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Effects of Three Recovery Protocols on Range of Motion, Heart Rate, Rating of Perceived Exertion, and Blood Lactate in Baseball Pitchers During a Simulated Game

Warren, Courtney D.1; Szymanski, David J.2; Landers, Merrill R.3

Journal of Strength and Conditioning Research: November 2015 - Volume 29 - Issue 11 - p 3016–3025
doi: 10.1519/JSC.0000000000000487
Original Research

Warren, CD, Szymanski, DJ, and Landers, MR. Effects of three recovery protocols on range of motion, heart rate, rating of perceived exertion, and blood lactate in baseball pitchers during a simulated game. J Strength Cond Res 29(11): 3016–3025, 2015—Baseball pitching has been described as an anaerobic activity from a bioenergetics standpoint with short bouts of recovery. Depending on the physical conditioning and muscle fiber composition of the pitcher as well as the number of pitches thrown per inning and per game, there is the possibility of pitchers fatiguing during a game, which could lead to a decrease in pitching performance. Therefore, the purpose of this study was to evaluate the effects of 3 recovery protocols: passive recovery, active recovery (AR), and electrical muscle stimulation (EMS) on range of motion (ROM), heart rate (HR), rating of perceived exertion (RPE), and blood lactate concentration in baseball pitchers during a simulated game. Twenty-one Division I intercollegiate baseball pitchers (age = 20.4 ± 1.4 years; height = 185.9 ± 8.4 cm; weight = 86.5 ± 8.9 kg; percent body fat = 11.2 ± 2.6) volunteered to pitch 3 simulated 5-inning games, with a maximum of 70 fastballs thrown per game while wearing an HR monitor. Range of motion was measured pre, post, and 24 hours postpitching for shoulder internal and external rotation at 90° and elbow flexion and extension. Heart rate was recorded after each pitch and after every 30 seconds of the 6-minute recovery period. Rating of perceived exertion was recorded after the last pitch of each inning and after completing each 6-minute recovery period. Immediately after throwing the last pitch of each inning, postpitching blood lactate concentration (PPLa−) was measured. At the end of the 6-minute recovery period, before the next inning started, postrecovery blood lactate concentration (PRLa−) was measured. Pitchers were instructed to throw each pitch at or above 95% of their best-pitched fastball. This was enforced to ensure that each pitcher was throwing close to maximal effort for all 3 simulated games. All data presented represent group mean values. Results revealed that the method of recovery protocol did not significantly influence ROM (p > 0.05); however, it did significantly influence blood lactate concentration (p < 0.001), HR (p < 0.001), and RPE (p = 0.01). Blood lactate concentration significantly decreased from postpitching to postrecovery in the EMS recovery condition (p < 0.001), but did not change for either the active (p = 0.04) or the passive (p = 0.684) recovery conditions. Rating of perceived exertion decreased from the postpitching to postrecovery in both the passive and EMS recovery methods (p < 0.001), but did not decrease for AR (p = 0.067). Heart rate decreased for all conditions from postpitching to postrecovery (p < 0.001). The use of EMS was the most effective method at reducing blood lactate concentration after 6 minutes of recovery during a simulated game (controlled setting). Although EMS significantly reduced blood lactate concentrations after recovery, blood lactate concentrations after pitching in the simulated games were never high enough to cause skeletal muscle fatigue and decrease pitching velocity. If a pitcher were to throw more than 14 pitches per inning, throw more total pitches than normal per game, and have blood lactate concentrations increase higher than in the simulated games in this study, the EMS recovery protocol may be beneficial to pitching performance by aiding recovery. This could potentially reduce some injuries associated with skeletal muscle fatigue during pitching, may allow a pitcher throw more pitches per game, and may reduce the number of days between pitching appearances.

1Triplex Physical Therapy and Training, Department of Physical Therapy, Chandler, Arizona;

2Department of Kinesiology, Louisiana Tech University, Ruston, Louisiana; and

3Department of Physical Therapy, University of Nevada, Las Vegas, Nevada

Address correspondence to Dr. Courtney D. Warren, swimtri.17@gmail.com.

