Investigation of Regional Interdependence of the Hip and Spine in Baseball Players With Low Back Pain

Low back pain (LBP) is a common musculoskeletal symptom in athletes. More than 40% percent of high school baseball players reported incidents of LBP during the previous year. University baseball athletes were 3.23 times more likely to have lumbar intervertebral disk degeneration than the nonathletic university students. According to the regional interdependence model, a patient's chief complaints may be directly or indirectly related to or influenced by physical impairments from various body systems and regardless of proximity to the primary symptom(s). Athletes with a chief complaint of LBP frequently demonstrate with mobility restrictions in the thoracic spine and hips, which may contribute to compensatory hypermobility in the lumbar spine and subsequently lead to LBP. Few studies have examined the relationship between thoracic spine mobility and LBP, while many studies investigating the relationship between hip joint mobility and LBP in athletes showed inconsistent results. The inconsistent results may be due to different types of sports and measurement methods. Therefore, the objectives of this research project are to: (1) examine if baseball players with a history of LBP have mobility restriction in the thoracic spine and hips and movement coordination within the spine and hip regions during baseball batting that are different from those without a history of LBP; (2) identify thoracic spine and hip joint mobility and coordination related predictors for batting velocity and LBP in baseball players. This 2-year research project plans to recruitment a total of 110 male baseball players aged between 18 and 30 years from university and community recreational league baseball teams (55 players with a history of LBP and 55 age-matched players without a history of LBP). Participants will receive physical examination for the thoracic spine and hip joints (joint mobility and muscle stiffness) and 3D motion analysis for baseball batting. The results of this research project will guide the development of more specific and effective treatment and preventative training for baseball players with LBP and enhance their batting performance.

Study Overview

• Status: Active, not recruiting
• Conditions: Low Back Pain; Thoracic
• Intervention / Treatment: Other: No intervention

• Study Type: Observational
• Enrollment (Estimated): 40

Contacts and Locations

Study Locations

• Taiwan
  • Tainan, Taiwan, 701
    • National Cheng Kung University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

university and recreational leagues baseball teams

Description

Inclusion Criteria:

• Baseball players who had experienced at least 2 episodes of LBP that limits their performance for a period of greater than 3 days in the previous year.

Exclusion Criteria:

• Current LBP symptoms including weakness and numbness in the lower extremities
• Previous surgery to the back, upper or lower extremities
• Marked spinal deformity (e.g., scoliosis, or kyphosis)
• Any other orthopedic or medical problem that would have limited their ability to fully participate in baseball training and competition in the last year.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
control group; Baseball players without a history of low back pain	Other: No intervention; Comare the difference in batting mechanics, hip and thoracic spine mobility, and muscle stiffness in baseball players with and without a history of low back pain
experimental group; Baseball players with a history of low back pain	Other: No intervention; Comare the difference in batting mechanics, hip and thoracic spine mobility, and muscle stiffness in baseball players with and without a history of low back pain

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Angular displacement of spine during baseball batting	Measured by the Vicon motion analysis system in the horizontal plane	immediately after enrollment
Angular displacement of hip during baseball batting	Measured by the Vicon motion analysis system in the horizontal plane	immediately after enrollment
Angular velocity of spine during baseball batting	Measured by the Vicon motion analysis system in the horizontal plane	immediately after enrollment
Angular velocity of hip during baseball batting	Measured by the Vicon motion analysis system in the horizontal plane	immediately after enrollment
Thoracic spine mobility	Measured by the Vicon motion analysis system in sitting	immediately after enrollment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hip joint mobility	Ranges of hip internal and external rotation measured by inclinometer in sitting	immediately after enrollment
Stiffness of biceps femoris muscle	Measured by the hand-held MyotonPRO device in N/m	immediately after enrollment
Stiffness of rectus femoris muscle	Measured by the hand-held MyotonPRO device in N/m	immediately after enrollment
Stiffness of tensor fasciae latae muscle	Measured by the hand-held MyotonPRO device in N/m	immediately after enrollment
Stiffness of glutues maximus muscle	Measured by the hand-held MyotonPRO device in N/m	immediately after enrollment
Stiffness of thoracic erector spinae muscle	Measured by the hand-held MyotonPRO device in N/m	immediately after enrollment
FABER's test	Measured as distance between knee and bed in cm	immediately after enrollment
Straight leg raising test	Measured as hip flexion angle (with knee extended) in degree	immediately after enrollment
Modified Thomas test	Measured as hip flexion angle (with knee flexed) in degree	immediately after enrollment
Ober test	Measured as hip adduction angle in degree	immediately after enrollment

Collaborators and Investigators

• Sponsor: National Cheng-Kung University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): November 2, 2022
• Primary Completion (Estimated): July 31, 2024
• Study Completion (Estimated): July 31, 2024

Study Registration Dates

• First Submitted: May 16, 2023
• First Submitted That Met QC Criteria: February 1, 2024
• First Posted (Actual): February 12, 2024

Study Record Updates

• Last Update Posted (Actual): February 12, 2024
• Last Update Submitted That Met QC Criteria: February 1, 2024
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Keywords: Muscle stiffness; Hip; Motion analysis; Joint mobility; Baseball batting; Regional interdependence,
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Back Pain; Low Back Pain
• Other Study ID Numbers: A-ER-110-579

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No