However, it is also important to consider the effects on performance (i.e., ball velocity and accuracy). This is because compliance from coaches, pitchers, and parents is one of the key factors in successful implementation of any intervention program. While potential effects of an selleck intervention program on injury prevention would appeal to most participants, programs that compromise performance would be met

with strong resistance and poor compliance from coaches and athletes. On the other hand, programs that help prevent injury and also improve performance will likely ensure high compliance from coaches, parents, and players, which may help achieve the primary goal of preventing injuries. There is some evidence to suggest that production of high ball velocity causes high joint loading. Greater maximal shoulder external rotation angle during pitching and higher shoulder and elbow distraction forces have been linked to both higher ball velocity and higher shoulder and elbow joint moments.27, 29, 116 and 117 In a prospective study, Bushnell et al.118 demonstrated that pitchers with higher ball velocity may be more susceptible to sustaining elbow injuries. However, it needs

to be noted that only 23 pitchers were included in this analysis, which limits the generalizability of this observation. On the other hand, there is also evidence Alpelisib cell line to suggest that production of higher ball velocity does not necessarily incur high joint loads. In a study by Werner et al.117 that investigated biomechanical Dichloromethane dehalogenase predictors of ball speed, none of the kinetic variables were found to be predictive of ball speed. In a study by Wight et al.,31 pitchers who demonstrated a more closed pelvis experienced higher shoulder and elbow joint loading compared to pitchers who demonstrated more open pelvis. However, ball velocity was similar between groups. In the previously mentioned study by Aguinaldo et al.,26 professional pitchers who presumably (ball speed was not reported in the study) pitched faster than high school and collegiate pitchers,59 did so while experiencing

lower absolute and normalized shoulder external rotation moments. Additionally, several kinematic variables (e.g., greater peak ground reaction force during a push-off,119 greater knee flexion at stride foot contact,117 greater knee extension angle and velocity at ball release,117 and 120 and forward trunk tilt angle at ball release116, 117 and 120) have been linked to higher ball velocity, but not to increased joint loading. This evidence indicates that reduction of joint loading can be achieved without compromising performance. Verbal instruction is one of the most common ways to modify specific skill components in pitching. In order for the verbal instruction to be effective, quantity of instruction and location of attentional focus directed by the instruction needs to be considered.