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De Luigi AJ. The role of osteopathic principles and practice in upper extremity injuries of the overhead athlete. J Osteopath Med 2024; 124:1-4. [PMID: 37796149 DOI: 10.1515/jom-2023-0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023]
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Rinonapoli G, Ceccarini P, Manfreda F, Talesa GR, Simonetti S, Caraffa A. Shoulder and Neck Pain in Swimmers: Front Crawl Stroke Analysis, Correlation with the Symptomatology in 61 Masters Athletes and Short Literature Review. Healthcare (Basel) 2023; 11:2638. [PMID: 37830674 PMCID: PMC10572881 DOI: 10.3390/healthcare11192638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
Background: Swimming and, specifically, front crawl, can be included among the "overhead" sports. Overhead sports are a risk factor for some problems of the musculoskeletal system, especially the shoulder. The aim of this study was to assess the incidence of shoulder and neck pain in a Masters Swimming Team and its correlation with the crawl stroke. Methods: This is an observational study through video-analysis of the stroke and a questionnaire. The participants selected for the present study were 61 athletes of a Masters team, whose prevailing training stroke was the front crawl. Their stroke was analyzed during training using a go-pro camera mounted on a sliding trolley on a track, evaluating their technical defects with their trainer. A questionnaire about frequency of shoulder and neck pain during the last five years was administered to all the participants at the study. Results: From the questionnaire, 45 and 55 out of 61 athletes had suffered from shoulder pain and cervical pain, respectively. Both types of pain were correlated with the weekly swimming volume. The swimmers with hyperflexion of the wrist and prolonged internal rotation in the pulling phase had shoulder problems. Those who suffered from current shoulder pain reduced the underwater time. The four swimmers with an excessive body roll during breathing and those who kept their heads extended, reported cervical pain. Conclusions: Shoulder and neck pain could be prevented with the correction of specific technical errors in crawl stroke.
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Affiliation(s)
- Giuseppe Rinonapoli
- Orthopaedics and Traumatology Department, University of Perugia, 06126 Perugia, Italy; (P.C.); (F.M.); (A.C.)
- Institute of Motor Sciences, Department of Medicine and Surgery, University of Perugia, 06126 Perugia, Italy;
| | - Paolo Ceccarini
- Orthopaedics and Traumatology Department, University of Perugia, 06126 Perugia, Italy; (P.C.); (F.M.); (A.C.)
| | - Francesco Manfreda
- Orthopaedics and Traumatology Department, University of Perugia, 06126 Perugia, Italy; (P.C.); (F.M.); (A.C.)
| | - Giuseppe Rocco Talesa
- Orthopaedics and Traumatology Department, S.Matteo degli Infermi Hospital, 06049 Spoleto, Italy;
| | - Simonetta Simonetti
- Institute of Motor Sciences, Department of Medicine and Surgery, University of Perugia, 06126 Perugia, Italy;
| | - Auro Caraffa
- Orthopaedics and Traumatology Department, University of Perugia, 06126 Perugia, Italy; (P.C.); (F.M.); (A.C.)
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Paramanidis N, Kabasakalis A, Koutlianos N, Tsalis G, Kouidi E. Shoulder Pain and Trunk Muscles Endurance in Young Male and Female Swimmers. Healthcare (Basel) 2023; 11:2145. [PMID: 37570385 PMCID: PMC10419166 DOI: 10.3390/healthcare11152145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Shoulder pain is a common syndrome in swimming and affects a large number of competitive swimmers. The purpose of the study was to investigate the relationship between pain in the shoulder girdle and the endurance of the trunk muscles in young swimmers. A total of 24 boys and 22 girls, aged 13 to 18 years, participated in the study. The measurements included the completion of a questionnaire (Shoulder Pain and Disability Index, SPADI) and a field test (McGill's Torso Muscular Endurance Test). The total SPADI score correlated weakly and negatively with the endurance time of back muscles in both sexes (r2 = 0.10, p = 0.035), and moderately and negatively in girls (r2 = 0.23, p = 0.023). A weak negative correlation was found between the disability index and the back muscles' endurance time in both sexes (r2 = 0.15, p = 0.007), which was moderate in girls only (r2 = 0.25, p = 0.019). The disability index displayed moderate negative correlations with the right oblique's (r2 = 0.18, p = 0.049) and left oblique's endurance time (r2 = 0.23, p = 0.024) in girls. Weight, body mass index, the total out-of-water training time per week and age significantly affected the endurance times of the trunk muscles in boys and girls (p < 0.05). In conclusion, strengthening the dorsal and the oblique muscles could reduce shoulder pain and disability in young swimmers and especially girls.
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Affiliation(s)
- Nikolaos Paramanidis
- Laboratory of Sports Medicine, School of Physical Education and Sports Science at Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.P.); (N.K.); (E.K.)
| | - Athanasios Kabasakalis
- Laboratory of Evaluation of Human Biological Performance, School of Physical Education and Sport Science at Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Nikolaos Koutlianos
- Laboratory of Sports Medicine, School of Physical Education and Sports Science at Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.P.); (N.K.); (E.K.)
| | - George Tsalis
- School of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, School of Physical Education and Sports Science at Thessaloniki, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.P.); (N.K.); (E.K.)
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Machado EDM, Haik MN, Ferreira JK, da Silva Santos JF, Camargo PR, Mendonça LDM. Association of trunk and lower limb factors with shoulder complaints and sport performance in overhead athletes: A systematic review including GRADE recommendations and meta-analysis. Phys Ther Sport 2023; 60:112-131. [PMID: 36791672 DOI: 10.1016/j.ptsp.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To identify the association of trunk and lower limb factors with shoulder complaints and sport performance in overhead athletes. METHODS Search performed at PubMed/Medline, Embase, CINAHL, LILACS, Cochrane, Web of Science and SPORTDiscus for observational studies. Methodological quality and strength of the evidence was assessed with the Newcastle-Ottawa Scale and GRADE. Meta-analysis and effects sizes analysis were calculated when possible. RESULTS Sixty-five studies were included. Low to very-low evidence suggests no association of trunk/lower limb strength, endurance, power, jump or balance with shoulder complaints and/or throwing performance. Athletes with shoulder complaints performed worse in trunk stability and endurance tests (mean difference: -6.83 (95%CI: -8.78, -4.88)). Athletes with high throwing performance presented better results in CMJ, horizontal jump, power measures and knee extension strength. For swimmers, there was no association of trunk/lower limb endurance with shoulder complaints (moderate evidence) and no association of balance and swimming performance (low evidence). Better trunk/lower limb strength, power and vertical jumps measures were associated with better swimming performance. CONCLUSIONS In methodologically similar studies, some trunk/lower limb outcomes are associated with shoulder complaint or sport/swimming performance. Results should be considered with caution and future studies should use better methodologies.
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Affiliation(s)
- Eliane de Morais Machado
- Post-Graduate Program in Physical Therapy (PPGFt), Universidade Federal de Sao Carlos (UFSCar), Sao Carlos, Brazil; Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, Sao Carlos, Brazil
| | - Melina Nevoeiro Haik
- Post-Graduate Program in Physical Therapy (PPGFt), Universidade Federal de Sao Carlos (UFSCar), Sao Carlos, Brazil; Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, Sao Carlos, Brazil
| | - Julia Kortstee Ferreira
- Post-Graduate Program in Physical Therapy (PPGFt), Universidade Federal de Sao Carlos (UFSCar), Sao Carlos, Brazil; Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, Sao Carlos, Brazil
| | - Jonatas Ferreira da Silva Santos
- Physical Training and Sport Performance Research Group, Department of Physical Education, School of Biological and Health Sciences, Universidade Federal dos Vales do Jequitinhonha e do Mucuri, Diamantina, MG, Brazil
| | - Paula Rezende Camargo
- Post-Graduate Program in Physical Therapy (PPGFt), Universidade Federal de Sao Carlos (UFSCar), Sao Carlos, Brazil; Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, Sao Carlos, Brazil
| | - Luciana De Michelis Mendonça
- Post-Graduate Program in Physical Therapy (PPGFt), Universidade Federal de Sao Carlos (UFSCar), Sao Carlos, Brazil; Physical Therapy Department, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
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Wilk KE, Thomas ZM, Arrigo CA, Campbell AM, Shahien A, Dugas JR. The Use of the Internal Brace to Repair the UCL Injury of the Elbow in Athletes. Int J Sports Phys Ther 2022; 17:1208-1218. [PMID: 36518840 PMCID: PMC9718695 DOI: 10.26603/001c.39614] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/22/2022] [Indexed: 11/12/2023] Open
Affiliation(s)
- Kevin E Wilk
- Vice President National Director Clinical Education & Research Champion Sports Medicine, Select Medical
- Director of Rehabilitative Research American Sports Medicine Institute
| | | | | | - Ashley M Campbell
- Director of Rehabilitation Nashville Hip Institute at TOA
- School of Physical Therapy Belmont University
| | - Amir Shahien
- Orthopaedic Surgeon, Fellow American Sports Medicine
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Ličen T, Kalc M, Vogrin M, Bojnec V. Injury Prevention in Tennis Players, Linking the Kinetic Chain Approach With Myofascial Lines: A Narrative Review With Practical Implications. Strength Cond J 2022. [DOI: 10.1519/ssc.0000000000000669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Uquillas CA, Sun Y, Van Sice W, ElAttrache NS, Banffy MB. Prevalence of femoroacetabular impingement in elite baseball players. J Hip Preserv Surg 2022; 9:145-150. [PMID: 35992028 PMCID: PMC9389915 DOI: 10.1093/jhps/hnac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/06/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
CAM-type femoroacetabular impingement continues to be an underrecognized cause of hip pain in elite athletes. Properties inherent to baseball such as throwing mechanics and hitting may enhance the risk of developing a cam deformity. Our goal is to gain an appreciation of the radiographic prevalence of cam deformities in elite baseball players. Prospective evaluation and radiographs of 80 elite baseball players were obtained during the 2016 preseason entrance examination. A sports medicine fellowship-trained orthopedic surgeon with experience treating hip disorders used standard radiographic measurements to assess for the radiographic presence of cam impingement. Radiographs with an alpha angle >55° on modified Dunn views were defined as cam positive. Of the 122 elite baseball players included in our analysis, 80 completed radiographic evaluation. Only 7.3% (9/122) of players reported hip pain and 1.6% (4/244) had a positive anterior impingement test. The prevalence of cam deformities in right and left hips were 54/80 (67.5%) and 40/80 (50.0%), respectively. The mean alpha angle for cam-positive right and left hips were 64.7 ± 6.9° and 64.9 ± 5.8°, respectively. Outfielders had the highest risk of right-sided cam morphology (Relative Risk (RR) = 1.6). Right hip cam deformities were significantly higher in right-handed pitchers compared with left-handed pitchers (P = 0.02); however, there was no significant difference in left hip cam deformities between left- and right-handed pitchers (P = 0.307). Our data suggest that elite baseball players have a significantly higher prevalence of radiographic cam impingement than the general population.
