Shoulder External Rotation Range Of Motion Research Articles

The COVID-19 lockdown as a model of detraining in division 1 college softball players

BackgroundThe COVID-19 pandemic interrupted the organized training of softball players, similar to the abrupt cessation of sports participation that can happen after an injury. Thus, the COVID-19 pandemic offers a unique model to study how sudden detraining influences softball players.MethodsWe recruited a sample of convenience of National Collegiate Athletic Association Division 1 softball players. They participated in three data collections: pre-lockdown (Jan 2020, T1), post-lockdown (Sept 2020, T2), and before the 2021 season (Jan 2021, T3). Between T1 and T2, players received an at-home conditioning and throwing program, but compliance was not strictly monitored. Between T2-T3, players resumed formal fall training (team-organized workouts, on-field practice, and within-team scrimmage games). At each time point, we collected bilaterally: 1) shoulder internal rotation (IR) and external rotation (ER) range of motion (ROM); 2) shoulder IR and ER strength; 3) hip IR and ER ROM; and 4) hip abduction and extension strength. We used four independent (2 Sides × 3 Timepoints) MANOVA with repeated measures; we followed up significant MANOVA main effect of time with Sidak posthoc tests for pairwise comparisons between time points.ResultsFifteen players participated in this study. We found a significant MANOVA main effect of time for shoulder and hip ROM (p < 0.01). Between T1-T2, dominant shoulder ER ROM decreased 6.5°, dominant shoulder IR ROM increased 4.3°, and lead hip IR ROM increased 4.4°. Between T2-T3, dominant shoulder ER ROM increased 6.3° and trail hip ER ROM increased 5.9°. We found a significant MANOVA main effect of time for shoulder strength (p = 0.03) but not for hip strength (p = 0.18). Between T2-T3, non-dominant shoulder IR and ER increased 1.8 kg and 1.5 kg, respectively.ConclusionA sudden and prolonged cessation of organized training generated changes in shoulder and hip ROM but affected strength to a lesser extent. The loss of shoulder ER and increased lead hip IR ROM are maladaptive as they are associated with injury in overhead athletes. Resuming team-organized training and scrimmage reversed some (shoulder ER), but not all of these changes. Practitioners should monitor clinical variables regularly and be aware of potential changes due to unexpected and prolonged interruptions in training, such as when players suffer sports-related injuries.

Clinical shoulder measurements related to joint loads in collegiate pitchers

Pitchers are prone to upper extremity injury due to repetitive high joint loads. Clinical measures of shoulder strength and range of motion (ROM) have shown links to injury risk in pitchers, however, these factors have rarely been studied in relation to throwing joint loads. The purpose of this study was to identify which clinical ROM and isokinetic strength variables were related to peak shoulder and elbow joint torques in collegiate pitchers. Thirty-three healthy collegiate pitchers participated in this study. Fastball velocity, shoulder concentric and eccentric strength, and passive shoulder ROM variables were analyzed using a Lasso regression to determine what factors influenced shoulder internal rotation torque and elbow varus torque. Fastball velocity was selected by the Lasso as indicator of increased shoulder and elbow torque. Passive shoulder external rotation ROM was also selected as an important factor in joint loading with increased shoulder external rotation ROM being related to lower joint loads. The bilateral ratio of shoulder internal rotator concentric strength was related to peak shoulder and elbow torques with an increase in the bilateral ratio of shoulder strength leading to reduced joint torques. Increases in the eccentric external rotator to concentric internal rotator strength (functional ratio) of the dominant arm and increases in dominant arm eccentric internal rotator strength were both related to increases in each joint torque. Results from the study indicate that pitch speed, passive shoulder external rotation ROM, and the isokinetic shoulder strength profile including internal rotator strength and functional strength ratio of pitchers are related to joint loading during the pitch and may be important to monitor in relation to injury risk and/or during rehabilitation. These results provide insight into the role that both shoulder ROM and rotator cuff strength play in the dynamic stabilization of the elbow and shoulder during pitching.

