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Grethe Myklebust - One of the best experts on this subject based on the ideXlab platform.
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does an effective Shoulder Injury prevention program affect risk factors in handball a randomized controlled study
Scandinavian Journal of Medicine & Science in Sports, 2020Co-Authors: Hilde Fredriksen, Ann Cools, Roald Bahr, Grethe MyklebustAbstract:Background Shoulder problems are common in handball, but Injury risk reduction is possible by implementing a prevention program. However, player compliance to the program remains a challenge, with feedback from players that the program is too time consuming. Aim To develop a more efficient program, we aimed to assess the effect of the Oslo Sports Trauma Research Center Shoulder Injury prevention program on external rotation (ER) strength and internal rotation (IR) range of motion (ROM), considered to represent key risk factors for Injury. Methods Four youth handball teams (three females, one males, 57 players, mean age 17.1 years) were randomized to an intervention or control group. The intervention program was conducted three times per week as a part of handball warm-up for 18 weeks, supervised by physical therapists. The main outcome variables were the between-group differences in ER strength and IR ROM change from baseline to postintervention. Isometric ER strength was measured with a handheld dynamometer and IR ROM with a digital goniometer. Results Mean dominant Shoulder isometric ER strength increased both in the intervention (10%) and the control group (6%) during the intervention, but there was no significant group by time interaction (group difference: 0.06 N/kg (95% CI: -0.04 to 0.17). IR ROM did not change in either group during the intervention. Conclusion The Oslo Sports Trauma Research Center Shoulder Injury prevention program did not affect the risk factors ER strength and IR ROM. The preventive effect of the program must therefore be due to other factors.
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preventing overuse Shoulder injuries among throwing athletes a cluster randomised controlled trial in 660 elite handball players
British Journal of Sports Medicine, 2017Co-Authors: Stig Haugsbo Andersson, Roald Bahr, Benjamin Clarsen, Grethe MyklebustAbstract:Background Shoulder problems are highly prevalent among elite handball players. Reduced glenohumeral rotation, external rotation weakness and scapula dyskinesis have been identified as risk factors. Aim Evaluate the effect of an exercise programme designed to reduce the prevalence of Shoulder problems in elite handball. Methods 45 elite handball teams (22 female teams, 23 male teams, 660 players) were cluster randomised (22 teams, 331 players in the intervention group, 23 teams, 329 players in the control group) and followed for 1 competitive season (7 months). The Oslo Sports Trauma Research Center (OSTRC) Shoulder Injury Prevention Programme, an exercise programme to increase glenohumeral internal rotation, external rotation strength and scapular muscle strength, as well as improve kinetic chain and thoracic mobility, was delivered by coaches and captains 3 times per week as a part of the handball warm-up. The main outcome measures, prevalence of Shoulder problems and substantial Shoulder problems, were measured monthly. Results The average prevalence of Shoulder problems during the season was 17% (95% CI 16% to 19%) in the intervention group and 23% (95% CI 21% to 26%) in the control group (mean difference 6%). The average prevalence of substantial Shoulder problems was 5% (95% CI 4% to 6%) in the intervention group and 8% (95% CI 7% to 9%) in the control group (mean difference 3%). Using generalised estimating equation models, a 28% lower risk of Shoulder problems (OR 0.72, 95% CI 0.52 to 0.98, p=0.038) and 22% lower risk of substantial Shoulder problems (OR 0.78, 95% CI 0.53 to 1.16, p=0.23) were observed in the intervention group compared with the control group. Conclusions The OSTRC Shoulder Injury Prevention Programme reduced the prevalence of Shoulder problems in elite handball and should be included as a part of the warm-up. Trial registration number ISRCTN96217107.
