scholarly journals Preseason Upper Extremity Range of Motion and Strength in Relation to In-Season Injuries in NCAA Division I Gymnasts

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097709
Author(s):  
Kaysha Heck ◽  
Giorgio Zeppieri ◽  
Michelle Bruner ◽  
Michael Moser ◽  
Kevin W. Farmer ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Upper Extremity ◽  
Ncaa Division I ◽  
External Rotation ◽  
Division I ◽  
Extremity Injury ◽  
Overhead Athletes ◽  
Upper Extremity Injury ◽  
Collegiate Gymnasts ◽  
Extremity Injuries

Background: Gymnastics is a demanding sport that places unique forces on the upper extremity. The repetitive nature of the sport and the high-impact forces involved may predispose the gymnast to overuse injuries. Risk factors for injuries in gymnastics are not well understood. Purpose/Hypothesis: The purpose of this study was to ascertain whether preseason upper extremity range of motion (ROM) and strength differ between National Collegiate Athletic Association (NCAA) Division I collegiate gymnasts who sustain an in-season upper extremity injury and those who do not. We hypothesized that gymnasts who sustain an upper extremity injury would demonstrate reduced ROM and strength compared with noninjured gymnasts. Study Design: Cohort study; Level of evidence, 3. Methods: Over 4 seasons, from 2014 to 2018, a total of 15 female NCAA Division I collegiate gymnasts underwent preseason upper extremity ROM (shoulder: flexion, internal and external rotation; elbow: extension; wrist: extension) and strength (shoulder: internal and external rotation, and middle and lower trapezius) testing. Overuse upper extremity injuries were tracked in each subsequent season. Gymnasts were dichotomized into injured and noninjured groups, and a 2 × 2 analysis of variance was used to measure differences in preseason measures between the groups as well as within arms (injured vs noninjured arm for the injured group; dominant vs nondominant arm for the noninjured group). Results: A total of 12 overuse upper extremity injuries (10 shoulders; 2 wrist/forearm) occurred during 31 gymnast-seasons. There were no significant interactions for preseason ROM and strength measurements between groups (injured vs noninjured) or within arms (injured and noninjured arm for the injured group; dominant and nondominant arm for the noninjured group; P = .07). Conclusion: Preseason upper extremity ROM and strength were not different between gymnasts who sustained an in-season upper extremity overuse injury and those who did not. It is possible that ROM and strength measures used to screen other overhead athletes may not capture the unique features and requirements of gymnastics. Further, it may be challenging to discern differences in clinical measures of ROM and strength in gymnastics populations owing to the bilateral nature of the sport.

scholarly journals Glenohumeral Internal Rotation Deficit and Risk of Upper Extremity Injury in Overhead Athletes: A Meta-Analysis and Systematic Review

2018 ◽  
Vol 10 (2) ◽  
pp. 125-132 ◽  
Author(s):  
Robert A. Keller ◽  
Anthony F. De Giacomo ◽  
Julie A. Neumann ◽  
Orr Limpisvasti ◽  
James E. Tibone
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Upper Extremity ◽  
Internal Rotation ◽  
Meta Analysis ◽  
Mean Difference ◽  
Extremity Injury ◽  
Overhead Athletes ◽  
Glenohumeral Internal Rotation Deficit ◽  
Upper Extremity Injury