Residual Effects of Glenohumeral Range of Motion, Strength, and Humeral Retroversion on Prior Overhead Athletes After Cessation of Sport.

Background:Research has shown that repetitive stress from playing an overhead (OH) sport can cause musculoskeletal and osseous adaptations to occur on the dominant side. Additionally, there are limited data about the residual effects of these adaptations after the cessation of sports participation.Purpose:To investigate the effects of prior participation in an OH sport versus not participating in an OH sport on glenohumeral range of motion (ROM), isometric strength, and humeral retroversion (HR).Study Design:Cross-sectional study; Level of evidence, 3.Methods:Forty-eight college-aged individuals participated. Participants were split into 2 groups: (1) individuals who previously participated in an OH sport (n = 20; age, 20.3 ± 1.1 years; height, 166.3 ± 15.27 cm; weight, 72.2 ± 13.5 kg) and (2) individuals who previously did not play an OH sport (n = 28; age, 20.6 ± 0.9 years; height, 168.8 ± 6.3 cm; weight, 68.1 ± 15.1 kg). After completing a health history questionnaire, the following were measured: side-to-side shoulder internal rotation (IR) and external rotation (ER) ROM via an inclinometer, isometric shoulder strength via a handheld dynamometer, and HR using an ultrasound imaging machine. A Mann-Whitney U test was used to determine group differences, and a Wilcoxon t test was used to analyze side-to-side differences within each group.Results:The Mann-Whitney U test revealed a statistically significant group difference for dominant shoulder ER ROM (U = 162.00, P = .014). Specifically, the prior OH group had significantly more ER than the control group. Within the prior OH group, testing revealed that athletes had significantly more HR (Z =–2.782, P = .005), ER ROM (Z =–1.979, P = .048), and ER isometric strength (Z =–2.763, P = .006) on their dominant than nondominant shoulder and significantly less IR ROM (Z =–3.099, P = .002) on their dominant than nondominant shoulder.Conclusion:Prior OH sports participation may have residual osseous and musculoskeletal effects that remain after cessation of the sport.

Cumulative Effects of a Week's Training Loads on Shoulder Physical Qualities and Wellness in Competitive Swimmers.

BackgroundCompetitive swimmers are exposed to high training loads, which can contribute to the development of shoulder pain. There is a lack of research investigating the interactions between the accumulation of training loads and factors associated to shoulder pain in swimmers.PurposeThe primary objective was to analyze the changes in shoulder physical qualities and wellness factors over a week of training in competitive swimmers. A secondary objective was to compare the changes in these variables between different swim-training volumes performed during the week.DesignCross-sectional.MethodsThirty-one national and regional-level swimmers were included (18 females, 13 males; age= 15.5 ± 2.2 years). Active shoulder external rotation (ER) range of motion (ROM), shoulder-rotation isometric torque, and wellness factors using the Hooper questionnaire were measured twice over the week: a baseline measurement (before Monday´s training session) and a follow-up during the week. Participants were divided into a high-volume group (HVG) and low-volume group (LVG) based on the day follow-up was performed. HVL (n= 15) was tested at the end of the training week (after Saturday´s session) and LVG (n= 16) during the week (after Thursday or Friday´s session). Rating of perceived exertion (RPE) of the whole week was recorded after the follow-up session.ResultsAt follow-up, the LVG averaged a volume of 26.2 ± 2.2 km, whereas the HVG averaged a volume of 37.5 ± 3.7 km. LVG and HVG participants decreased active shoulder ER ROM on dominant (p= 0.002; p= 0.006) and nondominant sides (p= 0.001; p= 0.004), displayed increased muscular soreness (p= 0.001; p= 0.007) and worsened overall wellness (p< 0.001; p= 0.010). Fatigue (p= 0.008) and poor sleep quality were increased (p= 0.023) in HVG, but not in LVG. There were no changes in shoulder-rotation torque and stress in any group. Regarding between-groups differences, only weekly RPE was higher (p= 0.004) in HVG.ConclusionsThe accumulation of training loads over the week negatively affect physical and wellness factors. Greater swim-volumes were associated with an increase perception of training loads. The regular monitoring of multiple factors to assess swimmers’ response to training might be necessary.Level of evidence3