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Introduction

The act of baseball pitching has been described as a high-intensity anaerobic activity from a bioenergetics standpoint with short bouts of recovery (3,27,28). Depending on the physical conditioning and muscle fiber composition of the pitcher as well as the number of pitches thrown per inning and per game, there is the possibility of pitchers fatiguing during a game, which could lead to a decrease in pitching performance. Since the competitive performance on the field is of the utmost importance to players, coaches, and owners of professional teams, it makes sense that sports science should be evaluating ways to enhance baseball pitching performance as well as ways to recover before the next required pitching performance. Unfortunately, because there is still a lack of research evaluating physiological aspects of recovery in pitching, pitchers are throwing in competitive situations as a starting pitcher (pitching every fourth or fifth day), as a middle relief pitcher (pitching every other day), or as a closing pitcher (pitching at the end of most games) and may not have appropriate recovery between pitching appearances based on the needs of the team or the injuries on a team. Although this may be happening, could recovery be addressed in another way? What if we had the ability to physiologically aid recovery between innings, which may assist the pitcher during the game they are throwing and possibly help them feel better before their next pitching performance? For baseball pitchers, this could mean being able to perform at optimal levels consistently. This could lead to more wins, better “arm health,” and ultimately, more money for the respective pitcher.

Periodization of training has been found to be an effective method of training athletes (8,47). This method of designing training programs requires that appropriate rest periods to be implemented to enhance performance (14,33). Because pitchers have an undetermined period of rest between each pitch and each inning due to the nature of the game, it is impossible to effectively implement appropriate rest periods during actual pitching appearances. Therefore, baseball coaches have attempted to decrease the stress on the starting pitcher's arm and body by implementing a 100–120 pitch count. This means that a starting pitcher will be removed from the game when they accumulate total pitches thrown in this range. Ironically, despite the introduction of the 100–120 pitch count and the increased use of relief pitchers, the injury rate of pitchers has continued to increase (21,23,26).

Hackney found that the overhead throwing athlete is prone to injuries, which differ from those of the nonthrowing population because the shoulder is at its most vulnerable point during the late cocking and follow through phases of the throwing motion (13). Because baseball pitching is a high-intensity, repetitive, ballistic motion that can cause muscle fatigue, the muscles of the throwing shoulder can experience a loss of control during the pitching process (13,36). This fatigue can contribute to decreases in the function of the sensorimotor system and can lead to abnormal movement of the humeral head (4,11,22,34,37,40,41). The functional fatigue of the sensorimotor system may lead to greater stresses being placed on the static and dynamic joint stabilizer muscles due to the angular velocities and forces produced during the pitching motion (29,37,41). Additionally, Reinold et al. (29) reported that baseball pitching has acute effects on ROM and implied that the change in ROM may determine the potential for injury.

Most recently, Warren et al. (46) evaluated 3 methods of recovery on baseball pitchers. They reported that blood lactate concentrations were reduced between innings when electrical muscular stimulation was used as a treatment recovery. However, one of the limitations of this study was that the mean prepitching blood lactate concentration for the pitchers before using the electrical muscular stimulation treatment recovery was higher than the other 2 prepitching blood lactate concentrations. Had these resting prevalues been similar to the other prepitching blood lactate values (passive and active recovery [AR] treatment games), which would be expected because the same pitchers were throwing all 3 simulated games with the same number of days of rest between pitching performances, it is speculated that there would not have been a significant difference in postpitching blood lactate concentration (PPLa−) for the pitchers using the electrical muscular stimulation treatment recovery. However, it was stated in the article that the pitchers in the study did prefer the electrical muscular stimulation to passive and AR methods.

