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Silva ER, Maffulli N, Migliorini F, Santos GM, de Menezes FS, Okubo R. Function, strength, and muscle activation of the shoulder complex in Crossfit practitioners with and without pain: a cross-sectional observational study. J Orthop Surg Res 2022; 17:24. [PMID: 35033136 PMCID: PMC8760714 DOI: 10.1186/s13018-022-02915-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/03/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The shoulder joint is the most commonly injured joint in CrossFit practitioners, because of the high intensity and loads associated with this sport. Despite the large number of clinical cases, there is a shortage of studies that investigate influence of biomechanical aspects of upper limbs' injuries on CrossFit practitioners. This study hypothesized that there would be a difference in function, strength, and muscle activation between Crossfit practitioners with and without shoulder pain. METHODS We divided 79 Crossfit practitioners into two groups according to whether they reported pain (n = 29) or no pain (n = 50) in the shoulder during Crossfit training. Muscle function, strength, and activation were assessed using the Disability Arm, Shoulder and Hand function questionnaire, Upper Quarter Y Balance Test and Closed Kinetic Chain Upper Extremity Stability Test shoulder tests, isometric muscle strength assessment by manual dynamometry and muscle activation by surface electromyography and pain report. RESULTS The function based on questionnaire was associated with pain (p = 0.004). We observed a statistically significant difference between the two groups only in the surface electromyography activity of the lower trapezius, and in the variables of shoulder pain and function (p = 0.038). CONCLUSION Crossfit practitioners with shoulder pain occurring during training showed good function and stability of the shoulder joint, but there was a reduction in the activation of stabilizing muscles, especially the lower trapezius. Trial registration Registro Brasileiro de Ensaios Clinico (Brasilian National Registry) with the ID: RBR-2gycyv.
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Affiliation(s)
- Elisa Raulino Silva
- Departamento de Fisioterapia, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brasil
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine, Surgery and Dentistry, Salerno, Italy
- Centre for Sports and Exercise Medicine at Queen, Mary University of London, London, UK
- Institute of Science and Technology in Medicine, Keele University School of Medicine, Stoke-on-Trent, UK
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Gilmar Moraes Santos
- Departamento de Fisioterapia, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brasil
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brasil
| | - Fábio Sprada de Menezes
- Departamento de Fisioterapia, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brasil
| | - Rodrigo Okubo
- Departamento de Fisioterapia, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brasil
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brasil
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Disantis AE, Martin R. Movement System Dysfunction Applied to Youth and Young Adult Throwing Athletes. Int J Sports Phys Ther 2022; 17:90-103. [PMID: 35024209 PMCID: PMC8720247 DOI: 10.26603/001c.30022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
Shoulder and elbow injuries in overhead athletes, especially baseball pitchers, have become more common and result in limited participation. Upper extremity injuries in baseball can occur secondary to high velocity repetitive loading at extreme ranges of motion causing microtrauma to the musculoskeletal structures. With the vast number of youth and young adult baseball players in the United States and the increasing number of throwing related injuries, it is crucial that clinicians can perform a movement system evaluation of the throwing motion. An adequate evaluation of the movement system as it relates to the throwing motion can provide insight into abnormal throwing mechanics and provide rationale for selecting appropriate interventions to address identified impairments that may lead to injury. The purpose of this clinical commentary is to present a recommended movement system evaluation that can be utilized during both pre-season and in-season to assess for modifiable injury risk factors in youth and young adult baseball players. LEVEL OF EVIDENCE 5.
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Affiliation(s)
| | - RobRoy Martin
- Department of Physical Therapy, Duquesne University; University of Pittsburgh Medical Center, Center for Sports Medicine
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Upper Quarter Y Balance test performance: Normative values for healthy youth aged 10 to 17 years. PLoS One 2021; 16:e0253144. [PMID: 34143826 PMCID: PMC8213051 DOI: 10.1371/journal.pone.0253144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
Background The Upper Quarter Y Balance test (YBT-UQ) is a field test for measuring shoulder mobility/stability. However, there is a lack of information regarding age- and sex-specific reference values for classifying the YBT-UQ performance of children and adolescents. Objective The aim was to investigate YBT-UQ performance in youth and to provide age- and sex-specific normative values. Method Six hundred and sixty-five persons (325 girls, 340 boys) aged between 10 and 17 years carried out the YBT-UQ test. Following this, maximum reach values, normalised in terms of arm length, were calculated for each arm (i.e., left and right) and reach direction (i.e., medial [MD], inferolateral [IL], superolateral [SL]), and the composite score (CS) per arm. Additionally, percentiles were displayed graphically and in tabular form, distinguished according to age and gender. Results In boys, those aged 14–15 years showed a higher achievement (e.g., MD direction) compared with both younger (12–13-year-olds) and older (16–17-year-olds) persons. In girls, differences related to age could only be observed for the IL direction and the CS, where the youngest age group (10–11-year-olds) achieved better results than the older groups. Sex-specific differences to the girls’ advantage could be observed in 12–13-year-olds (i.e., SL and CS), and to the boys’ advantage in 14–15-year-olds (i.e., for all reach directions) and 16–17-year-olds (i.e., IL and SL direction and CS). Further, curvilinear developments were observed with regard to the 10th, 50th, and 90th percentiles, and were more strongly marked in boys than in girls. Conclusions The obtained age- and sex-specific normative values for the YBT-UQ can be used by teachers, coaches, and therapists to classify the level of shoulder mobility/stability among 10–17 year-old children and adolescents.
