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Zachary W. Bell, Scott J. Dankel, Robert W. Spitz, Raksha N. Chatakondi, Takashi Abe and Jeremy P. Loenneke

only to those with the suitable equipment. Others who rely on more practical means of applying pressure (ie, wraps) have often set restriction pressures based on the individual’s perception of tightness. 2 – 4 Previous research found that subocclusive pressures could be applied when participants rated

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Elif Turgut, Irem Duzgun and Gul Baltaci

orientation problems, such as scapular dyskinesis, are often related to proposed secondary SIS mechanisms. 2 Alterations in the scapular orientation may be rooted in complex factors, such as poor posture, muscular dysfunction, and capsulo-ligamentious tightness of posterior capsule and/or pectoralis minor

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Gakuto Kitamura, Hiroshige Tateuchi and Noriaki Ichihashi

that the tightness of the hip-flexor muscle can reduce hip extension that create a lumbar hyperextension and pelvic anterior tilt in various movements in water. 6 Pelvic anterior tilting can make the pelvis at a lower position than normal in water. 6 A study examined the swimmers experiencing LBP and

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Landon Lempke, Rebecca Wilkinson, Caitlin Murray and Justin Stanek

control trial Randomized control trial Randomized control trial Randomized control trial Participants Of the 40 students (17 males and 9 females; mean age = 21.5 (1.3) y; mean body height = 172.8 (8.2) cm; and mean body mass index = 21.9 (3.0) kg·m −2 ) with bilateral hamstring tightness, only 26

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Damla Gulpinar, Sibel Tekeli Ozer and Sevgi Sevi Yesilyaprak

asymptomatic athletes with limited GIR, 8 and an association between reduced TROM and shoulder injury has been reported in elite handball players. 2 Another proposed risk factor, posterior shoulder tightness (PST), is also common. 9 It is thought to arise due to progressive tightening of the posterior

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Nicole D. Harshbarger, Bradly L. Eppelheimer, Tamara C. Valovich McLeod and Cailee Welch McCarty

Clinical Scenario:

It has been suggested that posterior shoulder tightness is a common contributor to shoulder impingement in overhead-throwing athletes. The incidence of shoulder pain in the general population has been reported to be as high as 27%, and as many as 74% of the patients who were seen for shoulder issues had signs of impingement. Particularly regarding physically active adults, shoulder impingement is frequent among overhead-throwing athletes and may lead to lost participation in sport, as well as other injuries including labral pathologies. Therefore, finding an effective mechanism to reduce posterior shoulder tightness in overhead athletes is important and may help prevent impingement-type injuries. Typically, posterior shoulder tightness is identified by measuring horizontal humeral adduction; although another clinical measure that is commonly used is the bilateral measurement of glenohumeral internal-rotation (IR) range of motion (ROM). It is important to note, however, that the measurement of glenohumeral IR ROM specifically aims to identify glenohumeral IR ROM deficits (GIRD). Although GIRD is believed to be a leading contributor to posterior shoulder tightness, this measure alone may not capture the full spectrum of posterior shoulder tightness. While treatment interventions to correct any ROM deficits typically include a stretching protocol to help increase IR, joint mobilizations have been found to produce greater mobility of soft tissue and capsular joints. However, it is unclear whether the combination of both joint mobilizations and a stretching protocol will produce even larger gains of ROM that will have greater longevity for the patient suffering from posterior shoulder tightness.

Focused Clinical Question:

Does the use of joint mobilizations combined with a stretching protocol more effectively increase glenohumeral IR ROM in adult physically active individuals who participate in overhead sports and are suffering from posterior shoulder tightness, compared with a stretching protocol alone?

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Kevin G. Laudner, Mike Moline and Keith Meister

Context:

Posterior shoulder tightness has been associated with altered shoulder range of motion (ROM) and several pathologic entities in baseball players. This tightness is hypothesized to be the result of the cumulative stress placed on the posterior shoulder during the deceleration phase of the throwing motion. The role of the posterior shoulder static restraints is to absorb this load while the glenohumeral (GH) external rotators eccentrically decelerate the arm after ball release and therefore also help dissipate this force. As such, the authors hypothesized that if the GH external rotators are weak, an excessive amount of this deceleration force is placed on the static restraints, which may lead to subsequent tightness.

