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Objectives: To measure short-term post surgery glenohumeral internal and external rotation strength, shoulder range of motion (ROM), and subjective self-report ratings following arthroscopic superior labral (SLAP) repair. Background:... more
Objectives: To measure short-term post surgery glenohumeral internal and external rotation strength, shoulder range of motion (ROM), and subjective self-report ratings following arthroscopic superior labral (SLAP) repair. Background: Physical therapists provide rehabilitation for patients following arthroscopic repair of the superior labrum. Little research has been published regarding the short-term results of this procedure while the patient is typically under the direct care of the physical therapist. Methods: Charts from 39 patients (7 females and 32 males) with a mean age of 43.4±14.9 years following SLAP repair were reviewed. All patients underwent rehabilitation by the same therapist using a standardized protocol and were operated on and referred by the same orthopaedic surgeon. Retrospective chart review was performed to obtain descriptive profiles of shoulder ROM at 6 and 12 weeks post surgery and isokinetically documented internal and external rotation strength 12 weeks post surgery. Results: At 12 weeks post-surgery, involved shoulder flexion, abduction, and external rotation active ROM values were 2-6 degrees greater than the contralateral, non-involved extremity. Isokinetic internal and external rotation strength deficits of 7-11% were found as compared to the uninjured extremity. Patients completed the self-report section of the Modified American Shoulder Elbow Surgeons Rating Scale and scored a mean of 37/45 points. Conclusion: The results of this study provide objective data for both glenohumeral joint ROM and rotator cuff strength following superior labral repair at time points during which the patient is under the direct care of the physical therapist. These results show a nearly complete return of active ROM and muscular strength following repair of the superior labrum and post-operative physical therapy.
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Research Interests: Medicine and Arthroplasty
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Background:Traditional exercises performed with the shoulder in the position of 90° abduction and external rotation with elbow flexion (90/90) while using a single elastic band showed moderate activity of both the lower trapezius (LT) and... more
Background:Traditional exercises performed with the shoulder in the position of 90° abduction and external rotation with elbow flexion (90/90) while using a single elastic band showed moderate activity of both the lower trapezius (LT) and infraspinatus (IS) muscle. The purpose of this study was to investigate activity of the teres minor (TMi) and the LT muscles during standing external rotation exercise with the shoulder in the 90/90 position with 2 elastic bands in both the frontal and the scapular plane.Hypothesis:TMi, IS, and LT muscle activities will vary depending on whether the shoulder is positioned in the frontal or scapular plane with the application of 2 elastic bands. Also, the serratus anterior (SA) and teres major (TMa) muscles will produce different muscular activity patterns during exercises performed with 2 elastic bands in the frontal plane compared with the TMi and LT muscles.Study Design:Controlled laboratory studyLevel of Evidence:Level 4.Methods:A total of 21 collegiate baseball players volunteered to participate. The electromyography (EMG) activities of the TMi, IS, LT, SA, TMa, middle deltoid (MD), posterior deltoid, and upper trapezius (UT) muscles were measured with the 90/90 arm position during both isometric and oscillation resistance exercises with 2 elastic bands oriented in the frontal and scapular planes.Results:A significant difference was observed in EMG activity of both the TMi and the LT muscles between single and double elastic band applications in the frontal plane (P < 0.05). In contrast, EMG activity of the IS, SA, and TMa muscles was significantly increased in the scapular plane compared with the frontal plane (P < 0.05).Conclusion:The standing 90/90 position effectively increased both TMi and LT muscle EMG activity with the double elastic band in the frontal plane while minimizing UT and MD muscle activity. EMG activity of the IS, SA, and TMa muscles increased with exercise in the scapular plane as compared with the frontal plane.Clinical Relevance:Oscillation movement under double elastic band application differentiated external rotator muscle and scapular muscle activities between the frontal and scapular plane during the 90/90 exercise in the frontal plane compared with the scapular plane. Clinicians can utilize each of the scapular and frontal positions based on their desired focus for muscular activation.
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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... more
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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... Louis, Missouri Greg Brittenham, MS New York Knickerbockers Jeff Carlson, PT Howard Head Sports Medicine Centers Michael A. Clark, MS ... Clinic Malachy P. McHugh, PhD The Nicholas Institute of Sports Medicine and Athletic Trauma... more
... Louis, Missouri Greg Brittenham, MS New York Knickerbockers Jeff Carlson, PT Howard Head Sports Medicine Centers Michael A. Clark, MS ... Clinic Malachy P. McHugh, PhD The Nicholas Institute of Sports Medicine and Athletic Trauma Terri Mitchell, PTA Austin, Texas Timothy ...
