See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/322349242 Classification of lumbopelvic-hip complex instability on kinematics amongst female team handball athletes Article in Journal of Science and Medicine in Sport · January 2018 DOI: 10.1016/j.jsams.2017.12.009 CITATIONS READS 12 263 3 authors: Gabrielle Grace Gilmer Sarah Gascon Auburn University Auburn University 5 PUBLICATIONS 47 CITATIONS 13 PUBLICATIONS 73 CITATIONS SEE PROFILE Gretchen Oliver Auburn University 223 PUBLICATIONS 1,983 CITATIONS SEE PROFILE All content following this page was uploaded by Gabrielle Grace Gilmer on 09 December 2020. The user has requested enhancement of the downloaded file. SEE PROFILE Journal of Science and Medicine in Sport 21 (2018) 805–810 Contents lists available at ScienceDirect Journal of Science and Medicine in Sport journal homepage: www.elsevier.com/locate/jsams Original research Classification of lumbopelvic-hip complex instability on kinematics amongst female team handball athletes Gabrielle G. Gilmer, Sarah S. Gascon, Gretchen D. Oliver ∗ Auburn University, School of Kinesiology, Sports Medicine and Movement Laboratory, United States1 a r t i c l e i n f o Article history: Received 14 July 2017 Received in revised form 13 December 2017 Accepted 21 December 2017 Available online 9 January 2018 Keywords: Core stability Kinetic chain Throwing mechanics a b s t r a c t Objectives: The purpose of this study was to examine how lumbopelvic-hip complex (LPHC) stability, via knee valgus, affects throwing kinematics during a team handball jump shot. Design: LPHC stability was classified using the value of knee valgus at the instant of landing from the jump shot. If a participant displayed knee valgus of 17◦ or greater, they were classified as LPHC unstable. Stable and unstable athletes’ throwing mechanics were compared. Methods: Twenty female team handball athletes (26.5 ± 4.7 years; 1.75 ± 0.04 m; 74.4 ± 6.4 kg; experience level: 4.8 ± 4.1 years) participated. An electromagnetic tracking system was used to collect kinematic data while participants performed three 9-m jump shots. The variables considered were kinematics of the pelvis, trunk, and shoulder; and segmental speeds of the pelvis, torso, humeral, forearm, and ball velocities. Data were analyzed across four events: foot contact, maximum shoulder external rotation, ball release, and maximum shoulder internal rotation. Results: Statistically significant differences were found between groups in pelvis, trunk, humerus, and forearm velocities at all events (p ≤ 0.05). Specifically, the unstable group displayed significantly slower speeds. Conclusions: These findings suggest the difference in throwing mechanics are affected by LPHC instability for this select group of female team handball athletes. These differences infer an increased risk of injury in the upper and lower extremities when landing from a jump shot because of the energy losses throughout the kinetic chain and lack of utilization of the entire chain. It is recommended that further investigations also consider muscle activation throughout the throwing motion. © 2018 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved. 1. Introduction Throwing is a kinetic chain activity requiring coordinated energy transfer from foot contact through the proximal segments of the pelvis and trunk to the most distal segments of the arm and hand.1 The summation of speed principle states that the total energy in the kinetic chain is the sum of each segment’s individual energy contribution.1,2 This principle can be applied to throwing, and optimal energy transfer throughout the kinetic chain can be achieved when the proximal segment reaches its maximum speed then the next distal adjacent segment reaches its maximum speed.1 Additionally, literature has shown inadequate strength and stability throughout the kinetic chain may contribute to ineffi- ∗ Corresponding author. E-mail address: gdo0001@auburn.edu (G.D. Oliver). 