. MMT outcomes for the Sixteen out of 29 (55%) pitchers demonstrated retro-
gluteus medius were 40.58 kg + 10.85 for the stride version in both limbs with four of the pitchers pre-

The International Journal of Sports Physical Therapy | Volume 10, Number 1 | February 2015 | Page 8
Table 4. Comparison of strength values between collegiate and professional pitchers.

senting with retroversion singularly in either the differences between the two limbs IR and ER PROM,
stride or trail limb, which was consistent with their they did not reach a statistically significant level.
ROM findings of greater hip ER than IR ROM.
The results of the current study revealed a 7 degree
Lumbo-pelvic control difference in stride limb IR when compared to the
Fifty–two percent of right-handed pitchers were posi- previously established normative values for IR in
tive on their trailing limb for the presence of early or professional players measured in the prone position.
excessive lumbopelvic rotation either during prone The presence of this deficit may prove to be prob-
active IR or ER and 43% were positive on the stride lematic as time progresses for pitchers and other
limb. Fifty percent of left-handed pitchers were posi- athletes where the demand for hip rotation is high.
tive on the stride limb, while all left-handed pitch- Limitations of hip ROM may result in changes at
ers were negative on the trail limb. Considering both the lumbo-pelvic region as a compensation strategy;
right and left-handers together resulted in 37% being especially during activities that require hip rotation
positive on trail limb and 45% positive on stride limb such as golf, racquetball, and baseball.27
for the inability to stabilize the lumbo-pelvic region Fifty-five percent of the pitchers in the current study
during active IR or ER rotation of the hip. presented with hip retroversion where an angle less
than eight degrees of femoral internal rotation in the
DISCUSSION
prone position with the greater trochanter positioned
Currently there are no studies exploring ROM,
parallel to the plinth was determined to be a position
strength, and motor control of the lumbo-pelvic
of retroversion. This can be highly problematic as
region during the prone active hip rotation test in
the retroverted orientation of the hip may give rise to
collegiate level Division II baseball pitchers. These
problems of impingement between the femoral neck
preliminary findings in collegiate level Division II
and anterior acetabulum.39 Prolonged and severe
baseball pitchers were inconsistent with the find-
impingement resulting from sporting activities can
ings of McCulloch et al comparing rotation mea-
lead to progressive degenerative changes at the hip
surements between the stride and trailing limb.3
where loads greater than eight times body weight
This may be due to the professional level status of
have been reported during competitive sports.40
the pitchers in McCulloch’s study who would have
had increased overall pitching time as compared to The unique part of this investigation that has not been
the collegiate level pitchers in the current study. previously explored is the ability of pitchers to main-
Although the results of the current study showed tain lumbo-pelvic motor control during the prone

The International Journal of Sports Physical Therapy | Volume 10, Number 1 | February 2015 | Page 9
active hip rotation test as described by Sahrmann.11 baseball including professional, collegiate, and high
The close proximity of the hip to the lumbo-pelvic school.
region may predispose the low back to excessive
rotational forces when more proximal regions need CONCLUSION
to compensate for limited rotation at the hips. The Strength findings of the gluteus maximus in the col-
regional interdependence of the low back and hips legiate population were similar to the previously
was assessed using the MSI prone active IR and ER reported values of professional players. Simple
test. Results of the current study indicate that 52% range of motion comparisons performed between
of the right-handed pitchers were positive for exces- outcomes recorded herein for collegiate players
sive lumbo-pelvic rotation with active hip rotation in revealed a 7-degree difference in stride limb IR
their trailing limb and 42% in the stride limb indicat- when compared to the previously established val-
ing that the pitchers had early or excessive lumbo- ues for IR in the prone position recorded for pro-
pelvic movement with active hip rotation. This was fessional pitchers. Although strength and ROM are
characterized by dysfunctional coupled movement often assessed in the lower quarter, they may not
of the pelvis and the hip where the pelvis rotated be sufficient to optimize potential pitching perfor-
prior to the hip reaching the limits of available mance.12 The results of the current study indicate
active ROM in the prone position. Fifty percent of that lumbo-pelvic motor control deficits were pres-
left-handed pitchers were positive in the stride limb ent during testing of both the stride and trailing limb
while none of the left-handed pitchers had excessive in greater than 50% of the pitchers tested. The early
lumbo-pelvic movement with active hip rotation in lumbo-pelvic motion with prone active hip rotation
the trailing limb. Previous research has linked early may represent an abnormal pattern of movement
lumbo-pelvic motion with an increased incidence of that may predispose the low back to excessive rota-
low back pain.41 tional forces as the low back compensates for lim-
ited rotation at the hips during rotational sports.
Although the strength findings of the glueteus maxi-
Further research should focus on the assessment of
mus in the collegiate population were similar to the
prone lumbo-pelvic control with active hip rotation
professional players, adequate strength and ROM
in baseball pitchers and all athletes that participate
alone may not be sufficient to ensure optimal pitch-
in high demand rotational sports.
ing performance.12 The regional interdependence of
the lumbo-pelvic region and hip should be assessed
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