In wheelchair sports, there is an increasing need to monitor mechanical power in the field. When rolling resistance is known, inertial measurement units (IMUs) can be used to determine mechanical power. However, upper body (i.e., trunk) motion affects the mass distribution between the small front and large rear wheels, thus affecting rolling resistance. Therefore, drag tests – which are commonly used to estimate rolling resistance – may not be valid. The aim of this study was to investigate the influence of trunk motion on mechanical power estimates in hand-rim wheelchair propulsion by comparing instantaneous resistance-based power loss with drag test-based power loss. Experiments were performed with no, moderate and full trunk motion during wheelchair propulsion. During these experiments, power loss was determined based on 1) the instantaneous rolling resistance and 2) based on the rolling resistance determined from drag tests (thus neglecting the effects of trunk motion). Results showed that power loss values of the two methods were similar when no trunk motion was present (mean difference [MD] of 0.6 ± 1.6 %). However, drag test-based power loss was underestimated up to −3.3 ± 2.3 % MD when the extent of trunk motion increased (r = 0.85). To conclude, during wheelchair propulsion with active trunk motion, neglecting the effects of trunk motion leads to an underestimated mechanical power of 1 to 6 % when it is estimated with drag test values. Depending on the required accuracy and the amount of trunk motion in the target group, the influence of trunk motion on power estimates should be corrected for.

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This multicenter observational study aimed to assess how pain reduction, induced by local anesthesia, affects the relative angular contributions of the shoulder girdle and trunk to the maximal angular performance during a semi-constrained overhead reach task in patients with ongoing shoulder pain. Twenty-nine individuals (age 59.0 SD 12.8 years;16-male) with symptomatic shoulders were administered corticosteroid and lidocaine injections by their attending orthopedic surgeon. Immediately before and after the injections, participants reached for a target on the ceiling ten times as high as possible while their pain levels, shoulder, and trunk movements were recorded. The analysis revealed that there was a significant reduction in pain following the injections. However, there were no significant differences in maximum shoulder and trunk inclination angles between the pre- and post-injection conditions. Notably, there were slight but statistically significant alterations in humeroscapular kinematics during the initial phase of arm elevation following the injections. In conclusion, acute pain relief following local anesthetics is not associated with immediate alterations in maximum shoulder girdle and trunk inclination angles during a semi-constrained overhead reach task in patients with ongoing shoulder pain. However, there are signs of small alterations in humeroscapular kinematics during the initial phase of arm elevation.

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Accurate assessment of rolling resistance is important for wheelchair propulsion analyses. However, the commonly used drag and deceleration tests are reported to underestimate rolling resistance up to 6% due to the (neglected) influence of trunk motion. The first aim of this study was to investigate the accuracy of using trunk and wheelchair kinematics to predict the intra-cyclical load distribution, more particularly front wheel loading, during hand-rim wheelchair propulsion. Secondly, the study compared the accuracy of rolling resistance determined from the predicted load distribution with the accuracy of drag test-based rolling resistance. Twenty-five able-bodied participants performed hand-rim wheelchair propulsion on a large motor-driven treadmill. During the treadmill sessions, front wheel load was assessed with load pins to determine the load distribution between the front and rear wheels. Accordingly, a machine learning model was trained to predict front wheel load from kinematic data. Based on two inertial sensors (attached to the trunk and wheelchair) and the machine learning model, front wheel load was predicted with a mean absolute error (MAE) of 3.8% (or 1.8 kg). Rolling resistance determined from the predicted load distribution (MAE: 0.9%, mean error (ME): 0.1%) was more accurate than drag test-based rolling resistance (MAE: 2.5%, ME: −1.3%).

