This document discusses screening tests for the shoulder girdle in elite tennis players. It describes studies that examined strength, range of motion, and muscle imbalances in adolescent tennis players in Sweden. The studies found increased upward rotation of the scapula on the dominant side, as well as strength imbalances between dominant and non-dominant sides. MRI screening of elite players found high rates of tendinosis, especially in the infraspinatus and supraspinatus tendons. The implications are that screening can help identify risk factors for injury and guide return-to-play criteria focusing on normal strength, range of motion, and function.
A criteria based progression rehabilitation protocol for hamstring strain injuries presented at the Sports Medicine Australia conference 2015 during the Hamstring symposium
The Epidemic of ACL Injuries in Female Youth Athletesthegraymatters
Orthopedic Grand Rounds at Univ. of Missouri by Aaron Gray, MD, Sports Medicine Specialist. Discusses Epidemiology, risk factors, and focuses on prevention of ACL injuries in female youth athletes.
Mark Sherry
Manager of Sports Rehabilitation at the University of Wisconsin Sports Medicine Center, Physical Therapist, Madison, Wisconsin, USA.
-
Return to Play Guidelines Following Acute Hamstring Strain
(6th MuscleTech Network Workshop)
14th October, Barcelona
Johannes Tol
Sports medicine physician, Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
-
PRP for acute hamstring injuries: a 3-arm RCT in Qatar
(6th MuscleTech Network workshop)
14th October, Barcelona
El registro de diferentes variables relacionadas con el rendimiento de una persona que realiza ejercicio físico (ya sea deportista o no), es un aspecto importante de la valoración de la condición física y del control entrenamiento. Gracias al avance tecnológico de los últimos años y, sobre todo, a la miniaturización de la tecnología, cada vez es más frecuente la aparición de nuevas aplicaciones móviles o wearables destinados al registro de la actividad física. De hecho, durante los años 2016 y 2017 este ha sido el número uno en la lista de tendencias en el ámbito de la actividad física y el deporte desarrollado por el American College of Sport Medicine. Sin embargo, no todas estas son válidas o fiables en el cometido para el que han sido desarrolladas.
En la actualidad, existe una gran cantidad de enfermedades crónicas como puede ser la esclerosis múltiple, el alzheimer o incluso el propio envejecimiento, que no tiene un claro marcador de diagnóstico que permita detectar de manera temprana la aparición o evolución de la patología. Por el contrario, la toma de decisiones a la hora de administrar un tratamiento está basadas, en numerosas ocasiones, en la valoración del deterioro físico del paciente por parte del especialista médico. Para solventar la poca sensibilidad y objetividad de estas evaluaciones observacionales, en la actualidad se están desarrollando test para analizar las cualidades físicas del paciente en base a los sensores inerciales integrados en numeroso dispositivos tales como Smartphones, etc. Esto está permitiendo acercar pruebas de alta sensibilidad con costes clásicamente elevados (ej. posturografía para analizar el equilibrio), al día a día de la exploración clínica.
A criteria based progression rehabilitation protocol for hamstring strain injuries presented at the Sports Medicine Australia conference 2015 during the Hamstring symposium
The Epidemic of ACL Injuries in Female Youth Athletesthegraymatters
Orthopedic Grand Rounds at Univ. of Missouri by Aaron Gray, MD, Sports Medicine Specialist. Discusses Epidemiology, risk factors, and focuses on prevention of ACL injuries in female youth athletes.
Mark Sherry
Manager of Sports Rehabilitation at the University of Wisconsin Sports Medicine Center, Physical Therapist, Madison, Wisconsin, USA.
-
Return to Play Guidelines Following Acute Hamstring Strain
(6th MuscleTech Network Workshop)
14th October, Barcelona
Johannes Tol
Sports medicine physician, Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
-
PRP for acute hamstring injuries: a 3-arm RCT in Qatar
(6th MuscleTech Network workshop)
14th October, Barcelona
El registro de diferentes variables relacionadas con el rendimiento de una persona que realiza ejercicio físico (ya sea deportista o no), es un aspecto importante de la valoración de la condición física y del control entrenamiento. Gracias al avance tecnológico de los últimos años y, sobre todo, a la miniaturización de la tecnología, cada vez es más frecuente la aparición de nuevas aplicaciones móviles o wearables destinados al registro de la actividad física. De hecho, durante los años 2016 y 2017 este ha sido el número uno en la lista de tendencias en el ámbito de la actividad física y el deporte desarrollado por el American College of Sport Medicine. Sin embargo, no todas estas son válidas o fiables en el cometido para el que han sido desarrolladas.
