Rehabilitation and Prehabilitation for Upper Extremity in Throwing Sports: Emphasis on Lacrosse

Somatic characteristic, morphological asymmetry and postural stability of youth male canoeists compared to control. A cross-sectional study

OBJECTIVE

To determine the relationships between selected morphological characteristics and the level of body composition asymmetry with postural stability among canoeists and a control group.

METHODS

The sample consisted of 43 males (21 canoeists 21.8±3.29 years and 22 university students 21.7±1.32 years). Measurements included body height and weight. Segmental body composition analysis was assessed using the bioelectrical impedance by determining: fat mass (FM, kg, %), fat-free mass (FFM, kg) and predicted muscle mass (PMM, kg). Postural stability was tested using the BIODEX Balance System. Anterior-posterior stability index (APSI), medial-lateral stability index (MLSI) and overall stability index (OSI) were calculated.

RESULTS

Our findings suggest that the canoeists had statistically lower level of fatty tissue compared to controls. There was a statistically important difference between groups in lower limb FM (% and kg). In both groups morphological asymmetry was observed, but in most cases-in athletes. Asymmetries between right and left arms appeared in all parameters, while asymmetries between right and left legs were noted in all parameters except FM (kg). There were relationships between stature and body weight with postural stability in canoeists. Canoeists demonstrated better balance than controls, particularly in the APSI. For all stability indices, significant differences were observed between right and left legs across all participants.

CONCLUSIONS

Athletes, with larger asymmetries or poorer balance, require more attention to improve performance and reduce the risk of overload injury. Future studies needed to develop sport-specific level of morphofunctional asymmetry which would be optimal for sport results and health as well.

Three-Dimensional Biomechanics of the Trunk and Upper Extremity During Overhead Throwing in Wheelchair Lacrosse Athletes With Spinal Cord Injury

OBJECTIVE

Quantify differences in overhead throwing kinematics between wheelchair lacrosse athletes with spinal cord injury and able-bodied lacrosse athletes.

DESIGN

This is a cross-sectional, prospective study. Motion analysis captured overhead throwing motions of five wheelchair lacrosse athletes with spinal cord injury and six able-bodied lacrosse athletes seated in a wheelchair and standing. Three-dimensional thorax and dominant arm sternoclavicular, acromioclavicular, glenohumeral, elbow, and wrist joint angles, ranges of motion, as well as angular velocities were computed using an inverse kinematics model. Nonparametric tests assessed group differences ( P < 0.05).

RESULTS

Participants with spinal cord injury exhibited less peak thorax axial rotation, ranges of motion, and angular velocity, as well as greater wrist flexion than able-bodied participants seated. Participants with spinal cord injury exhibited less peak thorax axial rotation and lateral bending, ranges of motion, and three-dimensional angular velocities; less peak two-dimensional sternoclavicular joint motion, ranges of motion, and peak angular velocities; less peak acromioclavicular joint protraction angular velocity; less glenohumeral joint adduction-abduction and internal-external rotation motion, ranges of motion, and angular velocities; and greater wrist flexion than able-bodied participants standing.

CONCLUSIONS

Kinematic differences were observed between groups, with athletes with spinal cord injury exhibiting less thorax and upper extremity joint motion and slower joint angular velocities than able-bodied athletes. This knowledge may provide insights for movement patterns and potential injury risk in wheelchair lacrosse.

Fatigue Increases Muscle Activations but Does Not Change Maximal Joint Angles during the Bar Dip

The purpose of this study was to profile and compare the bar dip's kinematics and muscle activation patterns in non-fatigued and fatigued conditions. Fifteen healthy males completed one set of bar dips to exhaustion. Upper limb and trunk kinematics, using 3D motion capture, and muscle activation intensities of nine muscles, using surface electromyography, were recorded. The average kinematics and muscle activations of repetitions 2-4 were considered the non-fatigued condition, and the average of the final three repetitions was considered the fatigued condition. Paired t-tests were used to compare kinematics and muscle activation between conditions. Fatigue caused a significant increase in repetition duration (p < 0.001) and shifted the bottom position to a significantly earlier percentage of the repetition (p < 0.001). There were no significant changes in the peak joint angles measured. However, there were significant changes in body position at the top of the movement. Fatigue also caused an increase in peak activation amplitude in two agonist muscles (pectoralis major [p < 0.001], triceps brachii [p < 0.001]), and three stabilizer muscles. For practitioners prescribing the bar dip, fatigue did not cause drastic alterations in movement technique and appears to target pectoralis major and triceps brachii effectively.