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An important performance determinant in wheelchair sports is the power exchanged between the athlete-wheelchair combination and the environment, in short, mechanical power. Inertial measurement units (IMUs) might be used to estimate the exchanged mechanical power during wheelchair sports practice. However, to validly apply IMUs for mechanical power assessment in wheelchair sports, a well-founded and unambiguous theoretical framework is required that follows the dynamics of manual wheelchair propulsion. Therefore, this research has two goals. First, to present a theoretical framework that supports the use of IMUs to estimate power output via power balance equations. Second, to demonstrate the use of the IMU-based power estimates during wheelchair propulsion based on experimental data. Mechanical power during straight-line wheelchair propulsion on a treadmill was estimated using a wheel mounted IMU and was subsequently compared to optical motion capture data serving as a reference. IMU-based power was calculated from rolling resistance (estimated from drag tests) and change in kinetic energy (estimated using wheelchair velocity and wheelchair acceleration). The results reveal no significant difference between reference power values and the proposed IMU-based power (1.8% mean difference, N.S.). As the estimated rolling resistance shows a 0.9–1.7% underestimation, over time, IMU-based power will be slightly underestimated as well. To conclude, the theoretical framework and the resulting IMU model seems to provide acceptable estimates of mechanical power during straight-line wheelchair propulsion in wheelchair (sports) practice, and it is an important first step towards feasible power estimations in all wheelchair sports situations.

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Background: In baseball, repetitive pitching leads to medial elbow injuries, particularly to the ulnar collateral ligament (UCL). To prevent pitchers from UCL injuries, it is important to quantify the response to elbow stress. Repetitive elbow external valgus torque and muscular fatigue induced by repetitive pitching could affect markers of the response, that is, humeroulnar joint gap and UCL morphology. The aims of the study were three-folded: to investigate the effect of (1) exerted handgrip force on the humeroulnar joint gap, (2) repetitive pitching on the humeroulnar joint gap and the UCL morphology, and (3) exerted handgrip force on the humeroulnar joint gap for different levels of elbow valgus stress is different after compared to before repetitive pitching in asymptomatic baseball pitchers. Methods: Medial elbow ultrasound images were collected in 15 asymptomatic male baseball pitchers. Three levels of static elbow valgus stress (0N, 50N, 100N) were applied with a TELOS device before and after repetitive pitching and with or without handgrip force. These images were used to assess the humeroulnar joint gap size and UCL length and thickness. After 110 fastball pitches or when 80% self-perceived fatigue on a VAS scale was reached, participants were instructed to stop throwing. Repeated measures ANOVAs were used to statistically test significant differences. Results: Handgrip force did not significantly affect the humeroulnar joint gap. The UCL thickness and length and the humeroulnar joint gap were also not different after compared to before repetitive pitching. While higher levels of applied valgus stress significantly increased the humeroulnar joint gap (P < .001), this effect was not significantly different in the interaction with handgrip force and repetitive pitching. Conclusion: The humeroulnar joint gap changes for different levels of elbow valgus stress. However, adult baseball pitchers did not respond to elbow stress after a single pitching session with or without submaximal handgrip force in the humeroulnar joint gap and UCL morphology.

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While shoulder injuries resulting from the bench press exercise are commonly reported, no biomechanical evidence for lowering injury risk is currently available. Therefore, the aim of the present study was to compare musculoskeletal shoulder loads and potential injury risk during several bench press variations. Ten experienced strength athletes performed 21 technical variations of the barbell bench press, including variations in grip width of 1,1.5 and 2 bi-acromial widths (BAW), shoulder abduction angles of 45°, 70° and 90°, and scapula poses including neutral, retracted, and released conditions. Motions and forces were recorded by an opto-electronic measurement system and an instrumented barbell. An OpenSim musculoskeletal shoulder model was employed to estimate joint reaction forces in the glenohumeral and acromioclavicular joints. Time-series of joint reaction forces were compared between techniques by statistical non-parametric mapping. Results showed that narrower grip widths of <1.5 BAW decreased acromioclavicular compression (p < 0.05), which may decrease the risk for distal clavicular osteolysis. Moreover, scapula retraction, as well as a grip width of <1.5 BAW (p < 0.05), decreased glenohumeral posterior shear force components and rotator cuff activity and may decrease the risk for glenohumeral instability and rotator cuff injuries. Furthermore, results showed that mediolaterally exerted barbell force components varied considerably between athletes and largely affected shoulder reaction forces. It can be concluded that the grip width, scapula pose and mediolateral exerted barbell forces during the bench press influence musculoskeletal shoulder loads and the potential injury risk. Results of this study can contribute to safer bench press training guidelines.@en