1 www.sportsmedicineandmovement.com. cient force production and decrease energy transfer for throwing performance.3,4 The lumbopelvic-hip complex (LPHC) connects the lower extremity to the upper extremity and contributes approximately 50% of the energy and force during the dynamic motion of throwing.4 LPHC stability is defined as the ability to control the location of the torso over the pelvis that allows for uninterrupted energy transfer.4 In throwing, the LPHC stabilizes the upper extremity by increasing intra-abdominal pressure and thus creating an optimized energy flow; however, the lower extremity stabilizes the LPHC.4 Previous research has shown that proper stabilization of the LPHC leads to higher rotational velocities of the upper extremity segments during dynamic overhead throwing.5 It is known that LPHC instability has been associated with knee injury and is clinically recognized by an increase in hip varus, hip flexion, and ultimately dynamic knee valgus.4 It has also been shown that 49% of athletes with a posteriorsuperior labral tear in the shoulder have an unstable LPHC.6 During rehabilitation from labral reconstructive surgery, lower extremity https://doi.org/10.1016/j.jsams.2017.12.009 1440-2440/© 2018 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved. 806 G.G. Gilmer et al. / Journal of Science and Medicine in Sport 21 (2018) 805–810 engagement has been found to activate the scapula and shoulder.7 Additionally, a 20% decrease in energy generation from the hips leads to a 34% increase in demand on the shoulder and arm.4 When specifically examining the effects of the kinetic chain in dynamic movement, Elliot et al.8 found that tennis players who had a break down in the lower extremities increased the load on their shoulder and elbow by 23–27%. There has yet to be further investigation of the effects of lower extremity and LPHC instability on upper extremity motion in other sports, such as team handball. The sport of team handball is unique in that it has side-to-side cutting, jumping, and overhead throwing. The ability to transfer energy and perform an accurate shot on goal is dependent on the synchronization, stabilization, and strength of both the upper and lower extremities. The objective of the game is to score more goals than the opponent by throwing the ball into the opposing team’s goal. Athletes throw a variety of shots in order to score.9–11 The two most frequent shots are the run-up throw to a jump shot and a run-up throw to a set shot. In team handball, shoulder and knee injuries account for 44% and 26.7% of all injuries, respectively.12 Even though the injury rates and the importance of energy transfer throughout the kinetic chain are known, there has yet to be a comparison examining the effects of LPHC stability on throwing mechanics in female team handball athletes. Therefore, the purpose of this study was to examine how LPHC stability, via knee valgus, affects throwing kinematics during a team handball jump shot. It was hypothesized that LPHC instability would affect kinematics of the pelvis, trunk, and shoulder; and segmental sequencing of the pelvis, torso, humeral, forearm, and ball velocities. Specifically, the authors expected the unstable athletes to display significantly slower segmental speeds and ball velocities and more pathomechanic kinematics. 2. Methods Twenty female, team handball athletes (26.6 ± 4.7 years; 1.75 ± 0.04 m; 74.4 ± 6.4 kg; experience levels: 4.8 ± 4.1 years) were recruited to participate. All participants were active on the USA National Team residency program, in good physical condition, and had no injuries within the last six months. Training for the USA National Team includes 12 h per week of strength and conditioning and 16 h per week of practice. The University’s Institutional Review Board approved all testing protocols. Informed written consent was obtained from each participant before testing. Kinematic data were collected at 100 Hz using an electromagnetic tracking system (trakSTARTM , Ascension Technologies, Inc., Burlington, VT, USA) synced with The MotionMonitorTM (Innovative Sports Training, Chicago, IL, USA). The electromagnetic tracking system used has been previously validated for measuring humeral movements, and interclass correlation coefficients for axial humeral rotation in both loaded and non-loaded conditions have been reported greater than 0.96.13,14 