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Affiliation(s)
- Carlos A Uquillas
- Kerlan Jobe Orthopedic Clinic , 6801 Park Terrace, Suite 500, Los Angeles, CA 90045, USA
| | - Yuhang Sun
- Kerlan Jobe Orthopedic Clinic , 6801 Park Terrace, Suite 500, Los Angeles, CA 90045, USA
| | - Wade Van Sice
- Kerlan Jobe Orthopedic Clinic, 2055 Military Trail #204 , Jupiter, FL 33458, USA
| | - Neal S ElAttrache
- Kerlan Jobe Orthopedic Clinic , 6801 Park Terrace, Suite 500, Los Angeles, CA 90045, USA
| | - Michael B Banffy
- Kerlan Jobe Orthopedic Clinic , 6801 Park Terrace, Suite 500, Los Angeles, CA 90045, USA
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Kennedy SM, Sheedy P, Klein B, Gist MF, Hannon JP, Conway JE, Creed K, Garrison JC. Differences in Shoulder Internal Rotation Strength Between Baseball Players With Ulnar Collateral Ligament Reconstruction and Healthy Controls. Orthop J Sports Med 2022; 10:23259671211065025. [PMID: 35036451 PMCID: PMC8753246 DOI: 10.1177/23259671211065025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/16/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Studies have indicated decreased shoulder internal rotation (IR) and external rotation (ER) strength in the throwing limb of baseball players after ulnar collateral ligament injury. There is limited evidence on the recovery of shoulder rotation strength after primary ulnar collateral ligament reconstruction (UCLR). Hypothesis: At the time of return to throwing, baseball players who underwent UCLR would demonstrate decreased IR and ER shoulder strength in the throwing arm as compared with healthy baseball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Male competitive high school and collegiate baseball athletes participated in this study. Athletes who underwent UCLR were compared with healthy controls who were matched by age, height, weight, and position. Bilateral isometric shoulder ER and IR strength was measured using a handheld dynamometer for all participants at the time of initial evaluation (UCLR group) and throughout the course of a season (healthy group). Independent t tests were run to calculate mean differences in ER and IR shoulder strength between the groups, with significance set at P < .05. Results: A total of 86 baseball athletes participated in this study (43 UCLR group, 43 healthy group). At the time of return to throwing (mean ± SD, 194 ± 30 days postoperatively), the 2 groups demonstrated no significant differences in nonthrowing arm ER or IR strength (P = .143 and .994, respectively). No significant difference was found between groups for throwing arm ER strength (P = .921); however, the UCLR group demonstrated significantly less throwing arm IR strength than the healthy group (144.2 ± 27.8 vs 157.6 ± 27.1 N; P = .023). Conclusion: The results of this study demonstrate that throwing arm rotator cuff strength may not fully recover before the initiation of a return-to-throwing program after UCLR. These data provide a potential framework for clinicians to assist in the management and exercise prescription of the baseball athlete after UCLR and before medical release and the initiation of a return-to-throwing program.
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Affiliation(s)
- Sean M Kennedy
- Memorial Hermann Health, IRONMAN Sports Medicine Institute, Houston, Texas, USA
| | - Philip Sheedy
- Texas Health Sports Medicine, Fort Worth, Texas, USA
| | | | - Mason F Gist
- Texas Health Sports Medicine, Fort Worth, Texas, USA
| | - Joseph P Hannon
- Texas Health Sports Medicine, Fort Worth, Texas, USA.,St Louis Children's Hospital, Young Athlete Center, St Louis, Missouri, USA
| | - John E Conway
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kalyssa Creed
- Texas Health Sports Medicine, Fort Worth, Texas, USA
| | - J Craig Garrison
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
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Matsel KA, Brown SN, Hoch MC, Butler RJ, Westgate PM, Malone TR, Uhl TL. The Intra- and Inter-rater Reliability of an Arm Care Screening Tool in High School Baseball Coaches. Int J Sports Phys Ther 2021; 16:1532-1540. [PMID: 34909258 PMCID: PMC8637259 DOI: 10.26603/001c.29680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Preseason movement screening can identify modifiable risk factors, deterioration of function, and potential for injury in baseball players. Limited resources and time intensive testing procedures prevent high school coaches from accurately performing frequent movement screens on their players. PURPOSE To establish the intra-rater and inter-rater reliability of a novel arm care screening tool based on the concepts of the Functional Movement Screen (FMS™) and Selective Functional Movement Assessment (SFMA™) in high school coaches. STUDY DESIGN Methodological intra- and inter-rater reliability study. METHODS Thirty-one male high school baseball players (15.9 years ± 1.06) were independently scored on the Arm Care Screen (ACS) by three examiners (two coaches, one physical therapist) in real-time and again seven days later by reviewing video recordings of each players' initial screening performance. Results from each examiner were compared within and between raters using Cohen's kappa and percent absolute agreement. RESULTS Substantial to excellent intra-rater and inter-rater reliability were established among all raters for each component of the ACS. The mean Cohen's kappa coefficient for intra-rater reliability was 0.76 (95% confidence interval, 0.54-0.95) and percent absolute agreement ranged from 0.82-0.94 among all raters. Inter-rater reliability demonstrated a mean Cohen's kappa value of 0.89 (95% confidence interval, 0.77-0.99) while percent absolute agreement between raters ranged from 0.81-1.00. Intra- and inter-rater reliability did not differ between raters with various movement screening experience (p>0.05). CONCLUSIONS High school baseball coaches with limited experience screening movement can reliably score all three components of the ACS in less than three minutes with minimal training. LEVEL OF EVIDENCE Level 3, Reliability study.
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Bogdanov JM, Bolia IK, Benvegnu N, Michener LA, Weber AE, Petrigliano FA. Rehabilitation Following Ulnar Collateral Ligament Reconstruction in Overhead-Throwing Athletes. JBJS Rev 2021; 9:01874474-202104000-00004. [PMID: 33819204 DOI: 10.2106/jbjs.rvw.20.00154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The prevalence of ulnar collateral ligament (UCL) injury and UCL reconstruction (UCL-R) continues to rise, causing morbidity in overhead-throwing athletes. » Postoperative rehabilitation protocols are essential for proper healing of the reconstructed ligament and safely returning athletes to competition, yet there is no uniformly accepted standard of care. » UCL-R rehabilitation has traditionally been guided by expert opinion and conventional wisdom rather than scientific studies, resulting in substantial variability in rehabilitation practices, time to return to play, and outcomes. » Current research efforts aim to closely investigate the biomechanical implications of UCL-R and overhead throwing to better guide rehabilitation and to improve competitive performance and outcomes. » Additional biomechanical and scientific studies on rehabilitation modalities and timing are warranted for systematic analysis, optimization, and standardization of UCL-R rehabilitation.
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Affiliation(s)
- Jacob M Bogdanov
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California
| | - Neilen Benvegnu
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California
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Luo TD, Sciascia AD, Stone AV, Gwam CU, Grimes CA, Strahm JG, Mannava S, Naugher GL, Waterman BR, Freehill MT. The Effect of Straight-Line Long-Toss Versus Ultra-Long-Toss Throwing on Passive Glenohumeral Range of Motion Recovery After Pitching. Sports Health 2021; 13:237-244. [PMID: 33539268 DOI: 10.1177/1941738120980016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Repetitive throwing in baseball pitchers can lead to pathologic changes in shoulder anatomy, range of motion (notably glenohumeral internal rotation deficit), and subsequent injury; however, the ideal strengthening, recovery, and maintenance protocol of the throwing shoulder in baseball remains unclear. Two strategies for throwing shoulder recovery from pitching are straight-line long-toss (SLT) throwing and ultra-long-toss (ULT) throwing, although neither is preferentially supported by empirical data. HYPOTHESIS ULT will be more effective in returning baseline internal rotation as compared with SLT in collegiate pitchers after a pitching session. STUDY DESIGN Cohort study. LEVEL OF EVIDENCE Level 3. METHODS A total of 24 National Collegiate Athletic Association Division I baseball pitchers with mean age 20.0 ± 1.1 years were randomized to either the ULT group (n = 13; 9 right-hand dominant, 4 left-hand dominant) or SLT group (n = 11; 10 right-hand dominant, 1 left-hand dominant). Measurements (dominant and nondominant, 90° abducted external rotation [ER], internal rotation [IR], and total range of motion [TROM]) were taken at 5 time points across 3 days: before and immediately after a standardized bullpen session on day 1; before and immediately after a randomized standardized ULT or SLT session on day 2; and before practice on Day 3. RESULTS ULT demonstrated significantly greater final ER compared with baseline (+10°; P = 0.05), but did not demonstrate significant IR changes. Similarly, SLT demonstrated significantly greater post-SLT ER (+12°; P = 0.02) and TROM (+12°;P = 0.01) compared with baseline, but no significant IR changes. Final ER measurements were similar between ULT (135° ± 14°) and SLT (138° ± 10°) (P = 0.59). There was also no statistically significant difference in final IR between ULT (51° ± 14°) and SLT (56° ± 8°) (P = 0.27). CONCLUSION The routine use of postperformance, ULT throwing to recover from range of motion alterations, specifically IR loss, after a pitching session is not superior to standard, SLT throwing. Based on these findings, the choice of postpitching recovery throwing could be player specific based on experience and comfort. CLINICAL RELEVANCE The most effective throwing regimens for enhancing performance and reducing residual impairment are unclear, and ideal recovery and maintenance protocols are frequently debated with little supporting data. Two strategies for throwing shoulder recovery from pitching are SLT and ULT throwing. These are employed to help maintain range of motion and limit IR loss in pitchers. The routine use of ULT throwing for recovery and to limit range of motion alterations after a pitching session is not superior to SLT throwing.