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Heick JD, Haggerty J, Manske RC. A Comparison of Resting Scapular Posture and the Davies Closed Kinetic Chain Upper Extremity Stability Test. Int J Sports Phys Ther 2021; 16:835-843. [PMID: 34123535 PMCID: PMC8168985 DOI: 10.26603/001c.23425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In orthopaedic practice, it is well established that weak scapular stabilizers and an unstable scapula is related to shoulder dysfunction. Faulty scapular position has been linked to decreased scapular stability and is thought to be a result of weak or unbalanced timing in the recruitment of scapulothoracic dynamic stabilizing muscles. Kibler has described a four-type classification of scapulothoracic dysfunction. Functional performance testing is used to objectively measure activities that simulate various desired activities. The reliability of assessing the four static scapular positions may be important in diagnosing shoulder dysfunction. An understanding of the scapular position and its relationship to functional performance testing is needed. PURPOSE The purpose of this study was to determine if a static scapular test, the Kibler scapula classification, in healthy participants affects the ability to perform a closed chain functional test that involves the use of the scapula and the upper extremity, the Davies Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). A secondary analysis was performed to evaluate the reliability of a student physical therapist and an experienced physical therapist to identify scapular type by observation. STUDY DESIGN Multicenter, single session descriptive cohort. METHODS Sixty-one healthy participants (33 males, 28 females; mean age 24.19±2.61) completed testing across two locations in one testing session. Blood pressure and heart rate as well as height and weight were measured for each participant. Participants were classified by visual observation of Kibler scapular classification. The average number of CKUEST touches, a normalized score, and a power score were calculated for each participant. Three trials were performed and participants were required to take a 45-second rest break between each CKCUEST trial. RESULTS One way analysis of variance (ANOVA) showed statistically significant differences in Type I and Type IV Kibler scapula classification for the CKCUEST power score, however when an ANCOVA controlled for body mass index, there was no statistically significant difference. A strong correlation r=.94 was observed between student and experienced physical therapist in evaluating all four types of Kibler scapular classification. CONCLUSIONS Visually observed Kibler scapular position does not affect the ability to perform the Davies CKCUEST in healthy young adults. The ability to identify Kibler scapular position was reliable between student and experienced physical therapists. Additional studies are required to identify the usefulness of the Kibler scapular position classification. LEVEL OF EVIDENCE 2b: Individual Cohort Study.
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THE NONOPERATIVE REHABILITATION OF A TRAUMATIC COMPLETE ULNAR COLLATERAL LIGAMENT TEAR OF THE ELBOW IN A HIGH SCHOOL WRESTLER: A CASE REPORT. Int J Sports Phys Ther 2020; 15:1211-1221. [PMID: 33344036 DOI: 10.26603/ijspt20201211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Injuries frequently occur in competitive wrestling, with the elbow joint representing about 25% of all injuries. Specific to the elbow, the ulnar collateral ligament (UCL) can be injured traumatically from takedowns in wrestling. In athletes with complete UCL tears, surgical management is often recommended with nonoperative management resulting in less favorable outcomes. The purpose of this case report is to present a nonoperative criterion-based rehabilitation program for a high school wrestler with a complete UCL tear of the elbow. Case Description A 17-year-old male wrestler presented to outpatient physical therapy with a complete UCL tear sustained from falling on an outstretched hand during a wrestling match. He presented with limited elbow range of motion (ROM), medial elbow instability, and weakness of the involved shoulder and forearm musculature. A three staged criterion-based rehabilitation protocol was developed for this subject based on specific criteria, including pain, elbow ROM, arm strength, and functional outcomes. Outcomes The subject was treated for nine visits over six weeks, and demonstrated improvements in all strength tests of the involved upper extremity, with elbow flexion strength improving the most by 58%. Return to sport (RTS) tests were used to assess the subject's ability to return to practice. At approximately eight weeks after initial injury, the subject was able to return to full participation in competitive wrestling with no reports of elbow pain or instability. Discussion Through the utilization of a criterion-based rehabilitation protocol for the nonoperative management of an UCL injury, this high school wrestler was able to safely progress back to wrestling without pain or instability in an accelerated time frame. Previously, no detailed rehabilitation guidelines for nonoperative management of UCL injuries in contact sports have been described. Additionally, few studies exist which report on the inclusion of RTS testing following an injury to the UCL of the elbow, as RTS testing is optimal for determining readiness for sport. Level of Evidence 4, Case Report.
