Calcified Tissue International

, Volume 104, Issue 4, pp 373–381 | Cite as

Baseball and Softball Pitchers are Distinct Within-Subject Controlled Models for Exploring Proximal Femur Adaptation to Physical Activity

  • Robyn K. Fuchs
  • William R. Thompson
  • Alyssa M. Weatherholt
  • Stuart J. WardenEmail author
Original Research


Within-subject controlled models in individuals who preferentially load one side of the body enable efficient exploration of the skeletal benefits of physical activity. There is no established model of physical activity-induced side-to-side differences (i.e., asymmetry) at the proximal femur. Proximal femur asymmetry was assessed via dual-energy X-ray absorptiometry in male jumping athletes (JMP, n = 16), male baseball pitchers (BB, n = 21), female fast-pitch softball pitchers (SB, n = 22), and controls (CON, n = 42). The jumping leg was the dominant leg in JMP, whereas in BB, SB and CON the dominant leg was contralateral to the dominant/throwing arm. BB and SB had 5.5% (95% CI 3.9–7.0%) and 6.5% (95% CI 4.8–8.2%) dominant-to-nondominant leg differences for total hip areal bone mineral density (aBMD), with the asymmetry being greater than both CON and JMP (p < 0.05). BB and SB also possessed dominant-to-nondominant leg differences in femoral neck and trochanteric aBMD (p < 0.001). SB had 9.7% (95% CI 6.4–13.0%) dominant-to-nondominant leg differences in femoral neck bone mineral content, which was larger than any other group (p ≤ 0.006). At the narrow neck, SB had large (> 8%) dominant-to-nondominant leg differences in cross-sectional area, cross-sectional moment of inertia and section modulus, which were larger than any other group (p ≤ 0.02). Male baseball and female softball pitchers are distinct within-subject controlled models for exploring adaptation of the proximal femur to physical activity. They exhibit adaptation in their dominant/landing leg (i.e., leg contralateral to the throwing arm), but the pattern differs with softball pitchers exhibiting greater femoral neck adaptation.


DXA Exercise Femoral neck Hip Osteoporosis 



This contribution was made possible by support from the National Institutes of Health (R01 AR057740 and P30 AR072581).

Compliance with Ethical Standards

Conflict of interest

Robyn K. Fuchs, William R. Thompson, Alyssa M. Weatherholt, and Stuart J. Warden have no conflicts of interest.

Human and Animal Rights and Informed Consent

The study was approved by the Institutional Review Board of Indiana University and written informed consent was obtained from all participants.


