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Objective To investigate the test-retest reliability and validity of the Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score (KJOC) in elite Canoe Slalom athletes and determine its ability to predict future shoulder pain. Design Observational study with embedded test-retest reliability study. Setting British Canoe Slalom National Training Centre. Participants Nineteen athletes from the British Canoe Slalom team for the 2019 season. Main outcome measures The KJOC was completed at the start of winter training and start of the 2019 competitive season. Current, historical (6-months pre-questionnaire) and prospective (4-months post-questionnaire) shoulder injuries were recorded. Results Test-retest reliability was found to be excellent (ICC3,1 = 0.97), with a minimal detectable change (MDC95%) of 6.7. Compared to uninjured athletes, currently injured and historically injured athletes scored significantly lower (p = 0.002 and p = 0.011, respectively), with the difference between means > MDC95%. A cut-off of 88 was found to be predictive of shoulder pain (AUC: 0.779; sensitivity: 0.60; specificity: 0.95; positive likelihood ratio: 11.4). Conclusion The KJOC demonstrated excellent reliability and can distinguish between athletes with and without current or historical shoulder pain. A KJOC score of

Background Optimal rehabilitation following arthroscopic shoulder stabilisation for traumatic anterior instability is unknown. The purpose of this study was to establish current UK practice for this patient group. Methods A self-administered online questionnaire was developed and distributed to UK surgeons and physiotherapists. Results 138 responses were received. Routine immobilisation was reported in 79.7% of responses with a cross-body sling being the preferred position (63.4%). Duration of immobilisation and timescales to initiate movement were highly variable. Return to light work was advised when patients felt able (25.4%) or after 6 weeks (26.1%). 58.7% recommended waiting for 12 weeks to return to manual work. 56% recommended non-contact sport could be resumed after 12 weeks. For contact sport, recommendations varied from 6 weeks (3.8%) to 6 months (5.8%). Psychological readiness was the most frequently cited criteria for return to play (58.6%). Factors such as hyperlaxity (40.6%), age (32.6%) and kinesiophobia (28.3%) were not considered as relevant as reported quality of surgical fixation (50%). Conclusion There is no clear consensus regarding optimal post-operative rehabilitation following arthroscopic shoulder stabilisation. Further work is required to establish high value, personalised pathways for this patient group.

There is an absence of high-quality evidence to support rehabilitation and return-to-sport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sport. We developed the consensus via a 2-round Delphi process (involving more than 40 content and methods experts) and an in-person meeting. This consensus statement provides guidance with respect to load and risk management. supporting athlete shoulder rehabilitation, and decision making during the return-to-sport process. This statement is designed to offer clinicians the flexibility to apply principle-based approaches to managing the return-to-sport process within a variety of sporting backgrounds. The principles and consensus of experts working across multiple sports may provide a template for developing additional sport-specific guidance in the future.

Objective Investigate intra-rater and inter-rater reliability of the posterior shoulder endurance test (PSET) and calculate minimal detectable change (MDC) to establish measurement properties and inform use of the PSET in practice. Study design Test-retest reliability. Setting: British Canoe Slalom National Training Centre. Participants Twelve participants (7 male, 5 female; 22.5 ± 4.48 years; 73.4 ± 6.36 kg) were investigated by two physiotherapists with >10 years’ experience. Main outcome measure Intraclass correlation coefficients (ICC) were calculated for intra-rater reliability (ICC 3,1) and inter-rater reliability (ICC 2,1) and used to calculate MDC. Results Intra-rater reliability scores were 0.84 and 0.85 for rater A and B, respectively, with 95% confidence interval (CI) crossing moderate to excellent reliability for both raters (0.5–0.75 and > 0.9). Inter-rater reliability scores were 0.74 and 0.63 at baseline and follow-up, respectively, with 95% CI crossing poor to good reliability in both time points ( 0.75). MDC95% for intra-rater scores was 6 repetitions, MDC95% for inter-rater scores was 8 repetitions at baseline and 9 repetitions at follow-up. Conclusion The PSET has acceptable intra-rater reliability but further work is needed to narrow the CI to an appropriate level for inter-rater reliability. The MDC calculated helps clinicians interpret changes in tests scores.

Objective To investigate the correlation of arm length with different CKCUEST measures and determine if a modification of the test position (modified-CKCUEST), or normalisation of the CKCUEST (normalised-CKCUEST) score after testing, control for arm length most effectively. Study design Quasi Experimental. Setting British Canoe Slalom National Training Centre. Participants Thirteen (5 male, 8 female) asymptomatic national squad canoe/kayak slalom athletes were recruited during winter profiling. Main outcome measure Three measures of the CKCUEST were investigated. The CKCUEST, hands 36 inches apart; modified-CKCUEST, hands arm width apart (measured as C7 spinous process to tip of middle finger); and normalised-CKCUEST (measured as CKCUEST score/arm length). Results A significant positive correlation was found between arm length and the CKCUEST score (r = 0.807; p = 0.001) and normalised-CKCUEST score (r = 0.654; p = 0.015). No significant correlation was found between the modified-CKCUEST score and arm length (p = 0.745). A statistically significant difference between narrow and wide hand positions, greater than the minimal detectable change, was found (p = 0.000). Conclusions Arm length has a significant impact on CKCUEST score. The modified-CKCUEST score corrected for arm length where the normalised-CKCUEST score did not. Modifying the CKCUEST to individual anthropometrics needs to be performed pre-testing when comparisons are being made between individuals or groups.

