Osteopathic manipulative treatment for enhanced pitch performance in collegiate baseball players: a feasibility study on shoulder and hip interventions

Carissa Rosten; Sidney Brown; Tanaya Nandedkar; Alex Pearson; Ethan Worthington; Danielle Fastring

doi:10.1515/jom-2025-0106

Article Open Access

Osteopathic manipulative treatment for enhanced pitch performance in collegiate baseball players: a feasibility study on shoulder and hip interventions

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Published/Copyright: January 28, 2026

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From the journal Journal of Osteopathic Medicine

Abstract

Context

Previous studies have sought to improve pitch performance and shoulder function utilizing the Muscle Energy Technique (MET) or Spencer’s technique. The results of these studies have been mixed. Some found immediate, but short-lived, improvement to different planes of the range of motion (ROM) of the throwing shoulder. None found improved velocity or investigated further pitch metrics, such as spin rate.

Objectives

This study is the first to measure the effects of osteopathic manipulative treatment (OMT) among key points of the kinetic chain, measuring ROM of the shoulder and the hip, as well as pitch metrics beyond release velocity.

Methods

Baseball pitchers from a local collegiate baseball team were offered participation in this study. Pitchers had to be medically cleared for participation as members of the team and had to be given permission by the coach to join the study. Sixteen pitchers were assessed for inclusion, and 13 of the 16 were randomized into OMT and control groups for a prospective cohort study. One dropped out of the control group upon randomization, and one member of the control broke baseline protocol, leaving six members in the experimental group, and five members in the control group. Data, including pitch metrics, active ROM, and demographics were collected at three time points with statistical analyses comparing data between groups. Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC-SES) was collected twice. After the third time point, the control group was crossed over to receive the OMT protocol also. Data were analyzed utilizing paired t-tests and Fisher’s exact test.

Results

Six pitchers received intervention (OMT), and five pitchers received no intervention (control). Overuse injuries developed in the control group only, preventing two of the five members of the control group from throwing further pitches for data collection at 5 weeks. When analyzed by Fisher’s exact test, those in the control group were 9.29 times more likely to develop an injury than those receiving a single application of OMT. The only significant difference in pitch performance was an immediate 0.74 mph reduction in effective velocity in the OMT group (p=0.048), not sustained at the 5-week follow-up. Immediately posttreatment, the intervention group appreciated a 7.16° advantage in shoulder internal rotation over the control group (p=0.017). Five weeks posttreatment, the intervention group appreciated a 9.44° advantage in shoulder external rotation (p=0.047). Bilateral hip extension was immediately significantly improved in the treatment group (p<0.001). Left hip flexion was significantly improved in the treatment group when compared against the control group both immediately by 6.76° (p<0.011) and at 5-week follow-up by 12.87° (p<0.001). An advantage in right hip flexion was significant only at 5 weeks by 5.89° (p<0.02).

Conclusions

A single application of OMT is a low-risk intervention to prevent overuse injuries in the elite overhead athlete. While this study found differences in velocity, ROM, and injury risk, this study was limited by the sample size (n=11). A larger sample group is needed both for reproducibility and for assessment of other pitch parameters such as horizontal break, vertical break, and pitch extension.

Keywords: baseball; glenohumeral internal rotation deficit (GIRD); kinetic chain; osteopathic manipulative treatment; overuse injuries; pitch performance

