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Osteopathic Manipulative Treatment (OMT) for Injury Prevention in Collegiate Baseball Pitchers: Findings and Revised Protocol from a Feasibility Study on Shoulder and Hip Interventions
Nandedkar, T. [3]

Journal: Journal of Osteopathic Medicine Date: 2025/12, 125(12):Pages: A774–775. doi: Subito , type of study: review

Full text    (https://www.degruyterbrill.com/document/doi/10.1515/jom-2025-2000/html)

Keywords:

baseball [5]
elbow [34]
hip [382]
injury prevention [3]
narrative review [78]
OMT [3746]
osteopathic manipulative treatment [3766]
shoulder [124]

Abstract:

Context: Shoulders and elbows are the two most commonly injured joints in overhead athletes1. Specifically, Superior Labrum Anterior to Posterior (SLAP) tears, Glenohumeral Internal Rotation Deficit (GIRD), biceps tendinitis and Ulnar Collateral Ligament (UCL) damage remain some of the most commonly occurring injuries2. One study by Vargas et. al. reported that pitching was the mechanism of injury in 70% of the biceps tendinitis cases in injured baseball players. The enormous amount of valgus stress placed on the elbow during pitching puts athletes at high risk of UCL injuries. One possible explanation is generalized ligamentous laxity of the athletes at these joints1,3. The shoulder and elbow are part of the kinetic chain that acquires energy from the lower body and transmits it through these two joints to the to the baseballball when pitching. Thus, injury at one joint leads to compensation by the other, putting the other joint at further risk of injury as well. Pitching puts the shoulder into forceful internal rotation, one of the fastest human movements in sports1. Thus, limited internal rotation can hinder this phase of pitching phase, and the high velocities can provokeinvite more injury. Posterior shoulder capsule tightness, another common physical exam finding in baseball players, is another risk factor for injury, leading to pathology such as rotator cuff and labral tears, shoulder impingements, etc2. OMT for the shoulder has been repeatedly proven to be beneficial for these athletes1,2,4,5; however, elbow treatment is not emphasized in literature. Objective: To propose an updated treatment protocol for baseball pitchers to include the elbow based on WCUCOM’s feasibility study’s results. Methods: A feasibility study was conducted by William Carey University College of Osteopathic Medicine’s (WCUCOM) Osteopathic Manipulative Medicine (OMM) department on baseball pitchers by treating their shoulders and hips and recording their ranges of motion and pitching metrics. Techniques used included Muscle Energy (MET), Balanced Ligamentous Tension (BLT), articulatory, Fascial Distortion Model (FDM), Direct Inhibitory Pressure (DIP), Myofascial Release (MFR), and Counterstrain (CS). To provide a rationale to also include elbows in the treatment protocol for the proposed continuing study, a literature review was conducted on injury prevention with OMT in athletes. The following keywords were used: Osteopathic Manipulative Medicine, Osteopathic Manipulative Treatment, Athletes, Injury prevention, Baseball. The treatment modalities used and the results from the studies were analyzed and compared to WCUCOM’s study in order to identify shortcomings, weaknesses, and to propose a new protocol for future studies. Results: WCUCOM’s pilot study showed that 40% of the non-treated players (control group) developed injuries whereas the ones treated with OMT did not. One of the players that developed an injury and had to drop out of the study had a UCL injury. Another player developed biceps tendinitis. The players that were treated experienced increased shoulder internal rotation and abduction after a single treatment (p<0.05), but this gain was not maintained at follow-up. Curcio et. al. studied the effects on OMT on shoulder ranges of motion using the Spencer technique. Results showed increased shoulder internal rotation and abduction (p<0.05) as well; however, these results were also not retained at follow-up5. Another study by Moore et. al. reported on the positive effects of MET on the posterior shoulder joint. They showed that treating the shoulder abductors resulted in increased adduction and internal rotation (p<0.05)4. These studies show that OMT is beneficial in increasing shoulder ROM, thus preventing injuries by stabilizing the shoulder. However, there have been no studies performed at the elbow joint, despite being one of the most injured joints. This review informed the recommendation to include the elbow in the revised treatment protocol. The original protocol from the WCUCOM study was as follows:MET of the throwing shoulder, FDM of bilateral iliotibial (IT) bands, DIP of bilateral external rotators of hips, LAS of lower extremities, MFR of the abdominal diaphragm, MET of the sacrum, MFR of the scapulothoracic joint, and CS of the subscapularis and latissimus dorsi. It is advantageous to also include the dominant elbow in this protocol, as the elbow joint is the continuation of the kinetic chain. The revised protocol would then include BLT of the elbow, specifically the UCL. Balancing the elbow would stabilize it and allow it to efficiently bear the valgus force during pitching. A balanced shoulder and elbow would provide two stabilized joints that would work effortlessly with each other during pitching, without having to compensate for the other’s lack of motion or instability. Conclusion: The acceleration phase of pitching, one of the fastest movements in sports, puts excessive force on the shoulder and elbow. This puts pitchers at high risk of injuries such as shoulder impingement, rotator cuff tears, SLAP tears, GIRD, and UCL injury. OMT is effective in preventing injuries in overhead athletes. Past studies show increased shoulder ranges of motion in pitchers with OMT. WCUCOM’s original study focused on the whole kinetic chain of pitching, but only and treated hips and shoulders. The revised protocol takes into account common elbow injuries and therefore includes elbow BLT in the treatment.

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