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handball load and Shoulder Injury rate a 31 week cohort study of 679 elite youth handball players
British Journal of Sports Medicine, 2017Co-Authors: Merete Moller, Rasmus Ostergaard Nielsen, Jorn Attermann, Niels Wedderkopp, Martin Lind, Henrik Toft Sorensen, Grethe MyklebustAbstract:Background Knowledge of Injury patterns, an essential step towards Injury prevention, is lacking in youth handball. Aim To investigate if an increase in handball load is associated with increased Shoulder Injury rates compared with a minor increase or decrease, and if an association is influenced by scapular control, isometric Shoulder strength or glenohumeral range of motion (ROM). Methods 679 players (14–18 years) provided weekly reports on Shoulder Injury and handball load (training and competition hours) over 31 weeks using the SMS, phone and medical examination system. Handball load in a given week was categorised into (1) 60% relative to the weekly average amount of handball load the preceding 4 weeks. Assessment of Shoulder isometric rotational and abduction strength, ROM and scapular control was performed at baseline and midseason. Results An increase in handball load by >60% was associated with greater Shoulder Injury rate (HR 1.91; 95% CI 1.00 to 3.70, p=0.05) compared with the reference group. The effect of an increase in handball load between 20% and 60% was exacerbated among players with reduced external rotational strength (HR 4.0; 95% CI 1.1 to 15.2, p=0.04) or scapular dyskinesis (HR 4.8; 95% CI 1.3 to 18.3, p=0.02). Reduced external rotational strength exacerbated the effect of an increase above 60% (HR 4.2; 95% CI 1.4 to 12.8, p=0.01). Conclusions A large increase in weekly handball load increases the Shoulder Injury rate in elite youth handball players; particularly, in the presence of reduced external rotational strength or scapular dyskinesis.
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a large weekly increase in handball participation increases the Shoulder Injury rate in danish youth handball
British Journal of Sports Medicine, 2017Co-Authors: Merete Moller, Jorn Attermann, Niels Wedderkopp, Martin Lind, Henrik Toft Sorensen, Rasmus Oestergaard Nielsen, Grethe MyklebustAbstract:Background Knowledge of Injury patterns, an integral step towards Injury prevention, is lacking in youth handball. Objective To investigate if an increase in weekly handball participation is associated with increased Shoulder Injury rates compared with decrease or a minor increase, and if a potential association is influenced by scapular control, isometric Shoulder strength, or glenohumeral range of motion (ROM). Design Prospective cohort study with weekly reports on Shoulder Injury, and handball participation over 31 weeks using the SMS, Phone and Medical Examination system. Assessment of Shoulder isometric rotational and abduction strength, ROM and scapular control was performed at baseline and mid-season. Setting Danish elite youth handball. Participants 686 players were enrolled. Seven players were excluded, and data from 36 players were censored. Assessment of Risk Factors Weekly change in handball participation categorised into (1) 60% relative to the weekly average amount of handball participation the preceding four weeks. Scapular control, isometric Shoulder strength and ROM were included as effect measure modifiers. Main Outcome Measurements Any handball-related Shoulder problem irrespective of the need for time loss or medical attention. Results An increase in handball participation by >60% was associated with greater Shoulder Injury rate (Hazard Ratio (HR):1.91; 95% Confidence Interval (CI) 1.00; 3.70, p=0.05) compared with the reference group. The effect of an increase in handball participation between 20% to 60% was exacerbated amongst players with reduced external rotation strength (HR:4.0; 95% CI 1.1; 15.2, p=0.04) or scapular dyskinesis (HR 4.8; 95% CI 1.3; 18.3, p=0.02). Reduced external strength also exacerbated the effect of an increase above 60% (HR: 4.2; 95% CI 1.4; 12.8, p=0.01). Conclusions A large increase in weekly handball participation increases the Shoulder Injury rate in elite youth handball players; particularly in the presence of reduced external rotational strength or scapular dyskinesis.
Steven Z George - One of the best experts on this subject based on the ideXlab platform.