In addition, the current system was calibrated using previously established protocols prior to the collection of any data.13,15,16 After calibration, the error in determining position and orientation of the electromagnetic sensors with the current calibrated world axis system was less than 0.01 m and 3◦ , respectively. A 40 cm × 60 cm Bertec force plate (Bertec Corp., Columbus OH) was built into the surface from which all jump shots were made such that the participant’s stride foot would land on the force plate during the throwing motion. Force plate data were only used to event mark the instance of stride foot contact during the throwing motion and were sampled at a rate of 1000 Hz. If a participant did not land in the force plate, that trial was repeated. Participants had a series of 11 electromagnetic sensors affixed to the skin using PowerFlex cohesive tape (Andover Healthcare, Inc., Salisbury, MA) to ensure the sensors remained secure throughout testing. Sensors were attached to the following locations: (1) posterior aspect of the trunk at the first thoracic vertebrae (T1) spinous process; (2) posterior aspect of the pelvis at the first sacral vertebrae (S1); (3) flat, broad portion of the acromion on the throwing scapula; (4) lateral aspect of the throwing upper arm at the deltoid tuberosity; (5) posterior aspect of the distal throwing forearm, centered between the radial and ulnar styloid processes; (6–7) lateral aspect of each thigh, centered between the greater trochanter and the lateral condyle of the knee; (8–9) lateral aspect of each shank, centered between the head of the fibula and lateral malleolus; (10–11) dorsal aspect of each foot on top of the shoe.15 A twelfth, moveable sensor was attached to a plastic stylus used for the digitization of bony landmarks.16–18 Joint centers were digitized using previously established and tested protocols.19–21 Raw data regarding sensor position and orientation were transformed to locally based coordinate systems for each of the representative body segments using previously described methods.17–19 All data were time stamped through The MotionMonitorTM and passively synchronized using a data acquisition board. Even though dynamic knee valgus is known to indicate LPHC instability, no standard method has been described on how to measure LPHC instability within a throwing motion.5 For the current study, knee valgus at landing was used for classification due to the large number of knee injuries that occur at this point in the throw.12 In arthroscopy, knee valgus between 17◦ and 26◦ is considered grade II valgus deformation, and knee valgus greater than 26◦ is considered grade III valgus deformation.26,22 Knee valgus around 7◦ is considered normal.22 For the purpose of this study, LPHC instability was defined by a knee valgus of 17◦ or greater at landing because valgus deformation classification begins at this point and a large portion of knee injuries occur when landing from a throw. Based on the aforementioned stability groups, the LPHC stable athletes (27.8 ± 3.2 years; 1.73 ± 0.05 m; 76.8 ± 5.5 kg; experience level: 5.6 ± 4.6 years; n = 9) had a knee valgus of 6 ± 5◦ , and the LPHC unstable athletes (24.9 ± 6.62 years; 1.74 ± 0.04 m; 73.66 ± 6.73 kg; experience level: 3.9 ± 3.5 years; n = 11) had a knee valgus of 19 ± 5◦ . After sensor attachment and digitization, each participant was allotted an unlimited amount of time to warm-up (average warmup time: 5 min) and become familiar with all testing procedures. The testing began only when the participant was self-declared ready to partake in the shots. For testing, each participant was instructed to throw the ball (Internation Handball Federation (IHF) Size 2) into a modified team handball goal at 9 m distance. The participants were required to accomplish three successful shots on goal of the run-up to a jump shot. A successful shot was defined as an athlete shooting the team handball goal. Kinematic data (pelvis anterior/posterior and lateral tilt; trunk flexion/extension, lateral flexion, and rotation; shoulder plane of elevation, elevation, and rotation; and segmental sequencing of the pelvis, torso, humeral, forearm, and ball