Overhead throwing in elite pitchers is a rapid, highly coordinated motion that culminates in extreme action from the upper extremity [1]. Injuries to throwing athletes stereotypically occur to the shoulder and elbow; however, throwing is not solely an upper-extremity task. Baseball pitchers assume the role of a human trebuchet; the hips and lower body provide a counterbalance around which the throwing arm acts as a hypermobile sling. A pitcher’s windup generates potential energy through balance on one leg, which is transferred into momentum during the stride phase, with knee flexion during early cocking serving as a predictor of release velocity [2]. Elite pitchers can exceed 700° per second of pelvic rotation during the cocking phase, with pelvic rotational velocity positively corresponding to ball velocity [3]. Force generated by the pelvis is then transferred to the upper torso, where rotational velocities can reach 1,100° per second before forces transfer through the shoulder [3]. A 20 % decrease in kinetic energy from the hip and trunk requires a compensatory 34 % increase in rotational velocity from the shoulder [4]. Elite pitchers reach shoulder internal rotation velocities up to 7,500–7,800° per second during the arm acceleration phase, achieved by the subscapularis and latissimus dorsi [2]. During the deceleration phase of the pitch, distraction forces on the glenohumeral joint of the throwing arm can reach 81 % of the pitcher’s body weight [5]. A 5° loss in shoulder internal rotation is a risk factor for shoulder injuries, so improvement in this plane of motion has been hypothesized as protective against future injury [6], 7]. While earlier studies targeting pitchers sought to reduce injury and improve performance, they were limited to the pitcher’s dominant arm utilizing either the Muscle Energy Technique (MET) or the “Spencer’s technique” [8], 9]. These studies enjoyed an immediate but short-lived improvement in shoulder range of motion (ROM), and the study utilizing Spencer’s technique otherwise only measured pitch velocity. This study expands down the kinetic chain to treat the pitcher from the ankle up, investigating the impact of OMT on pitch-performance metrics as well as subjective measures of performance in baseball players. This approach targets the lower extremities, pelvis, abdominal diaphragm, and throwing shoulder.

To objectively assess interventional impact, key metrics utilized to track performance relevant to pitchers were obtained via Trackman, which utilizes Doppler radar and two 4k cameras with dual radar sensors for enhanced tracking accuracy [10], 11].

We hypothesized that a single application of the OMT protocol would improve release speed, effective velocity, zone time, release height, horizontal break, pitch extension, vertical break, induced vertical break, spin rate, and hip ROM, shoulder ROM, and Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC-SES) of those in the experimental vs. the control group. The KJOC-SES is an externally validated survey instrument to measure subjective functionality of the upper extremity in adult overhead athletes [12].

Methods

All methods were approved by the participating team’s baseball coaches and the Institutional Review Board at William Carey University (WCU) to optimize outcomes and mitigate risks. The protocol was retroactively registered with the United Kingdom’s Clinical Study Registry that was originally called the International Standard Randomised Controlled Trial Number (ISRCTN) as ISRCTN51846048. Participants were recruited from a local collegiate baseball team. Student athletes with current injuries that limited or prohibited participation in practice or games were excluded. Inclusion criteria were as follows: participants must be pitchers, currently participating in baseball, have a sports physical clearing them for athletic participation for the academic year, and have the permission of their coach to be included in the study. One week prior to baseline, the study was explained to the pitchers and coaches with a full treatment demonstration, and the pitchers were all given a printed copy of the informed consent to review at their convenience.

At baseline, the participants provided informed consent online. Participants could revoke consent at any time without penalty. Each participant was assigned a unique, nonidentifiable study ID and was randomized into one of two groups: the treatment group, which received the OMT intervention; or the control group, which did not receive the OMT intervention, but followed identical warm-up and data collection procedures.

Participants were randomized in the order that they consented utilizing a random number generator. Odd random numbers were allocated to the control group, and even random numbers were allocated to the experimental group.

This yielded seven members of the control group and six members of the experimental group. One participant dropped out upon being randomized to the control group, and another member of the control group deviated from the protocol and was excluded. What remained was an n of 11, with five control participants and six experimental participants. The flow of participants through each stage of the trial is presented in the Consolidated Standards of Reporting Trials (CONSORT) diagram (Figure 1).

Figure 1:

Participant allocations.

Data collection occurred at several points: baseline, which included pretreatment data collection; immediately posttreatment, which included data collection on the same day as baseline but following the intervention for the treatment group (or no intervention for the control group); 5-week follow-up; and 10-week follow-up. During the 5-week follow-up, after data collection, the participants in the control group were crossed over into the experimental group to also be treated and followed. The 10-week follow-up applied only to the crossover cohort. Data were collected from December 2024 through February 2025 to mitigate interference to the standard athletic schedule.

Data collection at each visit included the following metrics: Trackman pitch data, and active hip and shoulder ROM. The purpose of measuring active instead of passive ROM was to measure muscle recruitment rather than joint compliance. KJOC-SES was collected twice, at baseline and at 5 weeks.

Prior to measurement, participants followed their normal warm-up routine until able to pitch at full potential. For both the treatment and control groups, active ROM was obtained utilizing goniometry immediately following warm-up sessions. Two researchers evaluated each pitcher: one conducted measurements while the other verified the measurement and goniometer placement. The following measurements were obtained for all pitchers: throwing shoulder flexion, extension, abduction, internal rotation, and external rotation, bilateral hip flexion, extension, and abduction. Hip extension was obtained prone; the remainder of the measurements were obtained supine.