Context: Current perception dictates that glenohumeral internal rotation deficit (GIRD) is a chronic adaptation that leads to an increased risk of pathologic conditions in the dominant shoulder or elbow of overhead athletes. Objective: To determine whether adaptations in glenohumeral range of motion in overhead athletes lead to injuries of the upper extremity, specifically in the shoulder or elbow. Data Sources: An electronic database search was performed using Medline, Embase, and SportDiscus from 1950 to 2016. The following keywords were used: GIRD, glenohumeral internal rotation deficit, glenohumeral deficit, shoulder, sport, injury, shoulder joint, baseball, football, racquet sports, volleyball, javelin, cricket, athletic injuries, handball, lacrosse, water polo, hammer throw, and throwing injury. Study Selection: Seventeen studies met the inclusion criteria for this systematic review. Of those 17 studies, 10 included specific range of motion measurements required for inclusion in the meta-analysis. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 4. Data Extraction: Data on demographics and methodology as well as shoulder range of motion in various planes were collected when possible. The primary outcome of interest was upper extremity injury, specifically shoulder or elbow injury. Results: The systematic review included 2195 athletes (1889 males, 306 females) with a mean age of 20.8 years. Shoulders with GIRD favored an upper extremity injury, with a mean difference of 3.11° (95% CI, –0.13° to 6.36°; P = 0.06). Shoulder total range of motion suggested increased motion (mean difference, 2.97°) correlated with no injury ( P = 0.11), and less total motion (mean difference, 1.95°) favored injury ( P = 0.14). External rotational gain also favored injury, with a mean difference of 1.93° ( P = 0.07). Conclusion: The pooled results of this systematic review and meta-analysis did not reach statistical significance for any shoulder motion measurement and its correlation to shoulder or elbow injury. Results, though not reaching significance, favored injury in overhead athletes with GIRD, as well as rotational loss and external rotational gain.

Lumbopelvic Control and the Development of Upper Extremity Injury in Professional Baseball Pitchers

2021 ◽  
pp. 036354652098812
Author(s):  
Kevin Laudner ◽  
Regan Wong ◽  
Daniel Evans ◽  
Keith Meister
Keyword(s):  
Upper Extremity ◽  
Lower Limbs ◽  
Group Differences ◽  
Professional Baseball ◽  
Extremity Injury ◽  
Level Of Evidence ◽  
Balance Task ◽  
Upper Extremity Injury ◽  
Baseball Pitchers ◽  
Extremity Injuries

Background: The baseball-throwing motion requires a sequential order of motions and forces initiating in the lower limbs and transferring through the trunk and ultimately to the upper extremity. Any disruption in this sequence can increase the forces placed on subsequent segments. No research has examined if baseball pitchers with less lumbopelvic control are more likely to develop upper extremity injury than pitchers with more control. Purpose: To determine if baseball pitchers who sustain a chronic upper extremity injury have less lumbopelvic control before their injury compared with a group of pitchers who do not sustain an injury. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 49 asymptomatic, professional baseball pitchers from a single Major League Baseball organization participated. Lumbopelvic control was measured using an iPod-based digital level secured to a Velcro belt around each player’s waist to measure anteroposterior (AP) and mediolateral (ML) deviations (degrees) during single-leg balance with movement and static bridge maneuvers. During a competitive season, 22 of these pitchers developed upper extremity injuries, while the remaining 27 sustained no injuries. Separate 2-tailed t-tests were run to determine if there were significant differences in lumbopelvic control between groups ( P < .05). Results: There were no significant between-group differences for the stride leg (nondominant) during the bridge test in either the AP ( P = .79) or the ML ( P = .42) directions, or either direction during the drive leg bridge test ( P > .68). However, the injured group had significantly less lumbopelvic control than the noninjured group during stride leg balance in both the AP ( P = .03) and the ML ( P = .001) directions and for drive leg balance in both the AP ( P = .01) and the ML ( P = .04) directions. Conclusion: These results demonstrate that baseball pitchers with diminished lumbopelvic control, particularly during stride leg and drive leg single-leg balance with movement, had more upper extremity injuries than those with more control. Clinicians should consider evaluating lumbopelvic control in injury prevention protocols and provide appropriate exercises for restoring lumbopelvic control before returning athletes to competition after injury. Specific attention should be given to testing and exercises that mimic a single-limb balance task.

scholarly journals The Relationship Between Shoulder Range of Motion and Arm Stress in College Pitchers: A MOTUS Baseball Study

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0040
Author(s):  
Caleb Gulledge ◽  
Toufic Jildeh ◽  
Joseph Tramer ◽  
Fabien Meta ◽  
Kevin Taylor ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Upper Extremity ◽  
Internal Rotation ◽  
External Rotation ◽  
Outcome Measurement ◽  
Overhead Athletes ◽  
Shoulder Range Of Motion ◽  
Patient Reported ◽  
The Relationship ◽  
Shoulder Range

