Advanced Treatment of VEO in the Thrower
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1 Advanced Treatment of VEO in the Thrower by Toko Nguyen PT, DPT, OCS, SCS, FAAOMPT, CSCS Ben Renfrow PT, DPT, OCS, SCS, FAAOMPT AAOMPT Annual Conference 2015 Lexington, KY
2 Define VEO IAR OBJECTIVES Discuss the pathomechanics of VEO in the thrower Clinically reason through VEO Functionally assess for VEO Demonstrate advanced manual intervention for VEO
3 VEO Valgus Extension Overload
4 PATHOMECHANICS
5 BIOMECHANICAL PROBLEM BIOMECHANICAL SOLUTION
6 MOBILITY & STABILITY What s the Connection in the Thrower?
7 NEEDS OF THE THROWER Mobility Stability o Ankle o Hip o GH o Wrist o Thoracic o Foot / Ankle o Knee o Lumbopelvic o Scapula o Elbow
8 MOBILITY POINTS
9 VEO MOBILITY THORACIC SCAPULA GHJ HIPS HOW MUCH AT EACH JOINT?
10 MAXIMUM EXTERNAL ROTATION MER = Thoracic + Scapula + GHJ
11 MER / ER
12 ASSESSMENT q GHJ External Rotation Passive Functional q Upper Thoracic Rotation q Scapular Mobility Posterior Tilt / External Rotation Elevation / Upward Rotation
13 THE MILLION DOLLAR QUESTION: WHAT ABOUT GIRD?
14 INTERVENTION LAB Soft Tissue Release Joint Mobilizations Neuromuscular Re-Education
15 CONTACT INFO TOKO NGUYEN: BEN RENFROW:
16 References Borsa PA, Laudner KG, Sauers EL. Mobility and stability adaptations in the shoulder of the overhead athlete: a theoretical and evidence-based perspective. Sports Med. 2008; 38(1): Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19: Cools AM, Cambier D, Wivrouw EE. Screening the athlete s shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology. Br J Sports Med Jun; 42: Cools AM, Witvrouw EE, Declercq GA, Danneels LA, Cambier DC. Scapular muscle recruitment patterns: trapezius muscle latency with and without impingement symptoms. Am J Sports Med. 2003;31: Crockett HC, Gross LB, Wilk KE, Schwartz ML, Reed J, O Mara J, Reilly MT, Dugas JR, Meister K, Lyman S, Andrews JA. Osseous adaption and range of motion at the glenohumeral joint in professional baseball pitchers. Am J Sports Med. 2002: 30(1): Mihata T, McGarry MH, Kinoshita M, Lee TQ. Excessive glenohumeral horizontal abduction as occurs during the late cocking phase of the throwing motion can be critical for internal impingement. Am J Sports Med Feb;38(2):
17 References Miyashita K, Kobayashi H, Koshida S, Urabe Y. Glenohumeral, scapular, and thoracic angles at maximum shoulder external rotation in throwing. Am J Sports Med. 2010;38(2): Harada M, Takahara M, Mura N, Sasaki J, Ito T, Ogino T. Risk factors for elbow injuries among young baseball players. J Shoulder Elbow Surg. 2010;19(4): Reinold MM, Wilk KE, Macrina LC, et al. Changes in shoulder and elbow passive range of motion after pitching in professional baseball players. Am J Sports Med. 2008;36(3): McFarland EG, Hsu CY, Neira C, O Neil O. Internal impingement of the shoulder: a clinical and arthroscopic analysis. J Shoulder Elbow Surg. 1999;8(5): Halbrecht JL, Tirman P, Atkin D. Internal impingement of the shoulder: comparison of findings between the throwing and nonthrowing shoulders of college baseball players. Arthroscopy. 1999;15(3): Ellenbecker TS, Ellenbecker GA, Roetert EP, Silva RT, Keuter G, Sperling F. Descriptive profile of hip rotation range of motion in elite tennis players and professional baseball pitchers. Am J Sports Med Aug;35(8): Werner SL, Murray TA, Hawkins RJ, Gill TJ. Relationship between throwing mechanics and elbow valgus in professional baseball pitchers. J Shoulder Elbow Surg Mar-Apr;11(2):151-5.
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Scapular Position and Orientation in Throwing Athletes Joseph B. Myers,* PhD, ATC, Kevin G. Laudner, PhD, ATC, Maria R. Pasquale, MS, James P. Bradley, MD, and Scott M. Lephart, PhD, ATC From the Neuromuscular