Objective: Analyzing population trends of bone shape variation can provide valuable insights into growth processes. This review aims to overview state-of-the-art spatiotemporal statistical shape modeling techniques, emphasizing their application to 3D skeletal structures during healthy growth. Methods: We searched PubMed and Scopus for articles on statistical shape modeling using a pediatric spatiotemporal dataset of 3D healthy bone models. Dataset characteristics and details on the shape models' development, analyses, and potential clinical use were extracted. Results: Fourteen studies were found eligible, modeling one or multiple lower limb bones, the mandible, the skull, and vertebrae. The majority applied Principal Component Analysis on point distribution models to create a statistical shape model. Shape variation was analyzed based on shape modes, representing a specific shape change as a part of the overall variance. Unscaled models resulted in a more compact statistical shape model than scaled models. The latter represented more subtle shape variations due to the absence of size differences between the bone models. Four studies reported a significant correlation between the first shape mode and age, indicating a relationship between that type of shape variation and growth. Three studies reconstructed 3D models using prediction features of statistical shape modeling. Measuring difference between predicted and actual anatomy resulted in Root Mean Squared Errors below 3 mm. Conclusion: Spatiotemporal statistical shape modeling provides insight into modes of shape variation during growth. Such a model can be used to find predictive factors, like age or sex, and deploy these characteristics to predict someone's bone geometry.

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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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The baseball pitch is a repetitive, full-body throwing motion that exposes the elbow to significant loads, leading to a high incidence of elbow injuries. Elbow injuries in pitching are often attributed to high external valgus torques as these are generally considered to be a good proxy for the load on the Ulnar Collateral Ligament. The aim of the study is to contribute to elbow load monitoring by developing a prediction model based on the pelvis and trunk peak angular velocities and their separation time. Eleven male youth elite baseball pitchers (age 17 ± 2.2 years) threw 25 fastballs at full effort off a mound. Two-level varying-intercept, varying-slope Bayesian models were used to predict external valgus torque based on (inter)segmental rotation in fastball pitching with pitcher’s weight and height added to strengthen the individualisation of the prediction. The results revealed the high predictive performance of the models including a set of kinematic parameters trunk peak angular velocity and the separation time between the pelvis and trunk peak angular velocities. Such an approach allows individualised prediction of the external valgus torque for each pitcher, which has a great practical advantage compared to group-based predictions in terms of injury assessment and injury prevention.

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CONTEXT: Baseball pitching requires fast and coordinated motions of the whole body to reach high ball speeds, putting considerable strain on the musculoskeletal system, particularly the shoulder and elbow. OBJECTIVE: To describe musculoskeletal symptoms and the functional status of the shoulder and elbow in male high school baseball pitchers. DESIGN: Descriptive epidemiology study. SETTING: Dutch baseball talent academies. PATIENTS OR OTHER PARTICIPANTS: One hundred twenty-five male high school baseball pitchers aged 12 to 18 years who participated in 1 of the 6 Dutch baseball talent academies and the Dutch National U-18 team were recruited and enrolled. MAIN OUTCOME MEASURE(S): Musculoskeletal symptoms, functional status of the shoulder and elbow were registered for each player every 6 months over 2 consecutive baseball seasons through self-assessment questionnaires, including the Kerlan-Jobe Orthopaedic Clinic (KJOC) and the Western Ontario Shoulder Instability Index (WOSI) questionnaires. RESULTS: Five hundred seventy musculoskeletal (MSS) symptoms in 93 of the 125 players were reported. The average 6-month prevalence for symptoms of the throwing shoulder was 37% (95% CI = 33%-41%), and for the elbow 37% (95% CI = 31%-42%), followed by the lower back with 36% (95% CI = 26%-45%). The baseball pitchers who experienced only shoulder symptoms had an average KJOC score of 80.0 (95% CI = 75.3-84.7) points, whereas those with only elbow symptoms reported a score of 90.2 (95% CI = 89.2-95.3). On the WOSI questionnaire, baseball pitchers scored an average of 421.2 (95% CI = 200.1-642.4) points. CONCLUSIONS: In a cohort of Dutch high school baseball pitchers, one-third reported shoulder and elbow symptoms on the throwing side, with reduced functional status and lower back symptoms. Future efforts should focus on developing preventive strategies through early symptom detection, aiming to prevent symptom progression and, ultimately, the development of severe injuries.