Shoulder complaints more likely in volleyball players with a thickened bursa or supraspinatus tendon neovessels

Shoulder problems are common in volleyball and greatly impede both training and player performance. Subacromial bursa (SAB) thickening and tendon neovascularity have shown relevance in other populations, but their relationship with the development of shoulder complaints has not been investigated in volleyball players or overhead-throwing athletes. The study aim was to examine the role of SAB thickness, neovascularization of the supraspinatus tendon, shoulder strength, range of motion (ROM), player position, and age in the development of shoulder complaints in professional volleyball players. Players underwent preseason baseline testing (n=86) and reported shoulder complaints during the subsequent 12-week period. Generalized estimating equations were used to model for probabilities of complaints after adjusting for player position, SAB side-to-side difference, neovessel presence, shoulder external rotation (ER) ROM, and age. Outside hitters and opposites were 12.2-fold more likely to develop complaints, and greater shoulder ER ROM increased risk by 8% for each additional degree. A side-to-side difference in SAB thickness ≥0.3mm in the dominant compared with the non-dominant arm was associated with a 10.2-fold increased risk. Those with neovessels were 6.5 times more likely to develop complaints. Players without neovessels and with normal SAB thickness were very unlikely to develop complaints. This stark contrast to players with neovessels or increased SAB thickness, where nearly half of the players developed complaints, is of interest. Players with current complaints at baseline presented with greater IR:ER strength ratios; however, neither strength nor IR ROM at baseline was associated with an increased risk of developing complaints.

Acute Effects of Weighted Baseball Throwing Programs on Shoulder Range of Motion.

Baseball pitching injuries are increasing at an alarming rate. While weighted ball throwing programs may be effective at increasing pitching velocity, previous research has identified a 24% injury rate and a 3.3° increase in shoulder external rotation (ER) range of motion (ROM) after performing a 6-week program. However, previous research has not investigated, separately, the immediate effects of throwing underloaded and overloaded balls on ROM. The purpose of this study was to examine the acute effects of throwing differently weighted baseballs on shoulder ROM. By analyzing these differences, it may be possible to determine the specific weight range that may lead to the greatest increase in ROM and potential injury risk. Throwing with weighted balls will result in an increase in shoulder ER ROM. Randomized controlled trial. Level 2. A total of 16 male high school baseball pitchers agreed to participate in this study. The participants were (mean ± SD) 17.1 ± 1.0 years of age, 1.81 ± 0.09 m tall, and had a mass of 79.2 ± 11.1 kg. Each participant was tested on 3 different days, 1 week apart, with 3 different conditions in random order: (1) underload throwing, using regulation 5-oz baseballs and 4- and 2-oz balls; (2) overload throwing, using 5-, 6-, and 9-oz balls; and (3) extreme overload throwing, using 5-, 16-, and 32-oz balls. Each testing session began by measuring passive shoulder ROM (external rotation and internal rotation) using standard goniometric measurements. Participants then performed 3 throws with each weighted ball from 3 different positions (kneeling, rocker, and run-and-gun) for a total of 27 throws each test session. ROM measurements were repeated at the end of each test session. The effect of each throwing condition on ROM was compared from pre- to posttraining using a paired t test (P ≤ 0.05). There was no significant difference in ER after throwing at underloaded weights. The overload condition showed a statistically significant increase of 3.3° in external rotation (P = 0.05). The extreme overload condition showed a statistically significant increase in ER of 8.4° (P < 0.001). There were no differences in internal rotation for any group. A significant increase in shoulder ER was observed immediately after throwing overload weighted balls. This effect increased as the weights of the balls increased. Throwing with overload weighted baseballs causes an immediate increase in shoulder ER ROM. It is unknown why these changes occur; however, the results may explain both the increase in velocity and injury rates previously observed from throwing weighted balls. The current study results may be used to develop more scientifically validated weighted ball programs. Heavier balls should be used with caution, and ROM should be monitored during implementation of these programs.

