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Fontánez R, De Jesus K, Frontera WR, Micheo W. Return to Sports Following Shoulder Injury: Clinical Evaluation, Isokinetic, and Functional Testing. Curr Sports Med Rep 2023; 22:191-198. [PMID: 37294193 DOI: 10.1249/jsr.0000000000001072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
ABSTRACT The shoulder is commonly injured in overhead sports. This is associated with a high degree of mobility at the expense of stability, sports specific demands, high volume or intensity of practice and competition, biomechanical deficits, and poor technique. Following injury, the return to competition process includes nonsurgical or surgical treatment, comprehensive rehabilitation, and a structured return to sports program. The return to sports continuum is divided into phases which include return to practice of the sport, return to competition at a lower level or with reduced performance, and return to expected performance. Components of the return to sports decision include clinical evaluation of physical and psychological readiness, measurement of muscle strength using isokinetic tests, evaluation of overhead functional tasks, and progression in a supervised interval throwing program. The evidence for the effectiveness of return to sports programs following shoulder injury is limited but evolving and is an area that will merit continued investigation.
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Affiliation(s)
- Richard Fontánez
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico, School of Medicine, San Juan, PUERTO RICO
| | - Kevin De Jesus
- Physical Medicine and Rehabilitation, Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico, School of Medicine, San Juan, PUERTO RICO
| | - Walter R Frontera
- Department of Physical Medicine, Rehabilitation and Sports Medicine, Professor, Department of Physiology, University of Puerto Rico, School of Medicine, San Juan, PUERTO RICO
| | - William Micheo
- Sports Medicine Fellowship Director, Department of Physical Medicine Rehabilitation and Sports Medicine, University of Puerto Rico, School of Medicine, San Juan, PUERTO RICO
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Torres-Banduc MA, Jerez-Mayorga D, Moran J, Keogh JWL, Ramírez-Campillo R. Isokinetic force-power profile of the shoulder joint in males participating in CrossFit training and competing at different levels. PeerJ 2021; 9:e11643. [PMID: 34616590 PMCID: PMC8451436 DOI: 10.7717/peerj.11643] [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: 01/21/2021] [Accepted: 05/28/2021] [Indexed: 01/10/2023] Open
Abstract
Background As participants who engage in CrossFit training and competition perform a large volume of high intensity overhead activities, injuries to the shoulder are one of the most common in this sport. Previous research in other sports has indicated that the isokinetic force power profile of the shoulder joint (IPSJ) rotator muscles may assist in the prediction of shoulder injury. Aim Therefore, the objective of this study was to determine the IPSJ in males engaged in CrossFit training at different competitive levels. Methods In a cross-sectional study design, participants (age, 24.1 ± 2.7 years) classified as ‘beginner’ (n = 6), ‘intermediate’ (n = 7) or ‘advanced’ (n = 9) provided informed consent to participate in this study. The IPSJ assessment involved rotational and diagonal movements, including internal and external shoulder rotator muscles, at both 180°.s−1 and 300°.s−1. The variables analysed were peak torque/body mass (%), mean power (W) and the external/internal peak torque/body mass ratio (%). A Kruskal–Wallis test was used to compare the IPSJ of the three groups, with Dunn’s test used for post-hoc analysis. The alpha level was set at p < 0.05. Results The IPSJ showed greater torque and power values in those who competed at the advanced level as compared to those at a lower competitive level (i.e. intermediate, beginner). This was observed mainly for the internal rotation and internal diagonal movements at both 180°.s−1 and 300°.s−1. However, such differences between competitive levels were, in general, absent for the external rotation and external diagonal movements. Moreover, the participants from the advanced competitive level exhibited an imbalance of peak torque between the muscles responsible for the external–internal rotational and external-internal diagonal movements of the shoulder (i.e. peak torque external/internal ratio <66%), particularly in the dominant shoulder. Conclusion These findings suggest greater development of the shoulder internal rotators and a higher probability of shoulder injury in CrossFit athletes at the advanced competitive level. Based on these results, participants engaged in CrossFit training and competition may wish to increase the volume of training for the shoulder external rotator muscles to complement the large increases in shoulder internal rotator strength that occur as a part of their regular training regimes.