En la actualidad, existe una gran cantidad de enfermedades crónicas como puede ser la esclerosis múltiple, el alzheimer o incluso el propio envejecimiento, que no tiene un claro marcador de diagnóstico que permita detectar de manera temprana la aparición o evolución de la patología. Por el contrario, la toma de decisiones a la hora de administrar un tratamiento está basadas, en numerosas ocasiones, en la valoración del deterioro físico del paciente por parte del especialista médico. Para solventar la poca sensibilidad y objetividad de estas evaluaciones observacionales, en la actualidad se están desarrollando test para analizar las cualidades físicas del paciente en base a los sensores inerciales integrados en numeroso dispositivos tales como Smartphones, etc. Esto está permitiendo acercar pruebas de alta sensibilidad con costes clásicamente elevados (ej. posturografía para analizar el equilibrio), al día a día de la exploración clínica.
Cardiovascular Pathophysiology In the Setting of Spinal Cord InjuryInsideScientific
Dr. Christopher West shares his research that investigates the cardiovascular and autonomic changes that occur following spinal cord injury as well as the efficacy of neuro-therapeutic interventions.
Dr. West’s group uses small and large in vivo animal models to understand how the circuitry that controls the cardiovascular system changes following injury and what the downstream impact of these changes are for heart and blood vessel function. They also use these models to test the efficacy of novel therapies in the both the acute and chronic setting following injury. In the clinical and athletic spinal cord injury population, his group has conducted a number of mechanistic and applied studies to, 1) improve the understanding of how best to hemodynamically manage acutely injured patients, and 2) enhance the capacity of the cardiovascular system to enable an improved exercise response.
This webinar introduces the major cardiovascular changes that have been characterized following spinal cord injury in animal models and the clinical population. Chris shares some exciting results from recent studies in which his group has tested the efficacy of novel therapies to improve cardiovascular function. Finally, he provides his outlook for the future of the field.
Effects of Cooling Versus Active and Passive Recovery Interventions in HandballMarco Iorio
Purpose: Junior male handball players (n=15) were studied to examine the effect of Cooling versus Active and Passive Recovery interventions in the half of two 30 minutes trainings. Methods: Four test batteries (W, T1, Recov, T2) composed of Rate of Perceived Exertion and Thermal Stress Scales, blood samples taken from the earlobe to determine lactate level, countermovement jump, hand grip strength test and 10 meters sprint with light signal reaction time, were used during a simulated handball match. After 10 minutes of warm-up (W), two sessions of 30 minutes training (T1, T2) were separated by an 8 minutes recovery (Recov) period. During Recov one of the three recovery interventions (cooling vest applied on the upper body, cycling and seated rest) was applied. Results: Cycling group showed a lower blood lactate concentration during Recov (p<0><0><0><0,001), lower HR (p=0,039), and a tendency to significantly lower RPE value in Recov (p=0.062). Conclusion: The negative effect of Active Recovery on forearms flexor strength could be the consequence of the isometric arms position during cycling. The results after cold application may be correlated to a brain freshness: longer periods of cooling and different psychological tests may be necessary to better analyze this correlation. Cooling Recovery Intervention, giving a faster Reaction Time, could improve Handball performance.
We report the 11-year follow-up of a premenopausal woman with osteogenesisimperfecta (OI) who
was treated with alendronate. A 41-year-old Japanese premenopausal woman with OI type I who had
frequently experienced painful fragility fractures consulted our clinic because of chronic back pain associated
with spinal osteoporosis. She had undergone heart surgery (aortic valve replacement) because of aortic
regurgitation 5 years before her first consultation with our clinic. After surgery, she began taking warfarin (3
mg/day), and this treatment was continued during our follow-up period. She was treated with alendronate (5
mg/day or 35 mg/week) for 11 years. The patient’s urinary cross-linked N-terminal telopeptides of type I
collagen and serum alkaline phosphatase levels decreased, while the bone mineral density of her lumbar
spine (L2–L4) increased, as measured using dual energy X-ray absorptiometry. The serum calcium and
phosphorus levels stayed within the normal ranges. Three non-vertebral fractures occurred at the hip, ankle,
and ring finger during the 11-year treatment period, but no adverse effects were observed. Thus, the present
case report showed the long-term outcome and safety of alendronate treatment in a premenopausal woman
with OI type I.