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Paralympic wheelchair athletes solely depend on the power of their upper-body for their on- court wheeled mobility as well as for performing sport-specific actions in ball sports, like a basketball shot or a tennis serve. The objective of WheelPower is to improve the power output of athletes in their sport-specific wheelchair to perform better in competition. To achieve this objective the current project systematically combines the three Dutch measurement innovations (WMPM, Esseda wheelchair ergometer, PitchPerfect system) to monitor a large population of athletes from different wheelchair sports resulting in optimal power production by wheelchair athletes during competition. The data will be directly implemented in feedback tools accessible to athletes, trainers and coaches which gives them the unique opportunity to adapt their training and wheelchair settings for optimal performance. Hence, the current consortium facilitates mass and focus by uniting scientists and all major Paralympic wheelchair sports to monitor the power output of many wheelchair athletes under field and lab conditions, which will be assisted by the best data science approach to this challenge.

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Background: For bone morphology and biomechanics analysis, landmarks are essential to define position, orientation, and shape. These landmarks define bone and joint coordinate systems and are widely used in these research fields. Currently, no method is known for automatically identifying landmarks on virtual 3D bone models of the radius and ulna. This paper proposes a knowledge-based method for locating landmarks and calculating a coordinate system for the radius, ulna, and combined forearm bones, which is essential for measuring forearm function. This method does not rely on pre-labeled data. Validation: The algorithm is validated by comparing the landmarks placed by the algorithm with the mean position of landmarks placed by a group of experts on cadaveric specimens regarding distance and orientation. Results: The median Euclidean distance differences between all the automated and reference landmarks range from 0.4 to 1.8 millimeters. The median angular differences of the coordinate system of the radius and ulna range from -1.4 to 0.6 degrees. The forearm coordinate system's median errors range from -0.2 to 2.0 degrees. The median error in calculating the rotational position of the radius relative to the ulna is 1.8 degrees. Conclusion: The automatic method's applicability depends on the use context and desired accuracy. However, the current method is a validated first step in the automatic analysis of the three-dimensional forearm anatomy.

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Humans possess an incredible capacity for dexterity, but independent finger control is limited. One factor constraining finger independence is the connections between the tendons of the extrinsic finger muscles. The aim of this study was to assess to what extent the linkages between the distal tendons of flexor digitorum profundus (FDP) and those of the flexor digitorum superficialis (FDS) constrain finger independence. Experiments on human fresh frozen cadaveric upper extremities (n = 6) were performed. First, one finger (target) was flexed whereas the other (nontarget) fingers were held in a nearly extended position. The change (Δ) in total flexion angle (∑Θ; i.e., the sum of angles of the different finger joints) of the target finger from the ∑Θ corresponding to the extended position at the start of the movement until the ∑Θ corresponding to the onset of force exertion at the nontarget fingers was assessed. Second, the distribution of force across the four fingers upon loading the tendon of the target finger was assessed for two finger positions (extended, 90° flexion of metacarpal phalangeal joint). For both muscles and for all fingers, the range of independent movement was small (<7°). Δ∑Θ at force onset was lowest for fingers immediately adjacent to the target finger and highest for more distant fingers. For both muscles and for all fingers, some of the target finger force (<14% for FDP, <2% for FDS) was distributed to the nontarget fingers, which increased (up to 58%) only for FDP in response to target finger flexion. We conclude that mechanical connections between the FDP and FDS tendons constrain finger independence. Such constraints become apparent when moving one finger relative to the other fingers.