Following ROM measurements, pitchers performed 10 baseline throws. Following the throws, the pitchers received the intervention (OMT for the experimental group or sitting for the control group). This was to ensure that both groups had similar timings between the baseline and postintervention throws.

The treatment group received the following OMT techniques in order: Spencer’s Technique with MET of the throwing shoulder, fascial distortion model (FDM) of bilateral iliotibial (IT) bands, direct inhibitory pressure (DIP) of bilateral external rotators of hips, ligamentous articular strain (LAS) of lower extremities, myofascial release (MFR) of the abdominal diaphragm, MET of the sacrum, MFR of the scapulothoracic joint, and counterstrain (CS) of the subscapularis and latissimus dorsi. The different techniques and regions targeted are shown in Figure 2.

Figure 2:

Schematic showing different treatment modalities and their respective regional targets. Red=MET of throwing shoulder; green=FDM to IT band; dark blue=DIP of external rotators; pink=LAS of lower extremities; purple=MFR of diaphragm; light blue=MET of sacrum; gray=MFR of scapulothoracic joint; yellow=CS of subscapularis and latissimus dorsi.

LAS was applied to each of the lower extremities with the hip, knee, and ankle joints subsequently positioned for balanced tension. Gentle traction was applied to increase proprioceptive feedback and reset tension across the joints. For pelvic treatment, DIP was applied to the hip external rotators, while FDM was applied to the bilateral IT bands to reduce their resting muscle tone, improving ROM, recruitment of the gluteus maximus, and thereby pelvic stability. MET was also applied for articular gapping of the sacroiliac joint for the same purpose. MFR was applied to the abdominal diaphragm to improve trunk rotation and reduce compression on the psoas muscle by the arcuate ligaments. CS was applied to the subscapularis and latissimus dorsi to increase perfusion to these muscles. To improve scapular mobility, MFR was applied to the scapulothoracic joint. Following intervention, the pitchers returned to the field to perform their immediate postintervention throws, then returned for remeasurement.

Primary outcomes for statistical analysis included release speed, effective velocity, zone time, release height, horizontal break, pitch extension, vertical break, induced vertical break, spin rate, and changes in hip and shoulder ROM. Secondary outcomes included subjective performance scores from the KJOC-SES survey. All statistical analyses were conducted utilizing IBM SPSS (Statistical Package for the Social Sciences) Statistics (Version 29). To evaluate changes in performance metrics over time, dependent (paired-samples) t-tests were utilized to compare scores between baseline, immediately postintervention, and 5 weeks postintervention. Change scores were calculated for each variable by subtracting earlier time points from later ones (e.g., post – baseline, five weeks – baseline). These were used to quantify within-subject change over time. Assumptions of normality were assessed utilizing the Shapiro-Wilk test and Q-Q plots. Only variables that met the normality assumption were included in the t-test analyses; variables that violated normality were either analyzed descriptively or excluded from inferential testing. A significance level of p<0.05 was utilized for all statistical tests.

Results

Statistics for changes in shoulder and hip ROM, as well as Trackman pitch metrics, are presented in Table 1. Shoulder ROM was measured for only the throwing side, and all pitchers were right-handed. There were no significant changes in shoulder flexion or extension. The control group achieved a significant increase in shoulder abduction and internal rotation not maintained at 5-week follow-up. Shoulder external rotation was not significantly improved by treatment immediately postintervention, but a significant difference in change scores was evident at the 5-week follow-up (p<0.047).

Table 1:

The changes in ranges of motion (ROM) and the changes in Trackman data before, immediately after, and 5 weeks postintervention, including their means, standard deviation, and p values.