velocities) were collected across three trials of the jump shot for analysis. The throwing motion was defined by four events, as shown in Fig. 1: (1) foot contact (FC), (2) maximal shoulder external rotation (MER), (3) ball release (BR), and (4) maximal shoulder internal rotation (MIR). All data were processed using a customized MATLAB (MATLAB R2010a, MathWorks, Natick, MA, USA) script. Statistical analyses were performed using IBM SPSS Statistics 22 software (IBM Corp., Armonk, NY) for normally distributed data and a customized MATLAB script for non-normally distributed data with an alpha level set a priori at ˛ = 0.05. Prior to analysis, a Jarque–Bera test of Normality was run. Results showed normal distribution of the kinematic data and non-normal distribution for the segmental speeds. All kinematic variables were analyzed using repeated measure G.G. Gilmer et al. / Journal of Science and Medicine in Sport 21 (2018) 805–810 807 Fig 1. Throwing events of jump shot. A. foot contact, B. maximum external rotation, C. ball release, D. maximum internal rotation. ANOVAs that included event (FC, MER, BR, MIR) and group (stable versus unstable) as a between-subject factor. All segmental speeds were analyzed using a Wilcoxon rank-sum test. Repeated measure ANOVAs and Wilcoxon rank-sum testing were employed to examine differences in pelvis anterior/posterior and lateral tilt; trunk flexion/extension, lateral flexion, and rotation; shoulder plane of elevation, elevation, and rotation; as well as pelvis, torso, humerus, and forearm segmental velocities between LPHC stable and unstable female team handball athletes. A between-subjects 2 (groups) × 4 (events) design was utilized for pelvis, trunk, and shoulder kinematics. Mauchly’s test of sphericity was conducted prior to all normal analyses, and a Greenhouse–Geisser correction was imposed when sphericity was violated. 3. Results Repeated measure ANOVAs results revealed no significant differences in kinematics between groups in the run-up to jump shot (p > 0.05). Means and standard deviations are presented in Table 1. Wilcoxon rank-sum test results revealed significant differences between groups in the segmental sequencing (p < 0.05). Statistical data from Wilcoxon rank-sum test are shown at the bottom of Table 1. Median event results were statistically significant between groups at all events for pelvis, torso, humerus, and forearm velocities. Fig. 2 outlines the changes in velocities of each segment throughout the course of the throw. Wilcoxon rank-sum test revealed significant differences in ball speeds between groups (p = 0.0324, U = 154, z = 3.5950). The median speed for LPHC unstable athletes was 16.17 mph, and the median speed for LPHC stable athletes was 18.19 mph. 4. Discussion The purpose of this study was to examine how LPHC stability, via knee valgus, affects full body kinematics and segmental sequencing amongst American female team handball athletes during a jump shot. It was hypothesized that lower extremity instability would affect kinematics of the pelvis, trunk and shoulder; and segmental sequencing of the pelvis, torso, humerus, and forearm velocities. However, no kinematic differences were found between groups. Both groups displayed similar kinematic patterns across most throwing events. However, there were different trends in kinematics from FC to MER in that upon observation, the LPHC stable athletes decreased in pelvis lateral flexion and increased in trunk flexion and shoulder elevation; whereas LPHC unstable athletes increased in lateral flexion, and decreased in trunk flexion and shoulder elevation. Previous research has found that amongst male team handball players, trunk flexion and shoulder elevation increase from FC to MER.23 In addition, Lintner et al. found that tennis players who displayed “pull-through” (i.e. increased lateral flexion and shoulder elevation) are more prone to injury.24 These movements are most similar to that of the stable athletes, however, since no significant differences were found, it is unclear on whether or not this difference indicates instability. The lack of kinematic differences between the classified LPHC stable and unstable