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sensory and psychological factors predict exercise induced Shoulder Injury responses in a high risk phenotype cohort
The Journal of Pain, 2021Co-Authors: Katie A Butera, Paul A Borsa, Mark D Bishop, Warren H Greenfield, Roland Staud, Margaret R Wallace, Roger B Fillingim, Steven Z GeorgeAbstract:Abstract Our prior studies identified a high-risk phenotype (i.e. high pain sensitivity variant of the catechol-O-methyltransferase (COMT) gene (SNP rs6269) and pain catastrophizing scores) for Shoulder pain. The current study identified sensory and psychological predictors of heightened pain responses following exercise-induced Shoulder Injury. Healthy participants (N=131) with the SNP rs6269 COMT gene and Pain Catastrophizing Scale scores ≥5 underwent baseline sensory and psychological testing followed by an established Shoulder fatigue protocol, to induce muscle Injury. Movement-evoked pain, pain intensity, disability, and strength were assessed 24 hours post-Injury. Demographic, sensory, and psychological variables were included as predictors in full and parsimonious models for each outcome. The highest variance explained was for the Shoulder disability outcome (full model R2=0.20, parsimonious R2=0.13). In parsimonious models, the individual predictors identified were: a) 1st pulse heat pain sensitivity for isometric Shoulder movement-evoked pain and pain intensity; b) pressure pain threshold for Shoulder disability; c) fear of pain for active Shoulder movement-evoked pain and Shoulder disability; and d) depressive symptoms for Shoulder strength. Findings indicate specific pain sensitivity and psychological measures may have additional prognostic value for self-reported disability within a high-risk phenotype. These findings should be tested in a clinical cohort for validation. Perspective The current study extends previous work by providing insight regarding how poor Shoulder outcomes may develop within a high-risk phenotype. Specifically, 1st pulse heat pain sensitivity and pressure pain threshold were sensory measures, and fear of pain and depressive symptoms were psychological measures, that improved prediction of different Shoulder outcomes.
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sensory and psychological factors predict exercise induced Shoulder Injury responses in a high risk phenotype cohort
The Journal of Pain, 2021Co-Authors: Katie A Butera, Paul A Borsa, Mark D Bishop, Warren H Greenfield, Roland Staud, Margaret R Wallace, Roger B Fillingim, Steven Z GeorgeAbstract:Abstract Our prior studies identified a high-risk phenotype (ie, high pain sensitivity variant of the catechol-O-methyltransferase gene (Single Nucleotide Polymorphism [SNP] rs6269) and pain catastrophizing scores) for Shoulder pain. The current study identified sensory and psychological predictors of heightened pain responses following exercise-induced Shoulder Injury. Healthy participants (N = 131) with the SNP rs6269 catechol-O-methyltransferase gene and Pain Catastrophizing Scale scores ≥5 underwent baseline sensory and psychological testing followed by an established Shoulder fatigue protocol, to induce muscle Injury. Movement-evoked pain, pain intensity, disability, and strength were assessed 24 hours postInjury. Demographic, sensory, and psychological variables were included as predictors in full and parsimonious models for each outcome. The highest variance explained was for the Shoulder disability outcome (full model R2 = .20, parsimonious R2 = .13). In parsimonious models, the individual predictors identified were: 1) 1st pulse heat pain sensitivity for isometric Shoulder movement-evoked pain and pain intensity; 2) pressure pain threshold for Shoulder disability; 3) fear of pain for active Shoulder movement-evoked pain and Shoulder disability; and 4) depressive symptoms for Shoulder strength. Findings indicate specific pain sensitivity and psychological measures may have additional prognostic value for self-reported disability within a high-risk phenotype. These findings should be tested in a clinical cohort for validation. Perspective The current study extends previous work by providing insight regarding how poor Shoulder outcomes may develop within a high-risk phenotype. Specifically, 1st pulse heat pain sensitivity and pressure pain threshold were sensory measures, and fear of pain and depressive symptoms were psychological measures, that improved prediction of different Shoulder outcomes.
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genetic and psychological factors interact to predict physical impairment phenotypes following exercise induced Shoulder Injury
Journal of Pain Research, 2018Co-Authors: Paul A Borsa, Margaret R Wallace, Roger B Fillingim, Jeffrey J Parr, Yunfeng Dai, Steven Z GeorgeAbstract:Background We investigated interactions between genetic and psychological factors in predicting Shoulder impairment phenotypes. We hypothesized that pro-inflammatory genes would display stronger relationships compared with pain-related genes when combined with psychological factors for predicting phenotypic changes. Subjects and methods Altogether, 190 participants completed a 5-day experimental protocol. An experimental Shoulder Injury model was used to induce physical impairment, and a priori selected genetic (pain-related, pro-inflammatory) and psychological (anxiety, depressive symptoms, pain catastrophizing, fear of pain, kinesiophobia) factors were included as predictors of interest. Impairment phenotypes were Injury-induced deficits in range of motion (ROM) and strength. After controlling for age, sex, and race, genetic and psychological predictors were entered separately as main effects and interaction terms in regression models for each phenotype. Results Strong statistical evidence was provided for interactions between: 1) IL-1β (rs1143634) and fear of pain for predicting loss of Shoulder flexion and abduction, 2) IL-1β (rs1143634) and anxiety for predicting loss of flexion, and 3) IL-1β (rs1143634) and depressive symptoms for predicting loss of internal rotation. In addition, the interaction between OPRM1 (rs1799971) and fear of pain as well as COMT (rs4818) and pain catastrophizing provided strong statistical evidence for predicting strength loss. Conclusion Pro-inflammatory gene variants contributed more to physical impairment with two single nucleotide polymorphisms (SNPs; IL-1β [rs1143634] and TNF/LTA [rs2229094]) interacting with psychological factors to predict six Shoulder impairment phenotypes. In comparison, two pain-related gene SNPs (OPRM1 [rs1799971] and COMT [rs4818]) interacted with psychological factors to predict four Shoulder impairment phenotypes (abduction: 5-day average loss; strength loss: 5-day average, peak, and relative loss).