Muscle overload injuries in strength training might be prevented by providing personalized feedback about muscle load during a workout. In the present study, a new muscle load feedback application, which monitors and visualizes the loading of specific muscle groups, was developed in collaboration with the fitness company Gymstory. The aim of the present study was to examine the effectiveness of this feedback application in managing muscle load balance, muscle load level, and muscle soreness, and to evaluate how its actual use was experienced. Thirty participants were randomly distributed into ‘control’, ‘partial feedback’, and ‘complete feedback’ groups and monitored for eight workouts using the automatic exercise tracking system of Gymstory. The control group received no feedback, while the partial feedback group received a visualization of their estimated cumulative muscle load after each exercise, and the participants in the complete feedback group received this visualization together with suggestions for the next exercise to target muscle groups that had not been loaded yet. Generalized estimation equations (GEEs) were used to compare muscle load balance and soreness, and a one-way ANOVA was used to compare user experience scores between groups. The complete feedback group showed a significantly better muscle load balance (β = −18.9; 95% CI [−29.3, −8.6]), adhered better to the load suggestion provided by the application (significant interactions), and had higher user experience scores for Attractiveness (p = 0.036), Stimulation (p = 0.031), and Novelty (p = 0.019) than the control group. No significant group differences were found for muscle soreness. Based on these results, it was concluded that personal feedback about muscle load in the form of a muscle body map in combination with exercise suggestions can effectively guide strength training practitioners towards certain load levels and more balanced cumulative muscle loads. This application has potential to be applied in strength training practice as a training tool and may help in preventing muscle overload.@en

In baseball pitchers the elbow is exposed to high and repetitive loads (i.e. external valgus torque), caused by pitching a high number of balls in a practice session or game. This can result in overuse injuries like the ulnar collateral ligament (UCL) injury. To understand injury mechanisms, the effect of repetitive pitching on the elbow load magnitude and variability was investigated. In addition, we explored whether repetitive pitching affects elbow muscle activation during pitching. Fifteen pitchers threw each 60 to 110 balls. The external valgus torque and electromyography of three elbow muscles were quantified during each pitch. Linear mixed model analyses were performed to investigate the effect of repetitive pitching. On a group level, the linear mixed models showed no significant associations of repetitive pitching with valgus torque magnitude and variability and elbow muscle activity. Significant differences exist between pitchers in their individual trajectories in elbow valgus torque and muscle activity with repetitive pitching. This shows the importance of individuality in relation to repetitive pitching. In order to achieve effective elbow injury prevention in baseball pitching, individual characteristics of changes in elbow load and muscle activity in relation to the development of UCL injuries should be investigated.

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In wheelchair sports, the use of Inertial Measurement Units (IMUs) has proven to be one of the most accessible ways for ambulatory measurement of wheelchair kinematics. A three-IMU configuration, with one IMU attached to the wheelchair frame and two IMUs on each wheel axle, has previously shown accurate results and is considered optimal for accuracy. Configurations with fewer sensors reduce costs and could enhance usability, but may be less accurate. The aim of this study was to quantify the decline in accuracy for measuring wheelchair kinematics with a stepwise sensor reduction. Ten differently skilled participants performed a series of wheelchair sport specific tests while their performance was simultaneously measured with IMUs and an optical motion capture system which served as reference. Subsequently, both a one-IMU and a two-IMU configuration were validated and the accuracy of the two approaches was compared for linear and angular wheelchair velocity. Results revealed that the one-IMU approach show a mean absolute error (MAE) of 0.10 m/s for absolute linear velocity and a MAE of 8.1°/s for wheelchair angular velocity when compared with the reference system. The two-IMU approach showed similar differences for absolute linear wheelchair velocity (MAE 0.10 m/s), and smaller differences for angular velocity (MAE 3.0°/s). Overall, a lower number of IMUs used in the configuration resulted in a lower accuracy of wheelchair kinematics. Based on the results of this study, choices regarding the number of IMUs can be made depending on the aim, required accuracy and resources available.

