Ian Horsley

Task based rehabilitation protocol for elite athletes following Anterior Cruciate ligament reconstruction: a clinical commentary

Anterior Cruciate ligament (ACL) injuries are one of the most common and devastating knee injuries sustained whilst participating in sport. ACL reconstruction (ACLR) remains the standard approach for athletes who aim to return to high level sporting activities but the outcome from surgery is not assured. Secondary morbidities and an inability to return to the same competitive level are common following ACLR. One factor which might be linked to these sub-optimal outcomes may be a failure to have clearly defined performance criteria for return to activity and sport. This paper presents a commentary describing a structured return to sport rehabilitation protocol for athletes following ACLR. The protocol was developed from synthesis of the available literature and consensus of physiotherapists and strength and conditioning coaches based in the home country Institute of Sports within the United Kingdom.

Evaluation of shoulder joint position sense in both asymptomatic and rehabilitated professional rugby players and matched controls

OBJECTIVE To assess if joint position sense (JPS) in the shoulder differed between un-injured rugby players, matched control subjects and previously injured rehabilitated rugby players. DESIGN Mixed design. SETTING University biomechanics laboratory. PARTICIPANTS 15 asymptomatic professional rugby union players, 15 previously injured professional rugby union players, 15 asymptomatic matched non-rugby playing controls had their JPS assessed. MAIN OUTCOME MEASURES JPS was assessed using two criterion angles in the 90 degrees shoulder abduction position (45 degrees and 80 degrees external rotation). RESULTS The study found a significant difference between groups in error score (p=0.02). The testing angle also had a significant effect on error score (p=0.002), with greater error scores occurring in the mid range position. CONCLUSION This study showed rugby players to have better JPS than controls, indicating JPS might not be related to injury risk. Poor JPS appears to be related to injury, players having sustained an injury have decreased JPS despite surgery and/or rehabilitation and returning to sport without incident.

Does a tackling task effect shoulder joint position sense in rugby players

OBJECTIVE To assess the effect of a simulated tackling task on shoulder joint position sense (JPS) in rugby players. The study also aimed to assess if differences in JPS occurred between mid range and end of range JPS, and if the tackling task had angle-specific effects on these values. DESIGN Repeated measures. SETTING University human performance laboratory. PARTICIPANTS Twenty-two asymptomatic professional rugby union players. MAIN OUTCOME MEASURES JPS was assessed using two criterion angles in the 90 degrees shoulder abduction position (45 degrees and 80 degrees external rotation) prior to and following a simulated tackling task. RESULTS Prior to the tackling task JPS (absolute error scores) was worse at the 45 degrees than 80 degrees criterion angle (p<0.05). Following the tackling task absolute error scores were significantly increased at the 80 degrees angle (p<0.001), with no significant change at the 45 degrees angle (p>0.05), and no significant difference was present for error scores between angles (p=0.74). CONCLUSIONS This study found JPS to be significantly reduced following a fatiguing task. But this change was only true for the end of range position, with JPS in the mid range not changing. If the mechanoreceptors are unable to accurately report shoulder position in the outer range (stretch) position due to repetitive tackling, then there is a potential for the anterior structures to become stressed before any compensatory muscle contraction can take place. These results highlight the presence of sensorimotor system deficits following repeated tackling. These deficits are proposed to contribute to overuse injuries and micro-instability of the glenohumeral joint which may be related to the increasing rate of shoulder injuries in rugby.

Electromyographic analysis of selected shoulder muscles during a rugby football tackle

BackgroundEpidemiological studies have shown that the incidence of shoulder injuries is increasing in rugby and the majority are related to the contact/tackle phase of play. However, no data currently exists that describes preparatory muscle activity during tackle. This information could aid in guiding training and rehabilitation, if available. The purpose of the study was to assess the sequence of onset of EMG activity of selected scapulohumeral muscles during rugby tackle. 15 healthy professional rugby players participated in the study. Surface EMG activity was assessed for timing of onset relative to time of impact during a modified tackle activity in pectorialis major, biceps brachii, latissimus dorsi, serratus anterior and infraspinatus muscles.ResultsOnset of activity occurred in all muscles prior to impact. Factorial ANOVA showed significant differences between muscles in activation timing (p = 0.0001), paired t-tests revealed that serratus anterior was activated prior to all other muscles tested (p < 0.04, for all comparisons), with comparison between all other muscles showing no significant differences (p > 0.05), except pectorialis major on all comparisons showed significantly later activation timing than all other muscles (p < 0.001).ConclusionMuscle activation timing may if not properly balanced around the shoulder girdle expose the glenohumeral joint to excessive load and stress. This paper demonstrates a simple method which sets out some preliminary normative data in healthy players. Further studies relating these data to injured players are required.