"Kinetic chain" approach in rehabilitation - Mrs. Fabienne VandesteenePO-PP-Members
Professional Podiatrists Members' Day 2nd of October 2011
"Kinetic chain" approach in the rehabilitation of an athlete: increasing and decreasing chains
-- Mrs. Fabienne Vandesteene --
This presentation was given at the National Strength and Conditioning Association, Nevada State Clinic in November 2023. It features the following three elements:
1. A case study featuring an elite athlete biomechanical data >1 year post-operative.
2. Sample intervention strategies.
3. Implication for the future and innovative strategies.
Rotator Cuff Update 2022 for Medbelle Len Funk.pptxLennard Funk
the common questions patients will ask once they have had a scan and a tear has been reported, particularly if they have had no injury of trauma, they ask what caused my tear. If I have a tear what can you do to fix it, it’s got to be fixed. How can I get better if it is not fixed. I have already had physiotherapy and that didn’t fix it so how will more physiotherapy. Some patients who are not keen on surgery, do I really need to have an operation. I have not had an injury.
there are multiple options thrown into the mix here which we need to consider for an individual patient.
The below illustration shows a very rough decision making tool that I would use in determining surgical or treatment options for particular patients.
A younger patient who has both pain and weakness with a massive cuff tear, if it is partially repairable a biological augment would be suitable.
If their predominant weakness is external rotation i.e. a positive Hornblower sign but good elevation, a lat dorsi tendon transfer.
For an older patient who has a predominant weakness but no significant pain, deltoid rehabilitation programme is indicated.
If they do have pain, a suprascapular nerve procedure such as an ablation would be beneficial.
For those that have significant pain and weakness with failed non-operative options, a reverse shoulder replacement would be the best option.
The balloon as we said, has a very limited place and this is for the older patient with slight loss of function and pain with higher demands.
For those that have more significant pain and elevation weakness, a superior capsular reconstruction would be my preferred option.
Should We Repair Rotator Cuff Tears OPN 2017.pdfLennard Funk
Lennard Funk & Puneet Monga
Prepared for Orthopaedic Product News, 2017
Rotator cuff disease is very common. There is as much enthusiastic discussion and debate on its management as there was 80 years ago when Codman (1937) first described the pathology and surgical management. There is great variation amongst surgeons as to the management of rotator cuff tears biased by experience and their understanding of the literature, skills levels and regional variations. There has been a lot of research done on the pathology, non-operative and operative treatments over the last two decades. Also, over the last decade there have been massive strides in the development of new surgical techniques and technologies. However, despite these advances there is as much discussion and debate!
Superior Capsular Reconstruction Outcomes Wrightington 2020Lennard Funk
Hariharan Mohan, Jagwant Singh, Michael Walton, Lennard Funk, Puneet Monga
Cautious optimism following SCR may be offered to this challenging subset of patients with symptomatic irreparable rotator cuff tears. It is likely that the relatively low re-operation rates can be further improved by considering the negative prognostic factors in defining indications for surgery. Further studies with longer term followup are recommended.
Isolated scapula pain is uncommon, but very difficult to diagnose and manage. In this presentation I run through the known causes and an approach to the diagnosis, in order to guide best treatment.
The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...Lennard Funk
Presentation at ISAKOS, 2019
There were 442 primary arthroscopic labral repair procedures performed over the three-year period. The total cohort had a mean age of 25.91±9.09 years (range, 14-67 years) and consisted of 89.6% males. There was no significant difference in mean age or gender between the isolated anterior, posterior or combined groups (p=0.383 and p=0.541, respectively).
