A novel manual therapy technique is effective for short-term increases in tibial internal rotation range of motion.

The coupled motions of tibial internal rotation (T-IR) and ankle dorsiflexion (DF) are necessary for proper lower-limb function. Anecdotally, clinicians have been performing techniques to restore T-IR to improve ankle DF, however, no evidence exists to support their efficacy. Therefore, the two objectives were to: (a) determine the effectiveness of a manual therapy technique for improving T-IR range of motion (ROM) and (b) Examine the relationship between ankle DF and T-IR ROM. Twenty-four participants qualified to participate and were randomly allocated to either the control (n=12) or manual therapy (n=12) group. Closed-chain ankle DF and T-IR ROM were assessed at baseline and immediately posttreatment. Control group participants sat quietly for 5 minutes. The experimental group performed 3 sets of 15 repetitions of a manual therapy, mobilization with movement technique. With the patient in a kneeling lunge position, the examiner wrapped an elastic band around the tibia and fibula and was instructed to lunge forward while the examiner simultaneously manually internally rotated the lower leg. T-IR ROM significantly increased following the intervention for the manual therapy group when compared to the control group. There were no significant changes in standing or kneeling DF ROM. No significant correlation was found between T-IR and both standing and kneeling DF ROM. A single mobilization with movement treatment is effective for improving tibial IR ROM in the short-term compared to no treatment. However, active tibial IR and end-range dorsiflexion range of motion do not appear to be correlated based on these methods.

Comparison of the Graston Technique® With Instrument-Assisted Soft Tissue Mobilization for Increasing Dorsiflexion Range of Motion.

CONTEXT: Limited dorsiflexion (DF) range of motion (ROM) is commonly observed in both the athletic and general populations and is a predisposing factor for lower extremity injury. Graston Technique® (GT) is a form of instrument-assisted soft tissue mobilization (IASTM), used commonly to increase ROM. Evidence of the long-term effects of GT on ROM is lacking, particularly comparing the full GT protocol versus IASTM alone. OBJECTIVE: To evaluate the effectiveness of 6 sessions of the GT or IASTM compared with a control (CON) group for increasing closed-chain DF ROM. DESIGN: Cohort design with randomization. SETTING: Athletic training clinic. PATIENTS OR OTHER PARTICIPANTS: A total of 23 physically active participants (37 limbs) with <34° of DF. Participants' limbs were randomly allocated to the GT, IASTM, or CON group. INTERVENTION: Participants' closed-chain DF ROM (standing and kneeling) were assessed at baseline and 24-48 hours following their sixth treatment. Participants in the CON group were measured at baseline and 3 weeks later. The intervention groups received 6 treatments during a 3-week period, whereas the CON group received no treatment. The GT group received a warm-up, instrument application, stretching, and strengthening of the triceps surae. The IASTM group received a warm-up and instrument application. MAIN OUTCOME MEASURES: Closed-chain DF was assessed with a digital inclinometer in standing and kneeling. RESULTS: A significant difference between groups was found in the standing position (P = .03) but not in kneeling (P = .15). Post hoc testing showed significant improvements in DF in standing following the GT compared with the control (P = .02). CONCLUSIONS: The GT significantly increases ankle DF following 6 treatments in participants with DF ROM deficits; however, no differences were found between GT and IASTM. The GT may be an effective intervention for clinicians to consider when treating patients with DF deficits.

The Impact of a Foot-Toe Orthosis on Dynamic Balance: An Exploratory Randomized Control Trial.

