Paper 35: High School and Professional Pitchers with Early Excessive Ipsilateral Trunk Tilt: A Newly Characterized Parameter for Biomechanical Evaluation
Authors: Manzi Joseph , Estrada Jennifer , Dowling Brittany , Zeitlin Jacob , Ruzbarsky Joseph , Ciccotti Michael , Mcelheny Kathryn , Carr James , Dines Joshua 
Published: July 2022

Objectives: Though contralateral trunk tilt has been frequently studied in baseball pitchers, the phenomena of excessive ipsilateral trunk tilt has not been explored as a potential correlate with throwing arm kinetics. Excessive ipsilateral trunk tilt is often observed during earlier portions of the pitch cycle. High school pitchers with excessive contralateral trunk tilt during the late cocking phase of pitching have been noted to have significantly faster ball velocity, as well as increased elbow distraction force, shoulder distraction force, elbow varus torque, and shoulder internal rotation torque. Collegiate pitchers with excessive contralateral trunk tilt at maximum shoulder external rotation and at ball release have significantly faster ball velocity and higher elbow varus torque. The purpose of this study was to evaluate the effect of ipsilateral and contralateral trunk tilt on kinetic and kinematic parameters among high school and professional baseball pitchers. Methods: Professional and high school baseball pitchers were assessed with 3D-motion capture technology (480 Hz) while pitching in a controlled laboratory setting. Pitchers were grouped into ipsilateral, neutral, or contralateral trunk tilt groups based on the degree of lateral trunk tilt at foot contact (FC) and ball release (BR) (Figure 1). Trunk and shoulder kinematics, as well as throwing arm kinetics, were compared between subgroups with post-hoc regression analysis. Results: Professional pitchers (n=287) had significantly higher ipsilateral trunk tilt at FC (p<0.001) compared to high school pitchers (n=59) (Figure 2). High school pitchers with excessive contralateral trunk tilt at BR experienced significantly higher shoulder superior force (27.0 ± 7.4 vs. 17.6 ± 5.1 %Body Weight [BW] respectively, p<0.001) and shoulder anterior force (39.6 ± 8.2 vs. 35.7 ± 5.4 %BW respectively, p<0.001) compared to the ipsilateral trunk tilt cohort, while accomplishing comparable ball velocity (30.2±3.2 vs. 30.4±2.1m/s, p=0.633). For professional pitchers, for every 10° increase in ipsilateral trunk tilt at FC, ball velocity increased by 0.2 m/s (B: 0.02, β: 0.07, SE: 0.005, p=0.010), while elbow varus torque (EVT) decreased by 0.1%BWxHeight (B: -0.01, β: -0.08, SE: 0.002, p<0.001) and shoulder internal rotation torque (SIRT) decreased by 0.1 %BWxHeight (B: -0.01, β: -0.07, SE: 0.002, p=0.005). Conclusions: High school and professional pitchers with excessive ipsilateral trunk tilt at FC consistently demonstrated significantly decreased throwing arm kinetics (high school: shoulder anterior force, shoulder superior force; professional: SIRT, EVT) compared to pitchers with excessive contralateral trunk tilt at BR, with at least equivalent ball velocity. In addition, professional pitchers already appear to engage in significantly greater ipsilateral trunk tilt at early portions of the pitch cycle when compared to high school pitchers, which may represent a kinetically favorable method adopted by pitchers at higher playing levels to maintain adequate ball velocity while concomitantly minimizing throwing arm kinetics. While contralateral trunk tilt has previously been associated with throwing arm kinetics in high school and collegiate pitchers, ipsilateral lateral trunk tilt has not been assessed in professional pitchers, a subgroup characterized by distinct pitching kinematics compared to amateur pitchers. Further research is warranted to determine if the kinetic impact of trunk tilt during the throwing motion of baseball pitchers impacts the risk of injury. UPLOAD- https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/ada6d538-50e8-460e-ac42-c385825f1ce4/1/Trunk_Tilt_Fig_2.docx [Figure: see text]