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Matsel KA, Butler RJ, Malone TR, Hoch MC, Westgate PM, Uhl TL. Current Concepts in Arm Care Exercise Programs and Injury Risk Reduction in Adolescent Baseball Players: A Clinical Review. Sports Health 2021; 13:245-250. [PMID: 33514287 DOI: 10.1177/1941738120976384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Awareness of important injury risk factors associated with excessive pitching volume has been highlighted in the literature, but injury rates remain high. Shoulder pain in baseball players is associated with various changes in musculoskeletal movements, which presents as measurable impairments throughout the kinetic chain. Baseball coaches and rehabilitation professionals have utilized exercise programs targeting strength and flexibility of the throwing arm to prevent injuries. The purpose of this review is to summarize the current evidence regarding the effectiveness of arm care exercise programs in reducing upper extremity injury rates in adolescent baseball players. EVIDENCE ACQUISITION A search of electronic databases, including CINAHL with full text, MEDLINE, and SPORTDiscus was conducted to retrieve available articles in English from the years 2010 through 2020. The search terms injury prevention, exercise, and adolescent baseball were used. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Improving shoulder internal rotation range of motion by stretching the posterior shoulder muscles daily was associated with a 36% risk reduction of shoulder and elbow injuries. Group-based arm care exercise programs that target multiple musculoskeletal impairments demonstrated an approximately 50% reduced risk of elbow injury. CONCLUSION For adolescent baseball players, arm care injury prevention programs focusing on important musculoskeletal impairments are effective at reducing injury incidence rates. Multimodal injury prevention programs that improve multiple musculoskeletal impairments are more comprehensive and may result in better injury reduction than programs focusing on a singular impairment.
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Affiliation(s)
- Kyle A Matsel
- University of Kentucky, Lexington, Kentucky.,University of Evansville, Evansville, Indiana
| | - Robert J Butler
- Saint Louis Cardinals Baseball Organization, St Louis, Missouri
| | | | | | | | - Tim L Uhl
- University of Kentucky, Lexington, Kentucky
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Electromyographic Profile of the Shoulder During Stability Exercises With Kettlebells. J Sport Rehabil 2020; 30:653-659. [PMID: 33333490 DOI: 10.1123/jsr.2019-0541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 09/08/2020] [Accepted: 09/19/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Shoulder rehabilitation can be a difficult task due to the dynamic nature of the joint complex. Various weight training implements, including kettlebells (KB), have been utilized for therapeutic exercise in the rehabilitation setting to improve shoulder girdle strength and motor control. The KBs are unique in that they provide an unstable load and have been purported to promote greater muscle activation versus standard dumbbells. Recent literature has examined the efficacy of KB exercises for global strengthening and aerobic capacity; however, electromyographic data for shoulder-specific activities are lacking. OBJECTIVE To examine muscle activation patterns about the rotator cuff and scapular musculature during 5 commonly-utilized KB exercises. DESIGN Cross-sectional analysis of a single group. SETTING Clinical biomechanics laboratory. PARTICIPANTS Ten participants performed all exercises in a randomized order. MAIN OUTCOME MEASURES Mean electromyographic values for each subject were compared between exercises for each target muscle. RESULTS Significant differences (P < .05) between exercises were observed for all target muscles except for the infraspinatus. CONCLUSIONS The data in this study indicates that certain KB exercises may elicit activation of the shoulder girdle at different capacities. Physical therapy practitioners, athletic trainers, and other clinical professionals who intend to optimize localized strengthening responses may elect to prescribe certain exercises over others due to the inherent difference in muscular utilization. Ultimately, this data may serve to guide or prioritize exercise selection to achieve higher levels of efficacy for shoulder strength and stability gains.
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CONSIDERATION OF SPORT DEMANDS FOR AN 18-YEAR-OLD LACROSSE PLAYER WITH RECALCITRANT SYMPTOMATIC SPONDYLOLYSIS: A CASE REPORT. Int J Sports Phys Ther 2020; 15:1196-1210. [PMID: 33344035 DOI: 10.26603/ijspt20201196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Spondylolysis is an anatomical defect or fracture of the pars interarticularis and encompasses almost half of all cases of low back pain in adolescent athletes. Most athletes return to sport with conservative treatment, but it is possible that consideration of sport demands may further improve rate of successful return. When surgery is performed, complication rate is high, so all conservative measures should be explored before considering surgical intervention. The purpose of this case report is to present a program where demands of sport were considered and allowed successful return to sport for a subject with recalcitrant symptomatic spondylolysis that had failed to respond to prior treatment. Case Description An 18-year-old lacrosse player with a history of recalcitrant symptomatic spondylolysis that failed three courses of conservative treatment and had been unsuccessful in returning to sport. A multi-phase program with a focus on multi-planar and full kinetic chain activities that addressed the nature of the sport demands is described, along with improvements in pain level, strength, range of motion, and subjective outcome scores. Outcomes The subject was able to successfully return to sport after 10 weeks of physical therapy and complete the remaining few months of his lacrosse season without reinjury. Range of motion and strength testing was markedly improved upon discharge. The subject's Modified Oswestry Disability Index improved from 16% to 0% and his pain level did not rise above 2/10 with any sport activity upon return. Discussion/Conclusions Although return to sport rates following spondylolysis in young athletes is high, this case report demonstrates that a consideration of sport demands may increase return to sport rates in athletes that do not respond to standard care and prevent surgical intervention. Level of Evidence Level 4, single case report.
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Tsuruike M, Ellenbecker TS, Kagaya Y, Lemings L. Analysis of Scapular Muscle EMG Activity During Elastic Resistance Oscillation Exercises From the Perspective of Different Arm Positions. Sports Health 2020; 12:395-400. [PMID: 32525452 DOI: 10.1177/1941738120929305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Little is known about the optimal exercise intensity and the effects of arm position on elastic resistance exercise. The purpose of this study was to investigate scapular muscle activity in different arm positions utilized during standing elastic resistance exercise. HYPOTHESIS Lower trapezius (LT), serratus anterior (SA), and infraspinatus (IS) muscle activity will vary across arm positions above shoulder level. Also, oscillation resistance exercise will result in increased muscle activity compared with isometric contraction. STUDY DESIGN Controlled laboratory study. LEVEL OF EVIDENCE Level 4. METHODS A total of 19 uninjured male collegiate baseball players volunteered to participate in this study. The electromyography (EMG) activity of the LT, upper trapezius (UT), middle deltoid (MD), SA, and IS muscles was determined using surface EMG in 3 arm positions: diagonal pattern 1 (D1), 120° of shoulder abduction (120), and 90° shoulder abduction with external rotation and elbow flexion (90/90) during both isometric contraction and oscillation resistance exercise. RESULTS No difference in EMG activity of the LT muscle was found between the 120 and 90/90 position. However, the 120 position increased UT and MD muscle activity significantly more than those of the 90/90 position. The D1 arm position significantly increased SA muscle activity more than the 120 and 90/90 positions while the LT muscle activity was nearly silent. CONCLUSION The standing 90/90 position effectively generated both LT and IS muscle EMG activity while minimizing both UT and MD muscle activity. CLINICAL RELEVANCE The use of oscillation movements under elastic loading can create high muscle activation in the LT muscle without an adverse effect of the humeral head position and scapular rotation.
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Affiliation(s)
- Masaaki Tsuruike
- Department of Kinesiology, College of Health and Human Sciences, San José State University, San Jose, California
| | | | - Yoshinori Kagaya
- School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Kanagawa Prefecture, Japan
| | - Luke Lemings
- Conte Sport Performance Therapy, Scottsdale, Arizona
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Vila Dieguez O, Barden JM. Body roll differences in freestyle swimming between swimmers with and without shoulder pain. Sports Biomech 2020; 21:1277-1290. [PMID: 32500807 DOI: 10.1080/14763141.2020.1760923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Several studies have identified body roll as an important variable that affects shoulder pain due to its potential to modify upper limb kinematics. This study aimed to investigate potential differences in body roll between swimmers with and without shoulder pain. Twenty-four competitive swimmers participated in the study, 12 with unilateral shoulder pain and 12 without. Body roll was measured using two tri-axial accelerometers, one at the shoulder and one at the hip, during three trials of 100 m front crawl swimming at three different speeds. The results showed no significant difference in peak body roll angle between groups for the breathing side at the shoulders or hips. However, for the non-breathing side, swimmers with shoulder pain rolled significantly less at the hips (49º vs 57º, p = 0.018, r = 0.931) while no significant difference was found at the shoulders. These findings suggest that a potential relationship between hip rotation and shoulder pain may exist, such that hip roll is diminished to the non-breathing side in swimmers with unilateral shoulder pain. Given that a cause-effect relationship cannot be inferred from this cross-sectional study, future studies should attempt to identify the mechanisms that link body roll to the aetiology and pathomechanics of shoulder pain.
