***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY DESIGN Controlled cohort repeated- measures experimental design . OBJECTIVES To determine if a neuromuscular training program ( NMTP ) focused on core stability and lower extremity strength would affect performance on the star excursion balance test ( SEBT ) . We hypothesized that NMTP would improve SEBT performance in the experimental group and there would be no side-to-side differences in either group . BACKGROUND The SEBT is a functional screening tool that is used to assess dynamic stability , monitor rehabilitation progress , assess deficits following an injury , and identify athletes at high risk for lower extremity injury . The SEBT requires lower extremity coordination , balance , flexibility , and strength . METHODS Twenty uninjured female soccer players ( 13 experimental , 7 control ) participated . Players trained together as a team , so group allocation was not r and omized . The SEBT was administered prior to and following 8 weeks of NMTP in the experimental group and 8 weeks of no NMTP in the control group . A 3-way mixed-model ANOVA was used to determine the effect of group ( experimental versus control ) , training ( pretraining versus posttraining ) , and limb ( right versus left ) . RESULTS After participation in a NMTP , subjects demonstrated a significant improvement in the SEBT composite score ( mean ± SD ) on the right limb ( pretraining , 96.4 % ± 11.7 % ; posttraining , 104.6 % ± 6.1 % ; P = .03 ) and the left limb ( pretraining , 96.9 % ± 10.1 % ; posttraining , 103.4 % ± 8.0 % ; P = .04 ) . The control group had no change on the SEBT composite score for the right ( pretraining , 95.7 % ± 5.2 % ; posttraining , 94.4 % ± 5.2 % ; P = .15 ) or the left ( 97.4 % ± 7.2 % ; 93.6 % ± 5.0 % ; P = .09 ) limb . Further analysis identified significant improvement for the SEBT in the posterolateral direction on both the right ( P = .008 ) and left ( P = .040 ) limb and the posteromedial direction of the left limb ( P = .028 ) in the experimental group . CONCLUSION Female soccer players demonstrated an improved performance on the SEBT after NMTP that focused on core stability and lower extremity strength STUDY DESIGN Prospect i ve cohort . OBJECTIVE To determine if Star Excursion Balance Test ( SEBT ) reach distance was associated with risk of lower extremity injury among high school basketball players . BACKGROUND Although balance has been proposed as a risk factor for sports-related injury , few research ers have used a dynamic balance test to examine this relationship . METHODS AND MEASURES Prior to the 2004 basketball season , the anterior , posteromedial , and posterolateral SEBT reach distances and  limb lengths  of 235 high school basketball players were measured bilaterally . The Athletic Health Care System Daily Injury Report was used to document time loss injuries . After normalizing for lower limb length , each reach distance , right/left reach distance difference , and composite reach distance were examined using odds ratio and logistic regression analyses . RESULTS The reliability of the SEBT components ranged from 0.82 to 0.87 ( ICC3,1 ) and was 0.99 for the measurement of limb length . Logistic regression models indicated that players with an anterior right/left reach distance difference greater than 4 cm were 2.5 times more likely to sustain a lower extremity injury ( P<.05 ) . Girls with a composite reach distance less than 94.0 % of their limb length were 6.5 times more likely to have a lower extremity injury ( P<.05 ) . CONCLUSIONS We found components of the SEBT to be reliable and predictive measures of lower extremity injury in high school basketball players . Our results suggest that the SEBT can be incorporated into preparticipation physical examinations to identify basketball players who are at increased risk for injury Background : Youth baseball players are at high risk for elbow injuries , which can lead to future functional disability . Purpose : To evaluate the effectiveness of a prevention program to lower the risk of medial elbow injury in these athletes . Study Design : Cohort study ; Level of evidence , 2 . Methods : Youth baseball players , 8 to 11 years old , without a history of elbow and shoulder pain , were allocated to either the  intervention ( n = 136 ) or control ( n = 169 ) group . The intervention consisted of 9 strengthening and 9 stretching exercises , performed during warm-up or at home , with high compliance defined as completion of the program 1 or more times per week . The following outcome variables were measured : clinical assessment of the elbow and shoulder joint , ultrasonography assessment of the elbow , and assessment of physical function ( passive range of motion of the elbow , shoulder , and hip ; strength of the shoulder and scapular muscles ; and measurement of the thoracic kyphosis angle ) . The clinical and ultrasonography assessment s were measured at baseline and at 3-month intervals over the 1-year follow-up . Physical function outcomes were measured at baseline and at the endpoint of the follow-up . The primary endpoint of effectiveness was the incidence of medial elbow injury . Secondary endpoints were absolute measures of physical function and change in these measures over the 1-year follow-up . Results : The incidence rate of medial elbow injury was significantly lower in the intervention group ( 0.8/1000 athlete-exposures ) than the control group ( 1.7/1000 athlete-exposures ) ( hazard ratio , 50.8 % ; 95 % CI , 0.292 - 0.882 ; P = .016 ) . The program improved total range of shoulder rotation ( dominant side ) , hip internal rotation ( nondominant side ) , shoulder internal rotation deficit ( bilaterally ) , lower trapezius muscle strength ( dominant side ) , and the thoracic kyphosis angle . Improvements in the following variables of physical function were predictive of a lower rate of medial elbow injury : increased total shoulder total rotation ( odds ratio [ OR ] , 0.973 ; 95 % CI , 0.950 - 0.997 ) , increased hip internal rotation of the nondominant side ( OR , 0.962 ; 95 % CI , 0.936 - 0.989 ) , and decreased thoracic kyphosis angle ( OR , 1.058 ; 95 % CI , 1.015 - 1.103 ) . Conclusion : A