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Medial elbow overuse injuries are rising in baseball. The external valgus torque magnitude is a possible risk factor for medial elbow injuries. The magnitude on its own cannot explain why one pitcher sustains an injury and another does not. Therefore, the aim of this study is to describe the within-individual external valgus torque variability and to determine whether the within-individual external valgus torque variability can be described by a Gaussian distribution. Eleven youth elite baseball pitchers threw twenty-five fastball pitches. Body kinematics were measured with VICON motion capture at 400 Hz. Elbow valgus torques of the total 270 pitches were calculated with a custom-made inverse dynamic model in Python. Visual inspection and the Shapiro–Wilk test were performed to test for the within-individual elbow valgus torque normality. The results showed that within-individual valgus torque variability was present in pitchers and differed among pitchers. Furthermore, it was shown that the within-individual valgus torque variability was normally distributed in nine out of eleven subjects. In conclusion, the presence of and differences in within-individual elbow load variability among baseball pitchers can be useful variables as they might be related to overuse elbow injuries. @en

It is generally accepted that most of the energy transferred to the ball during a baseball pitch is generated in the trunk and lower extremities. Therefore, purpose of this study was to assess the energy flow through the lower extremities during a baseball pitch. It was hypothesised that the (stabilising) leading leg mainly transfers energy in a distal-to-proximal order as a kinetic chain while the (driving) trailing leg generates most energy, primarily at the hip. A joint power analysis was used to determine the rates of energy (power) transfer and generation in the ankles, knees, hips and lumbosacral joint (L5-S1) for 22 youth pitchers. Analyses showed that the leading leg mainly transfers energy upwards in a distal-to-proximal order just before stride foot contact. Furthermore, energy generation was higher in the trailing leg and primarily arose from the trailing hip. In conclusion, the legs contribute differently to the energy flow where the leading leg acts as an initial kinetic chain component and the trailing leg drives the pitch by generating energy. The actions of both legs are combined in the pelvis and passed on to the subsequent, more commonly discussed, open kinetic chain starting at L5-S1.

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Muscle force analysis can be essential for injury risk estimation and performance enhancement in sports like strength training. However, current methods to record muscle forces including electromyography or marker-based measurements combined with a musculoskeletal model are time-consuming and restrict the athlete's natural movement due to equipment attachment. Therefore, the feasibility and validity of a more applicable method, requiring only a single standard camera for the recordings, combined with a deep-learning model and musculoskeletal model is evaluated in the present study during upper-body strength exercises performed by five athletes. Comparison of muscle forces obtained by the single camera driven model against those obtained from a state-of-the art marker-based driven musculoskeletal model revealed strong to excellent correlations and reasonable RMSD's of 0.4–2.1% of the maximum force (Fmax) for prime movers, and weak to strong correlations with RMSD's of 0.4–0.7% Fmax for stabilizing and secondary muscles. In conclusion, a single camera deep-learning driven model is a feasible method for muscle force analysis in a strength training environment, and first validity results show reasonable accuracies, especially for prime mover muscle forces. However, it is evident that future research should investigate this method for a larger sample size and for multiple exercises.