CONTEXT: The influence of custom and over-the-counter foot orthoses on dynamic balance has been investigated in the past. However, there has not been an exploration of the use of a foot-toe orthosis for improving balance. The ability of clinicians to influence balance could have important implications for injury prevention and rehabilitation. OBJECTIVE: To determine the impact of a foot-toe orthosis on dynamic balance in healthy, young adults. DESIGN: Randomized control trial. SETTING: Athletic training laboratory. PARTICIPANTS: In total, 64 healthy, recreationally active participants aged 18-29 years were randomly allocated to one of the following groups: the foot-toe orthosis and laboratory-issued shoe group, the laboratory-issued shoe only (SO) group, or the control group. INTERVENTIONS: Subjects in the intervention group wore the foot-toe orthosis and laboratory-issued shoe with activities of daily living for 4 weeks. Subjects in the SO intervention group wore the laboratory-issued shoe with activities of daily living for 4 weeks. Participants in the control group did not receive any intervention. MAIN OUTCOME MEASURES: The instrumented version of the Star Excursion Balance Test, known as the Lower Quarter Y-Balance Test, was used to quantify the dynamic balance at baseline and follow-up. Reaches were normalized for leg length. RESULTS: There were statistically significant differences in postintervention scores on the Lower Quarter Y-Balance Test for both the dominant (P = .03, effect size = 0.84; 95% confidence interval, 0.25 to 1.43) and nondominant (P = .002, effect size = 0.74; 95% confidence interval, 0.15 to 1.32) legs when comparing dynamic balance scores of the foot-toe orthosis and laboratory-issued shoe group with the SO and control groups. No significant differences were observed when comparing dynamic balance between the SO and control groups. CONCLUSIONS: A 4-week intervention with a foot-toe orthosis and laboratory-issued shoe resulted in improved dynamic balance in a healthy young adult population. These findings suggest a novel intervention for increasing balance.

INTRA- AND INTER-RATER RELIABILITY OF THE SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT (SFMA) IN HEALTHY PARTICIPANTS.

BACKGROUND: The Selective Functional Movement Assessment (SFMA) is a popular assessment tool used to observe and detect components of dysfunctional movement patterns. The goal of the assessment is to identify impairments throughout the kinetic chain that may be contributing to movement dysfunction and/or pain. HYPOTHESIS/PURPOSE: The purpose of this research was to determine the intra- and inter-rater reliability of the 10 top-tier movements of the SFMA using the categorical scoring system. It was hypothesized the intra- and inter-rater reliability of the SFMA would be acceptable with variations based on the objectivity of the scoring criteria and the experience of the rater. STUDY DESIGN: Cross-sectional reliability study. METHODS: 25 (17 male, 8 female), physically active participants (age: 21.2 ± 1.6years, height: 177.1 ± 10.7cm, weight: 74.9 ± 13.9kg) were independently assessed in real time by three clinicians during two separate visits to the lab using a standard instructional script. Clinicians had varying levels of experience with the SFMA and the two visits occurred a minimum of 48 hours and maximum of seven days apart. Results from each clinician were compared within and between raters using the Kappa coefficient and ratings of absolute agreement. RESULTS: Overall, slight to substantial intra- and inter-rater reliability were observed using the categorical scoring tool, although variations existed depending on the movement pattern. Kappa coefficients for intra-rater reliability ranged from 0.21-1.00, while % absolute agreement ranged from 0.64-1.00. Inter-rater reliability for the same measures ranged from 0.11-0.89 and 0.52-0.96 respectively. Clinicians certified in the SFMA with the greatest amount of experience using the SFMA demonstrated higher intra-rater reliability. Similarly, higher inter-rater reliability was found between certified raters with the most experience. CONCLUSIONS: Certified SFMA raters with greater amounts of experience can demonstrate adequate intra- and inter-rater reliability using the categorical scoring method. LEVEL OF EVIDENCE: 2, Reliability study.

The Influence of Corrective Exercises on Functional Movement Screen and Physical Fitness Performance in Army ROTC Cadets.