Several strategies to facilitate recovery have been investigated in the literature, including AR, passive recovery (PR), and electrical muscular stimulation. Passive recovery is simply rest, often in the form of sitting, lying down, or stretching. Typically, 15–25 minutes of rest is thought to be the optimal time for returning pH levels to normal after performing moderate intensity exercise (5). This form of recovery has the ability to allow the body to maintain and restore its glycogen stores due to its inactive method (4). Passive recovery, in some studies, has shown to have the same effect of lowering blood lactate concentrations as AR, but without the energy expenditure (6,30,39).

Active recovery, wherein athletes participate in low-to-moderate intensity active movement, often cardiovascular in nature in an effort to increase blood flow, has been shown in previous studies to be an effective form of recovery (1,5,6,9,25). The rationale for AR is to allow vasodilatation and oxygen-rich blood to increase the rate of blood lactate clearance in the muscle (1,6,25,48). It has been found that the best AR has come from activity ranging from a progressive decline in intensity of 60–30% of the estimated maximum heart rate (HR) of the exercising person (13,25,32).

Electrical muscle stimulation (EMS), which is a relatively new modality for postexertional recovery, has received very little attention in the literature. It is based on the principle that EMS induces muscle contraction with corticospinal excitation, which would increase blood flow thereby reducing lactic acid build up. Studies have shown that EMS increases blood flow more than when voluntary muscle exercises are used (15,31,32,42,45). This increase of blood flow has been shown to help reduce the lactic acid build up (31,32). The theoretical advantage of EMS is that focal muscle stimulation can increase blood flow without accelerating the HR and without increasing arterial blood pressure (2,24,43,45). Thus, muscle contractions occur without cardiovascular strain or mental fatigue (7).

Presently, there is little evidence to support the use of 1 recovery method over another between innings while pitching in a baseball game. Therefore, the purpose of this study was to evaluate the effects of 3 recovery protocols on range of motion (ROM), HR, rating of perceived exertion (RPE), and blood lactate concentrations in baseball pitchers during a simulated game.

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Methods

Experimental Approach to the Problem

Baseball pitching performance requires a significant contribution from anaerobic energy sources including glycolytic metabolism. A consequence of producing energy by way of glycolytic metabolism is the production and accumulation of muscle and blood lactate. Elevated blood lactate concentration is related to muscular fatigue and if this occurs for a baseball pitcher, this could potentially negatively affect pitching performance. Most college pitchers throw an average of 14 pitches per inning (27). If they throw numerous innings, pitch counts for a starting pitcher could accumulate to 100–120 pitches per game. The duration of a baseball game is between 2.5 and 3.5 hours, depending on the number of runs scored by both teams. It is thought that pitchers might accumulate blood lactate when they throw more pitches per inning than normal or not have enough time to clear any accumulated blood lactate if the rest time between innings is less than normal. Both of these situations could negatively affect pitching performance or the ability to pitch again with a short number of days between pitching performances. It is important that these pitchers use appropriate recovery methods between innings to maximize the clearance of muscle and blood lactate. Previous studies have demonstrated the benefits of an active exercise recovery in reducing blood lactate when compared with a passive resting recovery for swimmers. There is reason to believe that other types of recovery treatments may also be beneficial in speeding the removal of lactate but have not been studied to the same extent as AR in baseball pitchers. One such recovery treatment is transcutaneous EMS. The rationale for EMS speeding the removal of lactate hinges on its ability to create low-frequency submaximal muscle contractions that potentially promote increased blood flow and lymphatic drainage from the exercised muscle. This investigation was designed to compare the effects of 3 types of recovery treatments; PR, AR, and EMS on blood lactate concentrations while throwing a simulated game. Blood samples were drawn immediately after each pitched inning and then again at the end of the 6-minute recovery protocol between innings to study the effect of the 3 recovery methods. On 3 separate days, with 4 days of recovery between simulated games, pitchers threw 14 pitches per inning for 5 innings while they randomly completed 1 of the 3 recovery protocols after every inning. Additionally, ROM of the shoulder and elbow were measured pre, post, and 24 hours postpitching. Heart rate was recorded after each pitch and every 30 seconds during the 5-minute and 6-minute recovery protocols of each simulated game. Rating of perceived exertion was recorded immediately after throwing the last pitch for each inning and after completing each of the 6-minute recovery protocols.