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Background: Baseball pitching performance can be mechanically explained by the summation of speed principle and the principle of optimal coordination of partial momenta. Impeding optimal energy generation or transfer by or between the pelvis and trunk segments could provide valuable insight into possible compensation or catch-up mechanisms that may manifest themselves based on these principles. Aim: The aim of the present study was to explore the effects of experimentally impeding the mobility of and between the pelvis and trunk segments (1) on ball speed and mechanical peak joint power, and (2) on mechanical peak load of the elbow and shoulder joints at maximal external rotation (MER) during fastball pitching. Methods: Eleven elite baseball pitchers (mean age 17.4, SD 2.2 years; mean pitching experience 8.9, SD 3.0 years) were instructed to throw at least 15 fastballs as fast and accurately as possible under two conditions. One condition involved impeding the mobility of the pelvis and trunk segments to hamper their ability to rotate independently, which consequently should affect the separation time, defined as the time interval between the pelvis and trunk peak angular velocities. In the other condition, pitchers threw unimpeded. Ball speed, mechanical peak joint power and peak net moment of the elbow and shoulder at MER were compared between conditions using Generalized Estimating Equations (GEE). Results: In the impeded pitching condition, the mean difference of the separation time was 12.4 milliseconds [95% CI (4.0, 20.7)] and for ball speed 0.6 mph [95% CI (0.2, 0.9)] lower compared to the unimpeded condition. Only the peak pelvic angular velocity, in addition to the trunk, upper arm and forearm, was 45 deg/s [95% CI (24, 66)] higher impeded condition. The mean differences of the joint power and net moments at the shoulder and elbow did not reach statistical significance. Conclusion: In elite adolescent baseball, the observed pitching performance after experimentally impeding pelvic and trunk mobility undermines a potential distal catch-up strategy based on the summation of speed principle. The increased peak pelvic angular velocity may indicate a compensation strategy following the optimal coordination of partial momenta principle to practically maintain pitching performance.

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Monitoring the performance and functional status of baseball pitchers’ upper extremity is important in maintaining the athlete’s health and performance. This study validated a Dutch translation of the original English Kerlan-Jobe Orthopaedic Clinic (KJOC) against the previously validated Disabilities of the Arm, Shoulder and Hand (DASH) and Western Ontario Shoulder Instability Index (WOSI) questionnaires in a group of talented juvenile Dutch baseball pitchers. Three times, from 2014–2016, 107 pitchers completed the Dutch KJOC, DASH and WOSI questionnaires. Participants’ questionnaire scores were analysed for the whole group and the symptomatic player subgroup separately. Internal consistency, construct validity and ceiling and floor effects were examined. Cronbach’s alpha was consistently above 0.8 for the three time periods for the whole group, and ranged between 0.62 and 0.86 for the symptomatic subgroup. Spearman’s rank correlation coefficients ranged from 0.47 to 0.67 for the whole group and 0.32 to 0.99 for the symptomatic subgroup. No floor effects were observed in the scores of the KJOC and only a ceiling effect for the whole group (15.2%) at one time period. The Dutch version of the KJOC has shown acceptable internal consistency and construct validity and can be used to assess overhead athletes’ shoulder and elbow functionality.

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Background: Baseball pitching is associated with a high prevalence of ulnar collateral ligament injuries, potentially due to the high external valgus load on the medial side of the elbow at the instant of maximal shoulder external rotation (MER). In-vitro studies show that external valgus torque is resisted by the ulnar collateral ligament but could also be compensated by elbow muscles. As the potential active contribution of these muscles in counteracting external valgus load during baseball pitching is unknown, the aim of this study is to determine whether and to what extent the elbow muscles are active at and around MER during a fastball pitch in baseball.

Methods: Eleven uninjured pitchers threw 15 fastball pitches. Surface electromyography of six muscles crossing the elbow were measured at 2000 Hz. Electromyography signals were normalized to maximal activity values. Co-contraction index (CCI) was calculated between two pairs of the flexor and extensor elbow muscles. Confidence intervals were calculated at the instant of MER. Four ranges of muscle activity were considered; 0–20% was considered low; 21–40% moderate; 41–60% high and over 60% as very high. To determine MER, the pitching motion was captured with a highspeed camera at 240 Hz.

Results: The flexor pronator mass, pronator teres, triceps brachii, biceps brachii, extensor supinator mass and anconeus show moderate activity at MER. Considerable variation between participants was found in all muscles. The CCI revealed co-contraction of the two flexor-extensor muscle pairs at MER.