Group		n	Mean	SD	p-Value
Shoulder flexion pre- and post-intervention	Control	5	−0.20	6.80	0.397
Shoulder flexion pre- and post-intervention	Treatment	9	−1.56	10.04	0.397
Shoulder flexion pre- and 5w post-intervention	Control	5	4.80	11.99	0.24
Shoulder flexion pre- and 5w post-intervention	Treatment	9	0.00	10.79	0.24
Shoulder extension pre- and post-intervention	Control	5	−1.20	4.38	0.122
Shoulder extension pre- and post-intervention	Treatment	9	7.56	15.38	0.122
Shoulder extension pre- and 5w post-intervention	Control	5	3.00	11.98	0.409
Shoulder extension pre- and 5w post-intervention	Treatment	9	1.78	7.61	0.409
Shoulder abduction pre- and post-intervention	Control	5	−7.20	5.72	0.017
Shoulder abduction pre- and post-intervention	Treatment	9	3.22	8.63	0.017
Shoulder abduction pre- and 5w post-intervention	Control	5	0.20	13.59	0.388
Shoulder abduction pre- and 5w post-intervention	Treatment	9	1.89	8.43	0.388
Shoulder internal rotation pre- and post-intervention	Control	5	−1.60	9.56	0.03
Shoulder internal rotation pre- and post-intervention	Treatment	9	6.56	5.34	0.03
Shoulder internal rotation pre- and 5w post-intervention	Control	5	−11.00	8.19	0.336
Shoulder internal rotation pre- and 5w post-intervention	Treatment	9	−7.00	19.35	0.336
Shoulder external rotation pre- and post-intervention	Control	5	2.20	5.81	0.481
Shoulder external rotation pre- and post-intervention	Treatment	9	2.00	7.97	0.481
Shoulder external rotation pre- and 5w post-intervention	Control	5	−5.00	10.30	0.047
	Treatment	9	3.44	7.14	0.047
L hip flexion pre- and post-intervention	Control	5	−4.20	3.63	0.011
L hip flexion pre- and post-intervention	Treatment	9	2.56	4.98	0.011
L hip flexion pre- and 5w post-intervention	Control	5	−10.20	6.02	0.001
L hip flexion pre- and 5w post-intervention	Treatment	9	2.67	4.85	0.001
L hip extension pre- and post-intervention	Control	5	−6.40	3.91	0.001
L hip extension pre- and post-intervention	Treatment	8	3.63	4.53	0.001
L hip extension pre- and 5w post-intervention	Control	5	−6.00	6.20	0.088
L hip extension pre- and 5w post-intervention	Treatment	9	−1.33	5.61	0.088
L hip abduction pre- and post-intervention	Control	5	−0.40	7.50	0.343
L hip abduction pre- and post-intervention	Treatment	9	−2.00	6.63	0.343
L hip abduction pre- and 5w post-intervention	Control	5	7.40	7.09	0.017
L hip abduction pre- and 5w post-intervention	Treatment	9	−3.89	9.01	0.017
R hip flexion pre- and post-intervention	Control	5	−3.60	5.37	0.224
R hip flexion pre- and post-intervention	Treatment	9	−1.78	3.42	0.224
R hip flexion pre- and 5w post-intervention	Control	5	−6.00	4.85	0.02
R hip flexion pre- and 5w post-intervention	Treatment	9	−0.11	4.43	0.02
R hip extension pre- and post-intervention	Control	5	−4.80	6.69	0.028
R hip extension pre- and post-intervention	Treatment	8	2.63	5.78	0.028
R hip extension pre- and 5w post-intervention	Control	5	−4.40	8.29	0.443
R hip extension pre- and 5w post-intervention	Treatment	9	−3.89	4.86	0.443
R hip abduction pre- and post-intervention	Control	5	1.80	6.87	0.404
R hip abduction pre- and post-intervention	Treatment	9	3.22	11.65	0.404
R hip abduction pre- and 5w post-intervention	Control	5	8.60	9.48	0.12
R hip abduction pre- and 5w post-intervention	Treatment	9	3.89	5.04	0.12
Release speed pre- and post-intervention	Control	5	−0.48	0.34	0.103
Release speed pre- and post-intervention	Treatment	8	−0.97	0.77	0.103
Release speed pre- and 5w post-intervention	Control	3	0.92	1.45	0.104
Release speed pre- and 5w post-intervention	Treatment	6	−0.18	0.97	0.104
Effective velocity pre- and post-intervention	Control	5	−0.37	0.37	0.048
Effective velocity pre- and post-intervention	Treatment	8	−1.12	1.04	0.048
Effective velocity pre- and 5w post-intervention	Control	3	1.16	2.24	0.115
Effective velocity pre- and 5w post-intervention	Treatment	6	−0.40	1.39	0.115
Zone time pre- and post-intervention	Control	5	0.00	0.00	0.15
Zone time pre- and post-intervention	Treatment	8	0.01	0.01	0.15