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Subjects

Twenty-one Division I intercollegiate baseball pitchers (starting pitchers = 8 and relief pitchers = 13) volunteered for this study. Their mean (±SD) age, height, weight, and percent body fat were 20.4 ± 1.4 years, age ranges were 19–24 yr; 185.9 ± 8.4 cm, 86.5 ± 8.9 kg, and 11.2 ± 2.6%, respectively. Their mean (±SD) number of years playing baseball and playing college baseball was 14.5 ± 2.8 and 2.7 ± 1.1 years, respectively. Data were collected in November and January after fall baseball practice had ended. Pitchers were well trained, had pitched the entire fall, and were selected for the study based on their health. Each participant had undergone and passed a physical performed by team doctors. At no time during this study were any participants under any medical supervision for conditions that would not allow for the normal biomechanics of a pitch (i.e., physical therapy, pre- or postsurgery within a year). The study was approved by the Institutional Review Board of A.T. Still University. All subjects signed an informed consent document before participation.

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Procedures

All participating pitchers received comprehensive instruction and demonstrations of the testing procedures before the initiation of the study. The subjects were tested individually on 3 occasions, each separated by 4 days of rest. The 3 in-between inning recovery protocols were randomly assigned to each pitcher to avoid any pitching fatigue effect or perceptions about the recovery treatments. All 3 testing sessions were completed outside during the off season, within 12 days at the respective university's baseball stadium. All subjects were required to wear their normal practice attire while wearing spikes and pitching from a bull-pen mound. Pitchers were instructed to eat and drink “normally” during the testing sessions to maintain their nutritional and hydration status.

One complete testing session consisted of the following parts. The subjects began 30 minutes before pitching the simulated game by drinking 16 oz of water and sitting quietly for 5 minutes to obtain resting or “baseline” HR and blood lactate concentration. Then, pitchers had their baseline ROM of their shoulder and elbow assessed. Once the baseline data were measured and recorded, pitchers were told to perform their normal pregame warm-up that consisted of jogging at low intensity for 8–10 poles (from left field to right field lines), followed by an active, dynamic upper- and lower-body warm-up. Once this was completed, pitchers played catch for 10–15 minutes (the number and distances of throws were not recorded). Next, they walked to the bull-pen mound and began warm-up throws from the mound. Each pitcher completed their normal throwing routine before pitching the simulated game. Normally, this entailed throwing 20–30 pitches. Once each pitcher felt they were properly warm, they began the simulated game, which consisted of throwing 5 warm-up pitches before each inning at submaximal velocities, throwing 14 pitches (fast balls) per inning at 95% of their best pitching velocity with 20 seconds of rest between each pitch for 5 innings, and having HR recorded after every pitch. At the end of each inning, pitchers were asked to give an RPE of their pitching effort and drank 4 oz of water. For the entire simulated game, this required each pitcher to throw 25 total warm-up pitches, 70 total game pitches, and drink 20 oz of water.

After throwing a complete inning, each pitcher had 6 minutes of rest, which was the equivalent of the time it took to complete the 14 pitches. During the 6 minutes of rest, the following recovery took place. Immediately after pitching, the pitcher walked to the simulated dug-out and had a blood sample drawn from a fingertip on the nonpitching hand to determine a “postpitching” blood lactate concentration. They then completed 1 of 3 recovery protocols in randomized order. Protocol 1 was a 6-minute seated PR during which the subjects simply sat in a chair in the simulated dug-out. Treatment 2 was a 6-minute AR during which the subjects pedaled an upper-body ergometer (UBE) while seated in the simulated dug-out. Treatment 3 was a 6-minute session of EMS while seated in the simulated dug-out. A blood sample was drawn from a fingertip on the nonpitching hand after the 6-minute recovery treatment session to determine a “postrecovery” blood lactate (PRLa−) concentration. Heart rate was taken every 30 seconds of the recovery during each recovery treatment to determine relative intensity values. Rating of perceived exertion was recorded after each 6-minute treatment recovery to determine relative effort of the various recovery methods.

