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Joseph B. Myers

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Joseph B. Myers

Shoulder pain is a common complaint among overhead athletes. Oftentimes, the cause of pain is impingement of the supraspinatus, bicipital tendon, and subacromial bursa between the greater tuberosity and the acromial arch. The mechanisms of impingement syndrome include anatomical abnormalities, muscle weakness and fatigue of the glenohumeral and scapular stabilizers, posterior capsular tightness, and glenohumeral instability. In order to effectively manage impingement syndrome nonoperatively, the therapist must understand the complex anatomy and biomechanics of the shoulder joint, as well as how to thoroughly evaluate the athlete. The results of the evaluation can then be used to design and implement a rehabilitation program that addresses the cause of impingement specific to the athlete. The purpose of this article is to provide readers with a thorough overview of what causes impingement and how to effectively evaluate and conservatively manage it in an athletic population.

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Elizabeth E. Hibberd, Sakiko Oyama, Jeffrey T. Spang, William Prentice and Joseph B. Myers

Context:

Shoulder injuries are common in swimmers because of the demands of the sport. Muscle imbalances frequently exist due to the biomechanics of the sport, which predispose swimmers to injury. To date, an effective shoulder-injury-prevention program for competitive swimmers has not been established.

Objective:

To assess the effectiveness of a 6-wk strengthening and stretching intervention program on improving glenohumeral and scapular muscle strength and scapular kinematics in collegiate swimmers.

Design:

Randomized control trial.

Setting:

University biomechanics research laboratory.

Participants:

Forty-four Division I collegiate swimmers.

Interventions:

The intervention program was completed 3 times per week for 6 wk. The program included strengthening exercises completed using resistance tubing—scapular retraction (Ts), scapular retraction with upward rotation (Ys), scapular retraction with downward rotation (Ws), shoulder flexion, low rows, throwing acceleration and deceleration, scapular punches, shoulder internal rotation at 90° abduction, and external rotation at 90° abduction—and 2 stretching exercises: corner stretch and sleeper stretch.

Main Outcome Measurements:

Scapular kinematics and glenohumeral and scapular muscle strength assessed preintervention and postintervention.

Results:

There were no significant between-groups differences in strength variables at pre/post tests, although shoulder-extension and internal-rotation strength significantly increased in all subjects regardless of group assignment. Scapular kinematic data revealed increased scapular internal rotation, protraction, and elevation in all subjects at posttesting but no significant effect of group on the individual kinematic variables.

Conclusions:

The current strengthening and stretching program was not effective in altering strength and scapular kinematic variables but may serve as a framework for future programs. Adding more stretching exercises, eliminating exercises that overlap with weight-room training and swim training, and timing of implementation may yield a more beneficial program for collegiate swimmers.

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Sean A. Jones, Derek N. Pamukoff, Timothy C. Mauntel, J. Troy Blackburn and Joseph B. Myers

Context: Verbal and tactile feedback (VTF) during rehabilitation exercises can increase muscle activation, thus improving the therapeutic benefits. However, it is unclear which feedback method elicits the greatest electromyographic (EMG) amplitude. Objective: To determine if the addition of tactile to verbal feedback (VF) increases EMG amplitude of selected shoulder musculature during scapular plane elevation (Ys), shoulder horizontal abduction with external rotation (Ts), and scapular retraction with external rotation (Ws). Design: Repeated-measures cross-over design. Setting: Biomechanics laboratory. Participants: A total of 30 physically active adults volunteered for this study—age = 20.23 (1.25) years; height = 1.71 (0.073) m; and mass = 70.11 (15.14) kg. Interventions: Electromyography of the serratus anterior; upper, middle, and lower trapezii; and anterior and posterior deltoids was recorded during Ys, Ts, and Ws with VTF and VF alone during separate testing sessions. Participants completed baseline trials without feedback, then received VTF and VF across 2 counterbalanced sessions. Main Outcome Measures: Difference scores were calculated between prefeedback and postfeedback interventions, and the difference score between baseline measurements was used as a control. One-way analysis of variance of the difference scores was used to evaluate the influence of VTF and VF on EMG amplitude during Ys, Ts, and Ws. Results: There was a significant difference between conditions for EMG amplitude of the middle trapezius (F 2,28 = 4.09, P = .02) and serratus anterior (F 2,28 = 3.91, P = .03) during Ys, the middle trapezius (F 2,28 = 7.82, P = .001) during Ws, and the upper (F 2,28 = 3.61, P = .03) and middle trapezii (F 2,28 = 5.81, P = .01) during Ts. Post hoc testing revealed that both feedback conditions elicited greater EMG amplitude compared with no feedback, but there were no significant differences between the feedback conditions. Conclusions: The addition of tactile feedback to VF does not increase EMG amplitude compared with VF alone. This study indicates that feedback, regardless of type, is more beneficial than providing no feedback, for increasing EMG amplitude.

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Brett S. Pexa, Eric D. Ryan, Elizabeth E. Hibberd, Elizabeth Teel, Terri Jo Rucinski and Joseph B. Myers

Context: Following a baseball pitching bout, changes can occur to glenohumeral range of motion that could be linked to injury. These effects are in part due to the posterior shoulder’s eccentric muscle activity, which can disrupt muscle contractile elements and lead to changes in muscle cross-sectional area (CSA), as measured by ultrasound. Objective: To assess changes in muscle CSA, and range of motion immediately before and after pitching, and days 1 to 5 following pitching. Design: Repeated measures. Setting: Satellite athletic training room. Patients: Ten elite college baseball pitchers participating in the fall season (age: 18.8 [1.2] y, height: 189.2 [7.3] cm, mass: 93.1 [15.3] kg, 8 starters, 2 long relievers). Intervention: A pitching bout of at least 25 pitches (63.82 [17.42] pitches). Main Outcome Measures: Dominant and nondominant infraspinatus CSA, as measured by ultrasound, and glenohumeral range of motion including internal rotation (IRROM), external rotation (ERROM), and total rotation range of motion (TROM) before pitching, after pitching, and days 1 to 5 following the pitching bout. Results: Dominant limb CSA significantly increased day 1 after pitching, and returned to baseline on day 2 (P < .001). Dominant and nondominant TROM did not change until day 5 (4.4°, P < .001) and day 3 (4.5°, P < .001), respectively, where they increased. Dominant IRROM was significantly decreased for 3 days (day 1: 1.9°, P < .001; day 2: 3.1°, P < .001; day 3: 0.3°, P < .001) following pitching and returned to baseline on day 4, with no such changes in the nondominant limb. Dominant external rotation significantly increased immediately post pitching (4.4°, P < .001) but returned to baseline by day 1. Conclusions: The results of the study demonstrate that infraspinatus CSA does not recover until 2 days following pitching, and IRROM does not recover until 4 days following pitching. Baseball pitching elicits damage to the posterior shoulder muscle architecture, resulting in changes to physical characteristics that last up to 4 days following pitching.