135 vol.฀2฀•฀no.฀2 SPORTS HEALTH T he overhand pitching motion consists of a sequence of body movements that start when the pitcher lifts the lead foot, progresses to a linked motion in the hips and trunk, and culminates with a ballistic motion of the upper extremity to propel the ball toward home plate. The effective synchronous use of selective muscle groups maximizes the efficiency of the kinetic chain (Table 1). The lower extremity and trunk generate and transfer energy to the upper extremity. Coordinated lower extremity muscles (quadriceps, hamstrings, hip internal and external rotators) provide a stable base for the trunk (core musculature) to rotate and flex. The extremely rapid rate of this motion makes assessment difficult. The time elapsed between front foot contact and ball release is only 0.145 seconds, 30 followed by an additional half second for the ball to reach home plate. 7 Maximum humeral internal rotation velocity during throwing may reach 7500 to 7700 degrees per second. 8,21 Extreme degrees of external rotation of the shoulder, coupled with forward linear trunk motion, allow a greater distance for the accelerating force to be applied to the ball, generating top velocity. 26 An intricate relationship between the dynamic stabilizers (rotator cuff, pectoralis major, and latissimus dorsi) and static stabilizers is required to simultaneously supply the range of motion, force, and stability of the glenohumeral joint. This integrated effort relies on the trapezius, rhomboids, levator scapulae, and serratus anterior muscles for stabilization, positioning, and synchronous scapular motion. The scapula acts synchronously with the rotator cuff to maintain the glenohumeral center of rotation within a physiologic range during the pitching motion. 13,18,20 Because the throwing motion occurs almost exclusively above 90° of abduction, the inferior glenohumeral ligament and capsule act as the primary static anterior restraint. The deltoid elevates the humerus while the rotator cuff adjusts the position of the humeral head on the glenoid. 16 The pectoralis major and latissimus dorsi power the shoulder forward. 16 A pitcher’s velocity, consistency, and durability may be linked to kinematic and kinetic factors as well as the temporal association of segmental body motions. Optimization of these parameters allows for efficient and consistent transfer of energy from proximal to distal components. Understanding the variables that optimize function may prevent injury by reducing the forces imparted to the shoulder and elbow joints. Breakdown of the kinetic chain will reduce its efficiency, making top velocity more difficult (Table 2). The Kinetic Chain in Overhand Pitching: Its Potential Role for Performance Enhancement and Injury Prevention Shane฀T.฀Seroyer,฀MD,*฀Shane฀J.฀Nho,฀MD,฀Bernard฀R.฀Bach,฀MD,฀Charles฀A.฀Bush-Joseph,฀MD, Gregory฀P.฀Nicholson,฀MD,฀and฀Anthony฀A.฀Romeo,฀MD The overhead throwing motion is a coordinated effort of muscle units from the entire body, culminating with explosive motion of the upper extremity. The throwing motion occurs at a rapid pace, making analysis difficult in real time. Electromyographic studies and high-speed video recordings have provided invaluable details regarding the involved musculature, the sequence of muscle involvement, and associated kinematic variables. The goal of the present article is to provide an overview of the kinetic chain—that is, a detailed description of the muscular coordination during each phase of pitching—and to describe specific types of pitches. An enhanced understanding of the components of the kinetic chain and the phases of the throwing motion can provide important information for rehabilitation, performance enhancement, and injury prevention. Keywords: pitching, throwing shoulder, kinetic chain, pitching motion, shoulder injuries [ Athletic Training ] From the Rush University, Chicago, Illinois *Address correspondence to Shane T. Seroyer, MD, 515 Mayfield Road, Ste 116, Arlington, TX 76014 (e-mail: sseroyer@gmail.com). No potential conflict of interest declared. DOI: 10.1177/1941738110362656 © 2010 The Author(s)