Objectives: Overuse injuries in overhead athletes are becoming more prevalent, with an unclear relationship between shoulder biomechanics and medial elbow symptoms and injury. The purpose of this study was to investigate the relationship of shoulder range of motion to torque across the medial elbow in college pitchers using a validated MOTUS sensor baseball sleeve. Methods: Pitchers were recruited from three local university baseball teams. Exclusion criteria included injury or restricted activity due to pain. They were evaluated in the preseason, within two weeks before their first game of the season. Pitchers completed workload questionnaires and patient reported outcome measurement information system (PROMIS) pain interference (PI), physical function (PF), and upper extremity (UE) surveys. Shoulder range of motion and upper extremity lengths were measured bilaterally. After adequate warm-up, pitchers were fitted with a MOTUS sensor baseball sleeve (Motus Global, Massapequa, NY) and instructed to throw 5 fastballs in a standardized manner off the mound at game-speed effort. The sensor placed at the medial elbow reported elbow torque, arm speed, arm slot, and shoulder rotation for each pitch, while a radar gun measured peak ball velocity. The primary outcome was to evaluate the relationship between shoulder range of motion and increased stress across the medial elbow. Additional outcomes evaluated pitcher characteristics, demographics, and outcome scores. Outcomes were assessed via a multivariable model, which controlled for possible covariates. Results: Twenty-eight pitchers were included in the preseason analysis with an average (SD) age of 20.1 (1.3) years and playing experience of 15.3 (1.8) years, 2.5 (1.2) of those years at collegiate level. The dominant shoulder demonstrated decreased internal rotation (54.5+/-10.6 vs 65.8+/-9.1) and increased external rotation (ER, 94.1+/-10.4 vs 88.4+/-9.2) relative to the non-dominant side (p < 0.001), while total rotational range of motion (TRROM) was significantly decreased in the dominant arm (148.6+/-12.4 vs 154.1+/-10.6, p < 0.001). The average glenohumeral internal rotation deficiency (GIRD) was 11.3 (9.87) and average external rotation gain (ERG) was 5.71 (8.8). External rotation was found to be a predictor of arm stress, with an increase in 0.35 Nm of elbow torque for every degree increase in ER (beta = 0.35+/-0.06, p = 0.003); there was moderate correlation between ER and arm stress (r = .45, P<.001). Pitchers demonstrated significantly greater arm stress with the following shoulder ROM measurements: GIRD < 20 as compared to greater than 20 degrees (46.6 +/- 0.5 versus 43.5 +/- 1.1, P=.011), ERG greater than 5 as compared to < 5 degrees (47.4 +/- 0.7 versus 45.1 +/- 0.6, P=.014), and loss of total rotational ROM less than 5 as compared to > 5 degrees (46.6 +/- 0.5 versus 43.6 +/- 1.1, P=.013). Multivariate analysis demonstrated significant predictors of PROMIS PF and UE scores were arm stress, ERG, and GIRD (p<0.05), while increased PROMIS PI scores were predicted by increased ERG and GIRD (p<0.05). Conclusion: We found medial elbow stress, arm speed, arm slot, and shoulder rotation as measured by the MOTUS baseball sensor sleeve were influenced by rotational adaptations of the pitching shoulder in collegiate throwing athletes prior to their season. Likewise, arm stress and shoulder rotational adaptations were reflected as predictors of PROMIS PF, UE, and PI scores.

scholarly journals Early versus Delayed Imaginal Exposure for the Treatment of Posttraumatic Stress Disorder Following Accidental Upper Extremity Injury

Hand ◽  
2012 ◽  
Vol 7 (2) ◽  
pp. 127-133 ◽  
Author(s):  
Jo M. Weis ◽  
Brad K. Grunert ◽  
Heidi Fowell Christianson
Keyword(s):  
Treatment Group ◽  
Upper Extremity ◽  
Stress Disorder ◽  
Extremity Injury ◽  
Imaginal Exposure ◽  
Delayed Treatment ◽  
Work Related ◽  
Upper Extremity Injury ◽  
Extremity Injuries ◽  
Ptsd Symptomatology

