Comparison of core neuromuscular control and lower extremity postural stability in athletes with and without shoulder injuries

Evaluation and Preparation of the Baseball Player in the Athletic Training Room

A critical aspect of the care of the baseball player involves understanding injury patterns, workload tolerance, and objective markers that can aid in identifying predisposing factors to injury. After injury, a well-structured rehabilitation program can return many players to the field. The greatest challenge is not only returning them to the previous level of performance but also preventing reinjury and maintaining durability. Potential factors implicated in the most common injuries include deficits in range of motion, balance, core strength, lumbopelvic control, thoracic rotation, posture, and muscle imbalance. Organizing an appropriate rehabilitation program with these factors in mind is critical.

Thinking outside the shoulder: A systematic review and metanalysis of kinetic chain characteristics in non-athletes with shoulder pain

INTRODUCTION

The kinetic chain is important in the proximal-distal energy transfer along body segments. Although biomechanical impairments in components of the kinetic chain have already been reported in athletes with shoulder pain, such investigations in non-athlete individuals have not yet been synthesized.

OBJECTIVE

To systematically review the literature and analyze the quality of evidence on the characteristics of the kinetic chain of non-athletes with shoulder pain compared to asymptomatic individuals.

METHODS

Studies published until February 2024 (without language restrictions) that quantitatively assessed outcomes related to the kinetic chain of non-athlete individuals were searched in five databases (MEDLINE, CINAHL, Web of Science, EMBASE, and SCOPUS). The risk of bias and quality of evidence were analyzed using the Joanna Briggs Institute Critical Appraisal Tool for Analytical Cross-Sectional Studies and the Grading of Recommendations, Assessment, Development, and Evaluation approach, respectively. To summarize the findings, meta-analyses with random-effects models were performed.

RESULTS

Six cross-sectional studies (n = 562 [282 with shoulder pain], mean age = 48.7 ± 8.1 years) with low risk of bias were included in this review. Very low-quality evidence suggests that individuals with shoulder pain may present a lower active range of motion and muscular endurance/strength in the cervical spine, thoracolumbar region, and hip, as well as deficits in neuromuscular control of the lower extremities. Findings related to thoracic spine posture were conflicting and no differences were found in cervical spine isometric muscular strength between individuals with and without shoulder pain.

CONCLUSION

Individuals with shoulder pain may present alterations in active mobility, muscular endurance, and neuromuscular control in kinetic chain segments. These findings suggest that broader physical assessments considering components of the kinetic chain may be clinically relevant in this population. However, based on the very low quality of evidence, the findings of this review should be interpreted with caution.

The effects of improvement in upper extremity function on gait and balance in children with upper extremity affected

BACKGROUND

This study aimed to investigate the effects of functional improvement in the upper extremity on gait and balance in children with upper extremity affected.

RESEARCH QUESTION

What are the effects of functional improvement in the upper extremity on gait and balance in children with upper extremity affected?

METHODS

Eighteen children with a diagnosis of rheumatologic diseases and 15 healthy children were evaluated with Shriners Hospital Upper Extremity Assessment, Jebsen-Taylor Hand Function Test, Abilhand Rheumatoid Arthritis Scale, 10-meter walk test and Childhood Health Assessment Questionnaire. For static balance assessment, the Biodex Balance was used. Ground reaction forces (peak forces (heel strike and push-off) and minimum force (loading response), single-limb support duration, Center-of-Force displacement and walking speed were evaluated with the Sensor Medica. Arm swing was evaluated with the Kinovea 2D motion analysis.

RESULTS

Before treatment, single-limb support duration and push-off force was higher and center-of-force displacement was lower on affected side compared to unaffected side in rheumatologic group. After the 6-week rehabilitation program, upper extremity function, quality of life and functional gait score improved. Single-limb support duration decreased on affected side and increased on unaffected side. On affected side, push-off force decreased. The arm swing parameters were similar before and after treatment.

SIGNIFICANCE

Improving upper extremity function can help with gait balance by decreasing the difference in walking and balance parameters between the affected and unaffected sides and providing for more symmetrical weight transfer.

Physical therapy management of an athlete with a Kim lesion using physical agents, manual therapy, and therapeutic exercise: a case report

BACKGROUND

Several operative procedures have been described for treating a Kim lesion. However, no physical therapy intervention has been documented as conservative treatment for these cases.

OBJECTIVE

The purpose of this report was to describe a physical therapy management protocol for an athlete with a Kim lesion.

CASE DESCRIPTION

A 22-year-old female volleyball athlete presented to physical therapy with an 8-month history of right shoulder pain when performing the serve and attack sports gestures. Pain was 5/10 on the visual analogue scale (VAS). Pain was localized along the glenohumeral joint, around the long head of the biceps brachii tendon, and at the subscapularis tendon insertion. Shoulder range of motion (ROM) was limited to flexion (150°), abduction (158°), and internal rotation (80°). Kim lesion was confirmed by clinical tests (Kim test and Jerk test) and via magnetic resonance imaging. Shoulder functional outcomes were verified through the University of California Los Angeles (UCLA) shoulder rating scale. Upper extremity sensorimotor control was verified in bimanual support by stabilometry on a baropodometer. Core function was assessed through a plank test and a side plank test. The 8-week course of treatment included manual therapy, physical agents, shoulder and scapular mobilizations, resistance and sensorimotor exercises, core strengthening, and functional exercises.

OUTCOMES

Physical therapy interventions resulted in a decrease in VAS pain (3/10), an increase in shoulder ROM (10.8°) and in UCLA shoulder score (from 22 to 33 points), a reduction in the center of pressure displacement (27-56%), and an increase in plank test (45%) and side plank test (21-29%) performance. The athlete had a full return to sport after the treatment.