Paul A Borsa - One of the best experts on this subject based on the ideXlab platform.
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sensory and psychological factors predict exercise induced Shoulder Injury responses in a high risk phenotype cohort
The Journal of Pain, 2021Co-Authors: Katie A Butera, Paul A Borsa, Mark D Bishop, Warren H Greenfield, Roland Staud, Margaret R Wallace, Roger B Fillingim, Steven Z GeorgeAbstract:Abstract Our prior studies identified a high-risk phenotype (i.e. high pain sensitivity variant of the catechol-O-methyltransferase (COMT) gene (SNP rs6269) and pain catastrophizing scores) for Shoulder pain. The current study identified sensory and psychological predictors of heightened pain responses following exercise-induced Shoulder Injury. Healthy participants (N=131) with the SNP rs6269 COMT gene and Pain Catastrophizing Scale scores ≥5 underwent baseline sensory and psychological testing followed by an established Shoulder fatigue protocol, to induce muscle Injury. Movement-evoked pain, pain intensity, disability, and strength were assessed 24 hours post-Injury. Demographic, sensory, and psychological variables were included as predictors in full and parsimonious models for each outcome. The highest variance explained was for the Shoulder disability outcome (full model R2=0.20, parsimonious R2=0.13). In parsimonious models, the individual predictors identified were: a) 1st pulse heat pain sensitivity for isometric Shoulder movement-evoked pain and pain intensity; b) pressure pain threshold for Shoulder disability; c) fear of pain for active Shoulder movement-evoked pain and Shoulder disability; and d) depressive symptoms for Shoulder strength. Findings indicate specific pain sensitivity and psychological measures may have additional prognostic value for self-reported disability within a high-risk phenotype. These findings should be tested in a clinical cohort for validation. Perspective The current study extends previous work by providing insight regarding how poor Shoulder outcomes may develop within a high-risk phenotype. Specifically, 1st pulse heat pain sensitivity and pressure pain threshold were sensory measures, and fear of pain and depressive symptoms were psychological measures, that improved prediction of different Shoulder outcomes.
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sensory and psychological factors predict exercise induced Shoulder Injury responses in a high risk phenotype cohort
The Journal of Pain, 2021Co-Authors: Katie A Butera, Paul A Borsa, Mark D Bishop, Warren H Greenfield, Roland Staud, Margaret R Wallace, Roger B Fillingim, Steven Z GeorgeAbstract:Abstract Our prior studies identified a high-risk phenotype (ie, high pain sensitivity variant of the catechol-O-methyltransferase gene (Single Nucleotide Polymorphism [SNP] rs6269) and pain catastrophizing scores) for Shoulder pain. The current study identified sensory and psychological predictors of heightened pain responses following exercise-induced Shoulder Injury. Healthy participants (N = 131) with the SNP rs6269 catechol-O-methyltransferase gene and Pain Catastrophizing Scale scores ≥5 underwent baseline sensory and psychological testing followed by an established Shoulder fatigue protocol, to induce muscle Injury. Movement-evoked pain, pain intensity, disability, and strength were assessed 24 hours postInjury. Demographic, sensory, and psychological variables were included as predictors in full and parsimonious models for each outcome. The highest variance explained was for the Shoulder disability outcome (full model R2 = .20, parsimonious R2 = .13). In parsimonious models, the individual predictors identified were: 1) 1st pulse heat pain sensitivity for isometric Shoulder movement-evoked pain and pain intensity; 2) pressure pain threshold for Shoulder disability; 3) fear of pain for active Shoulder movement-evoked pain and Shoulder disability; and 4) depressive symptoms for Shoulder strength. Findings indicate specific pain sensitivity and psychological measures may have additional prognostic value for self-reported disability within a high-risk phenotype. These findings should be tested in a clinical cohort for validation. Perspective The current study extends previous work by providing insight regarding how poor Shoulder outcomes may develop within a high-risk phenotype. Specifically, 1st pulse heat pain sensitivity and pressure pain threshold were sensory measures, and fear of pain and depressive symptoms were psychological measures, that improved prediction of different Shoulder outcomes.