Shoulder injuries in professional rugby: a retrospective analysis.

BackgroundIn the literature, little is known about the level and pattern of rugby injuries. Of the shoulder injuries reported, 51% of these are caused during a tackle, and 65% of all match injuries affected the shoulder.ObjectiveThe study aims to describe a sport-specific unique intra-articular shoulder pathology of professional rugby players, who presented with persistent pain and dysfunction despite physiotherapeutic treatment and rest.MethodThis study is a retrospective analysis set at a university sports medicine clinic. Eighty-seven professional rugby players, referred by their professional medical team since they could no longer play, underwent shoulder arthroscopy between June 2001 and October 2007 due to persistent shoulder pain and dysfunction. All were full-time professional male rugby union and rugby league players. They all had failed conservative treatment for their complaint, and the diagnosis was unclear. Arthroscopic findings were used as a measure of main outcome.ResultsThe primary mechanism of injury was reported as direct tackling (56%; n = 49) followed in succession by falling onto the arm (10%; n = 8). However, in 30% of the cases, no definite injury could be recalled. The main operative finding was that most patients exhibited multiple shoulder pathologies, with 75% of cases presenting with two or more pathologies. A superior labrum anterior to posterior (SLAP) lesion was evident at arthroscopy in 72 of the 87 cases (83%), while rotator cuff tears were evident in 43% of cases (n = 37). One-third of all cases had a Bankart tear (n = 29), despite none of them reporting previous dislocations, while other labral tears, excluding SLAP tears, to the inferior or posterior labrum were present in 34% (n = 30) of the cohort.ConclusionsRepeated tackling, which is clearly rugby specific, is most likely to be responsible for most of these shoulder injuries, which upon arthroscopic examination, showed signs of mixed pathology. We suggest that an early arthroscopic investigation is valuable in this population in order to confirm treatable diagnosis on the painful shoulder and expedite a safe return to play.

Does a SLAP lesion affect shoulder muscle recruitment as measured by EMG activity during a rugby tackle

BackgroundThe study objective was to assess the influence of a SLAP lesion on onset of EMG activity in shoulder muscles during a front on rugby football tackle within professional rugby players.MethodsMixed cross-sectional study evaluating between and within group differences in EMG onset times. Testing was carried out within the physiotherapy department of a university sports medicine clinic. The test group consisted of 7 players with clinically diagnosed SLAP lesions, later verified on arthroscopy. The reference group consisted of 15 uninjured and full time professional rugby players from within the same playing squad. Controlled tackles were performed against a tackle dummy. Onset of EMG activity was assessed from surface EMG of Pectorialis Major, Biceps Brachii, Latissimus Dorsi, Serratus Anterior and Infraspinatus muscles relative to time of impact. Analysis of differences in activation timing between muscles and limbs (injured versus non-injured side and non injured side versus matched reference group).ResultsSerratus Anterior was activated prior to all other muscles in all (P = 0.001-0.03) subjects. In the SLAP injured shoulder Biceps was activated later than in the non-injured side. Onset times of all muscles of the non-injured shoulder in the injured player were consistently earlier compared with the reference group. Whereas, within the injured shoulder, all muscle activation timings were later than in the reference group.ConclusionsThis study shows that in shoulders with a SLAP lesion there is a trend towards delay in activation time of Biceps and other muscles with the exception of an associated earlier onset of activation of Serratus anterior, possibly due to a coping strategy to protect glenohumeral stability and thoraco-scapular stability. This trend was not statistically significant in all cases

The Inter-rater Reliability of the Functional Movement Screen Within an Athletic Population Using Untrained Raters