• Of the 442 patients who underwent a shoulder labral repair, isolated anterior labral pathology occurred in 52.9% (n=234), with posterior and combined labral tears accounting for 16.3% (n=72) and 30.8%, respectively (n=136) (Table 3).
• Patients were stratified as either sporting or non-sporting; 74.9% of patients were categorised as sporting (n=331) and had a mean age of 24.91±5.69 years, which was significantly lower than the mean age of 35.40±11.94 years in the non-sporting population (p<0.001). In the non-sporting population 68.5% (n=76) of patients had isolated anterior labral tears with 12.6% (n=14) posterior and 18.9% (n=21) combined. In the sporting population isolated anterior labral tears accounted for 47.7% (n=158), posterior 17.5% (n=58) and combined labral tears 34.7% (n=115). The sporting population had a significantly greater proportion of posterior and combined labral tears with the non-sporting population a significantly greater proportion of anterior labral tears (p=0.013).
• Rugby players had the greatest incidence of shoulder instability within the sporting cohort accounting for 231 cases. Of the 231 cases, 47.2% were isolated anterior labral tears, 12.6% isolated posterior and 40.3% combined lesions.
Posterior and combined shoulder labral tears are more prevalent than previously reported in the civilian population. The rates are higher in young, sporting populations and especially in contact sports such as rugby.
Pectoralis major allograft reconstructionLennard Funk
Presentation at ISAKOS, 2019
We performed a total of 142 pectoralis major repairs over a ten year period, of which 19 required allograft reconstruction. Of these 19 patients, 11 were available for response. All 11 patients were male with a mean age of 38.3 years (21 to 48 years). The mean time between injury and surgery was 12.2 months (4 to 30 months). Ten patients (91%) were unable to perform their previous level of work pre-operatively, with all patients returning to pre-injury occupation levels post-operatively.
The main complaint prior to surgery was pain on pushing and moving the affected arm across the body, which improved in nine patients (82%), with no improvement reported in two patients. Strength improved significantly post-operatively, with only three patients reporting no improvement (paired t-test p=0.01). Six patients reported an improvement in cosmesis (50%).
Hydrodistention is a treatment for frozen shoulder (FS) that is gaining popularity again. However, no large, long-term outcome data has been published yet. Our aims were to evaluate hydrodistension for the treatment of primary frozen shoulder (FS) in a large cohort of patients with long follow-up period.
We present a case series of eighty-nine patients (36 males and 53 females) with a mean age of 52 years (33-73). Eleven (12.4%) had disease associations. We excluded post-operative secondary stiff shoulders. The mean volume injected was 33.7ml (16-66). 36/89 (40%) had capsular rupture. Six (6.7%) had adverse effects. The mean follow-up was 104.5 weeks (8-238).
Mean improvement in forward flexion was 165.4, abduction 111.6, external rotation was hand above head with elbow back (and internal rotation in extension to T12. Mean improvement in quickDASH score was 17.1 (p<0.001) and Constant Score was 70.0 (p<0.001). Mean improvement in VAS was 7.3 (p<0.001). No patients had night pain (p<0.001). Eighty-eight (99%) returned to their previous occupation. Seventy-six (85%) returned to their previous level of sport. Gender, previous intra-articular steroid injection, volume of the injectate, type of steroid used, capsular rupture and underlying aetiology had no impact on outcome.
Ann cools 4 screening tennis players [compatibiliteitsmodus]
1. SCREENING THE SHOULDER
GIRDLE IN ELITE TENNIS
PLAYERS
Ann Cools, PT, PhD
Dept Rehab. Sciences & Physiotherapy
Ghent University, Belgium
Ann Cools Wrightington Nov 2012 1
2. Purpose of this presentation:
1. Rationale for strength and ROM
screening in the overhead athlete
2. Results from studies on elite
adolescent tennis players (Swedish
Tennis Federation)
3. Implications for injury prevention
programs and return to play criteria
Ann Cools Wrightington Nov 2012 2
3. Why performing screening in
healthy elite overhead athletes?
