Abstract Background Concussions in Rugby Union are common with an increased risk to adolescent players. Coaches are key to injury prevention and a greater understanding of their knowledge and sentiments may guide future initiatives. There is a lack of data on rugby coaches, especially in South Africa. This study aimed to investigate the knowledge and opinions of high school rugby coaches regarding concussion management. Methods This cross-sectional study of 37 high school rugby coaches in South Africa, was conducted via a self-reported questionnaire. Concussion knowledge was scored for correct answers only with closed-question scaling methods to measure the importance of items of concussion management using a graphical rating scale. An attitude scale (Likert) was used to assess self-reported opinions and behaviours. Associations were calculated for participant characteristics and overall concussion injury knowledge. Results More participants showed good overall knowledge of ≥ 75% ( n = 22, 59% vs. n = 15, 40%), especially those with greater coaching experience ( p = 0.021). Player welfare was perceived more important than player performance (185 vs. 164), with concussion prevention most important (184 of 185). Appealing characteristics of an injury prevention programme were the improvement of player skill (173, SD ± 0.75, mean 4.68), being adaptable (171, ± 0.86, 4.62), and being completed in the warm-up (167, ± 0.93, 4.51). The biggest perceived barriers were duration (138, ± 1.59, mean 3.73), effort (130, ± 1.56, 3.51), compliance and lack of knowledge (both 127, ± 1.68, 3.43). Conclusion These results support the implementation of ongoing concussion education for rugby coaches and identify areas for promoting awareness and knowledge of concussion injury prevention, identification, and specific management of younger athletes. Appealing characteristics and barriers are highlighted and may allow for improved implementation and adherence to concussion prevention programmes. 

pdf/high-school-rugby-coaches-knowledge-and-opinions-of-2wz70vezlt.pdf

High school rugby coaches’ knowledge and opinions of concussion in Kwa-Zulu Natal province in South Africa: an ecological cross-sectional study

Background: Depending on anthropometrics and coaching style, pitchers are taught to pitch with a stride strategy that are traditionally classified as “tall and fall” or “drop and drive” for the purpose of maximizing pitch velocity. Purpose/Hypothesis: The purpose of this study was to determine the effects of stride strategy (tall and fall vs drop and drive) in college baseball pitching on pitch velocity and elbow valgus torque. It was hypothesized that pitch velocity and elbow valgus torque would increase as pitchers aligned more with the tall and fall technique. Study Design: Controlled laboratory study. Methods: Markerless motion capture data were recorded on 64 collegiate pitchers (height, 1.89 ± 0.06 m; weight, 93.06 ± 9.44 kg) during game play at the host institution during the 2023 season. Peak magnitudes of body center of mass (COM) vertical displacement were determined using a straight-line trajectory between peak knee height and lead foot contact and used as a continuous variable. Pitchers were required to throw ≥4 fastballs during their outing to be included in the analysis. Multilevel modeling was used to determine associations between peak magnitudes of positive and negative vertical displacement of COM on pitch velocity and elbow valgus torque. Every fastball throughout the season with biomechanics data for each pitcher was included in the multilevel model. Results: Fastball velocity was mean ± SD 90.68 ± 2.90 mph (40.54 ± 1.29 m/s). Mean maximal negative vertical COM displacement was −0.91 ± 0.47 inches (−0.023 ± 0.012 m), which occurred 18.1% ± 5.75% of the way between peak knee height and stride foot contact. Mean maximal positive vertical COM displacement was 1.73 ± 1.14 inches (0.044 ± 0.029 m), which occurred 65.7% ± 7.8% of the time from peak knee height to stride foot contact. Positive COM displacement (β = 0.54; P &lt; .001) and timing of peak positive COM displacement (β = 1.82; P = .023) reduced interpitcher variance by 9.9% and improved the ability of our model to predict fastball velocity. Negative COM displacement improved the ability of our model to predict ball velocity (β = −0.45; P = .021). Vertical COM displacement did not influence elbow valgus torque. Conclusion: Increasing vertical COM displacement in either the positive or the negative direction resulted in increased fastball velocity but did not result in greater elbow valgus torque. This indicates that the stride method may be used for performance enhancement but is unlikely to influence ulnar collateral ligament injury risk in college baseball pitchers. Clinical Relevance: Clinicians should not use stride mechanics as an injury risk indicator or diagnostic factor in injury etiology for college baseball pitchers. 

Tall and Fall Versus Drop and Drive Strategy in College Baseball Pitchers for Velocity and Elbow Valgus Torque

Management of UCL Injuries

Background: In 2022, Major League Baseball (MLB) implemented the universal designated hitter (DH) rule, thus allowing the pitcher to focus solely on defense while the DH, who bats for the pitcher, focuses solely on offense. Purpose/Hypothesis: The purpose of our study was to determine if implementation of the universal DH rule affected the incidence of injuries in MLB pitchers when compared with before implementation. It was hypothesized that the shift to the universal DH rule would be associated with a decrease in the rate of offense-related pitcher injuries. Study Design: Descriptive epidemiology study. Methods: Using publicly available data, we identified injuries sustained by MLB pitchers during the 2021 (before the DH rule change) and 2022 (after the rule change) regular seasons. Pitchers placed on the injured list for non–gameplay related reasons were excluded. Statistical analysis was performed with the chi-square and independent t tests. Results: The injury incidence rate decreased significantly from before to after the rule change for MLB pitchers overall (from 6.58 to 5.60 injuries/1000 athlete game-exposures [AGE]; P = .02) and for National League pitchers (from 7.62 to 6.26 injuries/1000 AGE; P = .04). No significant changes were seen in American League pitchers ( P = .20). Injury locations that decreased from before to after the rule change were the thigh (from 0.52 to 0.21 injuries/1000 AGE; P = .003) and the hand/finger/wrist (from 0.63 to 0.30 injuries/1000 AGE; P = .01). Total time lost decreased from 9471 days before the rule change to 8857 days after the rule change ( P = .00001). Conclusion: Implementation of the universal DH rule was associated with a decrease in pitcher injuries overall and within the National League. Injuries to the thigh and hand/finger/wrist also decreased overall and within the National League. Furthermore, total days lost decreased from before to after the rule change. These findings may be due to the elimination of offensive gameplay requirements for pitchers, which highlights a positive consequence of the universal DH rule, but further studies are needed. 