Background The consequences following work-related injuries are far reaching, which are in part due to unrecognized and untreated posttraumatic stress disorder (PTSD). Imaginal exposure is a frequently used cognitive behavioral approach for the treatment of PTSD. This study examined the impact of early versus delayed treatment with imaginal exposure on amelioration of PTSD symptomatology in individuals who suffered upper extremity injuries. Methods Sixty individuals who suffered severe work-related injuries received standard, non-randomly assigned psychological treatment for PTSD (e.g., prolonged imaginal exposure) either early (30–60 days) or delayed (greater than 120 days) following severe work-related upper extremity injury. Nine measures of various components of PTSD symptomatology were administered at onset of treatment, end of treatment, and at 6-month follow-up evaluations. Results Patients showed significant treatment outcomes at all three measurement intervals in both the early and delayed groups demonstrating that Prolonged Imaginal Exposure is an appropriate treatment for persons diagnosed with PTSD. In addition, there was no difference in return to work status between the early and the delayed treatment groups. However, the early treatment group required significantly fewer treatment sessions than the delayed treatment group. Conclusions Results supported the utility of imaginal exposure and the need for early assessment and referral for those diagnosed with PTSD following upper extremity injuries.

scholarly journals The Influence of Kinesiophobia on Perceived Disability in Patients With an Upper-Extremity Injury: A Critically Appraised Topic

2020 ◽  
pp. 1-6
Author(s):  
Olivia Bartlett ◽  
James L. Farnsworth
Keyword(s):  
Upper Extremity ◽  
Critical Evaluation ◽  
Extremity Injury ◽  
Bottom Line ◽  
Cross Sectional ◽  
Perceived Disability ◽  
Perceptions Of Disability ◽  
Upper Extremity Injury ◽  
Extremity Injuries ◽  
The Relationship

Clinical Scenario: Kinesiophobia is a common psychological phenomenon that occurs following injury involving fear of movement. These psychological factors contribute to the variability among patients’ perceived disability scores following injury. In addition, the psychophysiological, behavioral, and cognitive factors of kinesiophobia have been shown to be predictive of a patient’s self-reported disability and pain. Previous kinesiophobia research has mostly focused on lower-extremity injuries. There are fewer studies that investigate upper-extremity injuries despite the influence that upper-extremity injuries can have on an individual’s activities of daily living and, therefore, disability scores. The lack of research calls for a critical evaluation and appraisal of available evidence regarding kinesiophobia and its contribution to perceived disability for the upper-extremity. Focused Clinical Question: How does kinesiophobia in patients with upper-extremity injuries influence perceptions of disability and quality of life measurements? Summary of Key Findings: Two cross-sectional studies and one cohort study were included. The first study found a positive relationship between kinesiophobia and a high degree of perceived disability. Another study found that kinesiophobia and catastrophic thinking scores were the most important predictors of perceived upper-extremity disability. The third study found that kinesiophobia contributes to self-reported disability in the shoulder. Clinical Bottom Line: There is moderate evidence that supports the relationship between kinesiophobia and perceived disability, and the relationship between elevated perceptions of disability and increased kinesiophobia scores in patients with an upper-extremity injury. Clinicians should evaluate and monitor kinesiophobia in patients following injury, a condition that can enhance perceptions of disability. An elevated perception of disability can create a cycle of fear that leads to hypervigilance and fear-avoidance behavior. Strength of Recommendation: Consistent findings from reviewed studies suggest there is grade B evidence to support that kinesiophobia is related to an increased perceived disability following upper-extremity injuries.

GIRD syndrome in male handball and volleyball players: Is the decrease of total range of motion the turning point to pathology?

2021 ◽  
pp. 1-8
Author(s):  
Jonas Schmalzl ◽  
Helen Walter ◽  
Wolfram Rothfischer ◽  
Sören Blaich ◽  
Christian Gerhardt ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Turning Point ◽  
External Rotation ◽  
Constant Score ◽  
High Rate ◽  
Overhead Athletes ◽  
Glenohumeral Internal Rotation Deficit ◽  
Total Range ◽  
Volleyball Players