Context: Maximal power describes the ability to immediately produce power with the maximal velocity at the point of release, impact, and/or take off—the greater an athlete’s ability to produce maximal power, the greater the improvement of athletic performance. In reference to boxing performance, regular consistent production of high muscular power during punching is considered an essential prerequisite. Despite the importance of upper limb power to athletic performance, presently, there is no gold standard test for upper limb force development performance. Objective: To investigate the test–retest reliability of the force plate–derived measures of countermovement push-up in elite boxers. Design: Test–retest design. Setting: High Performance Olympic Training Center. Participants: Eighteen elite Olympic boxers (age = 23 [3] y; height = 1.68 [0.39] m; body mass = 70.0 [17] kg). Intervention: Participants performed 5 repetitions of countermovement push-up trials on FD4000 Forcedeck dual force platforms on 2 separate test occasions 7 days apart. Main Outcome Measures: Peak force, mean force, flight time, rate of force development, impulse, and vertical stiffness of the bilateral and unilateral limbs from the force–time curve. Results: No significant differences between the 2 trial occasions for any of the derived bilateral or unilateral performance measures. Intraclass correlation coefficients indicated moderate to high reliability for performance parameters (intraclass correlation coefficients = .68–.98) and low coefficient of variation (3%–10%) apart from vertical stiffness (coefficient of variation = 16.5%–25%). Mean force demonstrated the greatest reliability (coefficient of variation = 3%). In contrast, no significant differences (P < .001) were noted between left and right limbs (P = .005–.791), or between orthodox or southpaw boxing styles (P = .19–.95). Conclusion: Force platform–derived kinetic bilateral and unilateral parameters of countermovement push-up are reliable measures of upper limb power performance in elite-level boxers; results suggest unilateral differences within the bilateral condition are not the norm for an elite boxing cohort.

Muscular fatigue impacts on normal shoulder function, which is particularly pertinent to throwing athletes. This study aimed to investigate the relationship between grip strength and shoulder muscle fatigue to evaluate the role of grip strength as a surrogate measure for upper limb performance. Twenty healthy participants were recruited. EMG was recorded from 15 shoulder muscles during different fatiguing contractions: an initial baseline recording (Fat-Baseline); after a shoulder exhausting exercise regime (Fat-Exhaustion); and after a 10 minute rest period (Fat-Recovery). Grip strength was similarly measured in the same conditions. Grip strength differed significantly across the testing scenarios (p= 0.012

Shoulder injuries are a common feature of sport, and have reported high recurrence rates, which lead to extended periods of absence from training and competition. Athletes need shoulders with the functional mobility and stability necessary to cope with the speeds, loads, ranges and repetitions of their sports. Currently, there are no reported validated instruments that are designed to assess the function requirements of the upper limb in sporting athletes, and published recommendations are generally based on local shoulder function, and tend to generalise the functional requirements of the shoulder and shoulder girdle. Further attention needs to be paid to the position of the athlete at the time when optimal shoulder girdle function is required, and the requirements of that specific sport and since the kinetic chain has a role in optimal function of the shoulder girdle, one must take into consideration the required optimal function of distal parts and their influence on local function. Many of the current functional assessment tools reported in the literature are for use with a sedentary, non-sporting population, and are not suitable for use as a return-to-play assessment of athletes. Furthermore, using screening information from other sports is not always transferable to other (similar) sports due to the specialist movement characteristics of each sport.

© 2019 - IOS Press and the authors. All rights reserved. BACKGROUND: Disorders associated with the rotator cuff are regarded as the most common shoulder pain presentation. The range of diagnostic terms used to explain this problem reflect uncertainty in relation to causative mechanisms, diagnosis, prognosis, and the most effective treatments. The aim of this consensus exercise was to facilitate a shared understanding as a means of reducing mixed messages, informing clinical practice and providing a foundation for future research. METHODS: Nine physiotherapists with clinical and academic expertise in shoulder pain participated in an online and face-to-face consensus exercise. RESULTS: This consensus exercise suggests specific factors in the history and physical examination that might raise the index of suspicion of Rotator Cuff Related Shoulder Pain. The suggestions for non-surgical management include a minimal number of exercises prescribed to challenge the functional deficit of the patient over a minimum 12-week period. Apart from aiding exclusion of red flag pathology, imaging is not regarded as useful unless the patient does not respond as expected. Steroid injections wouldn't be considered a first-line intervention unless pain was severe and preventing engagement with exercise. CONCLUSION: This consensus exercise provides a benchmark for clinical reflection while highlighting areas of uncertainty that still exist and require further research.