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Rating of Perceived Exertion

The modified qualitative descriptors accompanying the Borg 0–10 point RPE scale (3) were presented to the subjects alongside the numerical ratings (0.5, very, very light; 1, very light; 2, fairly light; 3, moderate; 4, somewhat hard; 5, hard; 7, very hard; 10, very, very hard). The subjects were further verbally oriented to the scale with the explanation that a score of 0.5 would represent a very, very light activity, like “easy pitching”; a score of 7 was described as a pitching intensity that would be “very challenging, but you can continue”; and a score of 10 was described as marking the “maximum effort,” where he could do no more.

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Passive Recovery

Passive recovery for this research project was defined as sitting in the simulated dug-out with no activity for the 6-minute period. Pitchers were instructed to avoid any physical exertion during this 6-minute recovery period.

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Active Recovery

The form of AR for this study was done using the Monark 881E Rehab Trainer (HealthCare International, Inc., Langley, WA, USA) UBE for the 6-minute recovery period. The pitchers were instructed to sit in the simulated dug-out while using both arms to pedal the UBE. The first 2 minutes were set at 60 W, the following 2 minutes were at 40 W, and the last 2 minutes were at 20 W. This protocol was used to mimic the decreasing intensity of the EMS recovery protocol.

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Electrical Muscular Stimulation Recovery

The EMS unit that was used for this study was the Compex Sport unit (Compex Sport; Compex Technologies LLC, Ecublens, Switzerland). The participants received EMS recovery treatments using the “Active Recovery” setting, for a period of 6 minutes. The “Active Recovery” setting stimulates efferent motor neurons with a biphasic waveform. The specific setting was a rectangular biphasic symmetrical waveform, and the pulse width was 250 microseconds (0.00025 seconds). The program frequency started at 9 Hz and automatically decreased every 2 minutes. The first 2 minutes were at 9 Hz, the following 2 minutes were at 8 Hz, and the last 2 minutes were at 7 Hz. Eight electrical leads were placed on specific locations of the pitcher's throwing arm. The electricalde pads were placed on the anterior forearm flexors and posterior forearm extensors; biceps brachii and triceps brachii muscle bellies; anterior and posterior deltoid; and anterior and posterior portions of the upper trapezius (Figure 1). These muscles were selected because of their significant involvement in throwing a baseball.

Figure 1

Figure 1

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Determination of Range of Motion

One tester measured all subjects' passive internal, external, flexion, and extension ROM using a standard goniometer, whereas another tester manipulated the pitcher's arm to the correct position. All measurements were taken 3 times bilaterally, and a mean of the 3 measurements was calculated and used in the investigation. Rotational measurements were taken with the subject lying in the supine position, with the shoulder abducted to 90° in the coronal plane. The elbow was flexed to 90° and the forearm was in neutral rotation.

Passive external rotation ROM was measured by moving the subject's extremity into external rotation, maintaining the positions of abduction, elbow flexion, and forearm rotation. The extremity was rotated externally until end ROM was obtained. No passive overpressure was exerted during measurement, and the weight of the arm against gravity provided the end ROM measurement during this study. The axis of the goniometer was aligned with the olecranon process of the elbow. The stationary arm of the goniometer was aligned along the midline of the lateral forearm (Figure 2).

Figure 2

Figure 2

Passive internal rotation ROM was measured with the subject's shoulder in 90° of abduction and elbow and forearm positioning was identical to that described for external rotation. The subject's arm was internally rotated while an anterior force was applied to the coracoid and humerus to ensure that scapular compensation did not occur (10,29). No scapular protraction or upward rotation was allowed. Maximum passive internal rotation ROM was then recorded using identical goniometric landmarks.