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genetic and psychological factors interact to predict physical impairment phenotypes following exercise induced Shoulder Injury
Journal of Pain Research, 2018Co-Authors: Paul A Borsa, Margaret R Wallace, Roger B Fillingim, Jeffrey J Parr, Yunfeng Dai, Steven Z GeorgeAbstract:Background We investigated interactions between genetic and psychological factors in predicting Shoulder impairment phenotypes. We hypothesized that pro-inflammatory genes would display stronger relationships compared with pain-related genes when combined with psychological factors for predicting phenotypic changes. Subjects and methods Altogether, 190 participants completed a 5-day experimental protocol. An experimental Shoulder Injury model was used to induce physical impairment, and a priori selected genetic (pain-related, pro-inflammatory) and psychological (anxiety, depressive symptoms, pain catastrophizing, fear of pain, kinesiophobia) factors were included as predictors of interest. Impairment phenotypes were Injury-induced deficits in range of motion (ROM) and strength. After controlling for age, sex, and race, genetic and psychological predictors were entered separately as main effects and interaction terms in regression models for each phenotype. Results Strong statistical evidence was provided for interactions between: 1) IL-1β (rs1143634) and fear of pain for predicting loss of Shoulder flexion and abduction, 2) IL-1β (rs1143634) and anxiety for predicting loss of flexion, and 3) IL-1β (rs1143634) and depressive symptoms for predicting loss of internal rotation. In addition, the interaction between OPRM1 (rs1799971) and fear of pain as well as COMT (rs4818) and pain catastrophizing provided strong statistical evidence for predicting strength loss. Conclusion Pro-inflammatory gene variants contributed more to physical impairment with two single nucleotide polymorphisms (SNPs; IL-1β [rs1143634] and TNF/LTA [rs2229094]) interacting with psychological factors to predict six Shoulder impairment phenotypes. In comparison, two pain-related gene SNPs (OPRM1 [rs1799971] and COMT [rs4818]) interacted with psychological factors to predict four Shoulder impairment phenotypes (abduction: 5-day average loss; strength loss: 5-day average, peak, and relative loss).
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instrumented measurement of glenohumeral joint laxity and its relationship to passive range of motion and generalized joint laxity
American Journal of Sports Medicine, 2001Co-Authors: Eric L Sauers, Derald E Herling, Paul A Borsa, Rick D StanleyAbstract:The purpose of this study was to objectively characterize in vivo glenohumeral joint laxity using an instrumented Shoulder arthrometer. Secondary objectives were to examine the relationship of glenohumeral joint laxity with passive range of motion and generalized joint laxity. Fifty-one recreational athletes with no history of Shoulder Injury or long-term participation in overhead sports participated in this study. Anterior and posterior laxity data were obtained at displacement forces of 67, 89, 111, and 134 N. Bilateral passive Shoulder range of motion measures were obtained, and a modified Beighton Mobility Score was used to quantify generalized joint laxity. There were no significant differences in glenohumeral joint laxity between the right and left Shoulders (P values 0.14 to 0.73). No significant differences in laxity were seen between directions (F(1,400) 1.35, P 0.25). However, significant differences were observed between force levels (F(3,400) 27.17, P <0.0001). No moderate or stronger correlat...
Werner Krutsch - One of the best experts on this subject based on the ideXlab platform.