Context: Muscular power output of the upper limb is a key aspect of athletic and sporting performance. Maximal power describes the ability to immediately produce power with maximal velocity at the point of release, impact, or takeoff, with research highlighting that the greater an athlete’s ability to produce maximal power, the greater the improvement in athletic performance. Despite the importance of upper-limb power for athletic performance, there is presently no gold-standard test for upper-limb force development performance. Objective: The aim of this study was to investigate the test–retest reliability of force plate–derived measures of the countermovement push-up in active males. Design: Test–retest design. Setting: Controlled laboratory. Participants: Physically active college athletes (age 24 [3] y, height 1.79 [0.08] m, body mass 81.7 [9.9] kg). Intervention: Subjects performed 3 repetitions of maximal effort countermovement push-up trials on Kistler force plates on 2 separate test occasions 7 days apart. Main Outcome Measures: Peak force, mean force, flight time, rate of force development, and impulse were analyzed from the force–time curve. Results: No significant differences between the 2 trial occasions were observed for any of the derived performance measures. Intraclass correlation coefficient and within-subject coefficient of variation calculations indicated performance measures to have moderate to very high reliability (intraclass correlation coefficient = .88–.98), coefficient of variation = 5.5%–14.1%). Smallest detectable difference for peak force (7.5%), mean force (8.6%), and rate of force development (11.2%) were small to moderate. Conclusion: Force platform–derived kinetic parameters of countermovement push-up are reliable measurements of power in college-level athletes.

There is an interest within elite sport in understanding the impact of a vibrating platform as an adjunct to exercise in the training and rehabilitation of throwing athletes. However, there has been no comprehensive evaluation of its impact on the rotator cuff muscles or its effect on the timing of shoulder muscle recruitment more globally. Twenty healthy participants were recruited with EMG recorded from 15 shoulder girdle muscles. Isometric shoulder flexion at 25% maximal voluntary contraction was performed in three testing scenarios [no vibration; whole body vibration (WBV); and arm vibration (AV)]. A press up and triceps dips with and without vibration were also performed. Muscular recruitment was assessed pre- and post-vibration exposure as participants initiated forward flexion. Activation of the anterior deltoid (p = 0.002), serratus anterior (p = 0.004), and rotator cuff muscles (p = 0.004–0.022) occurred significantly earlier following exposure to vibration. Significantly greater activation was seen in the anterior, middle and posterior deltoid, upper, middle and lower trapezius, serratus anterior, teres major, latissimus dorsi, supraspinatus, and infraspinatus when the isometric contraction was performed with either WBV and/or AV (p =

Background Shoulder pain or injury is the most common issue facing elite competitive swimmers and the most frequent reason for missed or modified training. Literature suggests that highly repetitive upper limb loading leads to inappropriate adaptations within the shoulder complex. The most likely maladaptations to occur are variations in shoulder rotational range of motion, reduction in joint position sense and shortened pectoralis minor length. This has yet to have been confirmed in experimental studies. The aim of this study was to investigate the short-term effects of swimming training load upon internal and external rotation range of motion, joint position sense and pectoralis minor length. Method Sixteen elite swimmers training in the British Swimming World Class programme participated. Measures of internal and external range of motion, joint position sense error score and pectoralis minor length were taken before and after a typical 2 h swimming session. Results Following swimming training shoulder external rotation range of motion and pectoralis minor length reduced significantly (−3.4°, p = Discussion This study determined that elite level swimming training results in short-term maladaptive changes in shoulder performance that could potentially predispose them to injury.

Background Shoulder pain as a result of rotator cuff pathology is one of the most common musculoskeletal complaints presenting within primary care. Assessment of hand grip strength has been proposed as an indicator of rotator cuff function. This experimental study assessed the relationship between grip strength and shoulder lateral rotator muscle strength in a number of different shoulder positions, aiming to investigate whether such a relationship existed and whether grip strength could be used as a functional assessment tool for the posterior cuff. Methods Twenty-seven healthy, physically active, volunteers (19 males, eight females) with no history of shoulder, upper limb or neck injury comprised the study group. The mean (SD) age was 19.8 (5.7) years (range 18 years to 23 years). Grip strength (measured with hand grip dynamometer) and lateral rotator strength (measured with a hand held dynamometer) was measured at neutral, 90° abduction, and 90° abduction with 90° external rotation. Results The correlation between grip strength and shoulder lateral rotation strength ranged between r = 0.91 ( r2 = 0.84) and r = 0.72 ( r2 = 0.52) across all positions. Conclusions A strong correlation between grip strength and lateral rotator strength was shown at all positions for both left and right hands, suggesting that assessment of grip strength could be used as a rotator cuff monitor of recruitment function.