For elbow flexion and extension measurements, the fulcrum of the goniometer was positioned over the lateral epicondyle of the humerus, with 1 arm of the device along the length of the humerus to the tip of the acromion process and the other arm along the length of the radius to the radial styloid process. Positive elbow extension was defined as motion past 0° into hyperextension. Conversely, negative elbow extension was defined as motion before 0°, such as with an elbow flexion contracture. Measurements were initially taken before any warm-up, exercise, or throwing program was performed. Measurements were then taken after pitching, and then 24 hours postpitching by the same 2 investigators.

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Determination of Blood Lactate Concentration

Blood lactate concentrations were determined using a Lactate Plus blood lactate meter (Nova Biomedical, Waltham, MA, USA) that was calibrated and operated according to the manufacturer's specifications. A portable analyzer was selected so that blood lactate measurements could be made in the simulated dug-out. The analyzer works by placing a sample of whole blood on the test strip and inserting it into the analyzer for it to react with lactate oxidase. Lactate concentration is then determined from reflectance photometry in the range of 0.7–26.0 mmol·L−1. The reliability and validity of the Lactate Plus analyzer have been reported in previous studies. Tanner et al. (38) showed the analyzer to be reliable (intraclass correlation coefficient [ICC] r = 0.988) and to demonstrate good association (ICC r = 0.936) with the Radiometer ABL 700 blood gas analyzer (Radiometer Medical ApS, Bronshoj, Denmark).

Blood samples were drawn from the lateral aspect of the fingertip midway between the nail plate and the inferior distal phalanx of the nonpitching hand. The sample sites were wiped with isopropyl alcohol swabs and punctured with a spring-loaded lancet device followed by 2–3 seconds of a “milking” technique (alternating pressure and release 6–8 mm from the puncture site) to enhance blood flow from the wound. Blood droplets approximately 3 mm in diameter were applied directly to the test strips for the determination of blood lactate (mmol·L−1). For subsequent blood samples, if wiping the previous wound with an alcohol swab and milking the area elicited an adequate flow of blood to collect an adequate sample, no further puncture was necessary. However, if the previous site did not provide an adequate sample, a new site was selected from the nonpitching hand and used for subsequent sampling.

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Recovery Preference

After all testing was competed, participants were asked to rank the recovery protocols. Rankings were assigned based on which protocol the athletes felt provided them with the best recovery being assigned as 1. The least favorable protocol for recovery was ranked as number 3.

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Statistical Analyses

All statistical analyses were run using SPSS 19.0 (SPSS, Inc., Chicago, IL, USA). A 3 (recovery condition: active, passive, EMS) × 3 (time: pre, post, 24 hours postpitching) analysis of variance (ANOVA) with repeated measures on both factors was run for each of the ranges of motion. A 3 (recovery condition: active, passive, EMS) × 2 (time: pre, post) ANOVA with repeated measures on both factors was run for the following variables: HR, RPE, and blood lactate concentrations. All interactions were broken down with simple main effects testing using a Bonferroni corrected alpha. If an interaction was not observed, main effects were analyzed. An alpha level of 0.05 was chosen for all statistical comparisons. Preference for recovery method was reported using frequencies.

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Results

Range of Motion

Range of motion, in any plane, did not have a different trajectory over time (pre, post, and 24 hours postpitching) for any of the 3 different recovery methods, ps > 0.05. Main effects revealed that external rotation did improve from the pre (mean = 115.3; SE = 3.0) to the post (mean = 118.0; SE = 2.5) regardless of recovery method (p = 0.046) but returned back to pre after 24 hours (mean = 115.7; SE = 2.6). Thus, the recovery methods did not differentially influence ROM in any plane although there was a small transient increase in external rotation ROM.