Association of the Universal Designated Hitter Rule With Changes to Injuries in Major League Baseball Pitchers

Timing of Surgery In Professional Baseball – An Analysis of Major League Baseball Pitchers Who Underwent Ulnar Collateral Ligament Reconstruction

Background: There is growing concern among sports medicine professionals regarding the increasing prevalence of ulnar collateral ligament (UCL) surgery in baseball players. At this time, it is unclear whether collegiate head baseball coaches possess adequate knowledge of UCL injuries. Purpose/Hypothesis: The purpose of this study was to assess the knowledge and perceptions of UCL injury among National Collegiate Athletic Association (NCAA) head baseball coaches. It was hypothesized that NCAA head baseball coaches would demonstrate misconceptions and knowledge disparities regarding UCL injury. Study Design: Cross-sectional study. Methods: An online 35-question survey was designed to assess NCAA head baseball coaches’ knowledge of UCL injury. The survey included questions related to participant characteristics, UCL injury, biometric performance and pitching variables, throwing fatigue, surgical variables/performance outcomes, and collegiate athlete recruitment. A total of 788 NCAA head baseball coaches were asked to participate. Responses were analyzed and reported using descriptive statistics where appropriate. Statistical comparisons and contrasts were made using chi-square and Fisher exact tests. Results: A total of 103 NCAA head baseball coaches participated in the survey, representing a 13.1% response rate. Only 31% of respondents could correctly identify all UCL injury symptoms, and 93% recommended <8 weeks off from overhead throwing during the off-season. Previous elbow injury observation was associated with UCL symptom identification (χ2 = 10.614; P = .005). Regular access to an athletic trainer (P = .015) and regular access to a strength and conditioning coach (P = .004) were both associated with NCAA division status, with Division I programs having the most access. Neither sports medicine physician (P = .656) nor athletic trainer (P = .611) access was associated with the geographic location of the baseball program; however, strength and conditioning coach access was associated with geographic location (χ2 = 6.696; P = .010). Conclusion: This study demonstrates that limited UCL injury knowledge and various misconceptions exist among NCAA baseball head coaches. The majority of responding coaches recommended an amount of time off from overhead throwing during the off-season that may be inadequate and were unable to identify all symptoms associated with UCL injury, representing the most concerning findings of the present study.

Knowledge and Perceptions of Ulnar Collateral Ligament Injuries in Baseball Players: A Survey of NCAA Head Baseball Coaches

Background: Previous research has documented the proportion of “tall and fall” (TF) and “drop and drive” (DD) pitching styles among Major League Baseball (MLB) pitchers who underwent ulnar collateral ligament reconstruction (UCLR). The proportion of these 2 styles among all MLB pitchers remains unknown. Purpose: To determine the proportion of the TF and DD pitching styles in all rostered MLB pitchers during a single season as well as the proportion of TF and DD pitchers who sustained an upper extremity (UE) injury and those who underwent UCLR. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Pitcher demographic characteristics from the 2019 MLB season and pitching information were obtained via open-access sources. Two-dimensional video analysis was used to categorize the included pitchers into TF and DD groups. Statistical comparisons and contrasts were made using 2-tailed t tests, chi-square tests, and Pearson correlation analyses as appropriate. Results: Of the 660 MLB rostered pitchers in 2019 (age, 27.39 ± 3.51 years; body mass index, 26.34 ± 2.47 kg/m2; fastball velocity, 150.49 ± 3.99 kph [93.51 ± 2.48 mph]), 412 (62.4%) pitchers used the TF style and 248 (37.6%) pitchers used the DD style. Significantly more UE injuries were seen in the TF group compared with the DD group (112 vs 38 injuries, respectively; P < .001). Twelve pitchers underwent UCLR (TF, 10; DD, 2), representing a 1.8% UCLR rate among all pitchers. This was a second surgery for 2 pitchers, both of whom used the TF pitching style. Significantly more pitchers in the TF group than the DD group had undergone UCLR before 2019 (135 vs 56 pitchers, respectively; P = .005). Conclusion: The results of the present study demonstrated a higher prevalence of both UE injury and prior UCLR in TF pitchers. Further research is needed to explore the potential association between pitching style and UE injury.

https://journals.sagepub.com/doi/pdf/10.1177/23259671231173691

Comparison of the “Tall and Fall” Versus “Drop and Drive” Pitching Styles: Analysis of Major League Baseball Pitchers During a Single Season

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Knowledge and Perceptions of Ulnar Collateral Ligament Injuries in Baseball Players: A Survey of NCAA Head Baseball Coaches

Comparison of the “Tall and Fall” Versus “Drop and Drive” Pitching Styles: Analysis of Major League Baseball Pitchers During a Single Season