ContextCompromise to the acromiohumeral distance has been reported in participants with subacromial impingement syndrome compared with healthy participants. In clinical practice, patients with subacromial shoulder impingement are given strengthening programs targeting the lower trapezius (LT) and serratus anterior (SA) muscles to increase scapular posterior tilt and upward rotation. We are the first to use neuromuscular electrical stimulation to stimulate these muscle groups and evaluate how the muscle contraction affects the acromiohumeral distance.ObjectiveTo investigate if electrical muscle stimulation of the LT and SA muscles, both separately and simultaneously, increases the acromiohumeral distance and to identify which muscle-group contraction or combination most influences the acromiohumeral distance.DesignControlled laboratory study.SettingHuman performance laboratory.Patients or Other ParticipantsTwenty participants (10 men and 10 women, age = 26.9 ± 8.0 years, body mass index = 23.8) were screened.Intervention(s)Neuromuscular electrical stimulation of the LT and SA.Main Outcome Measure(s)Ultrasound measurement of the acromiohumeral distance.ResultsAcromiohumeral distance increased during contraction via neuromuscular electrical stimulation of the LT muscle (t19 = −3.89, P = .004), SA muscle (t19 = −7.67, P = .001), and combined LT and SA muscles (t19 = −5.09, P = .001). We observed no differences in the increased acromiohumeral distance among the 3 procedures (F2,57 = 3.109, P = .08).ConclusionsOur results supported the hypothesis that the muscle force couple around the scapula is important in rehabilitation and scapular control and influences acromiohumeral distance.

Objective A previous study on shoulder pain mapping showed specific pain patterns for common shoulder disorders. This study aimed to test those patterns for accuracy, modify shoulder pain mapping as needed, and observe their reliability and validity. Methods This prospective study used a two-step process and was undertaken to determine its potential utility in daily practice. New shoulder pain patients marked their pain, its character and severity, on a custom-made mapping form. Then a researcher blinded to the diagnoses gave their estimations on the basis of previously established maps, and they were correlated with final diagnoses. Subsequently, a guide table was developed on how to read the maps, and intertester reliability was performed with three independent testers. Results The study included 194 patients, and the overall accuracy for estimations was between 45.4% and 49.5%. The sensitivity was high, especially for instability, followed by calcific tendinitis, acromio-calvicular joint pathology, and impingement. The intertester reliability showed clinically significant agreement between testers for both disease groups (κ = 0.70) and individual disorders (κ = 0.52). Conclusions This was a unique and extensive study on shoulder pain mapping. The study concluded that pain mapping could be a useful adjunct to the clinical assessment of patients with shoulder pain and can be used in the primary care setting as well as secondary care and for research.

Anterior Cruciate ligament (ACL) injuries are one of the most common and devastating knee injuries sustained whilst participating in sport. ACL reconstruction (ACLR) remains the standard approach for athletes who aim to return to high level sporting activities but the outcome from surgery is not assured. Secondary morbidities and an inability to return to the same competitive level are common following ACLR. One factor which might be linked to these sub-optimal outcomes may be a failure to have clearly defined performance criteria for return to activity and sport. This paper presents a commentary describing a structured return to sport rehabilitation protocol for athletes following ACLR. The protocol was developed from synthesis of the available literature and consensus of physiotherapists and strength and conditioning coaches based in the home country Institute of Sports within the United Kingdom.

Objective To assess if joint position sense (JPS) in the shoulder differed between un-injured rugby players, matched control subjects and previously injured rehabilitated rugby players. Design Mixed design. Setting University biomechanics laboratory. Participants 15 asymptomatic professional rugby union players, 15 previously injured professional rugby union players, 15 asymptomatic matched non-rugby playing controls had their JPS assessed. Main outcome measures JPS was assessed using two criterion angles in the 90° shoulder abduction position (45° and 80° external rotation). Results The study found a significant difference between groups in error score ( p =0.02). The testing angle also had a significant effect on error score ( p =0.002), with greater error scores occurring in the mid range position. Conclusion This study showed rugby players to have better JPS than controls, indicating JPS might not be related to injury risk. Poor JPS appears to be related to injury, players having sustained an injury have decreased JPS despite surgery and/or rehabilitation and returning to sport without incident.

To assess the effect of a simulated tackling task on shoulder joint position sense (JPS) in rugby players. The study also aimed to assess if differences in JPS occurred between mid range and end of range JPS, and if the tackling task had angle-specific effects on these values.Repeated measures.University human performance laboratory.Twenty-two asymptomatic professional rugby union players.JPS was assessed using two criterion angles in the 90 degrees shoulder abduction position (45 degrees and 80 degrees external rotation) prior to and following a simulated tackling task.Prior to the tackling task JPS (absolute error scores) was worse at the 45 degrees than 80 degrees criterion angle (p0.05). Following the tackling task absolute error scores were significantly increased at the 80 degrees angle (p0.001), with no significant change at the 45 degrees angle (p0.05), and no significant difference was present for error scores between angles (p=0.74).This study found JPS to be significantly reduced following a fatiguing task. But this change was only true for the end of range position, with JPS in the mid range not changing. If the mechanoreceptors are unable to accurately report shoulder position in the outer range (stretch) position due to repetitive tackling, then there is a potential for the anterior structures to become stressed before any compensatory muscle contraction can take place. These results highlight the presence of sensorimotor system deficits following repeated tackling. These deficits are proposed to contribute to overuse injuries and micro-instability of the glenohumeral joint which may be related to the increasing rate of shoulder injuries in rugby.