  1. 1.
    Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB (2009) Incidence and mortality of hip fractures in the United States. JAMA 302:1573–1579CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, Sherrington C, for the Fragility Fracture Network Rehabilitation Research Special Interest G (2016) A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 16:158CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Weaver CM, Gordon CM, Janz KF, Kalkwarf HJ, Lappe JM, Lewis R, O’Karma M, Wallace TC, Zemel BS (2016) The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int 27:1281–1386CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ 3rd, O’Neill T, Pols H, Reeve J, Silman A, Tenenhouse A (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194CrossRefPubMedGoogle Scholar
  5. 5.
    Hernandez CJ, Beaupre GS, Carter DR (2003) A theoretical analysis of the relative influences of peak BMD, age-related bone loss and menopause on the development of osteoporosis. Osteoporos Int 14:843–847CrossRefPubMedGoogle Scholar
  6. 6.
    Bailey DA, McKay HA, Mirwald RL, Crocker PR, Faulkner RA (1999) A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: the university of Saskatchewan bone mineral accrual study. J Bone Miner Res 14:1672–1679CrossRefPubMedGoogle Scholar
  7. 7.
    Baxter-Jones AD, Faulkner RA, Forwood MR, Mirwald RL, Bailey DA (2011) Bone mineral accrual from 8 to 30 years of age: an estimation of peak bone mass. J Bone Miner Res 26:1729–1739CrossRefPubMedGoogle Scholar
  8. 8.
    Kannus P, Haapasalo H, Sankelo M, Sievänen H, Pasanen M, Heinonen A, Oja P, Vuori I (1995) Effect of starting age of physical activity on bone mass in the dominant arm of tennis and squash players. Ann Intern Med 123:27–31CrossRefPubMedGoogle Scholar
  9. 9.
    Bass SL, Saxon L, Daly RM, Turner CH, Robling AG, Seeman E, Stuckey S (2002) The effect of mechanical loading on the size and shape of bone in pre-, peri-, and.postpubertal girls: a study in tennis players. J Bone Miner Res 17:2274–2280CrossRefPubMedGoogle Scholar
  10. 10.
    Ireland A, Maden-Wilkinson T, Ganse B, Degens H, Rittweger J (2014) Effects of age and starting age upon side asymmetry in the arms of veteran tennis players: a cross-sectional study. Osteoporos Int 25:1389–1400CrossRefPubMedGoogle Scholar
  11. 11.
    Warden SJ, Mantila Roosa SM, Kersh ME, Hurd AL, Fleisig GS, Pandy MG, Fuchs RK (2014) Physical activity when young provides lifelong benefits to cortical bone size and strength in men. Proc Natl Acad Sci USA 111:5337–5342CrossRefPubMedGoogle Scholar
  12. 12.
    Janz KF, Letuchy EM, Burns TL, Eichenberger Gilmore JM, Torner JC, Levy SM (2014) Objectively measured physical activity trajectories predict adolescent bone strength: Iowa bone development study. Br J Sports Med 48:1032–1036CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Kannus P, Haapasalo H, Sievanen H, Oja P, Vuori I (1994) The site-specific effects of long-term unilateral activity on bone mineral density and content. Bone 15:279–284CrossRefPubMedGoogle Scholar
  14. 14.
    Warden SJ, Bogenschutz ED, Smith HD, Gutierrez AR (2009) Throwing induces substantial torsional adaptation within the midshaft humerus of male baseball players. Bone 45:931–941CrossRefPubMedGoogle Scholar
  15. 15.
    Anliker E, Sonderegger A, Toigo M (2013) Side-to-side differences in the lower leg muscle-bone unit in male soccer players. Med Sci Sports Exerc 45:1545–1552CrossRefPubMedGoogle Scholar
  16. 16.
    Chang G, Regatte RR, Schweitzer ME (2009) Olympic fencers: adaptations in cortical and trabecular bone determined by quantitative computed tomography. Osteoporos Int 20:779–785CrossRefPubMedGoogle Scholar
  17. 17.
    Ireland A, Korhonen M, Heinonen A, Suominen H, Baur C, Stevens S, Degens H, Rittweger J (2011) Side-to-side differences in bone strength in master jumpers and sprinters. J Musculoskelet Neuronal Interact 11:298–305PubMedGoogle Scholar
  18. 18.
    Weatherholt AM, Warden SJ (2016) Tibial bone strength is enhanced in the jump leg of collegiate-level jumping athletes: a within-subject controlled cross-sectional study. Calcif Tissue Int 98:129–139CrossRefPubMedGoogle Scholar
  19. 19.
    Wu J, Ishizaki S, Kato Y, Kuroda Y, Fukashiro S (1998) The side-to-side differences of bone mass at proximal femur in female rhythmic sports gymnasts. J Bone Miner Res 13:900–906CrossRefPubMedGoogle Scholar
  20. 20.
    Young KC, Sherk VD, Bemben DA (2011) Inter-limb musculoskeletal differences in competitive ten-pin bowlers: a preliminary analysis. J Musculoskelet Neuronal Interact 11:21–26PubMedGoogle Scholar
  21. 21.
    Coh M, Supej M (2008) Biomechanical model of the take-off action in the high jump: a case study. New Stud Athlet 23:63–73Google Scholar
  22. 22.
    Luhtanen P, Komi PV (1979) Mechanical power and segmental contribution to force impulses in long jump take-off. Eur J Appl Physiol Occup Physiol 41:267–274CrossRefPubMedGoogle Scholar
  23. 23.
    Mero A, Komi PV (1986) Force-, EMG-, and elasticity-velocity relationships at submaximal, maximal and supramaximal running speeds in sprinters. Eur J Appl Physiol Occup Physiol 55:553–561CrossRefPubMedGoogle Scholar
  24. 24.