Context: The functional movement screen (FMS) is a tool designed to identify limitations between sections of the body during fundamental movements. However, there is limited evidence on the effectiveness of corrective exercises to improve FMS scores. Objective: To examine the effects of individualized corrective exercises on improving FMS scores in Reserve Officers' Training Corps cadets and to correlate these changes with physical fitness performance as established with the standard Army Physical Fitness Test (APFT). Design: Cluster randomized, cohort study. Setting: Controlled laboratory setting (FMS) and a field-based setting (APFT). Participants: Forty-four healthy, physically active cadets met all inclusion and exclusion criteria. Intervention: Participants were randomly assigned to the experimental (n = 24) or control (n = 20) group by cluster. Personalized intervention programs were developed through the FMS Pro360 system, a subscription-based software that generates corrective exercises based on individual FMS test scores. The experimental group performed the individualized programs 3 times per week for 4 weeks prior to morning physical training regime. The control group continued to participate in the standard warm-up drills as part of morning physical training. Main Outcome Measures: The dependent variables included the individual and composite FMS and APFT scores. Scores were reported and analyzed in several ways to determine the efficacy of corrective exercises. Results: Group FMS and APFT scores were similar at pretest. The experimental group had a significantly greater improvement in FMS composite score at 4 weeks post (U = 87; z = -3.83; P = .001; effect size = 1.33; 95% confidence interval, 0.69-1.98). No significant changes in APFT scores were found (U = 237.5, z = -0.33, P = .74). A nonsignificant weak correlation between the FMS and APFT scores (r = .25, P = .10) was found. Conclusion: Individualized corrective exercises improved FMS scores, but did not change physical fitness performance. FMS composite scores and APFT performance are not related.

Comparison of Compressive Myofascial Release and the Graston Technique for Improving Ankle-Dorsiflexion Range of Motion.

CONTEXT: Restricted dorsiflexion (DF) at the ankle joint can cause acute and chronic injuries at the ankle and knee. Myofascial release and instrument-assisted soft tissue mobilization (IASTM) techniques have been used to increase range of motion (ROM); however, evidence directly comparing their effectiveness is limited. OBJECTIVE: To compare the effects of a single session of compressive myofascial release (CMR) or IASTM using the Graston Technique (GT) on closed chain ankle-DF ROM. DESIGN: Randomized controlled trial. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Participants were 44 physically active people (53 limbs) with less than 30° of DF. INTERVENTION(S): Limbs were randomly assigned to 1 of 3 groups: control, CMR, or GT. Both treatment groups received one 5-minute treatment that included scanning the area and treating specific restrictions. The control group sat for 5 minutes before measurements were retaken. MAIN OUTCOME MEASURE(S): Standing and kneeling ankle DF were measured before and immediately after treatment. Change scores were calculated for both positions, and two 1-way analyses of variance were conducted. RESULTS: A difference between groups was found in the standing ( F2,52 = 13.78, P = .001) and kneeling ( F2,52 = 5.85, P = .01) positions. Post hoc testing showed DF improvements in the standing position after CMR compared with the GT and control groups (both P = .001). In the kneeling position, DF improved after CMR compared with the control group ( P = .005). CONCLUSIONS: Compressive myofascial release increased ankle DF after a single treatment in participants with DF ROM deficits. Clinicians should consider adding CMR as a treatment intervention for patients with DF deficits.

Collegiate Football Players' Ankle Range of Motion and Dynamic Balance in Braced and Self-Adherent-Taped Conditions.

CONTEXT: Ankle sprains are one of the most common injuries in the physically active population. Previous researchers have shown that supporting the ankle with taping or bracing is effective in preventing ankle sprains. However, no authors have compared the effects of self-adherent tape and lace-up ankle braces on ankle range of motion (ROM) and dynamic balance in collegiate football players. OBJECTIVE: To examine the effectiveness of self-adherent tape and lace-up ankle braces in reducing ankle ROM and improving dynamic balance before and after a typical collegiate football practice. DESIGN: Crossover study. SETTING: Collegiate athletic training room. PATIENTS OR OTHER PARTICIPANTS: Twenty-nine National Collegiate Athletic Association Division I football athletes (age = 19.2 ± 1.14 years, height = 187.52 ± 20.54 cm, mass = 106.44 ± 20.54 kg). INTERVENTION(S): Each participant wore each prophylactic ankle support during a single practice, self-adherent tape on 1 leg and lace-up ankle brace on the other. Range of motion and dynamic balance were assessed 3 times for each leg throughout the testing session (baseline, prepractice, postpractice). MAIN OUTCOME MEASURE(S): Ankle ROM for inversion, eversion, dorsiflexion, and plantar flexion were measured at baseline, immediately after donning the brace or tape, and immediately after a collegiate practice. The Y-Balance Test was used to assess dynamic balance at these same time points. RESULTS: Both interventions were effective in reducing ROM in all directions compared with baseline; however, dynamic balance did not differ between the tape and brace conditions. CONCLUSIONS: Both the self-adherent tape and lace-up ankle brace provided equal ROM restriction before and after exercise, with no change in dynamic balance.