Background Maintenance of the subacromial space is important in impingement syndromes. Research exploring the correlation between biomechanical factors and the subacromial space would be beneficial. Objectives To establish if relationship exists between the independent variables of scapular rotation, shoulder internal rotation, shoulder external rotation, total arc of shoulder rotation, pectoralis minor length, thoracic curve, and shoulder activity level with the dependant variables: AHD in neutral, AHD in 60° arm abduction, and percentage reduction in AHD. Design Controlled laboratory study. Method Data from 72 male control shoulders (24.28years STD 6.81 years) and 186 elite sportsmen's shoulders (25.19 STD 5.17 years) were included in the analysis. The independent variables were quantified and real time ultrasound was used to measure the dependant variable acromio-humeral distance. Results Shoulder internal rotation and pectoralis minor length, explained 8% and 6% respectively of variance in acromio-humeral distance in neutral. Pectoralis minor length accounted for 4% of variance in 60° arm abduction. Total arc of rotation, shoulder external rotation range, and shoulder activity levels explained 9%, 15%, and 16%–29% of variance respectively in percentage reduction in acromio-humeral distance during arm abduction to 60°. Conclusion Pectorals minor length, shoulder rotation ranges, total arc of shoulder rotation, and shoulder activity levels were found to have weak to moderate relationships with acromio-humeral distance. Existence and strength of relationship was population specific and dependent on arm position. Relationships only accounted for small variances in AHD indicating that in addition to these factors there are other factors involved in determining AHD.

Normal shoulder function is essential for popular sports, and shoulder dysfunction causes significant impairment of everyday quality of life (Kibler, 2001). Shoulder problems, particularly in sportsmen and women involved in overhead sports, are often difficult to treat to gain full resolution of symptoms (Magarey, Jones, & Grant, 1996). Often, upper quadrant postural deviations contribute to muscle imbalances around the shoulder girdle, leading to subtle signs of instability (Einhorn, Mandas, Sawyer, & Brownstair, 1997) and, later impingement. This syndrome has been classified as primary or secondary impingement. Primary shoulder impingement is a pathology which, within musculoskeletal medicine, is often described as a mechanical compression of the rotator cuff tendons, subacromial bursa, and long head of the biceps tendon against the inferior surface of the acromion process and coracoacromial ligament (Matsen & Arntz, 1990). The causes of secondary impingement are generally thought to occur as a result of a tight posterior capsule (Harryman et al., 1990), scapulothoracic dyskinesis (Brossmann et al., 1996; Flatow et al., 1994) and shoulder instability (Kamkar, Irrgang, & Whitney, 1993). Panjabi et al. (1994) described clinical instability as the ‘loss of ability under physiologic loads to maintain . patterns of displacement so that there is no initial or additional neurological deficit, no major deformity, and no incapacitating pain’.

Changes in the isokinetic moment curve of the knee flexors have been proposed to be associated with functional instability in anterior cruciate ligament deficient (ACLD) patients. The purpose of this study was to assess if this relationship exists between breaks in the knee flexor moment curve and functional instability in an ACLD patient population. The study involved two groups: an asymptomatic control group (n = 20) and a second experimental group (n = 20) diagnosed as having an anterior cruciate ligament rupture. Both groups underwent isokinetic strength assessment of the knee flexors, with the moment curves being inspected for irregularities or breaks. All subjects also completed Lysholm and Tegner questionnaires and had a standardized assessment using the International Knee Documentation Committee (IKDC) form. The findings of the questionnaires were then correlated with presence of breaks in the torque curve to assess association between these factors. Breaks in the knee flexor moment curve were established to occur in some patients with ACL deficiency; these patients also had lower scores on a variety of functional indices. Further investigation would appear to be warranted on a larger population to establish if the presence of break phenomena in knee flexor torque curves can be used to identify those patients who can and cannot cope with ACL deficiency.

Objective: In professional male golfers the shoulder is the third most commonly injured area with the lead/non-dominant shoulder three times more likely to be injured than the trail/dominant shoulder. Resting length of pectoralis minor musculature influences scapular and glenohumeral orientation which when suboptimal is associated with shoulder injuries. This study investigates the resting pectoralis minor muscle length in professional male golfers. Method: Forty five male golfers on European Challenge Tour and thirty six control volunteers met the inclusion criteria for the study. Resting pectoralis minor length was measured in the supine position with the Palmmeter device. Results: Within groups: controls exhibited a significantly longer pectoralis minor muscle on the non-dominant side (p=0.01), and golfers had a significantly longer pectoralis minor muscle on the trail/dominant side (p=0.01). Between groups: controls exhibited a significantly longer pectoralis minor length on the non-dominant/ lead side when compared to golfers (p=0.01). Conclusion: When compared to age-matched controls professional male golfers have a unique pattern of resting pectorals minor muscle length, with longer pectoralis minor length noted in the trail/ dominant shoulder. Comparison of the lead/non-dominant shoulder with controls highlights that golfers have a shorter pectoralis minor length which in turn affects scapular and glenohumeral orientation. This may place the golfer at greater risk of shoulder injury in the lead side.