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The most common overuse injuries in sports medicine are rotator cuff tendinitis and shoulder impingement. Anatomic and biomechanical analysis of the shoulder complex demonstrates the likelihood of overuse injury to this region. Total... more
The most common overuse injuries in sports medicine are rotator cuff tendinitis and shoulder impingement. Anatomic and biomechanical analysis of the shoulder complex demonstrates the likelihood of overuse injury to this region. Total rehabilitation includes relief of inflammation, restoration of normal joint arthrokinematics, and rotator cuff strengthening. The reduction of force overload to the shoulder in sport-specific activities and total arm strengthening are also emphasized in a comprehensive rehabilitation program.
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The measurement of muscular strength of the shoulder internal and external rotators is an integral part of the comprehensive evaluation and treatment of the shoulder joint. The purpose of this study was to compare normal grade (S /S)... more
The measurement of muscular strength of the shoulder internal and external rotators is an integral part of the comprehensive evaluation and treatment of the shoulder joint. The purpose of this study was to compare normal grade (S /S) manual muscle strength with isokinetic testing of the shoulder internal and external rotators. One hundred and fourteen consecutive subjects were tested isokinetically in the supine position with 90° of glenohumeral joint abduction on a Cybex 3S0 dynamometer. Prior to isokinetic testing each patient was tested by two physical therapists using manual muscle testing (MMT) with the shoulder abducted 90° for internal OR) and external (ER) rotation. All subjects were rated as normal (S /S) grade for both IR and ER by both therapists to be included in this investigation. A two factor analysis of variance was used to test for differences between extremities. Results of this study showed significant (P < 0.01) differences between extremities in isokinetic peak torque and single repetition work scores. Differences between extremities ranged from 11 to 28% among a sample with normal grade (MMT). The results of this study identify objective, isokinetically measured discrepancies in muscular strength in subjects rated as 'normal' in shoulder internal and external rotation strength. This study demonstrates the efficacy of isokinetic testing of the shoulder internal and external rotators in clinical rehabilitation and evaluation of the glenohumeral joint.
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Evaluation, treatment, and prevention of musculoskeletal injuries in the overhead athlete require a systematic approach and high-level understanding of the biomechanical stressors, repetitive loading schematics, common injury patterns,... more
Evaluation, treatment, and prevention of musculoskeletal injuries in the overhead athlete require a systematic approach and high-level understanding of the biomechanical stressors, repetitive loading schematics, common injury patterns, and pathology as well as the identification and monitoring of key parameters or factors which have been linked to elevated injury risk in the overhead athlete. To achieve this, the clinician is required to have clinical tools to objectively monitor and evaluate previously identified injury risk factors such as range of motion, muscular strength and endurance, scapular dysfunction, and sports biomechanics. The purpose of this chapter will be to overview several key principles and factors that are required to modify injury risk in the overhead athlete.
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Injuries to the adolescent elbow are common because of the repetitive overuse inherent in many overhead sport activities. The management of these patients is greatly facilitated through a greater understanding of the demands placed on the... more
Injuries to the adolescent elbow are common because of the repetitive overuse inherent in many overhead sport activities. The management of these patients is greatly facilitated through a greater understanding of the demands placed on the upper extremity kinetic chain during these overhead activities as well as a detailed examination and rehabilitation for the entire upper extremity kinetic chain. Particular emphasis on improving rotator cuff strength and muscular endurance, along with scapular stabilization, is a critical part of elbow rehabilitation in these patients. In addition, the use of a strategic and progressive interval sport return program is necessary to minimize reinjury and return the adolescent overhead athlete to full function.
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... However, it is vital during every phase of rehabilitation not to stress healing tissue beyond its tolerance. ... Swelling Swelling is an indicator of an overzealous rehabilitation program. After injury to a joint, there should be very... more
... However, it is vital during every phase of rehabilitation not to stress healing tissue beyond its tolerance. ... Swelling Swelling is an indicator of an overzealous rehabilitation program. After injury to a joint, there should be very minimal to no swelling when a functional progression is ...