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Heart Rate

There was a statistically significant interaction between the different recovery methods over time for HR, F 2,40 = 43.560, p < 0.001 (ηp 2 = 0.685). Post hoc tests, using a Bonferroni corrected alpha (α = 0.01), revealed that HR decreased during the recovery for all conditions (ps < 0.01); however, the HR for the PR method was significantly lower than the AR (p = 0.006). Electrical muscle stimulation recovery was not different from the PR (p = 1.00) or AR (p = 0.03) methods (Figure 3). Figure 4 shows the average HR during pitching vs. average recovery HR by inning.

Figure 3

Figure 3

Figure 4

Figure 4

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Rating of Perceived Exertion

There was a statistically significant difference in the trajectory of RPE over time for the 3 different recovery methods, F 2,40 = 6.983, p = 0.01 (ηp 2 = 0.259) (Greenhouse-Geisser corrected). Post hoc tests (Bonferroni corrected α = 0.01) revealed a significant decline in RPE for the passive and EMS recovery methods (ps < 0.01); however, the AR methods did not decrease statistically over time, p = 0.067 (Figure 5).

Figure 5

Figure 5

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Blood Lactate Concentrations

There was a different trajectory in blood lactate concentrations among the 3 recovery methods over time, F 2,40 = 14.058, p < 0.001 (ηp 2 = 0.413). Post hoc testing with a Bonferroni corrected alpha (α = 0.01) demonstrated that blood lactate concentrations did not change due to PR (p = 0.684) or AR (p = 0.04); however, blood lactate concentrations did decrease significantly due to EMS recovery, p < 0.001 (Figure 6). Figure 7 displays the average PPLa− concentration vs. average PRLa− concentration by inning.

Figure 6

Figure 6

Figure 7

Figure 7

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Recovery Preference

There was a clear distinction of which recovery method was preferred the most. Of the 3 different recovery methods administered in this study, EMS was the preferred recovery method by 18 of the 21 participants. The remaining 3 participants liked PR (n = 2) and AR (n = 1) the most. Passive recovery was the second most preferred recovery method by 15 of the 21 pitchers. Active recovery was the least preferred recovery method with 16 of the 21 liking it least of the 3 recovery methods.

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Discussion

Because the amount of time between innings is always unknown and ever changing in the game of baseball, finding the most effective method of recovery could have a significant impact on maintaining or enhancing a pitcher's performance and potentially reduce injuries due to fatigue. With the knowledge that as a pitcher becomes fatigued, there is an increased likelihood of injury, proper recovery should be of the utmost importance to coaches and team staff (15). Fatigue is defined as “a decrease in the maximum power of contraction” (33). The increase in blood lactate accumulation is associated with fatigue (35). Recovery is defined as the normalization of the pH within the muscle (18,19,35). This normalization can be reached with a decrease in blood lactate accumulation; this in turn should improve performance of the muscle (35). An increase in the blood flow will decrease the blood lactate accumulation to improve the performance (11,20). Within sports performance, several ideas on recovery methods have been offered. Three forms of recovery (AR, PR, and EMS) were approached within this study.

The use of EMS showed the most significant difference in blood lactate concentrations for pitchers from PPLa− to PRLa− (Figure 6). The decrease in the blood lactate concentration suggests that the muscle is receiving an effective recovery. The pitchers also felt that they received a better recovery during the EMS recovery period according to the rating of preference score. This would suggest that the muscle is being effectively flushed of blood lactate with the use of the EMS (16,17). This flushing would include an increase in the amount of new blood into the muscle. This new blood would include glycogen that would be able to be stored within the muscle more effectively due to the lack of blood lactate to prevent storage (31). Effective recovery is associated with the decrease in blood lactate. Electrical muscular stimulation provides the benefits of AR without the cardiovascular strain (31). This would allow the flushing action of the muscle without the use of the glycogen stores to do it (31). Also, there is potential to have increased neurological function, which would allow for better muscle reaction. The neurological system would be able to effectively recover by not being used and having an outside source create the muscle functions (31).