Performance enhancement: longitudinal
follow up in view of performance/
ranking
Injury prevention - risk factors for
injury and preventive programs
Return to play – normative data and
individual results after injury
Ann Cools Wrightington Nov 2012 3
4. INTERNATIONAL PhD PROJECT:
Age-related adaptations of the shoulder
girdle in elite Swedish adolescent tennis
players
Ann Cools, PT, PhD & Fredrik Johansson, PT, MsC
Ghent University – Gent - Belgium
Swedish Tennis Federation – Stockholm - Sweden
Ann Cools Wrightington Nov 2012 4
5. INTERNATIONAL PhD PROJECT:
Age-related adaptations of the shoulder
girdle in elite Swedish adolescent tennis
players – Fredrik Johansson/Ann Cools
Musculoskeletal tests: shoulder girdle strength,
flexibility, ROM and position
Physical tests: physical capacity, functional
strength, velocity…
Imaging: bilateral MRI both shoulders
Ann Cools Wrightington Nov 2012 5
6. Subjects: Swedish National Selection Tennis
35 players, Age 10-17 years
Number of years playing in competition: 7.1(±1.4) years
Hours playing / week: 13.9 ± 2.4 hours
Male players (n=19) Female players (n=16) p-value independent
t-tests
Age (years) 13.6 (± 1.4) 12.6 (± 1.3) 0.34
Height (cm) 163.6 (± 12) 156.6 (± 10.5) 0.84
Weight (kg) 53 (± 11.8) 46.1 (± 7.8)
Ann Cools Wrightington Nov 2012 0.053 6
11. Discussion
Conflicting results in literature: Scapular
upward (Downar 2005, Myers 2005) or
downward (Laudner 2007, Omaya 2008)
rotation in baseball pitchers
More upward rotation possibly protects
the player from injury
Ann Cools Wrightington Nov 2012 11
12. Results(2)
Scapular Muscle Strength
180
160
* *
140
120
100 ND
80 D
60
40
20
0
UT SA MT LT
Ann Cools Wrightington Nov 2012 12
13. Discussion
Cools et al. 2007 : elite gymnasts
show side differences and muscle
“imbalance” in the scapular muscles
due to high performance adaptations
Trakis et al. 2008: side differences in
MT and LT strength in pitchers with
throwing related shoulder pain
Ann Cools Wrightington Nov 2012 13
14. Results (3)
Pectoralis minor length
13,5
13
12,5
*
12
11,5 * ND
D
11
10,5
10
9,5
female male
Significant side differences with shorter PML on Nov 2012
Ann Cools Wrightington
the dominant side (p<0.001) 14
15. Discussion
Borstad et al. JOSPT 2005:
short PM influences scapular
kinematics and induces
changes similar to
impingement related
dyskinesis
Ann Cools Wrightington Nov 2012 15
16. Limitation of the first study:
Descriptive profile of elite tennis
players 11-17y, no subdivision in
age groups, limited sample size
Only scapular position and strength,
no shoulder measurements
Purpose of the 2nd study: Age-
related changes in shoulder and
scapular variables in elite tennis
players between 10-20 years
Ann Cools Wrightington Nov 2012 16
17. Tennis-screening Båstad/Stockholm-
Sweden April 2009 – April 2011
Subjects: Swedish National Selection Tennis
59 players, age 10-20y
3 age-cathegories: -14y, 14-16y, +16y
31 boys, 28 girls
56 right handed, 3 left handed
N Hours/ Height (cm) Weight (kg)
w
-14y (12,7y±0,8) 24 12,3 154,1 ± 8,8 44,8 ± 6,9
14-16y 22 15,3 168,8 ± 8,4 57,1 ± 9,1
(14,2y±0,4)
+16y (17,4±1,5) 13 15,6 172,4 ± 7,8 72,5 ± 9,0
Ann Cools Wrightington Nov 2012 17
19. Results
(1) Scapular upward rotation:
16+ players have less upward rotation at higher
elevation angles on their dominant side (p=0.012), possibly
increasing the risk for scapular dyskinesis and chronic
Ann Cools Wrightington Nov 2012 19
shoulder pain
20. Results
(2) Scapular Muscle Strength:
4 UT 4 SA