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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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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

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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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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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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The large stream of data from wearable devices integrated with sports routines has changed the traditional approach to athletes’ training and performance monitoring. However, one of the challenges of data-driven training is to provide actionable insights tailored to individual training optimization. In baseball, the pitching mechanics and pitch type play an essential role in pitchers’ performance and injury risk management. The optimal manipulation of kinematic and temporal parameters within the kinetic chain can improve the pitcher’s chances of success and discourage the batter’s anticipation of a particular pitch type. Therefore, the aim of this study was to provide a machine learning approach to pitch type classification based on pelvis and trunk peak angular velocity and their separation time recorded using wearable sensors (PITCHPERFECT). The Naive Bayes algorithm showed the best performance in the binary classification task and so did Random Forest in the multiclass classification task. The accuracy of Fastball classification was 71%, whilst the accuracy of the classification of three different pitch types was 61.3%. The outcomes of this study demonstrated the potential for the utilization of wearables in baseball pitching. The automatic detection of pitch types based on pelvis and trunk kinematics may provide actionable insight into pitching performance during training for pitchers of various levels of play.@en

Purpose: To evaluate the current literature on the effects of anatomic changes caused by the Latarjet procedure and to identify areas for future research. Methods: English-language studies that addressed the consequences of anatomic alterations after the open Latarjet procedure were included. Articles written in languages other than English, reviews, and case reports were excluded. Titles and abstracts were screened by 2 authors. Studies that met the inclusion criteria were screened by the same authors. The following data were extracted from the included studies: authors, year of publication, journal, country of origin, aims or purpose, study population and sample size, methods, procedure, intervention type, and key findings that relate to the scoping review questions. Results: Twenty-two studies were included for analysis, yielding the following findings: First, the Latarjet procedure may change the position of the scapula owing to pectoralis minor tenotomy and/or transfer of the conjoint tendon. Second, dissection of the coracoacromial ligament may result in increased superior translation of the humeral head. The impact of this increased translation on patients’ function remains unclear. Third, the subscapularis split shows, overall, better internal rotation strength compared with subscapularis tenotomy. Fourth, passive external rotation may be limited after capsular repair. Fifth, despite the movement of the conjoint tendon, elbow function seems unchanged. Finally, the musculocutaneous nerve is lengthened with a changed penetration angle into the coracobrachialis muscle, but the clinical impact seems limited. Conclusions: The Latarjet procedure leads to anatomic and biomechanical changes in the shoulder. Areas of future research may include better documentation of scapular movement (bilateral, as well as preoperative and postoperative) and elbow function, the effect of (degenerative) rotator cuff ruptures after the Latarjet procedure on shoulder function, and the impact of capsular closure and its contribution to the development of glenohumeral osteoarthritis. Clinical Relevance: This comprehensive overview of anatomic changes after the Latarjet procedure, with its effects on shoulder and elbow function, showed gaps in the current literature. Orthopaedic shoulder surgeons and physical therapists could use our findings when providing patient information and performing future clinical research.

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Up to 60% of patients experience recurrence after a first traumatic anterior shoulder dislocation (FTASD), which is often defined as having experienced either dislocation or subluxation. Thus surgical intervention after FTASD is worthy of consideration and is guided by the number of patients who need to receive surgical intervention to prevent 1 redislocation (i.e., number needed to treat), (subjective) health benefit, complication risk, and costs. Operative intervention through arthroscopic stabilization can be successful in reducing recurrence risk in FTASD, as has been shown in multiple randomized controlled trials. Nevertheless, there is a large “gray area” for the indication of arthroscopic stabilization, and it is therefore heavily debated which patients should receive operative treatment. Previous trials showed widely varying redislocation rates in both the intervention and control group, meta-analysis shows 2% to 19% after operative and 20% to 75% after nonoperative treatment, and redislocation rates may not correlate with patient-reported outcomes. The literature is quite heterogeneous, and a major confounder is time to follow-up. Furthermore, there is insufficient standardization of reporting of outcomes and no consensus on definition of risk factors. As a result, surgery is a reasonable intervention for FTASD patients, but in which patients it best prevents redislocation requires additional refinement.

