Short-term neurophysiological response after spinal thrust manipulation to guide return-to-throwing in collegiate pitchers: a randomized crossover pilot study

Overhead throwing athletes experience high injury rates throughout the body. While previous studies have focused on risk factors and injury prevention strategies, few have explored the potential of neurophysiological markers like pressure pain threshold (PPT) to guide return-to-throwing decisions. This study aims to investigate the utility of physical performance tests and PPT changes after spinal thrust manipulation (STM) as biomarkers to predict performance and reduce injury risk in overhead throwing athletes. Baseball pitchers were recruited through convenience sampling at an NCAA Division II university. Participants were randomly allocated to STM or sham over a 1-2-week washout period. Performance and clinical measures were performed following interventions in both conditions. Medicine ball scoop test distance emerged as the strongest predictor of throwing velocity (<i>R</i> = 0.713, R² = 0.509, <i>p</i> = <0.001). Combining MB distance with STM-induced change in PPT further improved the model's predictive power (<i>R</i> = 0.794, R² = 0.630, <i>p</i> = <0.001). Medicine ball scoop test is a potential tool for evaluating throwing velocity capacity and informing return-to-throwing decisions. STM-induced changes in PPT may be a novel biomarker for identifying pitchers with greater neurophysiological modulation and potential for higher performance.