athletes may originate from compensations within the kinetic chain. As members of the USA National Team residency program, these athletes train five days per week and perform weight lifting activities with a strength and conditioning coach three days per week. Because of this advanced training, these athletes’ muscles may be able to re-stabilize the body in order to perform a shot without injury. When examining segmental speeds, differences were found between LPHC stable and unstable athletes. These findings support the hypothesis as well as previously reported data.1,4,5 As seen in Fig. 2, the LPHC unstable athletes displayed slower segmental speeds across all investigated throwing events. These results agree with the summation of speeds principle because the median ball speed for LPHC unstable athletes was 16.17 mph, and the median speed for stable athletes was 18.19 mph.1,2 Though LPHC unstable athletes were slower, they still followed the summation of speed theory. As stated previously, approximately 50% of the energy from the throwing motion is generated from the LPHC, and the lower extremity acts as a base for the LPHC.4 The current results imply that with a lack of LPHC stability, unstable athletes were unable to generate as much force during the throwing motion. Saeterbakken et al.5 examined exercises intended to minimize energy loss due to instability and found that specific core activities increased the ball speed amongst female team handball athletes. The unstable athletes of this study may benefit from core engaging exercises. Limitations of this study include the total number of American female team handball athletes. Team handball is not a popular sport in the USA; however, it is a popular sport in Europe. Thus, all of the current publications as of December 2016 concerning female team handball are based on European athletes. This is a notable difference because of the cultural differences in team handball. 808 G.G. Gilmer et al. / Journal of Science and Medicine in Sport 21 (2018) 805–810 Table 1 Jump shot kinematics and segmental velocities means and standard deviations for stable and unstable groups at the throwing events. Significant differences were found amongst all speeds at all events. The statistical results from the Wilcoxon rank sum test are listed below each significant finding. Throwing events include: foot contact (FC), maximum external rotation of the shoulder (MER), ball release (BR), and maximum internal rotation of the shoulder (MIR). Trunk flexion Stable Unstable Trunk lateral flexion Stable Unstable Trunk rotation Stable Unstable Pelvis flexion Stable Unstable Pelvis lateral flexion Stable Unstable Pelvis rotation Stable Unstable Shoulder plane of elevation Stable Unstable Shoulder elevation Stable Unstable Shoulder rotation Stable Unstable Pelvis rotation velocity Stable Unstable p U Z Torso rotation velocity Stable Unstable p U Z Humerus rotation velocity Stable Unstable p U Z Forearm rotation velocity Stable Unstable p U Z FC MER BR MIR 3.44 ± 9.41 −0.63 ± 13.62 3.31 ± 9.03 2.83 ± 13.67 2.37 ± 13.63 −1.00 ± 7.46 −0.41 ± 28.71 −7.84 ± 6.18 3.48 ± 9.58 3.48 ± 10.73 −2.37 ± 21.09 −3.30 ± 13.32 −32.21 ± 21.86 −31.28 ± 8.86 −27.67 ± 26.03 −29.38 ± 12.11 −62.62 ± 46.19 −60.38 ± 28.28 −33.25 ± 37.53 −31.52 ± 28.47 25.31 ± 33.70 24.51 ± 13.43 23.14 ± 51.42 17.01 ± 11.85 −12.55 ± 9.52 −15.33 ± 8.67 −9.60 ± 6.69 −13.53 ± 9.40 −9.14 ± 7.72 −10.62 ± 10.68 −5.14 ± 9.46 −5.00 ± 10.18 −17.35 ± 6.23 −12.82 ± 9.59 −17.45 ± 5.37 −11.75 ± 7.18 15.61 ± 8.69 −12.03 ± 6.61 −12.43 ± 9.13 −7.36 ± 6.76 −37.80 ± 17.21 −34.14 ± 21.56 −15.71 ± 15.20 −7.57 ± 25.99 4.12 ± 20.49 7.09 ± 15.49 −4.41 ± 19.38 −1.26 ± 12.58 −2.34 ± 34.33 −9.65 ± 22.54 6.49 ± 21.76 8.41 ± 29.38 34.31 ± 14.24 48.17 ± 21.52 57.97 ± 25.95 77.10 ± 19.65 −62.27 ± 20.62 −62.95 ± 25.59 −61.31 ± 64.95 −98.84 ± 15.39 −74.95 ± 21.97 −88.11 ± 17.23 −64.81 ± 24.16 −59.17 ± 18.74 −41.38 ± 19.75 −39.91 ± 49.29 −80.49 ± 19.23 −103.10 ± 25.06 −60.82 ± 21.48 −80.29 ± 22.85 −29.83 ± 25.45 −47.76 ± 23.25 152.99 104.68 0.036 642 5.9037 345.01 301.08 0.008 632 5.6689 241.97 182.87 0.028 627 5.3168 182.64 127.07 0.011 617 5.3168 156.81 118.07 0.048 619 5.3637 662.09 