CONCLUSION

We concluded that the protocol used for conservative management of Kim lesion resulted in clinical satisfactory physical and functional outcomes for the athlete.

Kinetic chain revisited: consensus expert opinion on terminology, clinical reasoning, examination, and treatment in people with shoulder pain

BACKGROUND

The purpose of this study was to reach consensus on the most appropriate terminology and issues related to clinical reasoning, examination, and treatment of the kinetic chain (KC) in people with shoulder pain among an international panel of experts.

METHODS

A 3-round Delphi study that involved an international panel of experts with extensive clinical, teaching, and research experience in the study topic was conducted. A search equation of terms related to the KC in Web of Science and a manual search were used to find the experts. Participants were asked to rate items across 5 different domains (terminology, clinical reasoning, subjective examination, physical examination, and treatment) using a 5-point Likert-type scale. An Aiken coefficient of validity (V) ≥0.7 was considered indicative of group consensus.

RESULTS

The participation rate was 30.2% (n = 16), whereas the retention rate was high throughout the 3 rounds (100%, 93.8%, and 100%). A total of 15 experts from different fields and countries completed the study. After the 3 rounds, consensus was reached on 102 items: 3 items were included in the "terminology" domain; 17 items, in the "rationale and clinical reasoning" domain; 11 items, in the "subjective examination" domain; 44 items, in the "physical examination" domain; and 27 items, in the "treatment" domain. Terminology was the domain with the highest level of agreement, with 2 items achieving an Aiken V of 0.93, whereas the domains of physical examination and treatment of the KC were the 2 areas with less consensus. Together with the terminology items, 1 item from the treatment domain and 2 items from the rationale and clinical reasoning domain reached the highest level of agreement (V = 0.93 and V = 0.92, respectively).

CONCLUSION

This study defined a list of 102 items across 5 different domains (terminology, rationale and clinical reasoning, subjective examination, physical examination, and treatment) regarding the KC in people with shoulder pain. The term "KC" was preferred and a agreement on a definition of this concept was reached. Dysfunction of a segment in the chain (ie, weak link) was agreed to result in altered performance or injury to distal segments. Experts considered it important to assess and treat the KC in particular in throwing or overhead athletes and agreed that no one-size-fits-all approach exists when implementing shoulder KC exercises within the rehabilitation process. Further research is now required to determine the validity of the identified items.

Effects of core stability on shoulder and spine kinematics during upper limb elevation: A sex-specific analysis

BACKGROUND

Upper limb elevation begins with core stabilization, but the effects of core stability on shoulder and spine kinematics are unknown. Sex differences also exist in shoulder kinematics and core stability.

OBJECTIVE

To clarify the effects of core stability on shoulder and spine kinematics during upper limb elevation by taking sex into account.

DESIGN

Cross-sectional.

METHODS

The Sahrmann Core Stability Test, lumbar spine motor control test battery, and Y Balance Test (lower and upper quarters) were performed in 50 healthy young adults. For each test, a principal component (PC) analysis was conducted according to sex; the overall core stability score was calculated. The top and bottom third of the PC scores were defined as high and low score groups, respectively (each group: nine males and eight females). Shoulder and spine kinematics during upper limb elevation were compared separately for males and females.

RESULTS

Spinal extension was greater in the low score group by a maximum of 1.9° in males (P < .001; η² = 0.068) and 1.6° in females (P < .001; η² = 0.141). In the low score group of females, the scapular posterior tilt was a maximum of 5.6° smaller (P < .001; η² = 0.221) and glenohumeral elevation was a maximum of 4.5° larger (P < .001; η² = 0.113) than the high score group of females.

CONCLUSION

Core stability affected spine and female scapular and glenohumeral kinematics during upper limb elevation. Core stability may be one of the potential contributors to shoulder kinematics, particularly in females.

Motor alterations in the kinetic chain in individuals with chronic shoulder pain

BACKGROUND

Shoulder pain may be related to biomechanical dysfunctions in the kinetic chain.

OBJECTIVE

To compare the mobility and muscular endurance of thoracolumbar spine and hip, and the neuromuscular control of the lower extremity of individuals with and without shoulder pain and to determine the discriminative capacity between groups of these variables.

DESIGN

A cross-sectional study.

METHOD

One hundred and two individuals with and without shoulder pain were evaluated to range of motion (ROM) of the thoracolumbar spine and hips, the muscular endurance time of the thoracolumbar spine and hips muscles, and the neuromuscular control of the lower extremity, by the Star Excursion Balance Test (SEBT).

RESULTS

Individuals with shoulder pain presented lower ROM and muscular endurance time in all tests evaluated (p < 0.01-p = 0.03), greater perception of pain during all ROM and muscle endurance (p < 0.01-p = 0.04) evaluations, and less neuromuscular control of the lower extremity in the compound reach (p < 0.01-p = 0.01), anterior and posteromedial (p < 0.01-p = 0.04) directions of the SEBT on both sides. The anterior reach direction of the SEBT of the contralateral limb to the shoulder pain (AUC=0.80, cut-off point=47.7%) presented excellent capacity to discriminate individuals with shoulder pain, while the other variables showed between acceptable and small capacity (AUC=0.58-0.76).

CONCLUSION

Individuals with chronic shoulder pain presented alterations in joint mobility, muscular endurance time of the thoracolumbar spine and hips and neuromuscular control of the lower extremity. The anterior reach of the SEBT of the contralateral limb showed excellent discriminative capacity.