3,5 3
ND
3 ND 2
D D
2,5 1
2 0
-14 14-16 16+ -14 14-16 16+
2 LT 2 MT
1,5 1,5
ND ND
1 1
D D
0,5 0,5
0 0
-14 14-16 16+ -14 14-16 16+
no increase in normalised muscle strength of
scapular stabilizers (middle/lower trap, serr ant), in spite
Ann Cools Wrightington Nov 2012 20
of general increase in shoulder strength
21. Results
(3) Glenohumeral ROM
IR Total RM
in general age-related decrease of IR-ROM (-10°) en
TRM (-15°), however not significant (p=0.077 and
p=0.06)
Ann Cools Wrightington Nov 2012 21
22. Results
(4) Rotator Cuff strength: IR, ER, ER/IR ratio
IR strength ER strength ER/IR ratio
between 14-16y IR strength increases (p=0.03) and
ER/ER ratio decreases (below 70%)
Ann Cools Wrightington Nov 2012 22
23. Conclusions
Age-related changes in shoulder and
scapular variables possibly increase
the risk for overuse injury in the
shoulder
- Decrease of glenohumeral ROM
- Insufficient gain in scapular stabilizing
muscle strength
- Changes in rotator cuff muscle balance
Ann Cools Wrightington Nov 2012 23
24. Physical testing
&
MRI screening of the shoulder
in Elite Swedish Tennis Players
Fredrik Johansson, Stockholm, Sweden, SVTF
Ann Cools, PhD, Ghent University, Belgium
Edin De Bri PhD, Orthopeadic Surgeon, Stockholm, Sweden
Ann Cools Wrightington Nov 2012 24
25. MRI screening
Ann Cools Wrightington Nov 2012 25
(Fredrik Johansson, Scand Congress Sports Medicine, Malmö Sept 2012)
26. Subjects MRI
Elite Swedish National Players
N = 35 (15 boys and 20 girls)
Median age 17 (range 13-24)
Antropometry
– Heigth 171 cm
– Weigth 65 kg
– Heigth 178,6 cm
– 71,8 kg
Hours playing / week: 17 ± 2-5
hours
Matches per year 100-120
Ann Cools Wrightington Nov 2012 26
(Fredrik Johansson, Scand Congress Sports Medicine, Malmö Sept 2012)
27. MRI findings results
19 players (54,2%) had a normal MRI
examination
16 players (45.8%) had an abnormal
examination.
14 players showed a total of 16 tendinosis
(2 players both in IS/SS), predominately in
Infraspinatus (10), Supraspinatus (5) and
Subscapularis (1).
Ann Cools Wrightington Nov 2012 27
(Fredrik Johansson, Scand Congress Sports Medicine, Malmö Sept 2012)
28. Most common MRI findings
Boys 13-24 years
Infraspinatus tendinosis Supraspinatustendinosis
DA DA
3 out of 15 players (20%) 0 out of 15 players
Ann Cools Wrightington Nov 2012 28
(Fredrik Johansson, Scand Congress Sports Medicine, Malmö Sept 2012)
29. Most common MRI findings
Girls 13-24 years
Infraspinatus tendinosis Supraspinatustendinosis
DA DA
7 out of 20 players (35%) 5 out of 20 players (25%)
Ann Cools Wrightington Nov 2012 29
(Fredrik Johansson, Scand Congress Sports Medicine, Malmö Sept 2012)
30. Aerobe/Anaerobe tests
Modified 30 s wingate
Treadmill test test
Ann Cools Wrightington Nov 2012 30
(Fredrik Johansson, Scand Congress Sports Medicine, Malmö Sept 2012)
31. Correlation divided into gender
(Fredrik Johansson, Scand Congress Sports Medicine, Malmö Sept 2012)
Ann Cools Wrightington Nov 2012 31
32. Threshold/SvTF criteria for Girls
(Fredrik Johansson, Scand Congress Sports Medicine, Malmö Sept 2012)
Only 1 girl (5,5%)
Threshold meet the SvTF
square for criteria for both
aerobic/anaerobic
Sprintbike capacity
(anaerobic)
Threshold
”under square for
threshold Vo2 max
in both” (aerobic)
Ann Cools Wrightington Nov 2012 32
33. Threshold/SvTF criteria for Boys
(Fredrik Johansson, Scand Congress Sports Medicine, Malmö Sept 2012)
6
boys
28%
Ann Cools Wrightington Nov 2012 33
34. Is general physical capacity related to local
joint load?