Abstract Elias JE. The inter-rater reliability of the functional movement screen within an athletic population using untrained raters. J Strength Cond Res 30(9): 2591–2599, 2016—The functional movement screen (FMS) is a commonly used screening tool designed to identify restrictions to movement patterns and increased injury risk using 7 predesigned tests. The purpose of this study was to analyze the inter-rater reliability of scoring of the FMS using a group of “untrained” subjects. Additionally, the study also examined if clinical experience level had any effect on reliability. Twenty fully qualified Physiotherapists working at the English Institute of Sport, with elite athletes, volunteered to participate in the study. The group comprised both level 2 and level 3 physiotherapists based on clinical experience levels. Five elite athletes, free from injury, were recruited and videoed completing 6 of the 7 FMS tests using a 3 camera system. The videos were scored by each Physiotherapist using the standardized scoring sheet, as developed by Cook et al. Each practitioner marked each athlete completing the 6 tests. The total scores were calculated for each athlete (maximum score of 18). The inter-rater reliability of the test was shown to be high, intraclass coefficient 0.906. An independent t test showed no significant differences between the level 2 and level 3 practitioners in the total scores (p = 0.502). The results of the test indicate that the FMS is a reliable screening tool when used by untrained practitioners in determining faulty movement patterns and that clinical experience level does not affect the reliability, therefore it may be a useful tool in the screening of athletic populations.

Do changes in hand grip strength correlate with shoulder rotator cuff function

Background Shoulder pain as a result of rotator cuff pathology is one of the most common musculoskeletal complaints presenting within primary care. Assessment of hand grip strength has been proposed as an indicator of rotator cuff function. This experimental study assessed the relationship between grip strength and shoulder lateral rotator muscle strength in a number of different shoulder positions, aiming to investigate whether such a relationship existed and whether grip strength could be used as a functional assessment tool for the posterior cuff. Methods Twenty-seven healthy, physically active, volunteers (19 males, eight females) with no history of shoulder, upper limb or neck injury comprised the study group. The mean (SD) age was 19.8 (5.7) years (range 18 years to 23 years). Grip strength (measured with hand grip dynamometer) and lateral rotator strength (measured with a hand held dynamometer) was measured at neutral, 90° abduction, and 90° abduction with 90° external rotation. Results The correlation between grip strength and shoulder lateral rotation strength ranged between r = 0.91 (r2 = 0.84) and r = 0.72 (r2 = 0.52) across all positions. Conclusions A strong correlation between grip strength and lateral rotator strength was shown at all positions for both left and right hands, suggesting that assessment of grip strength could be used as a rotator cuff monitor of recruitment function.

A comparison of the musculoskeletal assessments of the shoulder girdles of professional rugby players and professional soccer players.

ObjectiveTo identify posture types that exist in professional rugby players, and compare them with a population of non-overhead athletes in order to identify possible relationships towards the potential for shoulder injuries.DesignObservational design Setting: Sports Medicine Clinic Participants: Convenience sample Methodology: Static assessment of posture was carried out in standing, active and passive range of glenohumeral motion, and isometric strength was carried out in accordance with previously recorded protocols.InterventionsNil Outcome Measures: Observational classification of posture, active and passive range of glenohumeral joint range of motion, isometric strength of selected muscle groups, selected muscle flexibility and Hawkins and Neer impingement tests.ResultsThere was a significant difference on range of motion between the two groups (0.025–0.000), isometric middle (0.024–0.005), and lower trapezius (0.01–0.001). Conclusion: There were significant differences between strength and flexibility of muscles around the shoulder girdle between professional rugby players and a control group of professional non-overhead athletes.

Testing Shoulder Pain Mapping

Objective A previous study on shoulder pain mapping showed specific pain patterns for common shoulder disorders. This study aimed to test those patterns for accuracy, modify shoulder pain mapping as needed, and observe their reliability and validity. Methods This prospective study used a two-step process and was undertaken to determine its potential utility in daily practice. New shoulder pain patients marked their pain, its character and severity, on a custom-made mapping form. Then a researcher blinded to the diagnoses gave their estimations on the basis of previously established maps, and they were correlated with final diagnoses. Subsequently, a guide table was developed on how to read the maps, and intertester reliability was performed with three independent testers. Results The study included 194 patients, and the overall accuracy for estimations was between 45.4% and 49.5%. The sensitivity was high, especially for instability, followed by calcific tendinitis, acromio-calvicular joint pathology, and impingement. The intertester reliability showed clinically significant agreement between testers for both disease groups (κ = 0.70) and individual disorders (κ = 0.52). Conclusions This was a unique and extensive study on shoulder pain mapping. The study concluded that pain mapping could be a useful adjunct to the clinical assessment of patients with shoulder pain and can be used in the primary care setting as well as secondary care and for research.