Bench, Bar, and Ring Dips: Do Kinematics and Muscle Activity Differ?

The purpose of this study was to profile and compare the kinematics, using 3D motion capture, and muscle activation patterns, using surface electromyography (sEMG), of three common dip variations; the bench, bar, and ring dips. Thirteen experienced males performed four repetitions of each dip variation. For each participant, repetitions 2-4 were time-normalized and then averaged to produce a mean value for all kinematic and sEMG variables. The mean maximal joint angles and mean peak sEMG amplitudes were compared between each variation using a one-way ANOVA with repeated measures. Several significant differences (p < 0.05) between dip variations were observed in both kinematic and sEMG data. The bench dip predominantly targets the triceps brachii but requires greater shoulder extension range. The mean peak triceps brachii activation was 0.83 ± 0.34 mV on the bench, 1.04 ± 0.27 mV on the bar, and 1.05 ± 0.40 mV on the ring. The bar dip is an appropriate progression from the bench dip due to the higher peak muscle activations. The ring dip had similar peak activations to the bar dip, with three muscles increasing their activation intensities further. These findings have implications for practitioners prescribing the dip, particularly to exercisers with a history of shoulder pain and injury.

Musculoskeletal pain in lacrosse officials impacts function on the field

This study determined the prevalence of joint pain among lacrosse officials and described the impact of pain thereof on current officiating duties on the field. Members of the US Lacrosse Officials Development Programme were provided with an electronic survey (a 15.7% response rate resulted in N = 1,441 of completed surveys). Pain sites and severity, previous injuries and current impact of musculoskeletal pain on officiating duties were captured. Pain was present in 18.1-40.1% of respondents at the foot, shoulder, back and knee. A total of 437 officials reported diagnoses of osteoarthritis ([OA]; knee 48.7%, hip 10.5%, spine 10.1%, shoulder 8.0%) and 247 reported OA in more than one joint (p < .05). Officials with OA or previous lacrosse-related injuries reported frequent difficulty with running the entire field distance (p < 0.0001), starting and stopping on the field (p < 0.0001), keeping pace (p < 0.0001), focusing on multiple actions of players at once (p < 0.0001), and enjoyment (all p < 0.0001). Musculoskeletal pain is a common, unrecognized issue in this population that interferes with sport officiating functions. Additional study is needed to objectively determine the impact of OA pain and musculoskeletal injuries on measurable performance outcomes on the field and subjective measures of focus, attention and enjoyment.

CONSIDERATION OF SPORT DEMANDS FOR AN 18-YEAR-OLD LACROSSE PLAYER WITH RECALCITRANT SYMPTOMATIC SPONDYLOLYSIS: A CASE REPORT

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.

Running coaches and running group leaders' engagement with, and beliefs and perceived barriers to prehabilitation and injury prevention strategies for runners

OBJECTIVES

To identify which pre-and post-run injury risk reduction activities and prehabilitation (prehab) strategies Coaches and Running Group Leaders (Coaches/RGLs) engage in with runners; to explore their beliefs on why runners get injured; to identify Coaches/RGLs confidence providing injury prevention activities, and what they believe are effective for reducing risk of injury; to identify their perceived barriers to including prehab during running coaching/training.

DESIGN

Survey; Participants: UK Coaches/RGLs (N = 100) OUTCOME MEASURES: Online questionnaire with open, closed and Likert scale questions.

RESULTS

Most Coaches/RGLs performed active warm-ups (97%), cool-downs (94%),gave injury prevention advice (91%), and advice on recovery strategies (84%) during training. Fewer coaches/RGLs incorporated prehab (67%). Although they collectively exhibited a wide range of knowledge, individually there was less consistency and confidence providing this. Prehab was rated as very important for injury risk reduction, with supervision recommended to facilitate runner engagement. Coaches/RGLs found conflicting advice, time, environment, and resistance from runners as barriers to incorporating prehab into training.

CONCLUSION

Coaches/RGLs believe prehab is important for runners however lack of confidence and knowledge appeared to limit the wider inclusion of prehab with runners. Coaches/RGLs welcomed reputable information on prehab from evidence-based sources. This may assist in reducing injury.