Transcript Musculoskeletal Screening Tool for the Overhead Athlete

Musculoskeletal Screening Tool
for the Overhead Athlete
Chris Ham, ATC, Kerry Wilbar, ATC, Justin
Wenzel, ATC, Shannon Gordon, ATC, Tim Lee,
ATC, Jon Demarie, ATC
Research Questions
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What screening tools should be used on overhead athletes that
will help prevent the loss of play through reducing the
incidence of injury?
•
What is the relationship between lower extremity/core
deficiencies and the injuries sustained in the upper extremity?
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Will athletes who have deficiency indicators found during a
screening benefit from an appropriate core strengthening and
deficiency specific treatment protocol?
Methodology
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Subgroups were created to focus on and critically evaluate the
literature for the different areas of our project.
– Group 1: Examined the glenohumeral joint and upper
extremity
– Group 2: Looked at the scapula and its role in the screening
process
– Group 3: Evaluated the literature on the hips/core and their
role in the kinetic chain.
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All subgroups have compiled evidence-based literature in the
respective areas to establish the criteria for our screening to and its
utility for the overhead athlete.
Research Goals
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A screening tool will aid in properly identifying risk factors to
reduce incidence of injury
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Identifying these factors in advance will decrease the amount of
time lost to injury by the athletes requiring more extensive rehab
•
Properly identifying and treating conditions in a proactive manner
can reduce inherent costs associated with treatment
Screening Tool – Assessing Posture
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Areas of concern/focus
– Head Forward
– Rounded/Forward Shoulders
– Lateral Spine Curvature
– Level Hips
– Scapular Winging (Standing Posture)
– Scapular Rhythm
– Prominence of Scapula (Yes/No)
• Inferior Medial Border
• Entire Medial Border
• Superior Medial Border
Screening Tool – Range of Motion ROM
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Wrist – Measured Bilaterally
– Flexion
– Extension
Shoulder – Measure Bilaterally
– Flexion
– Extension
– Abduction (ABD)
– Internal Rotation (IR) @ 90 Degrees
– External Rotation (ER) @ 90 Degrees
– Horizontal Abduction Internal Rotation (HAIR)
– Total Arc (IR + ER)
Screening Tool – Range of Motion (ROM)
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Hips – Measured Bilaterally
– Flexion
– Abduction
– Internal Rotation (IR)
– External Rotation (ER)
Hamstrings and Quadriceps – Measured Bilaterally
– 90 Degree Extension lag
– Straight Leg
– Knee Flexion
– Thomas Test (Lack Hip Ext and Knee Flex < 45)
• Pass/Fail
– Thomas – Rectus Femoris Lag (Knee Flex <45)
• Pass/Fail
Screening Tool – Kinetic Chain
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Assessing Kinetic Chain
– Trendelenburg Test
– Single Leg Squat
Pathological Red Flags
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Glenohumeral Internal Rotation Deficit (GIRD)
– If the total arc of motion has a difference greater than 20
degrees, compared bilaterally, it is considered significant
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SICK Scapula
– Asymmetrical malpositioning of the scapula
– Results in scapular dyskinesis
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Hip Mobility
– Hips are critical in the transfer of energy
– Any loss of hip mobility, will lead to loss of energy or
misdirection of that energy
Core and Upper Extremity Injuries
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Literature lacks true definition of “core”
– What musculoskeletal structures should be included in this
region?
– Many Facets have been examined
• The lack of a defined “core” and the muscles that may be
involved have led to the ambiguity of the research being
conducted
Assessment – Year One
•
A review of current literature focusing on the measurements
associated with posture, glenohumeral ROM, scapular positioning,
lower extremity ROM, and core strength were used to construct a
musculoskeletal screening tool
•
Data encompassing a criterion of indicators and pathologies in the
kinetic chain that affect overhead athletes were, and will be
collected
Assessment- Year Two
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Intervention
– “Core” strengthening and deficiency specific treatment
protocol
• An intervention program will be designed based upon the
specific indicators or pathologies noted during the
screening tool
Project Timeline
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Now through August 2009
– Complete literature review on corrective exercises for
pathological deficiencies identified with screening tool
September – December 2009
– Develop treatment plan for individual areas that need to be
addressed as a result of screening
January 2010
– Begin rough draft
March 2010
– Presentation of Data
May 2010
– Poster Fair