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Fanning E, Maher N, Cools A, Falvey EC. Outcome Measures After Shoulder Stabilization in the Athletic Population: A Systematic Review of Clinical and Patient-Reported Metrics. Orthop J Sports Med 2020; 8:2325967120950040. [PMID: 32984424 PMCID: PMC7498977 DOI: 10.1177/2325967120950040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/07/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Athletic endeavor can require the “athletic shoulder” to tolerate significant
load through supraphysiological range and often under considerable
repetition. Outcome measures are valuable when determining an athlete’s safe
return to sport. Few data are available to guide a clinician’s choice from
the variety of measures available. Purpose: To describe the use of quantifiable objective outcome measures and
patient-reported outcome tools after glenohumeral joint stabilization,
specifically in an athletic population. The secondary aim of our study was
to assess whether the method of measurement used was clearly described and
standardized to aid clinical interpretation. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of MEDLINE, Scopus, SPORTDiscus, and Web of Science
databases was performed in December 2018 based on the PRISMA (Preferred
Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. After
the application of selection criteria, a full review of identified papers,
and screening of reference lists, a total of 62 studies were included in the
review. All studies were independently appraised for quality, predefined
data fields were populated and cross-checked for accuracy, and results were
then summarized from these data fields. Results: Of the 62 included studies, 94% used a quantifiable objective clinical
outcome. A majority (85%) of the studies measured range of motion, 21%
recorded muscle strength, 5% measured electromyographic activity, 5%
examined shoulder kinematics, and 3% assessed joint proprioception after
surgery. However, only 18% of the studies clearly described a standardized
method of measuring the outcome. Nearly all (95%) of the studies used at
least 1 patient-reported outcome measure. The Rowe score was most commonly
used (35%). Conclusion: We must standardize and clearly describe the use of quantifiable objective
outcome measures to aid clinical interpretation. A concerted effort should
also be made to standardize the use of patient-reported outcome tools after
shoulder stabilization in the athletic population.
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Affiliation(s)
- Edel Fanning
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,University College Cork, Cork, Ireland
| | - Natasha Maher
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, West Yorkshire, UK
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Gent, Belgium
| | - Eanna C Falvey
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,University College Cork, Cork, Ireland
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Bauer J, Schedler S, Fischer S, Muehlbauer T. Relationship between Upper Quarter Y Balance Test performance and throwing proficiency in adolescent Olympic handball players. BMC Sports Sci Med Rehabil 2020; 12:50. [PMID: 32874591 PMCID: PMC7457287 DOI: 10.1186/s13102-020-00199-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/20/2020] [Indexed: 11/24/2022]
Abstract
Background Olympic handball is a sport mainly focused on executing throwing and passing techniques with the throwing arm. Functional specialization due to the unilateral characteristic and dominance of the throwing arm may lead to adapted control of shoulder stability and mobility. Thus, we examined side differences between the throwing and the non-throwing arm. Additionally, correlations between the Upper Quarter Y Balance Test (YBT-UQ) and handball-specific performance measures were investigated. Methods All participants (F = 13 yrs., n = 14, training experience [te] 5.9 ± 1.3 yrs.; M = 14 yrs., n = 24, te 6.5 ± 2.5 yrs.; M = 15 yrs., n = 18, te 9.3 ± 2.2 yrs) were Olympic handball players of a regional youth selection team. YBT-UQ was executed assessing performance in medial, inferolateral and superolateral reach direction normalized to the upper limb length together with a composite score of the mean of all reach directions. A radar gun and a target net were used for the assessment of throwing velocity and throwing accuracy. The paired t-test was used to detect side differences in YBT-UQ performance. Pearson’s correlation analysis was calculated for associations between YBT-UQ and throwing velocity/accuracy. Results Significant differences between the throwing and non-throwing arm were only detected for the superolateral reach direction in the 14-year-old males. Small correlations between YBT-UQ performance and throwing velocity/accuracy (13-year-old females: − 0.01 ≤ r ≤ − 0.37 / 0.01 ≤ r ≤ 0.31; 14-year-old males: 0.10 ≤ r ≤ 0.45 / -0.01 ≤ r ≤ .-0.51; 15-year-old males: 0.06 ≤ r ≤ 0.34 / 0.01 ≤ r ≤ − 0.45) were observed, irrespective of age and sex category. Conclusions There was only a minimal difference in performance of the YBT-UQ between the throwing and non-throwing arm and only weak if any relationships between throwing performance and stability/mobility of the upper extremities in adolescent Olympic handball players existed. Further research is needed to investigate whether the YBT-UQ is a useful tool to detect training-related improvements in measures of shoulder stability/mobility and functional performance.