549.66 0.019 634 5.7159 232.24 136.93 0.006 632 5.6689 234.35 163.41 0.014 487 2.2652 364.56 281.94 0.047 601 4.9412 1103.03 823.9 0.020 646 5.9975 1180.63 1052.19 0.028 677 5.5515 711.52 607.91 0.050 619 5.3638 551.56 462.17 0.048 627 5.551 1064.2 861.8 0.047 637 5.7863 2018.75 1666.93 0.039 635 5.6454 674.64 563.41 0.046 631 5.6454 Pelvis ant/post tilt: (−) anterior tilt, (+) posterior tilt; pelvis lateral tilt: (−) away from throwing side, (+) toward throwing side; trunk flexion/extension: (−) flexion, (+) extension; trunk lateral flexion: (−) away from throwing side, (+) toward throwing side. Trunk rotation: (−) toward throwing side, (+) away from throwing side; shoulder plane of elevation: (−) abduction, (+) adduction. In Europe, most team handball athletes begin playing when they are children.25 In this particular study and most USA team handball athletes, athletes do not start playing team handball until they are adults. Literature has yet to show kinematic data comprised of American female team handball players, therefore the literature was restricted to European female team handball athletes. Adults learning new skill sets respond differently than adults who have learned a skill set as children so comparing American and European athletes is not justified.26 In addition, the literature as of December 2016 does not include methods on how to classify LPHC instability within a throwing motion. Landing is only a part of throwing motions that require jumping, and the methods for classifying LPHC instability in this study could not be repeated for sports, such as softball and baseball, that do not demand a combined jumping and throwing mechanism. Most stabilization tests are movements that are outside of the dynamics of a specific sport or sport movement. It may be beneficial to athletes to investigate classification methods that are sports specific since most injuries occur within a dynamic movement. 5. Conclusions Throwing requires engagement of the entire kinetic chain to efficiently transfer energy to the upper extremities. The current study reiterates the importance of proximal stability through LPHC stabilization and strength in the efficiency of the dynamic work of the kinetic chain. The main findings suggest that athletes who have LPHC instability, defined by knee valgus at landing greater than 17◦ , G.G. Gilmer et al. / Journal of Science and Medicine in Sport 21 (2018) 805–810 809 Fig. 2. The segmental speeds were plotted versus the throwing events. Significance was found in the pelvis rotational, torso rotational, humeral, and forearm velocities between the two groups at all four events. **denotes significant findings (p < 0.05). have significantly lower segmental speeds throughout the throwing motion of a jump shot. This interruption in the kinetic chain may cause these athletes to further compensate and put more strain on their shoulder and elbow. While this study only focused on upper extremity kinematics, previous research has clearly shown that high knee valgus indicates high risk of lower extremity injury.27 In addition, it is crucial for the sports medicine community to standardize how LPHC stability is classified to ease applications for coaches and players and keep the literature consistent. It is recommended that future research consider muscle activation when studying kinetic chain activities. Practical implications • Instability in the hip area leads to slowed body movement amongst female team handball athletes. • Instability in the hip area does not result in altered movement patterns amongst female team handball athletes. • There is a need for a practical and reproducible method for classifying hip instability. Acknowledgments The authors would like to acknowledge the assistance of all the members of the Sports Medicine and Movement lab for assisting with data collection, the US National Team Residency Program for agreeing to participate in this study, and the statistical expertise of Dr. Keith Lohse. References 1. Putnam CA. Sequential motions of body segments in striking and throwing skills: descriptions and explanations. J Biomech 1993; 26(Suppl. 1):125–135. 