The Effectiveness of PNF Versus Static Stretching on Increasing Hip-Flexion Range of Motion.

Clinical Scenario: Stretching is applied for the purposes of injury prevention, increasing joint range of motion (ROM), and increasing muscle extensibility. Many researchers have investigated various methods and techniques to determine the most effective way to increase joint ROM and muscle extensibility. Despite the numerous studies conducted, controversy still remains within clinical practice and the literature regarding the best methods and techniques for stretching. Focused Clinical Question: Is proprioceptive neuromuscular facilitation (PNF) stretching more effective than static stretching for increasing hamstring muscle extensibility through increased hip ROM or increased knee extension angle (KEA) in a physically active population? Summary of Key Findings: Five studies met the inclusion criteria and were included. All 5 studies were randomized control trials examining mobility of the hamstring group. The studies measured hamstring ROM in a variety of ways. Three studies measured active KEA, 1 study measured passive KEA, and 1 study measured hip ROM via the single-leg raise test. Of the 5 studies, 1 study found greater improvements using PNF over static stretching for increasing hip flexion, and the remaining 4 studies found no significant difference between PNF stretching and static stretching in increasing muscle extensibility, active KEA, or hip ROM. Clinical Bottom Line: PNF stretching was not demonstrated to be more effective at increasing hamstring extensibility compared to static stretching. The literature reviewed suggests both are effective methods for increasing hip-flexion ROM. Strength of Recommendation: Using level 2 evidence and higher, the results show both static and PNF stretching effectively increase ROM; however, one does not appear to be more effective than the other.

Active duty firefighters can improve Functional Movement Screen (FMS) scores following an 8-week individualized client workout program.

BACKGROUND: Firefighting is a dangerous occupation that requires adequate functional movement patterns to help reduce injury risk. Structured programs for improving movement quality have not been studied in firefighters. OBJECTIVE: To examine the effects of an 8-week individualized corrective exercise training program on Functional Movement Screen (FMS) scores in active duty firefighters. METHODS: Fifty-six male firefighters volunteered to participate in the study. All subjects completed baseline FMS testing and scores were entered into the FMS Pro360 system, subscription-based software which generates an individualized corrective exercise workout based on each independent test score. Two, 4-week corrective exercise programs were generated for each participant based on baseline testing. Following the 8-weeks, participants completed follow-up FMS testing. RESULTS: A significant increase in total FMS score (pre = 12.09±2.75, post = 13.66±2.28) was found after the program. A significant increase in stability (pre = 4.13±1.21, post = 4.55±0.83) and advanced movements (pre = 4.45±1.28, post = 5.36±1.29) were also found, however, no difference was observed in mobility tests (3.52±1.09, post = 3.75±0.90). CONCLUSIONS: The results suggest an 8-week individualized corrective exercise program was effective at improving scores on the FMS. Providing corrective exercise programs specific to improving levels of dysfunction or maintaining/enhancing function, may increase firefighter preparedness and attempt to minimize injury risk.

The Effectiveness of Compression Socks for Athletic Performance and Recovery.