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Affiliation(s)
- Oscar Vila Dieguez
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, SK, Canada
| | - John M Barden
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, SK, Canada
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Courseault J, Labbe A, Mercer C, Moran A, Weldy J. Rehabilitation of the Throwing Athlete—How to Get Them Back to Sport. OPER TECHN SPORT MED 2020. [DOI: 10.1016/j.otsm.2020.150737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Cools AM, Maenhout AG, Vanderstukken F, Declève P, Johansson FR, Borms D. The challenge of the sporting shoulder: From injury prevention through sport-specific rehabilitation toward return to play. Ann Phys Rehabil Med 2020; 64:101384. [PMID: 32320753 DOI: 10.1016/j.rehab.2020.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 12/26/2022]
Abstract
Shoulder injuries and sports-related shoulder pain are substantial burdens for athletes performing a shoulder loading sport. The burden of shoulder problems in the athletic population highlights the need for prevention strategies, effective rehabilitation programs, and a individually based return-to-play (RTP) decision. The purpose of this clinical commentary is to discuss each of these 3 challenges in the sporting shoulder, to assist the professional in: (1) preventing injury; (2) providing evidence-based practice rehabilitation and; (3) to guide the athlete toward RTP. The challenges for injury prevention may be found in the search for (the interaction between) relevant risk factors, develop valid screening tests, and implement feasible injury prevention programmes with maximal adherence from the athletes. Combined analytical and functional testing seems mandatory screening an athlete's performance. Many questions arise when rehabilitating the overhead athlete, from exercise selection, over the value of stretching, toward kinetic chain implementation and progression to high performance training. Evidence-based practice should be driven by the available research, clinical expertise and the patient's expectations. Deciding when to return to sport after a shoulder injury is complex and multifactorial. The main concern in the RTP decision is to minimize the risk of re-injury. In the absence of a "gold standard", clinicians may rely on general guidelines, based on expert opinion, regarding cutoff values for normal range of motion, strength and function, with attention to risk tolerance and load management.
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Affiliation(s)
- Ann M Cools
- Dept. of Rehabilitation Sciences, Faculty of Health Sciences, Campus UZ Gent, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000 Gent, Belgium; Dept. of Occupational and Physical Therapy and Institute of Sports Medicine, University of Copenhagen, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, Denmark.
| | - Annelies G Maenhout
- Dept. of Rehabilitation Sciences, Faculty of Health Sciences, Campus UZ Gent, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000 Gent, Belgium
| | - Fran Vanderstukken
- Dept. of Rehabilitation Sciences, Faculty of Health Sciences, Campus UZ Gent, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000 Gent, Belgium
| | - Philippe Declève
- Dept. of Rehabilitation Sciences, Faculty of Health Sciences, Campus UZ Gent, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000 Gent, Belgium; Dept. of Physical Therapy, Institut Parnasse-ISEI, Avenue Mounier 84, 1200 Brussels, Belgium
| | - Fredrik R Johansson
- Sophiahemmet University, Musculoskeletal & Sports Injury Epidemiology Center, Box 5605, 114 86 Stockholm, Sweden
| | - Dorien Borms
- Dept. of Rehabilitation Sciences, Faculty of Health Sciences, Campus UZ Gent, Ghent University, Corneel Heymanslaan 10, B3, entrance 46, 9000 Gent, Belgium
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Richardson E, Lewis JS, Gibson J, Morgan C, Halaki M, Ginn K, Yeowell G. Role of the kinetic chain in shoulder rehabilitation: does incorporating the trunk and lower limb into shoulder exercise regimes influence shoulder muscle recruitment patterns? Systematic review of electromyography studies. BMJ Open Sport Exerc Med 2020; 6:e000683. [PMID: 32405430 PMCID: PMC7202723 DOI: 10.1136/bmjsem-2019-000683] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate the influence of trunk and lower limb motion on electromyography (EMG) muscle activity and recruitment patterns around the shoulder. DESIGN Systematic review. DATA SOURCES MEDLINE, CINAHL, PEDro, AMED, PubMed, Cochrane Central Register of Controlled trials, Cochrane Database of Systematic reviews, SportsDiscuss and PROSPERO. ELIGIBILITY CRITERIA Studies investigating both multiregional kinetic chain (KC) shoulder exercises and localised non-kinetic chain (nKC) shoulder exercises in healthy subjects under the same experimental conditions were included in this review. RESULTS KC exercises produced greater EMG activation levels in 5 of 11 studies for the lower trapezius. Of the remaining studies, five found no difference between the exercise types and one favoured nKC exercises. KC exercises produced greater EMG activation levels in 5 of 11 studies for the serratus anterior. Of the remaining studies, three reported the opposite and three found no significant difference between the exercise types. nKC exercises produced greater EMG activation in infraspinatus in three of four studies. KC exercises produced the lowest trapezius muscle ratios in all studies. Studies investigating the upper trapezius, middle trapezius, supraspinatus, subscapularis, biceps brachii, latifissimus dorsi, pectoralis major, deltoid, and trapezius and serratus anterior ratios showed inconsistency. CONCLUSION This review found evidence that integrating the KC during shoulder rehabilitation may increase axioscapular muscle recruitment, produce lower trapezius muscle ratios and reduce the demands on the rotator cuff. Stepping appears preferable to squatting. PROSPERO REGISTRATION NUMBER CRD42015032557, 2015.
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Affiliation(s)
- Eleanor Richardson
- Department of Physiotherapy, BMI The Alexandra Hospital, Cheadle, UK
- Faculty of Health Psychology and Social Care, Manchester Metropolitan University, Didsbury, Manchester, UK
| | - Jeremy S Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
- Therapy Department London, Central London Community Healthcare NHS Trust, London, UK
- Department of Physical Therapy and Rehabilitation Sciences, Qatar University, Doha, Qatar
| | - Jo Gibson
- Department of Physiotherapy, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
- The School of Health Sciences, University of Liverpool, Liverpool, UK
| | - Chris Morgan
- High Performance Unit, Medical Department, Arsenal Football Club, London, UK
| | - Mark Halaki
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Karen Ginn
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Gillian Yeowell
- Faculty of Health Psychology and Social Care, Manchester Metropolitan University, Didsbury, Manchester, UK
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Baritello O, Khajooei M, Engel T, Kopinski S, Quarmby A, Mueller S, Mayer F. Neuromuscular shoulder activity during exercises with different combinations of stable and unstable weight mass. BMC Sports Sci Med Rehabil 2020; 12:21. [PMID: 32226628 PMCID: PMC7098120 DOI: 10.1186/s13102-020-00168-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 03/04/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Recent shoulder injury prevention programs have utilized resistance exercises combined with different forms of instability, with the goal of eliciting functional adaptations and thereby reducing the risk of injury. However, it is still unknown how an unstable weight mass (UWM) affects the muscular activity of the shoulder stabilizers. Aim of the study was to assess neuromuscular activity of dynamic shoulder stabilizers under four conditions of stable and UWM during three shoulder exercises. It was hypothesized that a combined condition of weight with UWM would elicit greater activation due to the increased stabilization demand. METHODS Sixteen participants (7 m/9 f) were included in this cross-sectional study and prepared with an EMG-setup for the: Mm. upper/lower trapezius (U.TA/L.TA), lateral deltoid (DE), latissimus dorsi (LD), serratus anterior (SA) and pectoralis major (PE). A maximal voluntary isometric contraction test (MVIC; 5 s.) was performed on an isokinetic dynamometer. Next, internal/external rotation (In/Ex), abduction/adduction (Ab/Ad) and diagonal flexion/extension (F/E) exercises (5 reps.) were performed with four custom-made-pipes representing different exercise conditions. First, the empty-pipe (P; 0.5 kg) and then, randomly ordered, water-filled-pipe (PW; 1 kg), weight-pipe (PG; 4.5 kg) and weight + water-filled-pipe (PWG; 4.5 kg), while EMG was recorded. Raw root-mean-square values (RMS) were normalized to MVIC (%MVIC). Differences between conditions for RMS%MVIC, scapular stabilizer (SR: U.TA/L.TA; U.TA/SA) and contraction (CR: concentric/eccentric) ratios were analyzed (paired t-test; p ≤ 0.05; Bonferroni adjusted α = 0.008). RESULTS PWG showed significantly greater muscle activity for all exercises and all muscles except for PE compared to P and PW. Condition PG elicited muscular activity comparable to PWG (p > 0.008) with significantly lower activation of L.TA and SA in the In/Ex rotation. The SR ratio was significantly higher in PWG compared to P and PW. No significant differences were found for the CR ratio in all exercises and for all muscles. CONCLUSION Higher weight generated greater muscle activation whereas an UWM raised the neuromuscular activity, increasing the stabilization demands. Especially in the In/Ex rotation, an UWM increased the RMS%MVIC and SR ratio. This might improve training effects in shoulder prevention and rehabilitation programs.