Zone time pre- and 5w post-intervention	Control	3	−0.01	0.01	0.114
Zone time pre- and 5w post-intervention	Treatment	6	0.00	0.01	0.114
Speed drop pre- and post-intervention	Control	5	−0.15	0.67	0.134
Speed drop pre- and post-intervention	Treatment	8	0.31	0.72	0.134
Speed drop pre- and 5w post-intervention	Control	3	0.01	0.76	0.133
	Treatment	6	0.62	0.70
	Treatment	9	−1.56	10.04
	Treatment	9	0.00	10.79
	Treatment	9	7.56	15.38
	Treatment	9	1.78	7.61
Shoulder abduction pre- and post-intervention	Control	5	−7.20	5.72	0.017
	Treatment	9	3.22	8.63
	Treatment	9	1.89	8.43
Shoulder internal rotation pre- and post-intervention	Control	5	−1.60	9.56	0.03
	Treatment	9	6.56	5.34
	Treatment	9	−7.00	19.35
	Treatment	9	2.00	7.97
Shoulder external rotation pre- and 5w post-intervention	Control	5	−5.00	10.30	0.047
	Treatment	9	3.44	7.14	0.047
L hip flexion pre- and post-intervention	Control	5	−4.20	3.63	0.011
L hip flexion pre- and post-intervention	Treatment	9	2.56	4.98	0.011
L hip flexion pre- and 5w post-intervention	Control	5	−10.20	6.02	0.001
L hip flexion pre- and 5w post-intervention	Treatment	9	2.67	4.85	0.001
L hip extension pre- and post-intervention	Control	5	−6.40	3.91	0.001
	Treatment	8	3.63	4.53
	Treatment	9	−1.33	5.61
	Treatment	9	−2.00	6.63
L hip abduction pre- and 5w post-intervention	Control	5	7.40	7.09	0.017
	Treatment	9	−3.89	9.01
	Treatment	9	−1.78	3.42
R hip flexion pre- and 5w post-intervention	Control	5	−6.00	4.85	0.02
R hip flexion pre- and 5w post-intervention	Treatment	9	−0.11	4.43	0.02
R hip extension pre- and post-intervention	Control	5	−4.80	6.69	0.028
	Treatment	8	2.63	5.78
	Treatment	9	−3.89	4.86
	Treatment	9	3.22	11.65
	Treatment	9	3.89	5.04
	Treatment	8	−0.97	0.77
	Treatment	6	−0.18	0.97
Effective velocity pre- and post-intervention	Control	5	−0.37	0.37	0.048
	Treatment	8	−1.12	1.04
	Treatment	6	−0.40	1.39
	Treatment	8	0.01	0.01
	Treatment	6	0.00	0.01
	Treatment	8	0.31	0.72
	Treatment	6	0.62	0.70
Release height pre- and post-intervention	Control	5	−0.06	0.08	0.244
Release height pre- and post-intervention	Treatment	8	−0.02	0.08	0.244
Release height pre- and 5w post-intervention	Control	3	−0.15	0.06	0.474
Release height pre- and 5w post-intervention	Treatment	6	−0.15	0.08	0.474
Horizontal break pre- and post-intervention	Control	5	1.05	2.53	0.18
Horizontal break pre- and post-intervention	Treatment	8	−0.72	3.59	0.18
Horizontal break pre- and 5w post-intervention	Control	3	0.25	4.87	0.322
Horizontal break pre- and 5w post-intervention	Treatment	6	1.43	2.67	0.322
Extension pre- and post-intervention	Control	5	0.06	0.06	0.46
Extension pre- and post-intervention	Treatment	8	0.05	0.12	0.46
Extension pre- and 5w post-intervention	Control	3	0.11	0.21	0.458
Extension pre- and 5w post-intervention	Treatment	6	0.09	0.35	0.458
Vertical break pre- and post-intervention	Control	5	−1.25	1.51	0.301
Vertical break pre- and post-intervention	Treatment	8	−0.73	1.80	0.301
Vertical break pre- and 5w post-intervention	Control	3	2.22	1.85	0.396
Vertical break pre- and 5w post-intervention	Treatment	6	1.40	4.85	0.396
Induced vertical break pre- and post-intervention	Control	5	−0.89	1.40	0.071
Induced vertical break pre- and post-intervention	Treatment	8	0.27	1.23	0.071
Induced vertical break pre- and 5w post-intervention	Control	3	1.15	0.25	0.396
Induced vertical break pre- and 5w post-intervention	Treatment	6	1.76	3.72	0.396
Spin rate pre- and post-intervention	Control	5	12.24	81.36	0.351
Spin rate pre- and post-intervention	Treatment	8	9.38	104.34	0.351
Spin rate pre- and 5w post-intervention	Control	3	11.80	138.12	0.486
Spin rate pre- and 5w post-intervention	Treatment	6	9.36	69.98	0.486
Survey score change pre- and 5w post-intervention	Control	6	2.00	4.36	0.204
	Treatment	6	9.70	19.16
	Treatment	8	−0.72	3.59
	Treatment	6	1.43	2.67
	Treatment	8	0.05	0.12
	Treatment	6	0.09	0.35
	Treatment	8	−0.73	1.80
	Treatment	6	1.40	4.85
	Treatment	8	0.27	1.23
	Treatment	6	1.76	3.72
	Treatment	8	9.38	104.34
	Treatment	6	9.36	69.98
	Treatment	6	9.70	19.16