Clinical Scenario: The popularity of compression socks has increased substantially among athletes, particularly those participating in endurance events such as running and triathlon. Companies are increasingly marketing compression stockings to runners, triathletes, and other endurance athletes for the benefits of improved performance and/or decreased recovery time. Originally developed for the treatment of deep-vein thrombosis, compression socks are now marketed as a tool to improve venous return, thus believed to improve both performance and recovery in athletes. The use of compression socks during training aims to help the skeletal-muscle pump, increase deep venous velocity, and/or decrease blood pooling in the calf veins and alleviate delayed-onset muscle soreness. The scenario is a 28-y-old recreational triathlete seeking your advice while training for her first half-Ironman. She occasionally complains of tightness in the calves both during and after running. She wants your opinion on the effectiveness of using compression socks to help her performance and recovery. Focused Clinical Question: What is the effectiveness of using graduated compression socks for improving athletic performance and decreasing recovery time in healthy endurance athletes?

Physical activity participation and constraints among athletic training students.

CONTEXT: Researchers have examined the physical activity (PA) habits of certified athletic trainers; however, none have looked specifically at athletic training students. OBJECTIVE: To assess PA participation and constraints to participation among athletic training students. DESIGN: Cross-sectional study. SETTING: Entry-level athletic training education programs (undergraduate and graduate) across the United States. PATIENTS OR OTHER PARTICIPANTS: Participants were 1125 entry-level athletic training students. MAIN OUTCOME MEASURE(S): Self-reported PA participation, including a calculated PA index based on a typical week. Leisure constraints and demographic data were also collected. RESULTS: Only 22.8% (252/1105) of athletic training students were meeting the American College of Sports Medicine recommendations for PA through moderate-intensity cardiorespiratory exercise. Although 52.3% (580/1105) were meeting the recommendations through vigorous-intensity cardiorespiratory exercise, 60.5% (681/1125) were meeting the recommendations based on the combined total of moderate or vigorous cardiorespiratory exercise. In addition, 57.2% (643/1125) of respondents met the recommendations for resistance exercise. Exercise habits of athletic training students appear to be better than the national average and similar to those of practicing athletic trainers. Students reported structural constraints such as lack of time due to work or studies as the most significant barrier to exercise participation. CONCLUSIONS: Athletic training students experienced similar constraints to PA participation as practicing athletic trainers, and these constraints appeared to influence their exercise participation during their entry-level education. Athletic training students may benefit from a greater emphasis on work-life balance during their entry-level education to promote better health and fitness habits.

Concussion-assessment and -management techniques used by athletic trainers.

CONTEXT: Understanding concussion-assessmment and -management practices that athletic trainers (ATs) currently use will allow clinicians to identify potential strategies for enhancing the quality of care provided to patients. OBJECTIVE: To assess current clinical concussion diagnostic and return-to-participation practices among ATs. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A link to the survey was sent randomly to a convenience sample of 3222 members of the National Athletic Trainers' Association. A total of 1053 (32.7%) certified ATs (experience as an AT = 11.2 ± 9.1 years) responded to the survey. INTERVENTION(S): Prospective participants received electronic correspondence informing them of the purpose of the study and providing a link to the Web-based survey instrument. A reminder e-mail was sent approximately 6 weeks later, and the survey remained online for a total of 8 weeks. MAIN OUTCOME MEASURE(S): We collected information on the annual number of concussions assessed and tools employed to diagnose, manage, and safely return an athlete to participation. Descriptive statistics were computed for each variable. RESULTS: Participants reported observing 10.7 ± 11.0 concussions per year. Clinical examination (n = 743, 70.6%) was the most commonly reported means for evaluating and diagnosing concussion. Less than half of our respondents employed the Standardized Assessment of Concussion (n = 467, 44.3%), any variation of the Romberg test (n = 461, 43.8%), and computerized neuropsychological testing (n = 459, 43.6%). Clinical examination (n = 773, 73.4%), return-to-participation guidelines (n = 713, 67.7%), physician recommendation (n = 660, 62.7%), or player self-report (n = 447, 42.5%) contributed to the return-to-participation decisions of ATs. Only 20.8% (n = 219) of ATs reported using all 3 recommended domains of the concussion battery. CONCLUSIONS: Our study demonstrated a growth in the number of ATs incorporating objective clinical measures of concussion as a part of their concussion management. Conversely, fewer ATs reported using a standard clinical examination in their concussion assessment. These findings suggest ATs must continue to increase their use of both objective concussion assessment tools and the standard clinical examination.