Are the shoulders in the girls more prone to
degeneration/injury because the physical
capacity is not keeping up with the
demand?
Are tendinopathy findings on MRI correlated
to decreased muscle strength?
Ann Cools Wrightington Nov 2012 34
37. “Ideal” criteria for return to play
McCarty et al. Clin Sports Med 23 (2004) 335-351
Little/no pain
Patient subjectivity
Near normal ROM
Near normal strength
Normal functional ability
Normal sport-specific skills
Ann Cools Wrightington Nov 2012 37
38. Normal ROM?
< 20° side difference for IR
< 10% side difference for total ROM
(ER + IR)
(Ellenbecker & Cools BJSM 2010, 2012
Ann Cools Wrightington Nov Braun et al. JBJS 2009, 38
Tate et al. JAT 2012, Shanley et al. AJSM 2011)
39. Measurement of shoulder
ROM into ER and IR
Loss of ROM >25° increases risk for shoulder
injury
(Ellenbecker & Ann CoolsBJSM 2010, 2012
Cools Wrightington Nov Braun et al. JBJS 2009 39
Tate et al. JAT 2012, Shanley et al. AJSM 2011)
40. Normal strength RC?
– No side differences (10% more strength
on dominant side)
– ER/IR ratio 66% (isokinetic testing) or
75% (isometric testing)
– Special attention to ER
(Ellenbecker Ann Cools 2010,Nov 2012 et al. AJSM 2010,
& Cools Wrightington Byram 40
Niederdracht et al. 2008)
41. Measurement of RC
strength
ER/IR ratio <66% increases the risk for
shoulder injury in overhead athletes
(Byram et al. AJSM 2010)
Ann Cools Wrightington Nov 2012 41
42. Normal strength
scapular muscles?
– No side differences (10% more strength
on dominant side)
– Protraction/retraction ratio = 100%
– Special attention to middle and lower trap
(Cools et al. BJSM 2004, JAT 2005, JAT 2007, BJSM 2010,
Ann Cools Wrightington Nov 2012 42
Tate et al. JAT 2012, Kawasaki 2012)
43. Functional tests?
Eccentric strength RC:
– new protocol for ecc strength
measurement using compuFET HHD: 90°
- 3 seconds - ER
Ann Cools Wrightington Nov 2012 43
44. Functional tests?
Within- and between tester reliability and
validity of a new protocol for measuring
eccentric RC strength (Johansson & Cools,
unpublished data 2012)
Within tester tester 1 Tester 2
reliability
Trial 1 127,2N 119,1N
Trial 2 122,0N 112,2N
Trial 3 110,9N 111,5N
ICC between trials 0.88 0.86
(Cools et al. BJSM 2010, Nov 2012
Ann Cools Wrightington 44
Cools & Johansson, unpublished data 2012)
45. Functional tests?
Within- and between tester reliability and
validity of a new protocol for measuring
eccentric RC strength (Johansson & Cools,
unpublished data 2012)
Between tester reliability
Tester 1 120,1N
Tester 2 114,2N
ICC between testers 0,71
Validity with Biodex
CompuFET 114,2N
Biodex 110,9N
Pearson Correlation 0,78
coefficient Ann Cools Wrightington Nov 2012 45
46. Functional tests?
Endurance test in sport-specific position
(Maenhout et al. 2012, IJSM under revision)
Ann Cools Wrightington Nov 2012 46
48. Injury Prevention Program
(Cools et al. BJSM 2008, Ellenbecker & Cools BJSM 2010)
2. Strengthening the posterior cuff
Ann Cools Wrightington Nov 2012 48
49. Injury Prevention Program
(Cools et al. AJSM 2007, De Mey et al. JOSPT 2009,
Ellenbecker & Cools BJSM 2010)
3. Scapular training
Ann Cools Wrightington Nov 2012 49
50. Take home message
Return to play criteria after shoulder
injury?
1. ROM: <20° side difference for IR
2. RC strength: ratio 66-75%
3. Scapular strength ratio 100%
4. Functional tests??
5. Preventive stretching and strengthening program
Ann Cools Wrightington Nov 2012 50