Objective: Appropriate scapula position is necessary to optimise maximum force generation during the golf swing. Abnormalities in upward scapular rotation have been associated with various shoulder pathologies. Assessment of scapular position is considered an important clinical measure for sports therapists and trainers to prevent injury. This study investigated scapular upward rotation in elite golfers. Method: Forty five male golfers on European Challenge Tour and thirty six non-sportsman control volunteers met the inclusion criteria for the study. With the participant standing, the Palmmeter was used to measure lateral distances of the scapula from the spine and these measurements were used in the sin rule to calculate scapular rotation in the coronal plane. Result: The dominant scapula of controls was more upwardly rotated in both neutral (p=0.04, paired t-test) and in 60 degrees of shoulder abduction (p=0.04, paired t-test). The dominant scapula of golfers was significantly more upwardly rotated in neutral (p=0.01, paired t-test) and the lead scapula was significantly more upwardly rotated in 60° of shoulder abduction (p=0.01, paired t-test). Conclusion: Asymmetry of scapular rotation in the coronal plane in golfers as an indicator of risk in the golfers shoulder is not appropriate during screening. When compared with controls, golfers had a unique pattern of scapular upward rotation during arm abduction to 60°.

Shoulder injuries within the collision sport of rugby not only result in significant time loss from competition but also have a high reoccurrence rate. Rehabilitation of these athletes forms a critical element in both returning them to sport and reducing the risk of further injury. This review outlines the problems which clinicians encounter in managing these athletes and strategies to overcome them.

Objective To identify posture types that exist in professional rugby players, and compare them with a population of non-overhead athletes in order to identify possible relationships towards the potential for shoulder injuries. Design Observational design Setting: Sports Medicine Clinic Participants: Convenience sample Methodology: Static assessment of posture was carried out in standing, active and passive range of glenohumeral motion, and isometric strength was carried out in accordance with previously recorded protocols. Interventions Nil Outcome Measures: Observational classification of posture, active and passive range of glenohumeral joint range of motion, isometric strength of selected muscle groups, selected muscle flexibility and Hawkins and Neer impingement tests. Results There was a significant difference on range of motion between the two groups (0.025–0.000), isometric middle (0.024–0.005), and lower trapezius (0.01–0.001). Conclusion: There were significant differences between strength and flexibility of muscles around the shoulder girdle between professional rugby players and a control group of professional non-overhead athletes.

Rugby union is an international sport played by two teams of 15 players (8 forwards and 7 backs) over two 40 minute halves. It is ranked internationally, as a football code, second to soccer, and is the most popular world wide team contact sport involving collision (IRB, 2004). Professional rugby league is a contact sport involving two teams of 13 players (6 forwards and 7 backs), also played over two 40 minute halves. Each tem has a set of six tackles to advance the ball downfield (Gissane et al., 2003). Little is known about the level and pattern of injuries occurring since rugby union became a professional sport, and the number of prospective studies among elite players is small (Brooks, et al., 2005). Prior to Brooks et al., (2005), there have been several prospective cohort epidemiological studies of injuries sustained in professional Rugby Union (Bathgate, et al., 2002; Garraway, et al., 2000. Targett, 1998). The mean incidence of injuries recorded from three studies within professional rugby union is 86.4 injuries per 1000 player hours (Holtzhausen, 2001). Pooled data analysis of injury incidence in rugby league, found an overall injury rate of 40.3 injuries per 1000 player hours (Gissane et al., 2002). Brooks et al., (2005) conducted the England Rugby Injury and Training Audit, which included all 12 Premiership rugby union teams, and England, England ‘A’, Under 21 and England 7’s teams, during the 2002-2003 and 2003-2004 seasons. They used the operation definition which had been used previously by one of the authors in research into injuries in professional football; “any injury which prevented a player from taking a full part in all training activities typically planned for that day and match play for a period equal to or greater than 24 hours, from midnight of the day the injury was sustained” (Hawkins, and Fuller, 1999). Detailed analysis of this audit, with respect to shoulder injuries, reports that the average number of tackles carried out during a Premiership match is 250, and that 65% of all shoulder injuries occurring during a match are to the shoulder. During the 2005-2006 season the number of days lost to training or playing due to reported shoulder dislocation or instability was 176 days per 1000 hours play (Heady et al., unpublished). Thus the tackle appears to be the phase of play associated with the greatest risk of injury overall. (Brooks et al., 2005; Bird et al.,1998; Garraway and Macleod ,1995; yet there appears to be scant published research regarding the affect on shoulder joint position sense within rugby players, in general, and the effect that tackling has on it.

