24/01/2015. Return to play after shoulder injury and high performance training in the overhead athlete. Shoulder and scapular measurements:

Transcription

1 Return to play after shoulder injury and high performance training in the overhead athlete Dr Ann Cools, PT, PhD Dept Rehab. Sciences & Physiotherapy Ann Cools return Ghent to play and University, high performance Belgium Shoulder and scapular measurements: 1. Why? 2. What? 3. How? 4. Criteria for injury prevention and RTP? WHY?? InjuryPrevention in overhead athletes: sportspecific adaptations in ROM, strength and scapular position known to be risk factors for shoulder injuries (Byram et al. AJSM 2010, Shanley et al. AJSM 2012, Kawasaki et al. JSES 2012, Clarsen et al. BJSM 2014) Return to play criteria after shoulder injury should be based on objective measurements according to the DecisionBasedRTP model (Matheson et al. CJSM 2011) 1

2 Ideal criteria for return to play McCarty et al. Clin Sports Med 23 (2004) Little/no pain Patient subjectivity Near normal ROM Near normal strength Normal functional ability Normal sport-specific skills What should we measure? Outcome measurements and return to play decision: 1. GLENOHUMERAL JOINT (Cools JSES 2014, Johansson JAT 2014) 1. GH IR and ER ROM 2. GH rotator cuff strength 3. Eccentric strength of the external rotators 2. SCAPULOTHORACIC JOINT (Cools BJSM 2010) 1. Scapular upward rotation 2. Strength of the Scapular stabilizers 3. PM Length / PM Index 2

3 Practice 1. ROM IR-ER 2. Strength IR-ER 3. Ecc ER strength For each of the measurements: Arguments for methodology? Reliability (ICC, SEM, MDC)? Cut off values / normal values? 1. ROM MEASUREMENT Using a goniometer (Wilk AJSM 2011) Using an inclinometer (Wilk AJSM 2011) Using a smartphone (Shin Man Ther 2012) 3

4 Reliability? Excellent inter- and intra- tester reliability (ICC= 0.98, SEM=+/- 2, MDC= +/- 4 ) (Cools et al. JSES 2014) Frontal or scapular plane / scapular fixation (Wilk et al. AJSM 2011, Cools et al. JAT 2014) Ann Cools ESSKA Cut-off values for prevention and RTP? < side difference for IR < 5-10 side difference for total ROM (ER + IR) Ann Cools ESSKA ROM measurements: sportspecific adaptations A loss of >25 into IR is predictive for injury in baseball players. (Shanley et al. AJSM 2012) 4

5 ROM measurements: sportspecific adaptations A loss of 18 IR and a loss of 5 in TROM increases the risk for injury x2. (Wilk et al. AJSM 2011, Clarsen BJSM 2014) Resultsfromthisprocedure in overhead athletes (Cools training et 2014 al. JAT 2014) 2. STRENGTH MEASUREMENT Manual Muscle Testing Isokinetic strength testing Isometric testing with HHD 5

6 Reliability? Excellent inter- and intra- tester reliability for isometric testing: (ICC= , SEM= 4-7N, MDC= 10-16N) (Cools et al. JSES 2014) Ann Cools ESSKA Cut-off values for prevention and RTP? Isokinetic testing: ER/IR ratio 66% Isometric HHD: 0-0: ER/IR ratio 75% 90-0: ER/IR ratio % (depending on gender male vs female) 90-90: ER/IR 60-85% (depending on gender male vs female) Resultsfromthisprocedure on overhead athletes (Cools training et 2014 al. JAT 2014) 6

7 Normal values? 2de Ma REVAKI sportrevalidatie ECCENTRIC RC STRENGTH WHY? Need for a field-measurement tool for measuring eccentric external rotator strength Development of a new tool 7

8 Reliability and validity? (Johansson et al. Accepted JAT 2014) Withintester reliability tester 1 Tester 2 Trial 1 127,2N 119,1N Trial 2 122,0N 112,2N Trial 3 110,9N 111,5N ICC between trials MDC90 (Minimal Detectable Change) = 20-30N clinician can be 90% sure that the real score is within the measured score +/- MDC Reliability and validity? 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 coefficient 0,78 Cut-off values for prevention and RTP? Dominant side + 10% Ecc ER (normalized N/kg): 2-2,5 (depending on sports and age) Ecc ER/isom IR: 1-1,3 (depending on gender) 8

9 Normal values strength N/kg? 2de Ma REVAKI sportrevalidatie Normal values ratios? 2de Ma REVAKI sportrevalidatie Functional testing? Seated Medicine Ball Throw (Van den Tillaer JSCR 2013) Ann Cools clinical exam Chennai July

10 Functional testing? Seated Medicine Ball Throw Moderate to high correlation (> 0.75) between SMBT and muscle strength RC and scapular protraction and retraction (Van den Tillaer JSCR 2013) Ann Cools clinical exam Chennai July 2014 Functional testing? Y-balance test (Westrick et al. IJSM 2012 Ann Cools clinical exam Chennai July 2014 Functional testing? Y-balance test NO significant correlation between Y-balance test and muscle strength RC and scapular protraction and retraction (Van den Tillaer JSCR 2013) Ann Cools clinical exam Chennai July

11 Take home messages use reliable assessment tools for risk factor analysis and return-to-play decision Ann Cools ESSKA Challenge sportspecific demands? Return to play exercises for 1/ gymnast 2/ preparing the athlete for impact (goal keepers, hockey ) 3/ throwers High performance exercisesforthe GYMNAST Len Vande Lanotte Flemish Gymnastic Federation 11

12 High performance exercisesforthe GYMNAST Len Vande Lanotte Flemish Gymnastic Federation High performance exercisesforthe GYMNAST Len Vande Lanotte Flemish Gymnastic Federation High performance exercisesforthe GYMNAST Len Vande Lanotte Flemish Gymnastic Federation 12

13 Value of Sling therapy? 13 weeks 6x/w Open versus Sling exercises Sling exercises are equally as effective as open chain exercises in a strength training program for women, with a small advantage for sling regarding push-up Value of sling therapy (K. De Mey et al. J Strength Cond Res 2013) with 13

14 Conclusion of the study: The large glenohumeral muscles were highly activated when using RS, especially the pectoralis major during the pushup and knee prone bridging exercise and the posterior deltoid and latissimus dorsi during the pull-up exercise. Preparing the athlete for HIGH LEVEL IMPACT Preparing the athlete for HIGH LEVEL IMPACT 14

15 Preparing the athlete for HIGH LEVEL IMPACT Preparing the athlete for HIGH LEVEL IMPACT Preparing the athlete for HIGH LEVEL IMPACT 15

16 Preparing the athlete for THROWING Preparing the athlete for THROWING practice 16