Normative reference values for handgrip strength, shoulder and ankle range of motion and upper-limb and lower limb stability for 137 youth judokas of both sexes

ObjectivesTo provide reference values for handgrip strength, shoulder and ankle range of motion (ROM) and upper-limb and lower limb stability for youth judokas of both sexes and investigate the effects of sex and side dominance. DesignCross-sectional. MethodsA total of 137 youth judokas from under-18 (n=60) and under-21 (n=77) categories of both sexes were assessed. Handgrip strength was assessed using a Jamar dynamometer, ankle ROM was measured by lunge test, shoulder ROM was assessed by an inclinometer and upper-limb and lower limb stability were assessed by the Closed Kinetic Chain Upper Extremity Stability Test and by the Modified Star Excursion Balance Test (mSEBT). ResultsIn both categories, males had greater handgrip strength. In the under-18 category, the dominant side had greater handgrip strength, the non-dominant side of females had smaller shoulder external rotation ROM than the dominant side and also than both sides of males, and females had greater shoulder IR ROM. In the under-21 category, the dominant side of females had greater ankle dorsiflexion ROM than the dominant side of males, the dominant sides and females had greater shoulder ER ROM, and males had better performance in the mSEBT. ConclusionsThis study provided reference values for handgrip strength, shoulder and ankle ROM, upper and lower limb stability for youth judokas, which can be used to guide assessment during preseason. Sex influenced on shoulder ER and IR ROM, handgrip strength and lower limb stability. In addition, side dominance influenced on shoulder ER ROM and on handgrip strength.

Glenohumeral and Hip Range of Motion in Youth Softball Athletes.

The purpose of this study was to compare measures of bilateral shoulder and hip range of motion (ROM) between youth softball pitchers and position players. Fifty-two youth softball athletes (12.7±2.1 yrs.; 160.28±10.98 cm; 59.31±15.07 kg) participated. Bilateral hip and shoulder ROM were measured among pitchers (n=29) and position players (n=23). A 2 (pitcher/position player) × 2 (dominant/non-dominant) ANOVA was performed for both internal and external rotation ROM for the shoulder and hip. Paired sample t-tests were also conducted to examine side-to-side differences in total ROM. Data revealed a significant interaction between position and side dominance. Specifically, position players have significantly more non-dominant shoulder external rotation ROM (106.92°± 9.14°) than pitchers (100.12°± 11.21°). There were no significant differences between throwing and non-throwing sides. It is important that coaches and clinicians are aware of these adaptations between overhand and underhand throwing in order to properly develop conditioning and rehabilitation programs to alleviate injury susceptibility and cater to position-specific demands. Additionally, the current data suggest many of the functional adaptations seen within older populations are not fully developed until after youth.

DEVELOPMENT OF AN UPPER EXTREMITY ‘SWING COUNT’ and Performance Measures in NCAA Division I Volleyball Players over A COMPETITIVE SEASON

Monitoring the volume of activity (i.e. pitch counts) and tracking upper extremity (UE) performance changes is common in overhead athletes; however, a lack of evidence exists for volleyball players.Purpose: The purpose of this study was to investigate changes in shoulder mobility, strength, and pain, along with UE swing count volume in Division I collegiate female volleyball athletes over a competitive season.Study Design: Observational, longitudinal study. Swing count data was collected during two separate days of practice during weeks 1, 7, and 14 of the competitive season. Perceived swing counts were collected after each practice from athletes and two coaches. Actual swing counts were tallied by retrospective viewing of video footage. Dominant shoulder internal (IR) and external rotation (ER) range of motion (ROM) and isometric strength, along with UE pain, were assessed on five occasions: baseline, in-season (weeks 1, 7, 14) and post-season (week 22). Five Division I female volleyball athletes participated. Perceived UE swing counts among coaching staff were significantly correlated with actual swing count (r = 0.93 - 0.98, p<.05), while athlete perceived swing count was moderately correlated and was not statistically significant (r = 0.64, p = .25). Shoulder IR ROM decreased from baseline to week 14 (-5.6 ± 10.6, 95% CI: -18.76, 7.6; p = .03), with a large effect size (d = 1.0). Large effect sizes were observed for increases in UE pain, shoulder ER ROM, and IR strength (d = 0.8 - 2.3). An increase in shoulder IR strength occurred from baseline to week 14 (p = .001), but decreased during the eight weeks of post-season relative rest (p = .02). UE swing count estimates by coaching staff demonstrated higher correlation with actual swing counts obtained through video recording, as compared to volleyball athlete self-report. This cohort experienced increased shoulder IR strength and ER ROM over a competitive season. Shoulder IR ROM decreased during the first 14 weeks with a large effect size. Monitoring UE performance changes and swing count volume may have implications for injury prevention and program development for volleyball athletes. Level 2B.