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decreased external rotation strength is a risk factor for overuse Shoulder Injury in youth elite handball athletes
Knee Surgery Sports Traumatology Arthroscopy, 2020Co-Authors: Leonard Achenbach, Lior Laver, Sven S Walter, Florian Zeman, Matthias Kuhr, Werner KrutschAbstract:Purpose Overuse Shoulder injuries are common in youth handball, but research is limited. The purpose of this study was to identify pre-season risk factors associated with overuse Shoulder injuries in this population. Methods One-hundred and thirty-eight (70 boys and 68 girls) youth elite players (age 14.1 ± 0.8 years, height 175.2 ± 8.2 cm, weight 64.0 ± 9.6 kg) completed a pre-season screening protocol. Passive glenohumeral range of motion and maximum external (ER) and internal rotation (IR) strength were measured with a manual goniometer and a hand-held dynamometer. Scapular dyskinesia and maximum throwing velocity were also assessed. Players completed standardised questionnaires over the 2017-2018 season and reported any overuse Shoulder symptoms. Results Decreased isometric and eccentric ER strength was identified as a risk factor for overuse Shoulder Injury, both for absolute (OR 10.70, 95% CI 1.2-95.6, p = 0.034) and normalised ER strength (OR 1.2, 95% CI 1.0-1.4, p = 0.015) and the ER:IR strength ratio (OR 1.2, 95% CI 1.1-1.5, p = 0.012). ER gain of more than 7.5° (p = 0.025) and GIRD of more than 7.5° (p = 0.014) were identified as risk factors for overuse Shoulder Injury in girls. Scapular dyskinesia (OR 1.1, n.s.) and maximum throwing velocity did not seem to contribute to Injury risk. The average response rate was 63%. Conclusion In elite youth handball, deficits in ER strength is a risk factor for overuse Shoulder Injury for both sexes; ER gain and GIRD are only risk factors for girls. Focused pre-season assessments may aid the identification of risk factors for Shoulder overuse injuries and the application of specific programmes to reduce risk. Level of evidence II.
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decreased external rotation strength is a risk factor for overuse Shoulder Injury in youth elite handball athletes
Knee Surgery Sports Traumatology Arthroscopy, 2020Co-Authors: Leonard Achenbach, Lior Laver, Sven S Walter, Florian Zeman, Matthias Kuhr, Werner KrutschAbstract:Overuse Shoulder injuries are common in youth handball, but research is limited. The purpose of this study was to identify pre-season risk factors associated with overuse Shoulder injuries in this population. One-hundred and thirty-eight (70 boys and 68 girls) youth elite players (age 14.1 ± 0.8 years, height 175.2 ± 8.2 cm, weight 64.0 ± 9.6 kg) completed a pre-season screening protocol. Passive glenohumeral range of motion and maximum external (ER) and internal rotation (IR) strength were measured with a manual goniometer and a hand-held dynamometer. Scapular dyskinesia and maximum throwing velocity were also assessed. Players completed standardised questionnaires over the 2017–2018 season and reported any overuse Shoulder symptoms. Decreased isometric and eccentric ER strength was identified as a risk factor for overuse Shoulder Injury, both for absolute (OR 10.70, 95% CI 1.2–95.6, p = 0.034) and normalised ER strength (OR 1.2, 95% CI 1.0–1.4, p = 0.015) and the ER:IR strength ratio (OR 1.2, 95% CI 1.1–1.5, p = 0.012). ER gain of more than 7.5° (p = 0.025) and GIRD of more than 7.5° (p = 0.014) were identified as risk factors for overuse Shoulder Injury in girls. Scapular dyskinesia (OR 1.1, n.s.) and maximum throwing velocity did not seem to contribute to Injury risk. The average response rate was 63%. In elite youth handball, deficits in ER strength is a risk factor for overuse Shoulder Injury for both sexes; ER gain and GIRD are only risk factors for girls. Focused pre-season assessments may aid the identification of risk factors for Shoulder overuse injuries and the application of specific programmes to reduce risk. II.
Ben W Kibler - One of the best experts on this subject based on the ideXlab platform.