Bold indicates a statistically significant value. SD, standard deviation.

Hip ROM was obtained bilaterally. Bilateral hip extension was immediately significantly improved in the treatment group (p<0.001) but not significantly maintained at the 5-week follow-up. Left hip flexion was significantly improved in the treatment group both immediately (p<0.011) and at the 5-week follow-up (p<0.001). Right hip flexion improvement was significant only at 5 weeks (p<0.02). There was no statistically significant change in hip abduction.

The only statistically significant pitch metric was that of immediate postintervention effective velocity. The control group decreased by 0.4 mph, and the treatment group decreased by 1.1 mph from pre-to postintervention (p=0.048). Other metrics such as spin, zone time, release height, horizontal and vertical break, and pitch extension showed no statistically significant changes pre- and postintervention (p>0.05).

Regarding the KJOC-SES score, the treatment group displayed a greater but nonsignificant improvement compared to the control group (+9.7 vs. +2.0, respectively, with p=0.2). Although not included in the original hypothesis, treatment significantly reduced the likelihood of injury. Two of five pitchers (40.0 %) in the control group developed injuries that prevented them from throwing, although no such injuries occurred in the treatment group. Due to the small sample size and the presence of a zero-cell count, a Fisher’s exact test was utilized to assess the difference in injury rates between the two groups. The test yielded a p value of approximately 0.117 (one-tailed). To quantify the strength of the association, an odds ratio (OR) was calculated utilizing a continuity correction (adding 0.5 to each cell to handle the zero count). The resulting OR was 9.29 (95 % confidence interval [CI]: 0.34, 255.0).

Discussion

Strengths and limitations

This study is novel in that it evaluates the effects of OMT across the kinetic chain, expanding beyond prior research focusing solely on the throwing arm. We also include quantitative measures beyond pitch velocity from Trackman, a trusted technology for baseball analytics. Through a randomized control trial, we strengthened internal validity and minimized selection bias to ensure that the outcomes were likely due to OMT vs. other variables. Finally, utilizing a collegiate baseball team shows real-world applicability for athletic performance.

The participant pool was limited to a single university’s baseball team pitchers who were cleared by their physicians and coaches for sports participation. This selection criteria yielded a sample size of 13 pitchers. Among the 13, one participant withdrew upon randomization to the control arm, and two participants in the control arm of the study developed overuse injuries of the upper extremity before the 5-week follow-up. After crossover, the spring baseball season began, preventing one pitcher from providing final pitch data, further limiting data collection.

Having only three members of the control group able to pitch at the 5-week follow-up reduced statistical power from pitch metric data analysis, and none of the change scores for pitch metrics from baseline to 5 weeks were significantly different between the control and treatment groups. After analyzing the difference in injury occurrence between the groups, results indicated that individuals in the control group had approximately 9.3 times greater odds of injury compared to those in the treatment group; however, the CI was wide and included 1, reflecting the small sample size and limited precision. Thus, the findings suggest a potential protective effect of the treatment should the experiment be repeated with a larger sample. Statistical power was retained for ROM and KJOC-SES, as all pitchers from both the control and experimental arms were able to complete these data points without the risk of exacerbating overuse injuries.