Background The study objective was to assess the influence of a SLAP lesion on onset of EMG activity in shoulder muscles during a front on rugby football tackle within professional rugby players. Methods Mixed cross-sectional study evaluating between and within group differences in EMG onset times. Testing was carried out within the physiotherapy department of a university sports medicine clinic. The test group consisted of 7 players with clinically diagnosed SLAP lesions, later verified on arthroscopy. The reference group consisted of 15 uninjured and full time professional rugby players from within the same playing squad. Controlled tackles were performed against a tackle dummy. Onset of EMG activity was assessed from surface EMG of Pectorialis Major, Biceps Brachii, Latissimus Dorsi, Serratus Anterior and Infraspinatus muscles relative to time of impact. Analysis of differences in activation timing between muscles and limbs (injured versus non-injured side and non injured side versus matched reference group). Results Serratus Anterior was activated prior to all other muscles in all (P = 0.001-0.03) subjects. In the SLAP injured shoulder Biceps was activated later than in the non-injured side. Onset times of all muscles of the non-injured shoulder in the injured player were consistently earlier compared with the reference group. Whereas, within the injured shoulder, all muscle activation timings were later than in the reference group. Conclusions This study shows that in shoulders with a SLAP lesion there is a trend towards delay in activation time of Biceps and other muscles with the exception of an associated earlier onset of activation of Serratus anterior, possibly due to a coping strategy to protect glenohumeral stability and thoraco-scapular stability. This trend was not statistically significant in all cases

Background Epidemiological studies have shown that the incidence of shoulder injuries is increasing in rugby and the majority are related to the contact/tackle phase of play. However, no data currently exists that describes preparatory muscle activity during tackle. This information could aid in guiding training and rehabilitation, if available. The purpose of the study was to assess the sequence of onset of EMG activity of selected scapulohumeral muscles during rugby tackle. 15 healthy professional rugby players participated in the study. Surface EMG activity was assessed for timing of onset relative to time of impact during a modified tackle activity in pectorialis major, biceps brachii, latissimus dorsi, serratus anterior and infraspinatus muscles. Results Onset of activity occurred in all muscles prior to impact. Factorial ANOVA showed significant differences between muscles in activation timing (p = 0.0001), paired t-tests revealed that serratus anterior was activated prior to all other muscles tested (p < 0.04, for all comparisons), with comparison between all other muscles showing no significant differences (p > 0.05), except pectorialis major on all comparisons showed significantly later activation timing than all other muscles (p < 0.001). Conclusion Muscle activation timing may if not properly balanced around the shoulder girdle expose the glenohumeral joint to excessive load and stress. This paper demonstrates a simple method which sets out some preliminary normative data in healthy players. Further studies relating these data to injured players are required.

Context: Hip adduction and abduction strength plays an important role in the treatment and prevention of groin injuries in football players. Currently there are no reliable baseline values for uninjured football player’s hip adduction: abduction muscle strength ratios. Objective: To examine whether normal hip adduction: abduction strength ratios can be established in uninjured football players. To compare this data, and establish if there is an asymmetry between the dominant and non-dominant limb. Methods: Twenty, English Premier League academy football players 18.45 (± 2.06) years, 72.6 (± 5.56) kg, 180.15 (± 7.97) cm, 3 left limb dominant, and 17 right limb dominant were included in the study. Eccentric and concentric hip adduction and abduction strength of the dominant and non-dominant leg was tested using a Cybex isokinetic dynamometer. Results: The concentric ratio on the dominant limb was 1.59 (± 0.19) and on the non-dominant limb 1.45 (± 0.31). The eccentric ratio on the dominant limb was 1.45 (± 0.32) and on the non-dominant limb 1.26 (± 0.26). Overall the ratios were higher on the dominant limb and this was statistically significant P ≤ .05. Abduction strength was similar bilaterally. Adduction strength was 18%-22% greater on the dominant limb. Conclusions: The greater ratios on the dominant limb are due to increased adductor strength as a result of the kicking action. Elite football player’s hip adduction: abduction strength ratios should be 1.45-1.6 on the dominant limb and 1.25-1.45 on the non-dominant limb. The adductors on the dominant limb should be 18%-22% stronger than the non-dominant limb. Ratios outside these parameters could indicate the player is at risk of injury. Further research is required to support muscle imbalance as a cause of injury and identify injury risk thresholds for groin injuries in football players.