prevention program aim ing to improve physical function can prevent medial elbow injury in youth baseball players HYPOTHESIS AND BACKGROUND Though commonly suggested as an injury risk factor , scapular dysfunction has not been established as a prospect i ve cause of throwing-related upper extremity injury in baseball players . The purpose is to determine whether scapular dysfunction identified during preseason screening is predictive of increased risk of throwing-related shoulder and elbow injuries in high school baseball players . MATERIAL S AND METHODS The presence or absence of scapular dysfunction was obtained prospect ively during preseason screenings in 246 high school baseball players over the 2010 and 2011 seasons . Exposure and injury surveillance data were then obtained weekly over the course of each season to determine whether scapular dysfunction was predictive of subsequent throwing-related upper extremities sustained . RESULTS There were 12 throwing-related upper extremity injuries sustained in the 246 participants , yielding an injury rate of 1.0 per 1,000 athlete exposures . There were no significant differences in injury rates between the participants with normal scapular function versus subtle scapular dysfunction ( P = .62 ) , normal scapular function versus obvious scapular dysfunction ( P = .26 ) , or subtle versus obvious scapular dysfunction ( P = .45 ) . CONCLUSION This study showed that scapular dysfunction identified during preseason screenings is not associated with subsequent throwing-related upper extremity injury Background : Shoulder strength and motion deficits in high school baseball pitchers have been implicated in injury risk . Purpose /Hypothesis : To prospect ively determine if preseason strength and range of motion ( ROM ) are predictive of injury in high school baseball pitchers . It was hypothesized that ROM asymmetries and weakness would be predictive of injury . Study Design : Case-control study ; Level of evidence , 3 . Methods : Preseason strength and ROM measurements  were made on 101 pitchers from 4 different high schools over 4 seasons ( total 166 pitcher-seasons : 25 freshman , 46 junior varsity , and 95 varsity player-seasons ) .  Glenohumeral internal rotation ( IR ) , glenohumeral external rotation , and posterior shoulder ROM  were measured bilaterally . Strength in IR , external rotation , supraspinatus ( empty-can test ) , and scapular retraction  was measured bilaterally ( h and held dynamometer ) . Injury incidence ( injuries per 1000 pitches ) was computed for players categorized as above normal ( ≥1 SD above the mean ) , normal ( within 1 st and ard deviation of the mean ) , and below normal ( ≤1 SD below the mean ) for each potential risk factor . Injury was defined as a missed game or practice because of shoulder or elbow problem . Results : There were 28 upper extremity injuries ( 19 shoulder , 9 elbow ; incidence , 0.58 injuries/1000 pitches ) . There was a trend for supraspinatus weakness to be associated with increased injury risk ( relative risk [ RR ] , 3.60 ; 95 % CI , 0.75 - 17.32 ; P = .09 ) . When analyzing major injuries only ( > 3 missed games ) , preseason supraspinatus weakness was significantly associated with increased injury risk ( RR , 4.58 ; 95 % CI , 1.40 - 15.01 ; P = .02 ) . Paradoxically , pitchers with no IR loss were at increased risk compared with pitchers with ≥20 ° loss ( RR , 4.85 ; 95 % CI , 1.01 - 23.29 ; P = .04 ) . Other ROM and strength measures were unrelated to injury risk . Conclusion : Although excessive loss of IR ROM is thought to be a risk factor for injury , the opposite was the case in this study . The absence of IR ROM loss  in high school pitchers may indicate inadequate prior exposure to pitching , result ing in increased injury risk . Preseason supraspinatus weakness was associated with increased risk for a major injury , and preventative supraspinatus strengthening may be beneficial Background : Throwing injuries of the shoulder and elbow are common among youth baseball players . Hypothesis : A prevention program will reduce the incidence of throwing injuries of the shoulder and elbow by 50 % among youth baseball players . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : The authors block r and omized 16 youth baseball teams consisting of 237 players aged 9 to 11 years into an intervention group ( 8 teams , 117 players ) and a control group ( 8 teams , 120 players ) . The intervention program consisted of 5 stretching , 2 dynamic mobility , and 2 balance training exercises performed during warm-up . Both groups were followed up for 12 months , during which the incidence of shoulder and elbow injuries was recorded . In addition , ball speed during pitching as a performance-related factor and variables of physical function ( passive range of motion of the elbow , shoulder and hip , dynamic balance , and thoracic kyphosis angle ) were assessed during the pre- and postintervention periods . Results : The incidence of shoulder and elbow injuries in the intervention group ( 1.7 per 1000 athlete-exposures ) was significantly lower than that in the control group ( 3.1 per 1000 athlete-exposures ) ( hazard ratio , 1.940 ; 95 % CI , 1.175 - 3.205 ; P = .010 ) . The factors related to pitching performance , as assessed by ball speed , tended to increase in the intervention group as compared with the control group ( P = .010 ) . The program also improved shoulder horizontal adduction deficits on the dominant side , hip internal rotation on the nondominant side , and the thoracic kyphosis angle . Conclusion : A prevention program decreases throwing injuries of the shoulder and elbow and enhances the parameter of pitching performance in youth baseball players 
    Output:
    
Specific lower extremity deficits were found to be independent risk factors for elbow pain and injury in throwing athletes at certain levels of play .
Additionally , prevention programs design ed to correct deficits in identified risk factors were effective in reducing the incidence of elbow injury in youth athletes .
These results highlight the potential of screening and subsequent intervention to reduce the incidence of elbow injury in certain subsets of baseball players