Interpretation: The muscle activation of the flexor and pronator muscles at MER indicates a direct contribution of forearm muscles crossing the medial side of the elbow in counteracting the external valgus load during fastball pitching. The activation of both flexor and extensor muscles indicates an in-direct contributory effect as the combined activity of these muscles counteract opening of the humeroulnar joint space. We believe that active muscular contributions counteracting the elbow valgus torque can be presumed to relieve the ulnar collateral ligament from maximal stress and are thus of importance in injury risk assessment in fastball pitching in baseball.@en

In sports, inertial measurement units are often used to measure the orientation of human body segments. A Madgwick (MW) filter can be used to obtain accurate inertial measurement unit (IMU) orientation estimates. This filter combines two different orientation estimates by applying a correction of the (1) gyroscope-based estimate in the direction of the (2) earth frame-based estimate. However, in sports situations that are characterized by relatively large linear accelerations and/or close magnetic sources, such as wheelchair sports, obtaining accurate IMU orientation estimates is challenging. In these situations, applying the MW filter in the regular way, i.e., with the same magnitude of correction at all time frames, may lead to estimation errors. Therefore, in this study, the MW filter was extended with machine learning to distinguish instances in which a small correction magnitude is beneficial from instances in which a large correction magnitude is beneficial, to eventually arrive at accurate body segment orientations in IMU-challenging sports situations. A machine learning algorithm was trained to make this distinction based on raw IMU data. Experiments on wheelchair sports were performed to assess the validity of the extended MW filter, and to compare the extended MW filter with the original MW filter based on comparisons with a motion capture-based reference system. Results indicate that the extended MW filter performs better than the original MW filter in assessing instantaneous trunk inclination (7.6 vs. 11.7° root-mean-squared error, RMSE), especially during the dynamic, IMU-challenging situations with moving athlete and wheelchair. Improvements of up to 45% RMSE were obtained for the extended MW filter compared with the original MW filter. To conclude, the machine learning-based extended MW filter has an acceptable accuracy and performs better than the original MW filter for the assessment of body segment orientation in IMU-challenging sports situations.

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OBJECTIVE: The purpose of this study was to determine the effects of seat height, wheelchair mass and grip on mobility performance among wheelchair basketball players and to investigate whether these effects differ between classification levels. METHODS: Elite wheelchair basketball players with a low (n= 11, class 1 or 1.5) or high (n= 10, class 4 or 4.5) classification performed a field-based wheelchair mobility performance (WMP) test. Athletes performed the test six times in their own wheelchair, of which five times with different configurations, a higher or lower seat height, with additional distally or centrally located extra mass, and with gloves. The effects of these configurations on performance times and the interaction with classification were determined. RESULTS: Total performance time on the WMP test was significantly reduced when using a 7.5% lower seat height. Additional mass (7.5%) and glove use did not lead to changes in performance time. Effects were the same for the two classification levels. CONCLUSIONS: The methodology can be used in a wheelchair fitting process to search for the optimal individual configuration to enhance mobility performance. Out of all adjustments possible, this study focused on seat height, mass and grip only. Further research can focus on these possible adjustments to optimize mobility performance in wheelchair basketball.

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Upper extremity injuries are common in baseball. One of these is the ulnar collateral ligament (UCL) injury. In the field of sports injuries, most research focuses on average kinematics and kinetics between subjects, whereas focusing on within-subject variability appears to be more relevant for determining injury risk. We constructed a simple explanatory simulation model to illustrate the relationship between within-subject load variability and risk, illustrating how pitchers with a higher load variability are more likely to sustain an injury compared to pitchers with less load variability. Furthermore, the model comprises the (theoretical) effect of fatigue on load variability and injury threshold over time. @en

The purpose of the present study was to investigate the effect of an experimentally imposed kinetic chain disturbance in baseball pitching on ball speed and elbow kinetics. The experimental design consisted of two (within-subject) conditions. In one condition there was no manipulation (control condition). The other condition involved a manipulation of the kinetic chain by taping the pelvis and trunk. In both conditions, pitchers were instructed to throw fastballs until a minimum of 15 pitches were captured. Inverse dynamic solutions were used calculate the internal elbow moments of six elite youth baseball pitchers. The pitchers that were hampered in throwing fastballs, by the taped pelvis and trunk, showed significant lower ball speeds and peak internal varus moments compared to the pitchers that were allowed to throw without any hindrance. @en