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Affiliation(s)
- Omar Baritello
- Clinical Exercise Science, Department Sports and Health Science Medicine, University Outpatient Clinic Potsdam, University of Potsdam, Am Neuen Palais 10, House 12, 14469 Potsdam, Germany
| | - Mina Khajooei
- Clinical Exercise Science, Department Sports and Health Science Medicine, University Outpatient Clinic Potsdam, University of Potsdam, Am Neuen Palais 10, House 12, 14469 Potsdam, Germany
| | - Tilman Engel
- Clinical Exercise Science, Department Sports and Health Science Medicine, University Outpatient Clinic Potsdam, University of Potsdam, Am Neuen Palais 10, House 12, 14469 Potsdam, Germany
| | - Stephan Kopinski
- Clinical Exercise Science, Department Sports and Health Science Medicine, University Outpatient Clinic Potsdam, University of Potsdam, Am Neuen Palais 10, House 12, 14469 Potsdam, Germany
| | - Andrew Quarmby
- Clinical Exercise Science, Department Sports and Health Science Medicine, University Outpatient Clinic Potsdam, University of Potsdam, Am Neuen Palais 10, House 12, 14469 Potsdam, Germany
| | - Steffen Mueller
- Computer Science and Therapy Science, Trier University of Applied Science, Schneidershof, 54293 Trier, Germany
| | - Frank Mayer
- Clinical Exercise Science, Department Sports and Health Science Medicine, University Outpatient Clinic Potsdam, University of Potsdam, Am Neuen Palais 10, House 12, 14469 Potsdam, Germany
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21
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Borms D, Maenhout A, Cools AM. Incorporation of the Kinetic Chain Into Shoulder-Elevation Exercises: Does It Affect Scapular Muscle Activity? J Athl Train 2020; 55:343-349. [PMID: 32160060 DOI: 10.4085/1062-6050-136-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Scapular rehabilitation exercises should focus on selective activation of weaker muscles and minimal activation of hyperactive muscles. For rehabilitation of overhead athletes, single-plane open chain exercises below 90° of shoulder elevation are often recommended. Moreover, incorporating the kinetic chain in shoulder rehabilitation exercises is advised and has been suggested to influence scapular muscle activity levels. OBJECTIVE To study the influence of kinetic chain incorporation during 5 variations of a shoulder-elevation exercise on scapular muscle activity. DESIGN Cross-sectional study. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty-one asymptomatic participants (15 men, 16 women). MAIN OUTCOME MEASURE(S) The electromyographic activity of the upper (UT), middle (MT), and lower (LT) trapezius, and serratus anterior was determined during 5 variations of bilateral elevation with external rotation: (1) open-hand position (reference exercise), (2) closed-hand position, (3) dynamic bipedal squat, (4) static unipedal squat, and (5) dynamic unipedal squat on the contralateral leg. All data were normalized as a percentage of maximal voluntary isometric contraction (MVIC). RESULTS A closed-hand position (exercise 2) instead of an open-hand position (exercise 1) resulted in lower MT (mean difference = 3.44% MVIC) and LT (mean difference = 7.76% MVIC) activity. Incorporating the lower limb (exercises 3-5) increased UT activity when compared with exercise 1 (mean differences = 3.67, 2.68, 5.02% MVIC, respectively), which in general resulted in increased UT : MT ratios. Additionally, LT activity decreased when a dynamic unipedal squat was added (mean difference: 4.90% MVIC). For the serratus anterior, the greatest activity occurred during elevation in a static unipedal squat position (exercise 4, 22.90% MVIC). CONCLUSIONS Incorporating the kinetic chain during shoulder-elevation exercises influenced scapular muscle activity and ratios. In particular, incorporating the lower limb resulted in more UT activity, whereas the open-hand position increased MT and LT activity.
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Affiliation(s)
- Dorien Borms
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, Belgium
| | - Annelies Maenhout
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, Belgium
| | - Ann M Cools
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, Belgium
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Abstract
During the protective phase of treatment, therapy for hand and wrist injuries in athletes is similar to the plan of care provided to all patients. The nuances in the care provided to athletes become apparent during the transition to the postprotective phase of rehabilitation when the focus has shifted to return to play. Therapy following a sports injury should address the individual needs of the athletes in their everyday lives as well as the specificity of their training and sports-specific activities. The factors that influence return to play are discussed.
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Affiliation(s)
- Jane M Fedorczyk
- Center for Hand and Upper Limb Health and Performance, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, 901 Walnut Street, Suite 600, Philadelphia, PA 19107, USA.
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23
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Abstract
After failed conservative management, operative intervention is typically indicated for patients with partial-thickness rotator cuff tears (PTRCTs) with persistent pain and disability symptoms. For PTRCTs involving < 50% of the tendon thickness, debridement with or without acromioplasty resulted in favourable outcomes in most studies. For PTRCTs involving > 50% of the tendon thickness, in situ repair has proven to significantly improve pain and functional outcomes for articular and bursal PTRCTs. The few available comparative studies in the literature showed similar functional and structural outcomes between in situ repair and repair after conversion to full-thickness tear for PTRCTs. Most non-overhead athletes return to sports at the same level as previous to the injury after in situ repair of PTRCTs. However, rates of return to preinjury level of competition for overhead athletes have been generally poor regardless of the utilized technique. During long-term follow-up, arthroscopic in situ repair of articular and bursal PTRCTs produced excellent functional outcomes in most patients, with a low rate of revision.
Cite this article: EFORT Open Rev 2020;5:138-144. DOI: 10.1302/2058-5241.5.190010
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Affiliation(s)
- Luciano A Rossi
- Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
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Zaremski JL, Zeppieri G, Tripp BL. Sport Specialization and Overuse Injuries in Adolescent Throwing Athletes: A Narrative Review. J Athl Train 2020; 54:1030-1039. [PMID: 31633409 DOI: 10.4085/1062-6050-333-18] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A significant number of adolescent athletes throughout the world participate in various throwing-dominant sports, including but not limited to baseball, cricket, handball, softball, track and field throwing events, and water polo. Due to the unique stresses placed on the throwing arm and entire body in these sports, a robust volume of literature has highlighted concerns about sport specialization in these athletes and an associated increased risk of injury, particularly to the dominant shoulder and elbow, with sport specialization. This review will highlight the evidence-based literature for this athletic niche, focusing on risk factors for injury, national and international organizations' recommendations for limiting overuse injuries, principles of conditioning and rehabilitative programs, and potential future areas of research to curb the growing incidence of throwing-related injuries among adolescent throwing athletes.
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Affiliation(s)
- Jason L Zaremski
- Department of Orthopaedics and Rehabilitation, Divisions of Physical Medicine and Rehabilitation, Sports Medicine, & Research, College of Health and Human Performance, University of Florida, Gainesville
| | - Giorgio Zeppieri
- Orthopaedics and Sports Medicine Institute, Physical Therapy, College of Health and Human Performance, University of Florida, Gainesville
| | - Brady L Tripp
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville
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Rodriguez-Santiago B, Castillo B, Baerga-Varela L, Micheo WF. Rehabilitation Management of Rotator Cuff Injuries in the Master Athlete. Curr Sports Med Rep 2019; 18:330-337. [PMID: 31503045 DOI: 10.1249/jsr.0000000000000628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Rotator cuff (RTC) injuries are common in master athletes, especially overhead athletes. Risk factors include aging and degeneration as nonmodifiable and volume of activity, muscle weakness, and loss of motion as modifiable. The clinical presentation involves limited range of motion (ROM), pain at rest and at night. Injury classification into traumatic versus nontraumatic and tendinopathy, partial or full-thickness tears helps to establish a treatment plan. RTC injury rehabilitation protocols are criteria-based, multimodal, and divided into four phases. The acute phase addresses pain, inflammation, ROM, and RTC protection. The recovery phase addresses kinetic chain abnormalities, flexibility, and strength, and the functional phase involves exercises directed toward specific sport activities. Return to sports is based on clinical recovery, kinetic chain principles, and adequate sports technique. Nonsurgical management is recommended in most cases, and surgical management is considered if symptoms progress, especially for full-thickness tears.
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Affiliation(s)
- Belmarie Rodriguez-Santiago
- Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico, School of Medicine, San Juan, PUERTO RICO
| | - Brenda Castillo
- Physical Medicine and Rehabilitation Department-MossRehab, Elkins Park, PA
| | - Luis Baerga-Varela
- Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico, School of Medicine, San Juan, PUERTO RICO
| | - William F Micheo
- Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico, School of Medicine, San Juan, PUERTO RICO
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Erickson BJ, Chalmers PN, D'Angelo J, Ma K, Romeo AA. Performance and return to sport following rotator cuff surgery in professional baseball players. J Shoulder Elbow Surg 2019; 28:2326-2333. [PMID: 31311750 DOI: 10.1016/j.jse.2019.01.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND While many injuries to the rotator cuff in professional baseball players can be managed nonoperatively, recovery fails to occur with nonoperative treatment in some players and surgery on the rotator cuff is performed in an attempt to return to sport (RTS). METHODS All professional baseball players who underwent rotator cuff surgery between 2010 and 2016 were included by use of the Major League Baseball injury database. Demographic and performance data (before and after surgery) for each player were recorded. Preoperative and postoperative performance metrics were then compared. RESULTS Overall, 151 professional baseball players underwent rotator cuff débridement (n = 130) or rotator cuff repair (n = 21). In the rotator cuff repair group, 6 (28.6%) underwent single-row repair, 5 (23.8%) underwent double-row repair, and 10 (47.6%) underwent side-to-side repair. Among the 11 players who underwent either single- or double-row repair, the average number of anchors used per repair was 2.09 ± 1.1 (range, 1-4). Most performance metrics declined following rotator cuff débridement. For players who underwent débridement, the RTS rate was 50.8% (42.3% at the same level or a higher level and 8.5% at a lower level). For players who underwent repair, the RTS rate was 33.3% (14.3% at the same level or a higher level and 19% at a lower level). Most players underwent at least 1 concomitant procedure at the time of rotator cuff surgery. CONCLUSION Rotator cuff débridement is significantly more common than repair in professional baseball players, with 86% of all rotator cuff surgical procedures reported as débridement. RTS rates following débridement and repair are disappointing, at 50.8% and 33.3%, respectively. For players who do return, performance declines after surgery.