Three-dimensional scapular kinematics, shoulder outcome measures and quality of life following treatment for breast cancer – A case control study

BackgroundThere are no conclusive results concerning changes in scapular kinematics associated with upper limb dysfunctions after breast cancer surgery. ObjectiveTo compare the three-dimensional (3-D) scapular kinematics during elevation of the arm between women after breast cancer surgery and controls. Shoulder range of motion (ROM), muscle strength, pain intensity, upper limb function, and quality of life were also assessed. MethodsForty-two women were assigned to two groups (surgery group, n = 21; control group, n = 21). 3-D scapular kinematics was collected during elevation of the arm in the scapular plane. ROM was assessed using a digital inclinometer, muscle strength using a manual dynamometer, pain with the Visual Analogue Scale (VAS), upper limb function with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and quality of life with the 36-item Short-Form Health Survey (SF36). ResultsThe surgery group presented decreased scapular upward rotation at 120° of arm elevation in the scapular plane (p < .05; d = −0.88), decreased shoulder external rotation ROM and strength of shoulder abduction and external rotation when the affected side was compared to the non-affected side and control group. Moreover, the surgery group also reported higher pain, increased upper limb disability and poorer quality of life compared with healthy controls. ConclusionScapular upward rotation seems to be decreased at 120° of arm elevation in women following breast cancer surgery. In addition, shoulder external rotation ROM, abduction strength, external rotation strength, function, and quality of life are also impaired in these women. They also experienced pain during the studied movements.

Evaluation of a Shoulder Injury Prevention Program in Wheelchair Basketball.

Previous literature has theorized that alterations in shoulder physical characteristics are present in wheelchair athletes and contribute to shoulder pain and injury. Limited empirical evidence is present that evaluates the effectiveness of a shoulder injury prevention program focusing on improving these altered characteristics. To evaluate the effectiveness of a 6-week intervention program at improving characteristics that increases the risk of developing pain or shoulder injury. Pretest and posttest. Home-based and controlled laboratory. Seven college wheelchair athletes. Shoulder range of motion (ROM) and scapular muscle strength were assessed, and a 5-minute injury prevention program was taught to participants. Participants completed the intervention 3 times per week for 6 weeks. Following completion of the program, a postintervention screening was performed. Internal rotation (IR)/external rotation (ER) ROM, retraction strength, and IR/ER strength. Participants experienced a significant improvement in dominant limb shoulder IR ROM (t6 = 3.56, P = .01) with an average increase of 11.4° of IR ROM and a significant improvement in dominant limb shoulder ER ROM (t6 = 2.79, P = .03) with an average increase of 8.0° of ER ROM. There were no significant increases in shoulder IR or ER strength and scapular retraction strength (P > .05). Improvements in ROM have previously been linked to decreases in shoulder pain and injury in other upper-extremity dominant sports by improving scapular kinematics. These results provide evidence that a 6-week strengthening and stretching intervention program may decrease risk factors for shoulder injury in wheelchair basketball athletes.

Effects of Deployment on Musculoskeletal and Physiological Characteristics and Balance.