Single-limb-balance difficulty on 4 commonly used rehabilitation devices.

CONTEXT: Balance training is widely used by rehabilitation professionals and has been shown to be effective at reducing risk of injury, as well as improving function after injury. However, objective evidence for the difficulty of commonly available equipment is lacking. OBJECTIVE: To assess center-of-pressure (COP) area and average sway velocity in healthy subjects while performing a single-limb stance on 4 commonly available rehabilitation devices to determine their level of difficulty. DESIGN: Single-session, randomized, repeated-measures design to assess COP area and average sway velocity while performing a single-limb stance on 4 devices positioned on a force platform. SETTING: University laboratory. SUBJECTS: A convenience sample of 57 healthy college-age subjects. INTERVENTION: Each participant balanced on the dominant limb in a nonshod single-limb stance with eyes open for 20 s during 4 conditions. The 4 conditions were randomized and included the Both Sides Up (BOSU) trainer, Airex balance pad, half-foam roller, and DynaDisc. MAIN OUTCOME MEASURE: Means and standard deviations were calculated for maximum displacement in each direction. In addition, the means and standard deviations for COP area and average sway velocity were calculated for the 4 conditions and compared using a 1-way repeated-measure ANOVA. RESULTS: Significant differences were found for both COP area and average sway velocity between the BOSU trainer and the other 3 devices. A significant difference was also found between the DynaDisc and the half-foam roller. CONCLUSIONS: Level of difficulty, as measured by COP area and average sway velocity, is different for commonly available rehabilitation equipment. Clinicians may find these results a useful guide when progressing patients through balance training.

Effect of foot orthoses as treatment for plantar fasciitis or heel pain.

CLINICAL SCENARIO: Plantar fasciitis is a debilitating and painful problem present in the general population. It most often presents with moderate to severe pain in the proximal inferior heel region and is most commonly associated with repeated trauma to the plantar fascia. Plantar fasciitis, itself, is an injury at the site of attachment at the medial tubercle of the calcaneus, often due to excessive and repetitive traction. Plantar fasciitis is the most common cause of heel pain and is estimated to affect 2 million people in the United States alone. FOCUSED CLINICAL QUESTION: For adults suffering from plantar fasciitis, are foot orthoses a viable treatment option to reduce pain?

Hip- and trunk-muscle activation patterns during perturbed gait.

CONTEXT: Selected muscles in the kinetic chain may help explain the body's ability to avert injury during unexpected perturbation. OBJECTIVE: To determine the activation of the ipsilateral rectus femoris (RF), gluteus maximus (MA), gluteus medius (ME), and contralateral external obliques (EO) during normal and perturbed gait. DESIGN: Single-factor, repeated measures. SETTING: University research laboratory. PARTICIPANTS: 32 physically active, college-age subjects. INTERVENTION: Subjects walked a total of 20 trials the length of a 6.1-m custom runway capable of releasing either side into 30° of unexpected inversion. During 5 trials, the platform released into inversion. MAIN OUTCOME MEASURES: Average, peak, and time to peak EMG were analyzed across the 4 muscles, and comparisons were made between the walking trials and perturbed trials. RESULTS: Significantly higher average and peak muscle activity were noted for the perturbed condition for RF, MA, and EO. Time to peak muscle activity was faster during the perturbed condition for the EO. CONCLUSION: Rapid contractions of selected postural muscles in the kinetic chain help explain the body's reaction to unexpected perturbation.

The relationship of periscapular strength on scapular upward rotation in professional baseball pitchers.