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Affiliation(s)
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - John D'Angelo
- Major League Baseball Commissioner's Office, New York, NY, USA
| | - Kevin Ma
- Major League Baseball Commissioner's Office, New York, NY, USA
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Chelli M, Grimberg J, Lefebvre Y, Peduzzi L, Hardy A, Sanchez M, Holzer N, Garret J, Bertiaux S, Kany J, Levigne C, Clavert P. Internal impingement of the shoulder: An international survey of 261 orthopaedic surgeons. Orthop Traumatol Surg Res 2019; 105:S207-S212. [PMID: 31551195 DOI: 10.1016/j.otsr.2019.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/02/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Internal impingement of the shoulder (IIS) is a specific disorder of young overhead-throwing athletes that was first described in 1991. The many non-operative and surgical treatments suggested to date have produced mixed outcomes. The objective of this study was to compare the practices of surgeons in France versus other countries regarding the diagnosis and treatment of IIS. HYPOTHESIS Diagnostic and therapeutic practices regarding IIS differ between surgeons in France and in other countries. MATERIAL AND METHODS A 21-item questionnaire in French and English was emailed to the 1300 members of the French Arthroscopy Society and to surgeons from countries other than France. The questionnaire collected information on knowledge about IIS (2 items), the frequency of IIS in clinical practice (2 items), the diagnosis of IIS (6 items), the non-operative and surgical treatment of IIS (3 and 5 items, respectively), and return-to-sports rates after treatment for IIS (3 items). RESULTS The completed questionnaire was sent back by 261 surgeons, 206 in France and 55 in other countries, including 42 in Japan. Among the respondents, 90% knew about IIS. Experience with IIS in terms of number of patients seen or surgical treatments performed was greater in the international group (45% vs. 19% in France, p<0.001). Posterior shoulder pain in the arm cocking position was the most widely recognised symptom (99% in France, 74% internationally, p<0.001), followed by excessive external rotation during arm abduction (55% vs. 65%, p=0.23). The most commonly sought lesions were those of the postero-superior labrum and articular surface of the rotator cuff. Rotator cuff debridement was among the surgical options according to most respondents (74% vs. 70%). In contrast, postero-superior glenoidplasty was cited almost only by surgeons in France (67% vs. 4%, p<0.001). The proportion of patients who are able to return to sports was estimated at 50% to 75% by most respondents. DISCUSSION Most respondents had theoretical knowledge about IIS, but surgery was rarely performed in France. Only very few athletes in France play baseball, which is responsible for most sports injuries of the shoulder seen in Japan. This fact, combined with differences in the lesions or even the diagnoses, may have contributed to the differences in the responses to the survey items between the French and international groups.
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Affiliation(s)
- Mikaël Chelli
- Institut universitaire locomoteur et du Sport, CHU de Nice, 06000 Nice, France.
| | - Jean Grimberg
- Clinique Jouvenet-Ramsay GDS, 6, square Jouvenet, 75016 Paris, France
| | - Yves Lefebvre
- Rhéna clinique de Strasbourg, 16, Allée De La Robertsau, 67000 Strasbourg, France
| | - Lisa Peduzzi
- Centre chirurgical Émile-Gallé, CHU de Nancy, 54000 Nancy, France
| | | | | | - Nicolas Holzer
- Hôpitaux universitaires de Genève, 4, rue Gabrielle Perret-Gentil, 1211 Geneva 4, Switzerland
| | - Jérôme Garret
- Clinique du parc Lyon, 155, boulevard Stalingrad, 69006 Lyon, France
| | - Simon Bertiaux
- Hôpital privé de l'Estuaire, 505, rue Irène Joliot-Curie, 76620 Le Havre, France
| | - Jean Kany
- Nouvelle clinique de l'union, 31240 Saint-Jean, Martinique, France
| | | | - Philippe Clavert
- Service de chirurgie du membre supérieur, Hautepierre 2, CHRU de Strasbourg, 67000 Strasbourg, France
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- 15, rue Ampère, 92500 Rueil-Malmaison, France
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Glenohumeral external rotation weakness partially accounts for increased humeral rotation torque in youth baseball pitchers. J Sci Med Sport 2019; 23:361-365. [PMID: 31776067 DOI: 10.1016/j.jsams.2019.10.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/27/2019] [Accepted: 10/30/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To examine differences in shoulder internal rotation (IR) torque among youth pitchers of above and below average relative glenohumeral (GH) rotation strength levels. It was hypothesized that differences in IR torque during the pitching motion would could be explained by differences in relative IR and external rotation (ER) strength. DESIGN Descriptive laboratory study. METHODS Isometric GH rotation strength and upper extremity pitching mechanics were assessed in 78 male youth baseball pitchers (12.7±2.0yrs; 1.63±14.0m; 56.9±12.4kg). Shoulder IR torque during the pitch was examined at maximum humeral external rotation (MER) and throughout the arm acceleration phase (ACC). Multivariate analysis of covariance (MANCOVA) was used to examine the differences in pitching IR torque between GH strength groups. RESULTS A significant main effect of ER strength on the dependent variables was present after controlling for fastball velocity (λ=0.855, F2,72=6.13, p=0.003, ηp2=0.145). Follow up univariate tests indicated significant differences in IR torque between strength groups at MER (F1,73=12.36, p<0.001, ηp2=0.145) and during ACC (F1,73=6.65, p= 0.012, ηp2=0.083). Participants who displayed ER strength at or below the group mean experienced greater IR torque at MER and greater average IR torque during ACC than participants who displayed ER strength above the group mean. CONCLUSIONS Weakness of the GH ER musculature partially accounts for increased shoulder IR torque during pitching.
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Vincent HK, Vincent KR. Rehabilitation and Prehabilitation for Upper Extremity in Throwing Sports: Emphasis on Lacrosse. Curr Sports Med Rep 2019; 18:229-238. [PMID: 31385839 DOI: 10.1249/jsr.0000000000000606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Lacrosse imposes multiple simultaneous physical demands during play including throwing and catching a ball while holding a crosse, running, cutting, and jumping. Often, these skills are completed while experiencing contact from another player leading to both on-and-off platform movements. Other motions include defensive blocking and pushing past defenders. Repetitive motions over sustained durations in practice or competition impart mechanical stresses to the shoulder or elbow joints, supportive muscles, and connective tissue. Preparation for lacrosse participation involves bilateral optimization of strength and durability of stabilizer muscles. Passing and shooting skills are encouraged to be equally effective on both sides; therefore, symmetric strength and flexibility are vital for prehabilitation and rehabilitation efforts. This article will: 1) provide insights on the upper-extremity musculoskeletal demands of lacrosse and related sports with similar throwing motion and 2) describe prehabilitation and rehabilitation methods that improve athlete durability and reduce likelihood of upper-extremity injury.
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Affiliation(s)
- Heather K Vincent
- Department of Orthopaedics and Rehabilitation, UF Health Sports Performance Center, University of Florida, Gainesville, FL
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Bashir SF, Nuhmani S, Dhall R, Muaidi QI. Effect of core training on dynamic balance and agility among Indian junior tennis players. J Back Musculoskelet Rehabil 2019; 32:245-252. [PMID: 30248028 DOI: 10.3233/bmr-170853] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The effect of core training on dynamic balance and agility has yet to be established in literature, especially among junior athletes. OBJECTIVE To investigate the effect of core training on dynamic balance and agility among Indian junior tennis players. METHOD Thirty junior tennis players from various parts of Delhi and the national capital region participated in the study. The study featured a pre-test/post-test experimental design. The subjects were divided into the experimental group (mean age = 15.20 ± 0.41, mean BMI = 20.23 ± 1.54) and the control group (mean age = 15.53 ± 1.06, mean BMI = 20.71 ± 1.53). The control group performed regular training, and the experimental group followed a five-week core training program along with regular training. The subjects were evaluated with t-test for agility and the Star Excursion Balance Test (SEBT) for dynamic stability. RESULTS A significant difference was found in the post-test values of agility (t-test p= 0.000) and dynamic balance using SEBT ((anterolateral; p= 0.00), (lateral; p= 0.02), (posterolateral; p= 0.00), (posterior; p= 0.00), (posteromedial; p= 0.01), (medial; p= 0.03), and (anteromedial; p= 0.03)] except in the anterior direction (p= 0.23)) between the experimental and the control group. The experimental group showed a significant difference in the pre- and post-test values of the t-test and SEBT except in the anterior direction. CONCLUSION Core training programs can be incorporated safely with players' regular training to improve their dynamic balance and agility, which can eventually lead to better performance.