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Background: Elite tennis athletes experience injuries throughout the entire body. Impairments in trunk stability, lower limb flexibility, and hip range of motion (ROM) are modifiable risk factors that can impact injuries and performance.... more
Background: Elite tennis athletes experience injuries throughout the entire body. Impairments in trunk stability, lower limb flexibility, and hip range of motion (ROM) are modifiable risk factors that can impact injuries and performance. Information on nonmodifiable risk factors such as age and gender is limited. The purpose of this investigation was to provide information on risk factors to direct clinical decision-making and injury prevention and rehab programming in this population. Hypothesis: Prevalence and location of injuries will differ by age group and gender. Trunk stability, lower limb flexibility, and hip ROM will differ by age group and gender. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: A de-identified database (n = 237; females = 126) from the United States Tennis Association High Performance Profile (HPP) 2014-2015 was used for the analysis. Subjects were elite junior and professional tennis players (mean age 14.6 [range, 9-27] years). T...
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... However, it is vital during every phase of rehabilitation not to stress healing tissue beyond its tolerance. ... Swelling Swelling is an indicator of an overzealous rehabilitation program. After injury to a joint, there should be very... more
... However, it is vital during every phase of rehabilitation not to stress healing tissue beyond its tolerance. ... Swelling Swelling is an indicator of an overzealous rehabilitation program. After injury to a joint, there should be very minimal to no swelling when a functional progression is ...
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The best guide for strength band training is now expanded, updated, and better than ever! In this new edition, "Strength Band Training" shows you how to maximize strength, speed, and power in the gym, at home, or on the road.... more
The best guide for strength band training is now expanded, updated, and better than ever! In this new edition, "Strength Band Training" shows you how to maximize strength, speed, and power in the gym, at home, or on the road. With more than 160 exercises and predefined fitness and sport-specific workouts, the book shows you why strength bands are the ultimate tool for targeting, isolating, and developing every major muscle group. Portable and easy to adjust, the bands provide resistance for any level of strength, fitness, or ability. The exercises allow you to add resistance in multiple directions--something free weights and machines cannot do--for resistance routines that can simulate sport-specific demands, strengthen and tone your core, or target muscles to help you prevent or recover from common injuries. Whether you are seeking to improve athletic performance or wish to redefine, sculpt, or shape your physique, " Strength" "Band Training" provides ...
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Background: Epidemiological studies on tennis injuries are mainly conducted in either elite professional or junior players. Injury patterns might differ in the recreational tennis player. Purpose: To investigate acute injuries in the... more
Background: Epidemiological studies on tennis injuries are mainly conducted in either elite professional or junior players. Injury patterns might differ in the recreational tennis player. Purpose: To investigate acute injuries in the recreational tennis–playing population with an additional focus on acute injuries that require surgical treatment. Study Design: Case series; Level of evidence, 4. Methods: A retrospective data analysis was conducted among patients who sustained an acute tennis injury between January 2013 and December 2018 and who had treatment administered at a single university hospital. Demographic data, diagnosis, body region of the trauma, injury mechanism, and treatment methods were recorded. Data were evaluated using descriptive statistics. Results: A total of 449 patients sustained 467 injuries (148 female, 301 male; mean age, 43.6 years; range, 8.2-84.4 years). The injuries occurred throughout the year, with an increased prevalence in the summer months. Injurie...
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Glenohumeral osteoarthritis is a relatively uncommon type of osteoarthritis characterized by loss of anterior or forward flexion. Assessing range of motion, impingement, and strength, combined with radiologic imaging, can help determine... more
Glenohumeral osteoarthritis is a relatively uncommon type of osteoarthritis characterized by loss of anterior or forward flexion. Assessing range of motion, impingement, and strength, combined with radiologic imaging, can help determine the extent of damage. Published studies focus primarily on surgical treatment, but commonly used nonsurgical approaches include anti-inflammatory medications, oral and injectable viscosupplementation, and physical therapy. These conservative measures can be very effective for active patients and also appeal to their physicians who consider shoulder surgery as a last resort.
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Research Interests: Baseball, Adolescent, Medicine, Physical Medicine and Rehabilitation, Humans, and 15 moreShoulder, Rotator cuff, Male, The, Risk factors, Clinical Sciences, Adult, Analysis of Variance, Physical examination, Risk Factors, Rotation, Range of Motion, Scapula, Functional Laterality, and Internal Rotation
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Injuries to the adolescent elbow are common because of the repetitive overuse inherent in many overhead sport activities. The management of these patients is greatly facilitated through a greater understanding of the demands placed on the... more
Injuries to the adolescent elbow are common because of the repetitive overuse inherent in many overhead sport activities. The management of these patients is greatly facilitated through a greater understanding of the demands placed on the upper extremity kinetic chain during these overhead activities as well as a detailed examination and rehabilitation for the entire upper extremity kinetic chain. Particular emphasis on improving rotator cuff strength and muscular endurance, along with scapular stabilization, is a critical part of elbow rehabilitation in these patients. In addition, the use of a strategic and progressive interval sport return program is necessary to minimize reinjury and return the adolescent overhead athlete to full function.