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clinical implications of scapular dyskinesis in Shoulder Injury the 2013 consensus statement from the scapular summit
British Journal of Sports Medicine, 2013Co-Authors: Ben W Kibler, Paula M Ludewig, Phil W Mcclure, Lori A Michener, Klaus Bak, Aaron SciasciaAbstract:The second international consensus conference on the scapula was held in Lexington Kentucky. The purpose of the conference was to update, present and discuss the accumulated knowledge regarding scapular involvement in various Shoulder injuries and highlight the clinical implications for the evaluation and treatment of Shoulder injuries. The areas covered included the scapula and Shoulder Injury, the scapula and sports participation, clinical evaluation and interventions and known outcomes. Major conclusions were (1) scapular dyskinesis is present in a high percentage of most Shoulder injuries; (2) the exact role of the dyskinesis in creating or exacerbating Shoulder dysfunction is not clearly defined; (3) Shoulder impingement symptoms are particularly affected by scapular dyskinesis; (4) scapular dyskinesis is most aptly viewed as a potential impairment to Shoulder function; (5) treatment strategies for Shoulder Injury can be more effectively implemented by evaluation of the dyskinesis; (6) a reliable observational clinical evaluation method for dyskinesis is available and (7) rehabilitation programmes to restore scapular position and motion can be effective within a more comprehensive Shoulder rehabilitation programme.
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Injury patterns and biomechanics of the athlete s Shoulder
Clinics in Sports Medicine, 2008Co-Authors: David M Lintner, Thomas J Noonan, Ben W KiblerAbstract:Although Shoulder Injury patterns vary by sport and position, overhead sports, such as baseball, swimming, tennis, and volleyball, share a common dependence on the integrity of the kinetic chain. Disruption of this critical mechanism predisposes to Injury and deserves attention as the most important of the biomechanical principles required to help evaluate and manage problems of the athlete's Shoulder.
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evaluation of apparent and absolute supraspinatus strength in patients with Shoulder Injury using the scapular retraction test
American Journal of Sports Medicine, 2006Co-Authors: Ben W Kibler, Aaron Sciascia, David DomeAbstract:Background: Physical examination of patients with Shoulder Injury not involving actual rotator cuff tears frequently demonstrates decreased rotator cuff strength on manual muscle testing. This decrease has been attributed to supraspinatus muscle weakness, but it may be owing to alterations in scapular position.Hypothesis: The position of stabilized scapular retraction, by minimizing proximal kinetic chain factors and providing a stable base of muscle origin, positively influences demonstrated supraspinatus strength.Study Design: Controlled laboratory study.Methods: Supraspinatus strength was tested in 20 injured patients and 10 healthy controls in both the empty-can arm position and a position of scapular retraction using a handheld dynamometer. Pain in both maneuvers was measured by use of a visual analog scale.Results: Paired t tests indicated the scapular retraction position resulted in statistically significantly (P = .001) higher supraspinatus strength values within both groups. There was no signific...
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qualitative clinical evaluation of scapular dysfunction a reliability study
Journal of Shoulder and Elbow Surgery, 2002Co-Authors: Ben W Kibler, Jackson W Q Maddux, Paul V Brooks, Brian L Zeller, John McmullenAbstract:The purpose of this study was to determine the intrarater and interrater reliability of a clinical evaluation system for scapular dysfunction. No commonly accepted terminology presently exists for describing the abnormal dynamic scapular movement patterns that are commonly associated with Shoulder Injury. A method of observation was devised for clinical evaluation of scapular dysfunction. Blinded evaluators (2 physicians and 2 physical therapists) were familiarized with the evaluation method of scapular movement patterns before viewing a videotape of 26 subjects with and without scapular dysfunction. Each evaluator was asked to categorize the predominant scapular movement pattern observed during bilateral humeral scaption and abduction motions. Reliability was assessed by a coefficient. Intertester reliability ( 0.4) was found to be slightly lower than intratester reliability ( 0.5). These results indicate that, with refinement, this qualitative evaluation method may allow clinicians to standardize the categorization of dynamic scapular dysfunction patterns. (J Shoulder Elbow Surg 2002;11: 550-6.)
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the role of the scapula in athletic Shoulder function
American Journal of Sports Medicine, 1998Co-Authors: Ben W KiblerAbstract:The exact role and the function of the scapula are misunderstood in many clinical situations. This lack of awareness often translates into incomplete evaluation and diagnosis of Shoulder problems. In addition, scapular rehabilitation is often ignored. Recent research, however, has demonstrated a pivotal role for the scapula in Shoulder function, Shoulder Injury, and Shoulder rehabilitation. This knowledge will help the physician to provide more comprehensive care for the athlete. This “Current Concepts” review will address the anatomy of the scapula, the roles that the scapula plays in overhead throwing and serving activities, the normal biomechanics of the scapula, abnormal biomechanics and physiology of the scapula, how the scapula may function in injuries that occur around the Shoulder, and treatment and rehabilitation of scapular problems.