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Affiliation(s)
- Syed Fozia Bashir
- Department of Rehabilitation Science, Jamia Hamdard, New Delhi, India
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | | | - Qassim I Muaidi
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia
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Chalmers PN, Erickson BJ, D'Angelo J, Ma K, Romeo AA. Epidemiology of Shoulder Surgery Among Professional Baseball Players. Am J Sports Med 2019; 47:1068-1073. [PMID: 30883189 DOI: 10.1177/0363546519832525] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injuries remain a significant problem for professional baseball players. There is little information regarding the incidence and outcomes of shoulder surgical procedures among these athletes. PURPOSE/HYPOTHESIS To report the incidence, pathology, procedure type, demographics, and return-to-sport (RTS) rate of shoulder surgery among Major League Baseball (MLB) players. Most shoulder procedures would be performed on pitchers with a history of injury; the labrum would be the most commonly involved; and that the RTS rate would be >50%. STUDY DESIGN Descriptive epidemiology study. METHODS All MLB players who underwent surgery between 2012 and 2016 were identified from a database prospectively maintained by MLB. Demographic information and details regarding the procedure were recorded and RTS rates determined. Only those players with a minimum 2-year follow-up were included. RESULTS There were 581 shoulder procedures performed (542 players; pitchers, 60%; incidence, 1.48%). Overall, 19% of surgical procedures were performed on major league players and 81% on minor league players. Most players were between 20 and 25 years old. The majority of procedures were performed on the posterior and anterior labrum. Of these, 67% involved labral repair. Within rotator cuff surgery, 84% involved debridement; most tears were articular sided (87%); and 75% involved the supraspinatus. Overall, 11% of players had prior shoulder surgery, and 76% spent time on the disabled list before surgery. The overall rate of RTS was 63%. Of those who returned, 86% returned to at least the same level of play or higher as before surgery. Of those who returned to their prior level of play, 73% later ascended to a higher level of play or could not ascend to a higher level because they were already in the majors. CONCLUSION Shoulder surgery is uncommon among professional baseball players. Of those players who require surgery, the majority are pitchers and minor league players. Most procedures involve the labrum. Rotator cuff tears are mostly articular-sided supraspinatus tears. The overall RTS rate is 63%. Of those who return, 86% are able to return to the same or higher level of play as before surgery.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | | | - John D'Angelo
- Major League Baseball Commissioner's Office, New York, New York, USA
| | - Kevin Ma
- Major League Baseball Commissioner's Office, New York, New York, USA
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De la Rosa-Morillo F, Galloza-Otero JC, Micheo W. [Shoulder pain rehabilitation in young athletes]. Rehabilitacion (Madr) 2019; 53:85-92. [PMID: 31186101 DOI: 10.1016/j.rh.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/28/2018] [Accepted: 10/12/2018] [Indexed: 06/09/2023]
Abstract
Early specialisation in sports continues to increase and is a risk factor for the incidence of injuries in young athletes. In overhead athletes, the shoulder is the most affected joint, related to a combination of impingement and glenohumeral instability, as well as musculoskeletal immaturity. Identification of risk factors and rehabilitation is usually an effective recovery option for these athletes.
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Affiliation(s)
- F De la Rosa-Morillo
- Medicina Física y Rehabilitación, Hospital General Plaza de la Salud, República Dominicana.
| | - J C Galloza-Otero
- Departamento de Medicina Física, Rehabilitación y Salud Deportiva, Recinto de Ciencias Médicas, Universidad de Puerto Rico, Santo Domingo, República Dominicana, San Juan, Puerto Rico
| | - W Micheo
- Departamento de Medicina Física, Rehabilitación y Salud Deportiva, Recinto de Ciencias Médicas, Universidad de Puerto Rico, Santo Domingo, República Dominicana, San Juan, Puerto Rico
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Repair of the Ulnar Collateral Ligament of the Elbow: Rehabilitation Following Internal Brace Surgery. J Orthop Sports Phys Ther 2019; 49:253-261. [PMID: 30862273 DOI: 10.2519/jospt.2019.8215] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Injuries to the elbow in athletes who play overhead sports, especially in baseball pitchers, continue to increase in frequency. The anterior band of the ulnar collateral ligament (UCL), the primary restraint to valgus stress, is commonly injured from throwing. Historically, such injuries have been treated with surgical reconstruction techniques, using a tendon autograft. A recently developed UCL repair procedure with an internal brace, utilizing collagen tape, is gaining popularity. The primary goal of this surgery is to enhance elbow joint stability while the ligament is healing and to allow earlier return to sport after UCL reconstruction. The rehabilitation program following UCL repair with internal brace progresses through a different time frame than after UCL reconstruction. The purpose of this commentary, based on our experience with more than 350 cases, including 79 patients with at least a 1-year postsurgical follow-up, was to describe and provide the rationale for the rehabilitation process following UCL repair with internal brace. J Orthop Sports Phys Ther 2019;49(4):253-261. doi:10.2519/jospt.2019.8215.
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Garner S, Wicke J, Legreaux S, Chianchiano B. Effects of deceleration-focused exercise strategies on shoulder range of motion and throwing velocity in baseball and softball athletes. Sports Biomech 2019; 20:86-95. [PMID: 30702384 DOI: 10.1080/14763141.2018.1556325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study examined the effects of deceleration-focused exercises on shoulder range of motion and throwing velocity in both softball and baseball players. Volunteers included 28 Division III William Paterson University baseball and softball athletes (18 females and 10 males), who were evenly distributed across two groups both undertaking 14 sessions of either resistance band or handheld medicine ball exercises (band vs. ball group). A pre-test and post-test measured participants' best active internal/external shoulder rotation and best throwing velocity at a target 40 ft away. A two-tailed, independent t-test showed no significant differences in velocity, internal rotation or external rotation (p < 0.01) between the band and ball groups. However, the average change in velocity in the ball group was double that of the band group (1.50 ± 2.06 m/s versus 0.73 ± 2.24 m/s). For change in both internal and external rotation the band group (2.86 ± 5.27° and 3.29 ± 3.87°, respectively) was greater than the ball mean (1.93° ± 3.32° and 1.29 ± 6.52°, respectively). These findings suggest that overhead athletes aiming to increase throwing velocity can benefit from performing deceleration training with weighted balls whereas resistance bands appear to improve shoulder rotation.
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Affiliation(s)
- Sara Garner
- Department of Kinesiology, William Paterson University , Wayne, NJ, USA
| | - Jason Wicke
- Department of Kinesiology, William Paterson University , Wayne, NJ, USA
| | - Samantha Legreaux
- Department of Kinesiology, William Paterson University , Wayne, NJ, USA
| | - Ben Chianchiano
- Department of Kinesiology, William Paterson University , Wayne, NJ, USA
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Laudner KG, Wong RH, Latal JR, Meister K. Descriptive Profile of Lumbopelvic Control in Collegiate Baseball Pitchers. J Strength Cond Res 2018; 32:1150-1154. [PMID: 29570160 DOI: 10.1519/jsc.0000000000001946] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Laudner, K, Wong, R, Latal, J, and Meister, K. Descriptive profile of lumbopelvic control in collegiate baseball pitchers. J Strength Cond Res 32(4): 1150-1154, 2018-Throwing a baseball requires the transmission of forces generated in the lower extremity, through the trunk, then to the upper extremity, and ultimately out through the ball. Disruptions in this kinetic chain, specifically in lumbopelvic control, have been associated with decreased pitching performance and increased risk of injury. The purpose of this study was to establish normative data of lumbopelvic control among collegiate baseball pitchers. Data were compared bilaterally and with a group of nonthrowing physically active individuals. Eighteen asymptomatic pitchers and 30 nonthrowing subjects participated in this study. Each subject performed 6 separate tests bilaterally: single-leg balance, single-leg mini-squat, and static single-leg bridge. An iPod-based tilt sensor was placed around the waist of each subject and used to determine the amount of anterior-posterior lumbopelvic tilt during each test. Independent t tests showed that neither group had any bilateral differences in lumbopelvic control (p > 0.10). The groups had similar lumbopelvic tilt values during the single-leg balance (p > 0.08) and mini-squat tests (p > 0.72), but a significant difference during the bridge maneuver. For this test, the pitchers had less lumbopelvic control than the control group for both the lead leg (p = 0.003) and trail leg (p = 0.01). The descriptive values of this study may assist in designing lumbopelvic conditioning programs with the intent of enhancing pitching performance, as well as in the prevention, evaluation, and treatment of various injuries associated with lumbopelvic control deviations.
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Affiliation(s)
- Kevin G Laudner
- School of Kinesiology and Recreation, Illinois State University, Normal, Illinois
| | - Regan H Wong
- Texas Metroplex Institute for Sports Medicine and Orthopedics, Arlington, Texas
| | - James R Latal
- School of Kinesiology and Recreation, Illinois State University, Normal, Illinois
| | - Keith Meister
- Texas Metroplex Institute for Sports Medicine and Orthopedics, Arlington, Texas
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Okamoto S, Endo Y, Saito R, Nakazawa R, Sakamoto M. Three-dimensional kinematic analysis of glenohumeral, scapular, and thoracic angles at maximum shoulder external rotation associated with baseball shadow pitching: comparison with normal pitching. J Phys Ther Sci 2018; 30:938-942. [PMID: 30034102 PMCID: PMC6047959 DOI: 10.1589/jpts.30.938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/25/2018] [Indexed: 01/03/2023] Open
Abstract
[Purpose] The glenohumeral, scapular, and thoracic angles at maximum shoulder external
rotation during shadow pitching were evaluated and compared with those observed during
normal pitching. [Participants and Methods] Our study included 13 healthy males with
experience in pitcher activity. All participants performed both, shadow pitching using a
towel and normal pitching using a ball. The external rotation of the glenohumeral joint,
scapular posterior tilting, and thoracic extension angles in the cocking phase were
measured using a 3-dimensional motion analysis system. The ratios of the glenohumeral
external rotation angle to the scapular posterior tilting and/or thoracic extension angle
were calculated to evaluate the contribution of the scapulothoracic joint at maximum
external rotation during throwing/pitching activity. [Results] The glenohumeral external
rotation angle at maximum shoulder external rotation was significantly smaller during
shadow pitching than during normal pitching. The ratio of the glenohumeral external
rotation angle to the scapular posterior tilting and/or thoracic extension angle showed no
statistically significant difference. [Conclusion] We conclude that shadow pitching can
reduce the external rotation motion of the glenohumeral joint compared to that during
normal pitching and might be a useful pre-throwing program beneficial in the
rehabilitation of those presenting with throwing injuries.