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This study examined the effects of a 6-week strength-training program on serve velocity in youth tennis players. Thirty competitive healthy and nationally ranked male junior tennis players (13 years of age) were randomly and equally... more
This study examined the effects of a 6-week strength-training program on serve velocity in youth tennis players. Thirty competitive healthy and nationally ranked male junior tennis players (13 years of age) were randomly and equally divided into control and training groups. The training group performed 3 sessions (60-70 min) weekly for 6 weeks, comprising core strength, elastic resistance and medicine ball exercises. Both groups (control and training) also performed a supervised stretching routine at the end of each training session, during the 6 week intervention. Service velocity, service accuracy and shoulder internal/external rotation were assessed initially and at the end of the 6-week conditioning program for both, control and training groups. There was a significant improvement in the serve velocity for the training group (p = 0. 0001) after the intervention, whereas in the control group there were no differences between pre and post-tests (p = 0.29). Serve accuracy was not a...
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Plyometric exercises are frequently used to increase posterior rotator cuff and periscapular muscle strength and simulate demands and positional stresses in overhead athletes. The purpose of this study was to provide descriptive data on... more
Plyometric exercises are frequently used to increase posterior rotator cuff and periscapular muscle strength and simulate demands and positional stresses in overhead athletes. The purpose of this study was to provide descriptive data on posterior rotator cuff and scapular muscle activation during upper extremity plyometric exercises in 90° of glenohumeral joint abduction. Levels of muscular activity in the posterior rotator cuff and scapular stabilizers will be high during plyometric shoulder exercises similar to previously reported electromyographic (EMG) levels of shoulder rehabilitation exercises. Descriptive laboratory study. Twenty healthy subjects were tested using surface EMG during the performance of 2 plyometric shoulder exercises: prone external rotation (PERP) and reverse catch external rotation (RCP) using a handheld medicine ball. Electrode application included the upper and lower trapezius (UT and LT, respectively), serratus anterior (SA), infraspinatus (IN), and the m...
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In most shoulder conditions a loss of glenohumeral motion results in shoulder performance impairments. However, in the overhead athlete loss of glenohumeral internal rotation, termed glenohumeral internal rotation deficiency (GIRD), is a... more
In most shoulder conditions a loss of glenohumeral motion results in shoulder performance impairments. However, in the overhead athlete loss of glenohumeral internal rotation, termed glenohumeral internal rotation deficiency (GIRD), is a normal phenomenon that should be expected. Without a loss of glenohumeral internal rotation the overhead athlete will not have the requisite glenohumeral external rotation needed to throw a baseball at nearly 100 miles per hour, or serve a tennis ball at velocities of 120 miles per hour or more. Not all GIRD is pathologic. The authors of this manuscript have defined two types of GIRD; one that is normal and one that is pathologic. Anatomical GIRD (aGIRD) is one that is normal in overhead athletes and is characterized by a loss of internal rotation of less than 18°-20° with symmetrical total rotational motion (TROM) bilaterally. Pathologic GIRD (pGIRD) is when there is a loss of glenohumeral internal rotation greater than 18°-20° with a corresponding...
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Injuries to the ulnar collateral ligament (UCL) in throwing athletes frequently occurs from the repetitive valgus loading of the elbow during the throwing motion, which often results in surgical reconstruction of the UCL requiring a... more
Injuries to the ulnar collateral ligament (UCL) in throwing athletes frequently occurs from the repetitive valgus loading of the elbow during the throwing motion, which often results in surgical reconstruction of the UCL requiring a structured postoperative rehabilitation program. Several methods are currently used and recommended for UCL reconstruction using autogenous grafts in an attempt to reproduce the stabilizing function of the native UCL. Rehabilitation following surgical reconstruction of the UCL begins with range of motion and initial protection of the surgical reconstruction, along with resistive exercise for the entire upper extremity kinetic chain. Progressions for resistive exercise are followed that attempt to fully restore strength and local muscular endurance in the rotator cuff and scapular stabilizers, in addition to the distal upper extremity musculature, to allow for a return to throwing and overhead functional activities. Rehabilitation following UCL reconstruction has produced favorable outcomes, allowing for a return to throwing in competitive environments.