Impaired single-leg heel raise performance of the pivot leg relates with shoulder and elbow pain in youth baseball players

The standing single heel-raise test (SHRT) is recommended as useful clinical method to assess ankle plantar flexion function, balance and mobility. The aim of this study was to elucidate the relationship between players with shoulder/elbow pain and performance of the standing SHRT. Youth male baseball players from a single baseball academy of a professional baseball club, who attended preseason medical examination was included in the study. Participants completed a questionnaire asking their age, height, weight, dominant hand, years of baseball experience, and history of shoulder, elbow, or lower extremity injuries. All participants underwent physical examinations to check shoulder/elbow pain. The standing SHRT was evaluated by instructing the players to stand on one foot and lift their heels maximally during each heel raise of five times, with the ipsilateral knee extended. The test was defined positive if the heel was not lifted maximally or lifted with laterality, swayed or trunk lean was observed during the test, if the ipsilateral knee flexed, or if the participant could not lift their heel five times. The relationship between shoulder/elbow pain and standing SHRT results was statistically analyzed. Of the 552 players, 40 players complained of shoulder/elbow pain (7%), and 144 players (26%) showed a positive standing SHRT result on the pivot leg. Among the players with shoulder/elbow pain, positive standing SHRT on the pivot leg was positive in 45% (18 players). Meanwhile, among the players without shoulder/elbow pain, standing SHRT on the pivot leg was positive in only 25% (126 of 512 players), and this difference was statistically significant ( P = 0.008). Weakness of ankle plantar flexion and dysfunction of the lower extremity and foot function through evaluation of standing SHRT on the pivot leg may be related to shoulder/elbow pain among youth baseball players.