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Affiliation(s)
- Shogo Okamoto
- Graduate School of Health Sciences, Gunma University: 3-39-22 Showa, Maebashi, Gunma 371-8514, Japan.,Department of Rehabilitation, Gunma Chuo Hospital, Japan
| | - Yasuhiro Endo
- Division of Physical Therapy, Sendai Seiyo Gakuin College, Japan
| | - Ryuta Saito
- Graduate School of Health Sciences, Gunma University: 3-39-22 Showa, Maebashi, Gunma 371-8514, Japan.,Department of Rehabilitation, Gunma Chuo Hospital, Japan
| | - Rie Nakazawa
- Graduate School of Health Sciences, Gunma University: 3-39-22 Showa, Maebashi, Gunma 371-8514, Japan
| | - Masaaki Sakamoto
- Graduate School of Health Sciences, Gunma University: 3-39-22 Showa, Maebashi, Gunma 371-8514, Japan
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Saper M, Shung J, Pearce S, Bompadre V, Andrews JR. Outcomes and Return to Sport After Ulnar Collateral Ligament Reconstruction in Adolescent Baseball Players. Orthop J Sports Med 2018; 6:2325967118769328. [PMID: 29780844 PMCID: PMC5954308 DOI: 10.1177/2325967118769328] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: The number of ulnar collateral ligament (UCL) reconstructions in adolescent athletes has increased over the past 2 decades. Clinical results in this population have not been well studied. Purpose/Hypothesis: The purpose of this study was to evaluate the outcomes and return to sport after UCL reconstruction in a large group of adolescent baseball players. We hypothesized that excellent clinical outcomes and high rates of return to sport would be observed in this population at a minimum 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: We reviewed 140 adolescent (aged ≤19 years) baseball players who underwent UCL reconstruction with the American Sports Medicine Institute (ASMI) technique by a single surgeon. Medical records were reviewed for patient demographics, injury characteristics, operative details, and surgical complications. Patient-reported outcomes were assessed using the Conway scale, the Andrews-Timmerman (A-T) score, the Kerlan-Jobe Orthopaedic Clinic (KJOC) score, and a 0- to 100-point subjective scale for elbow function and satisfaction. Return to sporting activity was assessed using a custom-designed questionnaire. Results: The mean age at the time of surgery was 18.0 years (range, 13-19 years), and the mean follow-up was 57.9 months (range, 32.4-115.4 months). Over half (60%) of patients were high school athletes. The mean duration of symptoms before surgery was 6.9 months (range, 0.5-60.0 months). Partial tears were identified in 57.9% of patients, and 41.3% of patients had preoperative ulnar nerve symptoms. Graft type included the ipsilateral palmaris in 77.1% of patients. Concomitant procedures were performed in 25% of patients. Outcomes on the Conway scale were “excellent” in 86.4% of patients. The mean A-T and KJOC scores were 97.3 ± 6.1 and 85.2 ± 14.6, respectively. Mean patient satisfaction was 94.4. Overall, 97.8% of patients reported returning to sport at a mean of 11.6 months (range, 5-24 months), and 89.9% of patients returned to sport at the same level of competition or higher. A total of 11.6% of patients went on to play professional baseball. Conclusion: UCL reconstruction with the ASMI technique is an effective surgical option in adolescents, with excellent outcome scores. At a minimum of 2-year follow-up, nearly 90% of patients returned to their preinjury level of sport.
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Affiliation(s)
- Michael Saper
- Department of Orthopedics and Sports Medicine, Seattle Children's, Seattle, Washington, USA
| | - Joseph Shung
- Department of Orthopaedic Surgery, University of South Alabama, Mobile, Alabama, USA
| | - Stephanie Pearce
- Department of Orthopaedic Surgery, University of South Alabama, Mobile, Alabama, USA
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children's, Seattle, Washington, USA
| | - James R Andrews
- Andrews Institute for Orthopaedics & Sports Medicine, Gulf Breeze, Florida, USA
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The proximal-to-distal sequence in upper-limb motions on multiple levels and time scales. Hum Mov Sci 2017; 55:156-171. [DOI: 10.1016/j.humov.2017.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/06/2017] [Accepted: 08/14/2017] [Indexed: 01/12/2023]
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Marquez-Lara A, Stone AV, Luo TD, Parker BR, Sharma A, Freehill MT. Top 50 cited journal articles on overhead throwing athletes: a bibliographic analysis. JSES OPEN ACCESS 2017; 1:55-62. [PMID: 30675541 PMCID: PMC6340857 DOI: 10.1016/j.jses.2017.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The frequency of citations for a journal article is a reflection of its academic impact. The purpose of this study was to identify and characterize the top 50 cited journal articles related to overhead throwing athletes in the published literature. Methods The Web of Science database was searched on January 18, 2016, using the terms "throwing athlete," "baseball," and "pitcher" to identify the top 50 cited articles related to overhead throwing athletes using the all-database function. The type of study, country of origin, publishing journal, and year published were reviewed for each article. Results The top 50 articles identified were cited between 95 and 471 times and were published in 13 journals between 1969 and 2011. Most of the articles were small case series or nonsystematic literature reviews. The shoulder was the most common body region studied in the top 50 articles (33 of 50 [66%]). Among original studies (n = 43), there was a good representation of surgical management of shoulder and elbow pathology in overhead athletes (9 of 43 [20.9%]); however, most of the articles reported on shoulder and elbow kinematics (19 of 43 [44.2%]) and pathoanatomy (15 of 43 [34.9%]). Conclusion The greater prevalence of nonsurgical articles may reflect a continued effort to better understand the different pathologies specific to overhead throwing athletes. An understanding of the variable content and quality of frequently cited articles on overhead throwing athletes may serve as a stepping stone for future studies to advance the diagnosis and management of complex elbow and shoulder injuries in these high functional individuals.
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Affiliation(s)
- Alejandro Marquez-Lara
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Austin V Stone
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - T David Luo
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Benjamin R Parker
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Aman Sharma
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, MI, USA
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Wright AA, Hegedus EJ, Tarara DT, Ray SC, Dischiavi SL. Exercise prescription for overhead athletes with shoulder pathology: a systematic review with best evidence synthesis. Br J Sports Med 2017; 52:231-237. [PMID: 28404557 DOI: 10.1136/bjsports-2016-096915] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To produce a best evidence synthesis of exercise prescription used when treating shoulder pathology in the overhead athlete. DESIGN A systematic review of exercises used in overhead athletes including case studies and clinical commentaries. DATA SOURCES MEDLINE, PubMed, SPORTDiscus and CINAHL from database inception through July 8, 2016. METHODS We examined data from randomised controlled trials and prospective cohort (level I-IV evidence) studies that addressed exercise intervention in the rehabilitation of the overhead athlete with shoulder pathology. Case studies and clinical commentaries (level V evidence) were examined to account for expert opinion-based research. Data were combined using best evidence synthesis and graded (A-F) recommendations (Centre for Evidence-Based Medicine). RESULTS There were 33 unique exercises in six level I-IV studies that met our inclusion criteria. Most exercises were single-plane, upper extremity exercises performed below 90o of elevation. There were 102 unique exercises in 33 level V studies that met our inclusion criteria. These exercises emphasised plyometrics, kinetic chain and sport-specific training. CONCLUSIONS AND RELEVANCE Overall, evidence for exercise interventions in overhead athletes with shoulder pathology is dominated by expert opinion (grade D). There is great variability between exercise approaches suggested by experts and those investigated in research studies and the overall level of evidence is low. The strongest available evidence (level B) supports the use of single-plane, open chain upper extremity exercises performed below 90° of elevation and closed chain upper extremity exercises. Clinical expert pieces support a more advanced, global treatment approach consistent with the complex, multidimensional nature of sport.
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Affiliation(s)
- Alexis A Wright
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA
| | - Eric J Hegedus
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA
| | - Daniel T Tarara
- Department of Exercise Science, High Point University, High Point, North Carolina, USA
| | - Samantha C Ray
- Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Steven L Dischiavi
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA
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Erickson BJ, Chalmers PN, Bach BR, Dines JS, Verma NN, Bush-Joseph CA, Cohen SB, Romeo AA. Length of time between surgery and return to sport after ulnar collateral ligament reconstruction in Major League Baseball pitchers does not predict need for revision surgery. J Shoulder Elbow Surg 2017; 26:699-703. [PMID: 28325273 DOI: 10.1016/j.jse.2017.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/18/2017] [Accepted: 01/19/2017] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Pitchers who return to sport (RTS) sooner will have a higher risk of revision ulnar collateral ligament reconstruction (UCLR) than those who return later. METHODS All professional (major and minor league) baseball pitchers who underwent UCLR between 1974 and 2016 were identified. Date of the index UCLR was recorded. The date of the first game back at any professional level after surgery and the date the pitcher returned to the same level of play (if applicable) were recorded. Length of time between these dates was compared for pitchers who required a revision UCLR and those who did not. RESULTS Overall, 569 pitchers (average age, 24.8 ± 4.1 years) underwent UCLR and had reliable game logs after surgery. No statistically significant difference existed in the length of time to RTS at any professional level or at the same professional level between those pitchers who did not require a revision UCLR and those who did (P = .442, P = .238). Pitchers who required revision UCLR returned to any level of play almost 2 months earlier (14.7 vs. 16.5 months) and returned to the same level of play >2 months earlier (15.2 vs. 17.7 months) than matched controls who did not require revision UCLR, although this was not statistically significant (P = .179, P = .204). CONCLUSION No statistically significant difference existed in the length of time to RTS after UCLR in professional baseball players who required a revision UCLR and those who did not.
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Affiliation(s)
- Brandon J Erickson
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, Washington University at St. Louis, St. Louis, MO, USA
| | - Bernard R Bach
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Joshua S Dines
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | | | - Steven B Cohen
- Department of Orthopedic Surgery, Thomas Jefferson University, Rothman Institute, Philadelphia, PA, USA
| | - Anthony A Romeo
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
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Zaremski JL, Wasser JG, Vincent HK. Mechanisms and Treatments for Shoulder Injuries in Overhead Throwing Athletes. Curr Sports Med Rep 2017; 16:179-188. [DOI: 10.1249/jsr.0000000000000361] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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