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Affiliation(s)
- Maximiliano A Torres-Banduc
- Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad de Las Americas, Viña del Mar, Chile.,Escuela de Ciencias de la Salud, Universidad de Viña del Mar, Viña del Mar, Chile.,Department Physical Education and Sports. Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Daniel Jerez-Mayorga
- Facultad de Ciencias de la Rehabilitación, Universidad Andres Bello, Santiago, Chile
| | - Jason Moran
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Essex, United Kingdom
| | - Justin W L Keogh
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.,Sports Performance Research Centre New Zealand, AUT University, Auckland, New Zealand.,Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sunshine Coast, Australia.,Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Influence of Shoulder Position on Functional Control Ratio During Isokinetic Assessment. J Sport Rehabil 2020; 29:588-593. [PMID: 31094638 DOI: 10.1123/jsr.2018-0432] [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: 11/21/2018] [Revised: 02/20/2019] [Accepted: 03/24/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT One of the possible mechanisms leading to secondary impingement syndrome may be the strength imbalance of shoulder rotators which is known as functional control ratio (FCR). The FCR is a ratio dividing the eccentric peak torque of the external rotators by the concentric peak torque of the internal rotators. Previous studies have focused on the reproducibility and reliability of isokinetic assessment, but there is little information on the influence of variable shoulder positions on FCR. OBJECTIVE To compare shoulder FCR across 3 different shoulder abduction positions during isokinetic assessment. DESIGN Cross-sectional study. SETTING Biomechanics laboratory. PARTICIPANTS Thirty-one healthy young university students (age 22.35 [0.95] y, weight 60.52 [9.31] kg, height 168.23 [9.47] cm). INTERVENTIONS The concentric peak torque of internal rotators and eccentric peak torque of external rotators of right shoulder were measured on an isokinetic dynamometer. MAIN OUTCOME MEASURES Concentric peak torque of the internal rotators and eccentric peak torque of the external rotators, measured using an isokinetic dynamometer. RESULTS The concentric peak torque of internal rotators was significantly lower at 120° shoulder abduction compared with other positions (P < .001). The FCR was significantly higher at 120° shoulder abduction than 90° (P = .002) or 60° (P < .001) shoulder abduction because of the lower concentric peak torque. No significant difference was found in the FCR between the other 2 shoulder positions (P = .14). CONCLUSIONS Shoulder position variations may influence FCR because of weakness of the internal rotators. Rehabilitation and injury prevention training programs should specifically focus on strengthening the internal rotators at more elevated angles of shoulder abduction.
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Fredriksen H, Cools A, Bahr R, Myklebust G. Does an effective shoulder injury prevention program affect risk factors in handball? A randomized controlled study. Scand J Med Sci Sports 2020; 30:1423-1433. [PMID: 32293738 DOI: 10.1111/sms.13674] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Shoulder problems are common in handball, but injury risk reduction is possible by implementing a prevention program. However, player compliance to the program remains a challenge, with feedback from players that the program is too time consuming. AIM To develop a more efficient program, we aimed to assess the effect of the Oslo Sports Trauma Research Center shoulder injury prevention program on external rotation (ER) strength and internal rotation (IR) range of motion (ROM), considered to represent key risk factors for injury. METHODS Four youth handball teams (three females, one males, 57 players, mean age 17.1 years) were randomized to an intervention or control group. The intervention program was conducted three times per week as a part of handball warm-up for 18 weeks, supervised by physical therapists. The main outcome variables were the between-group differences in ER strength and IR ROM change from baseline to postintervention. Isometric ER strength was measured with a handheld dynamometer and IR ROM with a digital goniometer. RESULTS Mean dominant shoulder isometric ER strength increased both in the intervention (10%) and the control group (6%) during the intervention, but there was no significant group by time interaction (group difference: 0.06 N/kg (95% CI: -0.04 to 0.17). IR ROM did not change in either group during the intervention. CONCLUSION The Oslo Sports Trauma Research Center shoulder injury prevention program did not affect the risk factors ER strength and IR ROM. The preventive effect of the program must therefore be due to other factors.