Treatment duration provided a limitation to the study. Treatment took less than 13 min to prevent pitchers from cooling down after baseline throws, with the goal of a max cooldown period between the first and second set of throws being kept under 20 min. Our team performed a cost-benefit analysis throughout the treatment process. For example, an additional minute allotted to direct inhibition of the piriformis and counterstain of the subscapularis could both have yielded better pitch extension but would lengthen the cooldown time, increasing the risk of injury. Outside of a research protocol, players could be treated more thoroughly in an outpatient clinical setting to optimize improvements. All researchers took part in goniometry, which may have introduced interobserver variability. This limitation could be addressed in future studies by assigning one researcher to perform goniometry for all players or by utilizing digital goniometry.

Only players in the treatment group stated that they “felt tired” for their second set of throws. Collecting baseline and intervention pitch data on two separate dates and performing OMT prior to warm-up could mitigate the effect of treatment on immediate fatiguability (as evidenced by loss in effective velocity).

Implications and future work

Within this study, a single treatment improved bilateral hip extension, and reduced glenohumeral internal rotation deficit (GIRD) in baseball pitchers by 7.5° immediately, and by 4.5° at 5-week follow-up. Because a 5-degree loss in shoulder internal rotation is a risk factor for injury, OMT may reduce the risk of overuse injuries by providing a durable improvement in this plane of motion [5].

OMT is a possible preventative treatment during the training season alongside traditional strength and conditioning programs.

Full-scale studies planned by the authors will include more players across multiple collegiate teams to achieve increased statistical power, employ an adapted protocol whereby baseline data collection is performed on a separate day from OMT intervention, treatment with OMT prior to player warm-up, and measuring all cardinal planes of motion for the shoulder and hips. Additionally, measurement of hip internal rotation will be included so its relationship with pitch extension can be established. Because the shoulder must compensate for a reduction in power generated by the hip, it is possible that the hip is the ‘key lesion’ in the kinetic chain. Having a larger participant pool will provide statistical power to parse out whether the reduction in injury rate is secondary to treatment of the shoulder itself, or treatment of the hip.

Conclusions

A single application of OMT applied at points along the kinetic chain improved ROM and reduced the rate of injury among collegiate baseball pitchers, appearing to have a protective effect. This is significant to elite overhead athletes, their coaches, team physicians, and osteopathic physicians, who seek to optimize shoulder function among their athlete patient population. Because the sample size was small (n=11), effect sizes needed to be large to reach significance. This study should be expanded to include a larger group to evaluate subtler findings more thoroughly.

Corresponding author: Carissa Rosten, DO, Assistant Professor of Clinical Sciences, William Carey University College of Osteopathic Medicine, WCU Box 207, 710 William Carey Parkway, Hattiesburg, MS 39401, USA, E-mail: crosten@wmcarey.edu

Acknowledgments

The authors would like to thank Evan Williamson, DO, for help with both treatment and goniometry. Thanks also to Rosalynn Schneider, DO, both for help with preparing the study proposal for IRB submission and for converting the KJOC-SES to a digital format. The authors would also like to thank the William Carey University baseball coaches and team. Thank you to coaches Bobby Halford, Eric Ebers, and Jaimie McMahon, and to the pitchers of the 2024–2025 team for their patience with and trust in us. Without the coaches and pitchers, this study would not have been possible.

Research ethics: This study was approved by the William Carey Institutional Review Board and registered with the ISRCTN registry (ISRCTN51846048).
Informed consent: The participants provided informed consent prior to participation.
Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Use of Large Language Models, AI and Machine Learning Tools: None declared.
Conflict of interest: None declared.
Research funding: A new baseball radar system was purchased to obtain the most precise, accurate data possible. Funding for this radar was provided jointly by the William Carey Athletics department and the William Carey Department of Research. Participants were not offered compensation. No extra faculty protected time was granted for this study.
Data availability: Raw data may be obtained on request from the corresponding author.

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Received: 2025-05-28

Accepted: 2025-11-07

Published Online: 2026-01-28

This work is licensed under the Creative Commons Attribution 4.0 International License.

https://doi.org/10.1515/jom-2025-0106

Keywords for this article

baseball; glenohumeral internal rotation deficit (GIRD); kinetic chain; osteopathic manipulative treatment; overuse injuries; pitch performance

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BY 4.0