EMG has previously been used to analyse muscle activation during shoulder rehabilitation programmes and during sports related activities There are no reports on the muscle activity around the shoulder during a standard tackle within rugby football, although there is epidemiological evidence stating that the incidence of injuries to the shoulder within professional rugby is between 0.5 and 1.0 per 1000 playing hours with several studies have highlighted the tackle as being the major cause of all injuries within rugby. The purpose of this study was to define the sequence of muscular activity in selected gleno and scapulo humeral muscles during a front on rugby football tackle. It is hoped then that this information can be utilised to develop muscle specific training and rehabilitation protocols, which may, ultimately minimise the incidence of injury, enhance sports-specific performance, and the career span of professional rugby players. Five healthy asymptomatic experienced Rugby Union players were examined. Surface EMG activity was assessed during a modified tackle activity against a tackle dummy. Onset of EMG activity was assessed in Pectorialis Major, Biceps Brachii, Latissimus Dorsi, Serratus Anterior and Infraspinatus relative to time of impact in the tackle. Onset of activity occurred in all muscles prior to impact. One way ANOVA showed significant differences between muscles in activation timing ( p = 0.0001 ), paired t -tests (with Bonferroni corrections) revealed that Serratus Anterior was activated prior to all other muscles tested ( p p > 0.05 ). These findings indicate consistent early activation of Serratus Anterior prior to impact, ahead of other muscles. Previous literature has reported decreased or inconsistent Serratus Anterior recruitment in swimmers with shoulder pathology, further research is required to discover if altered recruitment of Serratus Anterior is also related to shoulder injuries in rugby.

This is the second edition of a book previously published in 1996 which has been reorganised to make it easier to use and broaden the scope of stretches presented. Chapter 1 begins with the historical basis of PNF, discussing the work of Kabat and later Knott and Voss. It then goes on to explain the myotactic stretch reflex and the role of muscle spindles, together with the role of the Golgi tendon organ in the inverse stretch reflex (autogenic inhibition) and its function in Chaitow's muscle energy technique, where muscle elongation takes place during “post-isometric relaxation”. Chapter 2, “Stretching basics”, skims over the subject of whether it is necessary to stretch. Although it is …

Objective To examine the diagnostic accuracy of standard clinical tests for the shoulder in recreational athletes with activity related pain. Design Cohort study with index test of clinical examination and reference standard of arthroscopy. Setting Sports Medicine clinic in Sheffield, U.K. Participants 101 recreational athletes (82 male, 19 female; mean age 40.8 ± 14.6 years) over a six year period. Interventions Bilateral evaluation of movements of the shoulder followed by standardized shoulder tests, formulation of clinical diagnosis and shoulder arthroscopy conducted by the same surgeon. Main Outcome Measurements Sensitivity, specificity, likelihood ratio for a positive test and over-all accuracy of clinical examination was examined retrospectively and compared with arthroscopy. Results Isolated pathology was rare, most patients (72%) having more than one injury recorded. O'Brien's clinical test had a mediocre sensitivity (64%) and over-all accuracy (54%) for diagnosing SLAP lesions. Hawkins test and Jobe's test had the highest but still not impressive over-all accuracy (67%) and sensitivity (67%) for rotator cuff pathology respectively. External and internal impingement tests showed similar levels of accuracy. When a positive test was observed in one of a combination of shoulder tests used for diagnosing SLAP lesions or rotator cuff disease, sensitivity increased substantially whilst specificity decreased. Conclusions The diagnostic accuracy of isolated standard shoulder tests in recreational athletes was over-all very poor, potentially due to the majority of athletes (71%) having concomitant shoulder injuries. Most likely, this means that many of these injuries are missed in general practice and treatment is therefore delayed. Clinical examination of the shoulder should involve a combination of clinical tests in order to identify likely intra articular pathology which may warrant referral to specialist for surgery.

Background In the literature, little is known about the level and pattern of rugby injuries. Of the shoulder injuries reported, 51% of these are caused during a tackle, and 65% of all match injuries affected the shoulder. Objective The study aims to describe a sport-specific unique intra-articular shoulder pathology of professional rugby players, who presented with persistent pain and dysfunction despite physiotherapeutic treatment and rest. Method This study is a retrospective analysis set at a university sports medicine clinic. Eighty-seven professional rugby players, referred by their professional medical team since they could no longer play, underwent shoulder arthroscopy between June 2001 and October 2007 due to persistent shoulder pain and dysfunction. All were full-time professional male rugby union and rugby league players. They all had failed conservative treatment for their complaint, and the diagnosis was unclear. Arthroscopic findings were used as a measure of main outcome. Results The primary mechanism of injury was reported as direct tackling (56%; n = 49) followed in succession by falling onto the arm (10%; n = 8). However, in 30% of the cases, no definite injury could be recalled. The main operative finding was that most patients exhibited multiple shoulder pathologies, with 75% of cases presenting with two or more pathologies. A superior labrum anterior to posterior (SLAP) lesion was evident at arthroscopy in 72 of the 87 cases (83%), while rotator cuff tears were evident in 43% of cases (n = 37). One-third of all cases had a Bankart tear (n = 29), despite none of them reporting previous dislocations, while other labral tears, excluding SLAP tears, to the inferior or posterior labrum were present in 34% (n = 30) of the cohort. Conclusions Repeated tackling, which is clearly rugby specific, is most likely to be responsible for most of these shoulder injuries, which upon arthroscopic examination, showed signs of mixed pathology. We suggest that an early arthroscopic investigation is valuable in this population in order to confirm treatable diagnosis on the painful shoulder and expedite a safe return to play.