Despite many nonbattle injuries reported during deployment, few studies have been conducted to evaluate the effects of deployment on musculoskeletal and physiological characteristics and balance. A total of 35 active duty U.S. Army Soldiers participated in laboratory testing before and after deployment to Afghanistan. The following measures were obtained for each Soldier: shoulder, trunk, hip, knee, and ankle strength and range of motion (ROM), balance, body composition, aerobic capacity, and anaerobic power/capacity. Additionally, Soldiers were asked about their physical activity and load carriage. Paired t tests or Wilcoxon tests with an α = 0.05 set a priori were used for statistical analyses. Shoulder external rotation ROM, torso rotation ROM, ankle dorsiflexion ROM, torso rotation strength, and anaerobic power significantly increased following deployment (p < 0.05). Shoulder extension ROM, shoulder external rotation strength, and eyes-closed balance (p < 0.05) were significantly worse following deployment. The majority of Soldiers (85%) engaged in physical activity. In addition, 58% of Soldiers reported regularly carrying a load (22 kg average). The deployment-related changes in musculoskeletal and physiological characteristics and balance as well as physical activity and load carriage during deployment may assist with proper preparation with the intent to optimize tactical readiness and mitigate injury risk.

Reliability and validity of goniometric iPhone applications for the assessment of active shoulder external rotation

ABSTRACTPurpose/hypothesis: The purpose of this study was to determine the reliability and validity of two smartphone applications: (1) GetMyROM – inclinometery-based and (2) DrGoniometry – photo-based in the measurement of active shoulder external rotation (ER) as compared to standard goniometry (SG). Participants: Ninety-four Texas Woman's University Doctor of Physical Therapy students from the School of Physical Therapy – Houston campus, were recruited to participate in this study. Materials/methods: Two iPhone applications were compared to SG using both novice and experienced raters. Active shoulder ER range of motion was measured over two time periods in random order by blinded novice and experienced raters. Results: Intra-rater reliability using novice raters for the two applications ranged from an intraclass correlation coefficient (ICC) of 0.79 to 0.81 with SG at 0.82. Inter-rater reliability (novice/expert) for the two applications ranged from an ICC of 0.92 to 0.94 with SG at 0.91. Concurrent validity (when compared to SG) ranged from 0.93 to 0.94. There were no significant differences between the novice and experienced raters. Conclusion: Both applications were found to be reliable and comparable to SG. A photo-based application potentially offers a superior method of measurement as visualizing the landmarks may be simplified in this format and it provides a record of measurement. Clinical relevance: Further study using patient populations may find the two studied applications are useful as an adjunct for clinical practice.

Influência da limitação da amplitude de movimento sobre a melhora da flexibilidade do ombro após um treino de seis semanas

Estudos anteriores têm mostrado que o nível aeróbico e de força pré-treinamento influenciam os ganhos obtidos após um período de treino. Nenhum estudo investigou esta relação em um programa de flexibilidade. O objetivo deste estudo foi observar a influência da limitação da amplitude de movimento (ADM) sobre a melhora da ADM de rotação externa de ombro após um programa de alongamento de seis semanas. 30 voluntários, estudantes de fisioterapia, com limitação da ADM de rotação externa de ombro foram divididos de forma randomizadas em três grupos: grupo controle (GC), grupo experimental 1 (GE1), com maior limitação de ADM e grupo experimental 2 (GE2), com menor limitação de ADM. Os sujeitos do grupo experimental foram submetidos a um programa de seis semanas de alongamento ativo para melhora da ADM de rotação externa de ombro. Na análise dos resultados, o teste de ANOVA one-way mostrou uma diferença significativa entre a média do ganho de ADM de rotação externa de ombro entre os três grupos (p=0,001), sendo que o GE1 teve o maior ganho de ADM (30,1° ± 8,6°) seguido pelos grupos GE2 (15,2° ± 7,5°) e GC (1,1° ± 5,8°). O teste de correlação de Pearson mostrou uma correlação negativa significativa entre ADM prévia e ganho de ADM (r= -0,70, p=0,001). Os resultados deste estudo mostraram que a ADM prévia de rotação externa de ombro influencia o ganho de ADM deste movimento após um programa de alongamento de seis semanas em uma população jovem e saudável. Indivíduos com maior limitação de ADM respondem com um ganho de ADM mais pronunciado.