As stated earlier, AR has been shown in previous studies to be the most effective form of recovery after intensive physical exercise (5,9,12,25) and has typically been considered the “Gold” standard method for recovery (25). During this study, AR was found not to be the most beneficial form of recovery when related to blood lactate concentrations or pitcher's preference although blood flow should be increased to the upper body compared with PR due to the UBE work performed during recovery. The pitchers within this study felt that the amount of activity during the AR did not allow them to fully recover. This would correspond to the decreased rating on the recovery preference score.

Passive recovery is typically the most common form of recovery used by pitchers, as well as position players, between innings in the game of baseball. Because of this, the pitcher is accustomed to this form of recovery. However, this form of recovery does not improve recovery from a blood lactate perspective; the body simply clears what is produced. This is indicative of the PPLa− to PRLa− concentrations seen in Figures 6 and 7.

In comparison, we see that the AR had a negative effect on the pitcher's blood lactate concentrations (Figures 6 and 7). Since the amount of time between innings of a baseball game is never the same and not predetermined, the data from this study indicate that AR should not be used as an effective recovery method for baseball pitchers. There is not enough time to properly use and receive the effects of an AR. The blood lactate concentrations and RPE are higher in relation to PR and EMS recovery methods used in this study.

The EMS recovery and PR were the 2 recovery methods most preferred by pitchers in this study. Electrical muscular stimulation had the most significant effect on blood lactate concentrations from PPLa− to PRLa−, suggesting that pitching fatigue may be delayed. If this occurs, then the potential to decrease injuries may occur. Passive recovery would be an effective form of recovery for a pitcher if EMS was unavailable. However, since PR allowed HR to decrease significantly more than AR or EMS, blood lactate was not cleared as effectively as EMS. But, PR spares muscle glycogen utilization compared with AR since muscles are not activated during recovery. The body can physiologically adapt to become more effective in the filtration of the blood during this recovery time, partially because there would not be a work load slowing biological processes down.

Electrical muscular stimulation was significantly more beneficial to the pitchers. The pitchers were able to receive the benefits of the PR, decreased HR and biological activity, as well as the sparing of muscle glycogen since muscles were not activated compared with AR. Since the electricity used to cause the contractions of the muscle is from the stimulation unit, no glycogen is needed to cause the muscle contraction. The EMS not only bypasses the neurological system to force the contraction but also receives the benefits of AR, which is the activity of the muscles to flush the blood and receive clean blood back into the muscles. (16,17,31,32) Pitching velocity was maintained throughout the 5-inning simulated games because of the 20 seconds of rest between pitches, low RPE postpitching and postrecovery, and 6 minutes of rest between innings. Further research is needed to validate this concept. It is known that fatigue causes poor mechanics and will lead to an increase in injury (7,15,32,44,46). Further studies need to be performed to find if effective recovery will decrease the injury rate. However, pitchers will need to throw more than 14 pitches per inning as this is the average number of pitches thrown per inning in college baseball.

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Practical Applications

Although EMS significantly reduced blood lactate concentrations after recovery, blood lactate concentrations after pitching in the simulated games were never high enough to cause skeletal muscle fatigue and decrease pitching velocity. If a pitcher were to throw more than 14 pitches per inning, throw more total pitches than normal per game, and have blood lactate concentrations increase higher than in the simulated games in this study, the EMS recovery protocol may be beneficial to pitching performance by aiding recovery. This could potentially reduce some injuries associated with skeletal muscle fatigue during pitching, may allow a pitcher throw more pitches per game, and may reduce the number of days between pitching appearances.

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Acknowledgments

The authors thank Josh Blaum, Lee Brown, Derek Bunker, Jeremy Carter, Emmett Findlay, and Josh Sparks for their contributions to data collection. Without them, this study could not have been completed. Additionally, the authors thank the coaches and pitchers of the Louisiana Tech University and Southern Utah University for their participation in this study.

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Keywords:

active recovery; electrical stimulation recovery; passive recovery

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