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Affiliation(s)
- Hilde Fredriksen
- Oslo Sports Trauma Research Center, Sports Medicine Department, Norwegian School of Sport Sciences, Oslo, Norway
| | - Ann Cools
- Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Sports Medicine Department, Norwegian School of Sport Sciences, Oslo, Norway
| | - Grethe Myklebust
- Oslo Sports Trauma Research Center, Sports Medicine Department, Norwegian School of Sport Sciences, Oslo, Norway
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Achenbach L, Laver L, Walter SS, Zeman F, Kuhr M, Krutsch W. Decreased external rotation strength is a risk factor for overuse shoulder injury in youth elite handball athletes. Knee Surg Sports Traumatol Arthrosc 2020; 28:1202-1211. [PMID: 30927025 DOI: 10.1007/s00167-019-05493-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Overuse shoulder injuries are common in youth handball, but research is limited. The purpose of this study was to identify pre-season risk factors associated with overuse shoulder injuries in this population. METHODS One-hundred and thirty-eight (70 boys and 68 girls) youth elite players (age 14.1 ± 0.8 years, height 175.2 ± 8.2 cm, weight 64.0 ± 9.6 kg) completed a pre-season screening protocol. Passive glenohumeral range of motion and maximum external (ER) and internal rotation (IR) strength were measured with a manual goniometer and a hand-held dynamometer. Scapular dyskinesia and maximum throwing velocity were also assessed. Players completed standardised questionnaires over the 2017-2018 season and reported any overuse shoulder symptoms. RESULTS Decreased isometric and eccentric ER strength was identified as a risk factor for overuse shoulder injury, both for absolute (OR 10.70, 95% CI 1.2-95.6, p = 0.034) and normalised ER strength (OR 1.2, 95% CI 1.0-1.4, p = 0.015) and the ER:IR strength ratio (OR 1.2, 95% CI 1.1-1.5, p = 0.012). ER gain of more than 7.5° (p = 0.025) and GIRD of more than 7.5° (p = 0.014) were identified as risk factors for overuse shoulder injury in girls. Scapular dyskinesia (OR 1.1, n.s.) and maximum throwing velocity did not seem to contribute to injury risk. The average response rate was 63%. CONCLUSION In elite youth handball, deficits in ER strength is a risk factor for overuse shoulder injury for both sexes; ER gain and GIRD are only risk factors for girls. Focused pre-season assessments may aid the identification of risk factors for shoulder overuse injuries and the application of specific programmes to reduce risk. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Leonard Achenbach
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany.
| | - Lior Laver
- The Royal Orthopaedic Hospital, Birmingham, UK
| | - Sven Stephan Walter
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany
| | | | - Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
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Étude de la balance musculaire au cours de mouvements de rotation de l’épaule : fiabilité de la méthode isocinétique par plage angulaire. Sci Sports 2018. [DOI: 10.1016/j.scispo.2018.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Habets B, Staal JB, Tijssen M, van Cingel R. Intrarater reliability of the Humac NORM isokinetic dynamometer for strength measurements of the knee and shoulder muscles. BMC Res Notes 2018; 11:15. [PMID: 29321059 PMCID: PMC5764011 DOI: 10.1186/s13104-018-3128-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/06/2018] [Indexed: 02/06/2023] Open
Abstract
Objective To determine the intrarater reliability of the Humac NORM isokinetic dynamometer for concentric and eccentric strength tests of knee and shoulder muscles. Results 54 participants (50% female, average age 20.9 ± 3.1 years) performed concentric and eccentric strength measures of the knee extensors and flexors, and the shoulder internal and external rotators on two different Humac NORM isokinetic dynamometers, which were situated at two different centers. The knee extensors and flexors were tested concentrically at 60° and 180°/s, and eccentrically at 60° s. Concentric strength of the shoulder internal and external rotators, and eccentric strength of the external rotators were measured at 60° and 120°/s. We calculated intraclass correlation coefficients (ICCs), standard error of measurement, standard error of measurement expressed as a %, and the smallest detectable change to determine reliability and measurement error. ICCs for the knee tests ranged from 0.74 to 0.89, whereas ICC values for the shoulder tests ranged from 0.72 to 0.94. Measurement error was highest for the concentric test of the knee extensors and lowest for the concentric test of shoulder external rotators. Electronic supplementary material The online version of this article (10.1186/s13104-018-3128-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bas Habets
- Sports Medical Center Papendal, Papendallaan 7, 6816 VD, Arnhem, The Netherlands. .,Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht, The Netherlands. .,Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - J Bart Staal
- Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Marsha Tijssen
- Sports Medical Center Papendal, Papendallaan 7, 6816 VD, Arnhem, The Netherlands.,Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Robert van Cingel
- Sports Medical Center Papendal, Papendallaan 7, 6816 VD, Arnhem, The Netherlands.,Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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