    Kageyama M, Sugiyama T, Kanehisa H, Maeda A (2015) Difference between adolescent and collegiate baseball pitchers in the kinematics and kinetics of the lower limbs and trunk during pitching motion. J Sports Sci Med 14:246–255PubMedPubMedCentralGoogle Scholar
  25. 25.
    MacWilliams BA, Choi T, Perezous MK, Chao EY, McFarland EG (1998) Characteristic ground-reaction forces in baseball pitching. Am J Sports Med 26:66–71CrossRefPubMedGoogle Scholar
  26. 26.
    Werner SL, Guido JA, McNeice RP, Richardson JL, Delude NA, Stewart GW (2005) Biomechanics of youth windmill softball pitching. Am J Sports Med 33:552–560CrossRefPubMedGoogle Scholar
  27. 27.
    Gümüştekin K, Akar S, Dane S, Yildirim M, Seven B, Varoglu E (2004) Handedness and bilateral femoral bone densities in men and women. Int J Neurosci 114:1533–1547CrossRefPubMedGoogle Scholar
  28. 28.
    Hind K, Burrows M (2007) Weight-bearing exercise and bone mineral accrual in children and adolescents: a review of controlled trials. Bone 40:14–27CrossRefPubMedGoogle Scholar
  29. 29.
    Tan VP, Macdonald HM, Kim S, Nettlefold L, Gabel L, Ashe MC, McKay HA (2014) Influence of physical activity on bone strength in children and adolescents: a systematic review and narrative synthesis. J Bone Miner Res 29:2161–2181CrossRefPubMedGoogle Scholar
  30. 30.
    Ducher G, Daly R, Bass S (2009) The effects of repetitive loading on bone mass and geometry in young male tennis players: a quantitative study using magnetic resonance imaging. J Bone Miner Res 24:1686–1692CrossRefPubMedGoogle Scholar
  31. 31.
    Guido JA Jr, Werner SL (2012) Lower-extremity ground reaction forces in collegiate baseball pitchers. J Strength Cond Res 26:1782–1785CrossRefPubMedGoogle Scholar
  32. 32.
    McNally MP, Borstad JD, Onate JA, Chaudhari AM (2015) Stride leg ground reaction forces predict throwing velocity in adult recreational baseball pitchers. J Strength Cond Res 29:2708–2715CrossRefPubMedGoogle Scholar
  33. 33.
    Elliott B, Grove JR, Gibson B (1988) Timing of the lower limb drive and throwing limb movement in baseball pitching. Int J Sports Biomech 4:59–67CrossRefGoogle Scholar
  34. 34.
    Oyama S, Myers JB (2018) The relationship between the push off ground reaction force and ball speed in high school baseball pitchers. J Strength Cond Res 32:1324–1328CrossRefPubMedGoogle Scholar
  35. 35.
    Chang JH, Tseng WM, Tseng JS, Huang SL (2008) Ground reaction force analysis of softball windmill pitch. In: Kwon YH, Shim J, Shim JK, Shin IS (eds) International Conference on Biomechanics in Sport, p 685Google Scholar
  36. 36.
    Huang CF, Wang LI, Chien CJ (2001) Characteristic ground reaction forces in softball pitching. In: Blackwell JR, Sanders RH (eds) International Symposium on Biomechanics in Sport, pp 104–107Google Scholar
  37. 37.
    Guido JA Jr, Werner SL, Meister K (2009) Lower-extremity ground reaction forces in youth windmill softball pitchers. J Strength Cond Res 23:1873–1876CrossRefPubMedGoogle Scholar
  38. 38.
    Oliver GD, Plummer H (2011) Ground reaction forces, kinematics, and muscle activations during the windmill softball pitch. J Sports Sci 29:1071–1077CrossRefPubMedGoogle Scholar
  39. 39.
    Oliver GD, Plummer HA, Washington JK, Saper MG, Dugas JR, Andrews JR (2018) Pitching mechanics in female youth fastpitch softball. Int J Sports Phys Ther 13:493–500CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Escamilla RF, Fleisig GS, Groeschner D, Akizuki K (2017) Biomechanical comparisons among fastball, slider, curveball, and changeup pitch types and between balls and strikes in professional baseball pitchers. Am J Sports Med 45:3358–3367CrossRefPubMedGoogle Scholar
  41. 41.
    Escamilla RF, Fleisig GS, Zheng N, Barrentine SW, Andrews JR (2001) Kinematic comparisons of 1996 Olympic baseball pitchers. J Sports Sci 19:665–676CrossRefPubMedGoogle Scholar
  42. 42.
    Fleisig GS, Barrentine SW, Zheng N, Escamilla RF, Andrews JR (1999) Kinematic and kinetic comparison of baseball pitching among various levels of development. J Biomech 32:1371–1375CrossRefPubMedGoogle Scholar
  43. 43.
    Corben JS, Cerrone SA, Soviero JE, Kwiecien SY, Nicholas SJ, McHugh MP (2015) Performance demands in softball pitching: a comprehensive muscle fatigue study. Am J Sports Med 43:2035–2041CrossRefPubMedGoogle Scholar
  44. 44.
    Skillington SA, Brophy RH, Wright RW, Smith MV (2017) Effect of pitching consecutive days in youth fast-pitch softball tournaments on objective shoulder strength and subjective shoulder symptoms. Am J Sports Med 45:1413–1419CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Smith MV, Davis R, Brophy RH, Prather H, Garbutt J, Wright RW (2015) Prospective player-reported injuries in female youth fast-pitch softball players. Sports Health 7:497–503CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Järvinen TLN, Kannus P, Sievänen H (1999) Have the DXA-based exercise studies seriously underestimated the effects of mechanical loading on bone? J Bone Miner Res 14:1634–1635CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Physical Therapy, School of Health and Human SciencesIndiana UniversityIndianapolisUSA
  2. 2.Indiana Center for Musculoskeletal HealthIndiana UniversityIndianapolisUSA
  3. 3.Department of Kinesiology and Sport, Pott College of Science, Engineering, and EducationUniversity of Southern IndianaEvansvilleUSA

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