BACKGROUND: Adaptations in glenohumeral range of motion may affect overhead athletes and lead to shoulder pathologies. OBJECTIVE: The purpose of this study was to evaluate glenohumeral internal rotation deficit (GIRD) and postero-superior impingement among male handball and volleyball players and the relationship between these pathologies and training level (amateur vs. professional), position (attack vs. no attack), experience (> 5 years vs. < 5 years) and sports. METHODS: Sixty-seven handball players and 67 volleyball players with a mean age of 25 [± 5] years were included. The range of motion including external and internal rotation in 90∘ abduction of the dominant and non-dominant shoulder was measured of each examined athlete. Visual analogue scale, disabilities of the shoulder and hand score, constant score and subjective shoulder value were recorded. The athletes were examined for postero-superior impingement and abduction force was measured with an isokinetic dynamometer. RESULTS: Internal rotation was significantly lower and external rotation was significantly greater in the dominant arm for both sports. 72% presented with GIRD. GIRD was more prevalent in athletes active for > 5 years (odds ratio (OR) 3), in those training > 3 times per week (OR 1.4) and in handball players (OR 2.7). 24% presented with postero-superior impingement. Players active for > 5 years (OR 1.22), professionals (OR 1.14), volleyball players (OR 1.19), offensive players (OR 2.2) and athletes with GIRD > 10∘ (OR 1.5) showed a higher prevalence of postero-superior impingement. CONCLUSION: GIRD is a common phenomenon in handball and volleyball players. Offensive players are frequently suffering from postero-superior impingement. GIRD > 10∘ leads in nearly 75% of the athletes to a decrease of total range of motion and a high rate of postero-superior impingement. Thus, a decreased range of motion seems to be the turning point from adaptation to pathology. Therefore, regular controls of range of motion and countermeasures by means of stretching the posterior shoulder joint should be integrated in the training content.

scholarly journals Association of Upper Extremity Pain With Softball Pitching Kinematics and Kinetics

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986517 ◽  
Author(s):  
Gretchen D. Oliver ◽  
Kenzie Friesen ◽  
Jeff W. Barfield ◽  
Kevin Giordano ◽  
Adam Anz ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Ncaa Division I ◽  
Stride Length ◽  
National Collegiate Athletic Association ◽  
Tracking System ◽  
Center Of Mass ◽  
The United States ◽  
Division I ◽  
Trunk Rotation ◽  
Kinetic Chain

Background: There is a paucity of research regarding the relationship between fastpitch softball pitching mechanics and reported pain. Thus, understanding the pitching mechanics of athletes pitching with upper extremity pain and those pain free is paramount. Purpose: To examine lower extremity pitching mechanics, upper extremity kinetics, and upper extremity pain in National Collegiate Athletic Association (NCAA) Division I female softball pitchers. Study Design: Descriptive laboratory study. Methods: A total of 37 NCAA Division I female softball pitchers (mean age, 19.84 ± 1.28 years; mean height, 173.67 ± 7.77 cm; mean weight, 78.98 ± 12.40 kg) from across the United States were recruited to participate. Participants were divided into 2 groups: upper extremity pain (n = 13; mean age, 19.69 ± 1.18 years; mean height, 172.60 ± 11.49 cm; mean weight, 86.75 ± 13.02 kg) and pain free (n = 24; mean age, 19.91 ± 1.35 years; mean height, 174.26 ± 4.96 cm; mean weight, 74.78 ± 9.97 kg). An electromagnetic tracking system was used to obtain kinematic and kinetic data during the riseball softball pitch. Results: At foot contact ( F 3,33 = 7.01, P = .001), backward elimination regression revealed that stride length, trunk rotation, and center of mass (COM) significantly explained about 33% of variance with softball pitchers experiencing upper extremity pain (adjusted R 2 = 0.33). Conclusion: At foot contact, the kinematic variables of increased trunk rotation toward the pitching arm side, increased stride length, and a posteriorly shifted COM were associated with upper extremity pain in collegiate softball pitchers. Variables early in the pitching motion that do not set a working and constructive proximal kinetic chain foundation for the rest of the pitch to follow could be associated with breakdowns more distal in the kinetic chain, possibly increasing the susceptibility to upper extremity pain. Clinical Relevance: The identification of pitching mechanics associated with pain allows clinicians to develop exercises to avoid such mechanics. Avoiding mechanics associated with pain may help reduce the prevalence of pain in windmill softball pitchers as well as help coaches incorporate quantitative biomechanics into their instruction.

Sign in / Sign up

Export Citation Format

Share Document