Objective:

To compare the relationship between GH external-rotation strength and posterior shoulder tightness as measured by GH horizontal-adduction and internal-rotation ROM.

Design:

Descriptive study.

Setting:

Laboratory.

Participants:

45 professional baseball players.

Main Outcome Measures:

GH external-rotation strength and GH horizontal-adduction and internalrotation ROM.

Results:

GH external-rotation strength showed no relationship with either GH horizontal-adduction ROM (r 2 = .02, P = .40) or GH internal-rotation ROM (r 2 = .002, P = .77).

Conclusion:

There is little to no relationship between GH external-rotation strength and posterior shoulder tightness in professional baseball players. The posterior static restraints of the shoulder may absorb a large majority of the deceleration forces during the throwing motion. Although strengthening of the posterior shoulder dynamic restraints should not be overlooked, routine stretching of the static restraints may be more beneficial for decreasing posterior shoulder tightness and the subsequent risks associated with this tightness, although future research is warranted.

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Kim M. Clabbers, John D. Kelly, Dov Bader, Matthew Eager, Carl Imhauser, Sorin Siegler and Ray A. Moyer

Context:

Throwing injuries.

Objective:

To study the effects of posterior capsule tightness on humeral head position in late cocking simulation.

Design:

Eight fresh frozen shoulders were placed in position of “late cocking,” 90 degrees abduction, and 10 degrees adduction and maximal external rotation. 3D measurements of humeral head relationship to the glenoid were taken with an infrared motion sensor, both before and after suture plication of the posterior capsule. Plications of 20% posterior/inferior capsule and 20% entire posterior capsule were performed, followed by plications of 40% of the posterior/inferior capsule and 40% entire posterior capsule.

Setting:

Cadaver Lab.

Intervention:

Posterior capsular placation.

Main Outcome Measures:

Humeral head position.

Results:

40%, but not 20%, posterior/inferior and posterior plications demonstrated a trend to increased posterior-superior humeral head translation relative to controls.

Conclusion:

Surgically created posterior capsular tightness of the glenohumeral joint demonstrated a nonsignificant trend to increased posterior/superior humeral head translation in the late cocking position of throwing.

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Megan Pathoomvanh, Chase Feldbrugge, Lauren Welsch and Bonnie Van Lunen

Clinical Question:

Are posterior shoulder stretching programs effective in reducing posterior shoulder tightness, or tightness to the soft tissue of the shoulder, in overhead athletes?

Clinical Bottom Line:

In overhead athletes, there is high quality evidence to support the use of posterior shoulder stretching to reduce a commonly used measure of posterior shoulder tightness. All three studies1–3 reported an increase in shoulder internal rotation range of motion following implementation of posterior shoulder stretching.

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Kenny Guex, Francois Fourchet, Heiko Loepelt and Gregoire P. Millet

Context:

A passive knee-extension test has been shown to be a reliable method of assessing hamstring tightness, but this method does not take into account the potential effect of gravity on the tested leg.

Objective:

To compare an original passive knee-extension test with 2 adapted methods including gravity’s effect on the lower leg.

Design:

Repeated measures.

Setting:

Laboratory.

Participants:

20 young track and field athletes (16.6 ± 1.6 y, 177.6 ± 9.2 cm, 75.9 ± 24.8 kg).

Intervention:

Each subject was tested in a randomized order with 3 different methods: In the original one (M1), passive knee angle was measured with a standard force of 68.7 N (7 kg) applied proximal to the lateral malleolus. The second (M2) and third (M3) methods took into account the relative lower-leg weight (measured respectively by handheld dynamometer and anthropometrical table) to individualize the force applied to assess passive knee angle.

Main Outcome Measures:

Passive knee angles measured with video-analysis software.

Results:

No difference in mean individualized applied force was found between M2 and M3, so the authors assessed passive knee angle only with M2. The mean knee angle was different between M1 and M2 (68.8 ± 12.4 vs 73.1 ± 10.6, P < .001). Knee angles in M1 and M2 were correlated (r = .93, P < .001).

Conclusions:

Differences in knee angle were found between the original passive knee-extension test and a method with gravity correction. M2 is an improved version of the original method (M1) since it minimizes the effect of gravity. Therefore, we recommend using it rather than M1.