CONTEXT: Deficiencies in scapular upward rotation and periscapular strength have been associated with various shoulder pathologies and decreased athletic performance. Therefore, proper periscapular strength and concomitant scapular upward rotation are important factors among overhead athletes, such as baseball players. OBJECTIVE: To assess the relationships between lower trapezius and serratus anterior strength and the quantity of scapular upward rotation. DESIGN: Descriptive study. SETTING: Laboratory. PARTICIPANTS: 24 professional baseball pitchers. MEASURES: Scapular upward rotation was measured at 0 degrees , 60 degrees , 90 degrees , and 120 degrees of humeral elevation. The maximum isometric strength of the lower trapezius and serratus anterior were measured. RESULTS: There was a moderate-good positive relationship between lower trapezius strength and scapular upward rotation at 90 degrees (r2 = .56, P = .001) and 120 degrees (r2 = .53, P = .001). The relationships between scapular upward rotation and serratus anterior strength were all poor. CONCLUSION: A moderate-good relationship existed between lower trapezius strength and scapular upward rotation.

Differences in scapular upward rotation between baseball pitchers and position players.

BACKGROUND: Baseball pitchers have been reported to have an increased prevalence of shoulder injury compared with position players such as infielders and outfielders. Furthermore, insufficient scapular upward rotation has been empirically linked with several of these shoulder disorders. However, the difference in scapular upward rotation between pitchers and position players is not known. HYPOTHESIS: Pitchers will have decreased scapular upward rotation of their dominant shoulders compared with position players. STUDY DESIGN: Descriptive laboratory study. METHODS: Dominant shoulder scapular upward rotation was measured with the arm at rest and at 60 degrees , 90 degrees , and 120 degrees of humeral elevation among 15 professional baseball pitchers and 15 position players with no recent history of upper extremity injury. RESULTS: Independent t tests showed pitchers have significantly less scapular upward rotation at 60 degrees (3.9 degrees , P = .011) and 90 degrees (4.4 degrees , P = .009) of humeral elevation compared with position players. CONCLUSION: Baseball pitchers have less scapular upward rotation than do position players, specifically at humeral elevation angles of 60 degrees and 90 degrees . CLINICAL RELEVANCE: This decrease in scapular upward rotation may compromise the integrity of the glenohumeral joint and place pitchers at an increased risk of developing shoulder injuries compared with position players. As such, pitchers may benefit from periscapular stretching and strengthening exercises to assist with increasing scapular upward rotation.

Assessing posterior shoulder contracture: the reliability and validity of measuring glenohumeral joint horizontal adduction.

CONTEXT: Increased contracture of the dominant posterior shoulder in throwing athletes has been associated with the development of altered shoulder rotational motion as well as several shoulder conditions. Clinicians must be able to accurately and reliably measure posterior shoulder contractures during the evaluation of such athletes in order to provide appropriate treatment. OBJECTIVE: To evaluate the reliability and validity of assessing posterior shoulder contracture by measuring supine glenohumeral (GH) horizontal adduction. DESIGN: Descriptive with repeated measures. SETTING: The biomechanics laboratory at Illinois State University (Normal, IL) and the athletic training room in Surprise, AZ. PATIENTS OR OTHER PARTICIPANTS: Twenty-four shoulders were tested in 12 subjects (age = 21.9 +/- 4.3 years, height = 175.0 +/- 10.0 cm, mass = 82.4 +/- 19.1 kg) for determination of reliability, and 46 shoulders were tested in 23 professional baseball pitchers (age = 21.25 +/- 1.66 years, height = 190.0 +/- 5.0 cm, mass = 88.45 +/- 6.99 kg) for determination of validity. MAIN OUTCOME MEASURE(S): We examined intratester and intertester reliability over 3 testing sessions by having 2 examiners measure GH horizontal adduction with the subject in a supine position with the scapula stabilized. To determine the validity and clinical usefulness of this measurement, we examined the relationship between GH horizontal adduction motion and internal shoulder rotational motion among a group of baseball pitchers. RESULTS: Intraclass correlation coefficients were high for intratester (0.93, SEM = 1.64 degrees ) and intertester (0.91, SEM = 1.71 degrees ) measurements. This measurement was also shown to have a moderate to good relationship with lost internal shoulder rotational motion ( r = .72, P = .001) of the dominant arm among the baseball pitchers. CONCLUSIONS: Based on the results of this study, we found that measuring GH horizontal adduction with the subject supine and the scapula stabilized is a reliable and valid technique for assessing posterior shoulder contracture.