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Objectives Home-based physiotherapy interventions to improve post-stroke mobility are successful in high-income countries. These programs require less resources compared to center-based programs. However, feasibility of such an intervention in a low and middle-income setting remains unknown. Therefore, the SunRISe (Stroke Rehabilitation In Suriname) study aimed to assess feasibility and preliminary effectiveness of a home-based semi-supervised physiotherapy intervention to promote post-stroke mobility in a low resource setting. Design Prospective randomized controlled trial. Methods Chronic stroke patients were recruited and randomized into either an intervention group (IG (N = 20)) or a control group (CG (N = 10)). The IG received a 3-days-a-week home-based physiotherapy program that was supervised in the first 4 weeks and tele-supervised during the second 4 weeks. The physiotherapy program consisted of walking as well as functional and mobilization exercises. The CG received usual care. Feasibility outcome measures included adherence, patient satisfaction and safety. Efficacy measures included functional exercise tolerance (six-minute walking test (6MWT), functional balance (Berg Balance Score (BBS), upper extremity (UE) function (Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire), and UE strength ((non-)paretic handgrip (HG) strength). Two-way analysis of variance was used for data analysis. Results Thirty participants (61.8 ± 9.2 years old, 13 men) were enrolled in the study. The intervention was completed by 14 participants (70%). Adherence was affected by rainy season associated infrastructural problems (n = 2), the medical status of participants (n = 3) and insufficient motivation to continue the program without direct supervision (n = 1). No adverse events were noted and participants were satisfied with the program. Functional exercise tolerance (57.2 ± 67.3m, p = 0.02) and UE function (-9.8 ± 15.2, p = 0.04) improved in the IG compared to no change in the CG. HG strength was unaltered and a ceiling effect occurred for BBS. Conclusion Our home-based semi-supervised physiotherapy intervention seems safe, associated with moderate to high levels of engagement and patient satisfaction and results in functional improvements.

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Background: After latissimus dorsi transfer (LDT), an increase in scapulothoracic (ST) contribution in thoracohumeral (TH) elevation is observed when compared to the asymptomatic shoulder. It is not known which shoulder muscles contribute to this change in shoulder kinematics, and whether the timing of muscle recruitment has altered after LDT. The aim of the study was to identify which shoulder muscles and what timing of muscle recruitment are responsible for the increased ST contribution and shoulder elevation after LDT for a massive irreparable posterosuperior rotator cuff tear (MIRT). Methods: Thirteen patients with a preoperative pseudoparalysis and MIRT were recruited after LDT with a minimum follow-up of 1 year. Three-dimensional electromagnetic tracking was used to assess maximum active elevation of the shoulder (MAES) in both the LDT and the asymptomatic contralateral shoulder (ACS). Surface electromyography (EMG) tracked activation (% EMG max) and activation timing of the latissimus dorsi (LD), deltoid, teres major, trapezius (upper, middle and lower) and serratus anterior muscles were collected. MAES was studied in forward flexion, scapular abduction and abduction in the coronal plane. Results: In MAES, no difference in thoracohumeral motion was observed between the LDT and ACS, P = .300. However, the glenohumeral motion for MAES was significantly lower in LDT shoulders F(1,12) = 11.230, P = .006. The LD % EMG max did not differ between the LDT and ACS in MAES. A higher % EMG max was found for the deltoid F(1,12) = 17.241, P = .001, and upper trapezius F(1,10) = 13.612, P = .004 in the LDT shoulder during MAES. The middle trapezius only showed a higher significant difference in % EMG max for scapular abduction, P = .020 (LDT, 52.3 ± 19.4; ACS, 38.1 ± 19.7).The % EMG max of the lower trapezius, serratus anterior and teres major did not show any difference in all movement types between the LDT and ACS and no difference in timing of recruitment of all the shoulder muscles was observed. Conclusions: After LDT in patients with a MIRT and preoperative pseudoparalysis, the LD muscle did not alter its % EMG max during MAES when compared to the ACS. The cranial transfer of the LD tendon with its native %EMG max, together with the increased %EMG max of the deltoid, middle and upper trapezius muscles could be responsible for the increased ST contribution. The increased glenohumeral joint reaction force could in turn increase active elevation after LDT in a previous pseudoparalytic shoulder.

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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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