2. Bunn J. Scientific Principles of Coaching, 2nd ed. Englewood Cliffs, NJ, Prentice Hall, 1972. 3. van der Hoeven H, Kibler WB. Shoulder injuries in tennis players. Br J Sports Med 2006; 40(5):435–440, discussion 440. 4. Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Med 2006; 36(3):189–198. 5. Saeterbakken AH, van den Tillaar R, Seiler S. Effect of core stability training on throwing velocity in female handball players. J Strength Cond Res 2011; 25(3):712–718. 6. Burkhart SS, Morgan CD, Ben Kibler W. The disabled throwing shoulder: spectrum of pathology part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy 2003; 19(6):641–661. 7. Kibler WB, Wilkes T, Sciascia A. Mechanics and pathomechanics in the overhead athlete. Clin Sports Med 2013; 32(4):637–651. 8. Elliott B, Fleisig G, Nicholls R et al. Technique effects on upper limb loading in the tennis serve. J Sci Med Sport 2003; 6(1):76–87. 9. Wagner H, Pfusterschmied J, Tilp M et al. Upper-body kinematics in teamhandball throw, tennis serve, and volleyball spike. Scand J Med Sci Sports 2014; 24(2):345–354. 10. Wagner H, Pfusterschmied J, Von Duvillard SP et al. Skill-dependent proximalto-distal sequence in team-handball throwing. J Sports Sci 2012; 30(1):21–29. 11. Wagner H, Pfusterschmied J, Von Duvillard SP et al. Performance and kinematics of various throwing techniques in team handball. J Sports Sci Med 2011; 10:73–80. 12. Giroto N, Hespanhol Junior LC, Gomes MR et al. Incidence and risk factors of injuries in Brazilian elite handball players: a prospective cohort study. Scand J Med Sci Sports 2017; 27(2):195–202. 13. Day J, Murdoch D, Dumas G. Calibration of position and angular data from a magnetic tracking device. J Biomech 2000; 33:1039–1045. 14. Meskers C, Fraterman H, Helm F et al. Calibration of the Flock of Birds electromagnetic tracking device and its application in shoulder motion studies. J Biomech 1999; 32:629–633. 15. Plummer H, Oliver GD. Quantitative analysis of kinematics and kinetics of catchers throwing to second base. J Sports Sci 2013; 31(10):1108–1116. 16. Oliver GD, Keeley DW. Gluteal muscle group activation and its relationship with pelvis and torso kinematics in high-school baseball pitchers. J Strength Cond Res 2010; 24(11):3015–3022. 17. Oliver GD, Keeley DW. Pelvis and torso kinematics and their relationship to shoulder kinematics in high-school baseball pitchers. J Strength Cond Res 2010; 24(12):3241–3246. 18. Wu G, Siegler S, Allard P et al. ISB recommendation on definitions of joint coordinate system of various joints for reporting of human joint motion—part I: ankle, hip, and spine. J Biomech 2002; 35(4):543–548. 19. Wu G, van der Helm FCT, Veeger HEJ et al. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion—part II: shoulder, elbow, wrist and hand. J Biomech 2005; 38(5):981–992. 20. Huang YH, Wu TY, Learman KE et al. A comparison of throwing kinematics between youth baseball players with and without a history of medial elbow pain. Chin J Physiol 2010; 53(3):160–166. 810 G.G. Gilmer et al. / Journal of Science and Medicine in Sport 21 (2018) 805–810 21. Veeger HE. The position of the rotation center of the glenohumeral joint. J Biomech 2000; 33(12):1711–1715. 22. Apostolopoulos AP, Nikolopoulos DD, Polyzois I et al. Total knee arthroplasty in severe valgus deformity: Interest of combining a lateral approach with a tibial tubercle osteotomy. Orthop Traumatol Surg Res 2010; 96:777–784. 23. Plummer HA, Oliver GD. The effects of localised fatigue on upper extremity jump shot kinematics and kinetics in team handball. J Sports Sci 2017; 35(2):182–188. 24. Lintner D, Noonan TJ, Kibler WB. Injury patterns and biomechanics of the athlete’s shoulder. Clin Sports Med 2008; 27(4):527–551. View publication stats 25. Čižmek A, Ohnjec K, Vucetic V et al. Morphological differences of elite Croatian female handball players according to their game position. Croat Sports Med J 2019; 25(2). 26. Granados C, Izquierdo M, Ibanez J et al. Differences in physical fitness and throwing velocity among elite and amateur female handball players. Int J Sports Med 2007; 28(10):860–867. 27. Hewett TE, Myer GD, Ford KR et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med 2005; 33(4):492–501.