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Affiliation(s)
- Julian Bauer
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, Gladbecker Str. 182, 45141 Essen, Germany
| | - Simon Schedler
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, Gladbecker Str. 182, 45141 Essen, Germany
| | - Stephan Fischer
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, Gladbecker Str. 182, 45141 Essen, Germany
| | - Thomas Muehlbauer
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, Gladbecker Str. 182, 45141 Essen, Germany
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Decleve P, Van Cant J, De Buck E, Van Doren J, Verkouille J, Cools AM. The Self-Assessment Corner for Shoulder Strength: Reliability, Validity, and Correlations With Upper Extremity Physical Performance Tests. J Athl Train 2020; 55:350-358. [PMID: 32053404 DOI: 10.4085/1062-6050-471-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Rotator cuff weakness and rotation ratio imbalances are possible risk factors for shoulder injury among overhead athletes. In consensus statements, organizations have highlighted the importance of a screening examination to identify athletes at risk of injury. The screening should be portable and designed to be feasible in many different environments and contexts. OBJECTIVE To evaluate the reliability and validity of the Self-Assessment Corner (SAC) for self-assessing shoulder isometric rotational strength and examining whether performance on 2 physical performance tests was correlated with isometric shoulder rotational strength using the SAC in handball players. DESIGN Cross-sectional study. SETTING Sport setting. PATIENTS OR OTHER PARTICIPANTS A first sample of 42 participants (18 men, 24 women) was recruited to determine the reliability and validity of the SAC. In a second sample of 34 handball players (18 men, 16 women), we examined correlations between physical performance tests and the SAC. MAIN OUTCOME MEASURE(S) The SAC was used to measure isometric rotational strength with the upper extremity at 90° of abduction in the frontal plane and 90° of external rotation and the elbow flexed to 90° with neutral rotation of the forearm. The SAC findings were compared with those from manual testing. Results from the seated medicine ball throw (SMBT) and closed kinetic chain upper extremity stability test (CKCUEST) were used to establish relationships with the SAC. We calculated intraclass correlation coefficients to determine relative reliability and used standard error of measurement and minimal detectable change to quantify absolute reliability. Relationships among the different strength-testing procedures and with the physical performance tests were determined using the Pearson product moment correlation coefficient (r) or Spearman rank correlation coefficient (rs). RESULTS We observed good to excellent reliability (intraclass correlation coefficient [2,k] range = 0.89 to 0.92). The standard error of measurement varied from 3.45 to 3.48 N. The minimal detectable change with 95% confidence intervals ranged from 8.06 to 8.13 N. Strong correlations were present among strength procedures (r = 0.824, rs range = 0.754-0.816). We observed moderate to strong correlations between the CKCUEST findings and rotational strength (r range = 0.570-0.767). Moderate correlations were found between rotational strength and SMBT (r range = 0.573-0.626). CONCLUSIONS The SAC is a clinically applicable and standardized protocol for self-assessing rotational strength in young healthy adults without pathologic conditions. Performance on the SMBT and CKCUEST may be valuable as a screening tool to further assess shoulder strength.
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Affiliation(s)
- Philippe Decleve
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, Belgium.,Department of Physical Therapy, Institut Parnasse-ISEI, Brussels, Belgium
| | - Joachim Van Cant
- Department of Physical Therapy, Institut Parnasse-ISEI, Brussels, Belgium
| | - Ellen De Buck
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, Belgium
| | - Justine Van Doren
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, Belgium
| | - Julie Verkouille
- 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
PURPOSE OF REVIEW The objectives of this review are to evaluate the current evidence-based literature and concepts surrounding rehabilitation in patients with anterior shoulder instability injuries and surgical repair. RECENT FINDINGS The current literature evidence for shoulder rehabilitation for anterior shoulder instability and labral repair is limited. As a result, there are variations among surgeons and physical therapists in rehabilitation protocols after anterior shoulder instability injuries and repair. While general consensus on certain rehabilitation parameters exists, the evidence for the importance of rehabilitation and functional performance test for return to sport in future injury prevention is still lacking in literature. Rehabilitation after anterior shoulder instability injury and anterior labral repair is paramount in the injured or post-operative shoulder. Restoration of soft tissue mobility, dynamic glenohumeral joint stability, and balance and strength around the shoulder not only protect healing of injured or repaired soft tissues but also potentially minimizes future re-injury or recurrence risk.
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