Sarah Mottram

Altered lumbopelvic movement control but not generalized joint hypermobility is associated with increased injury in dancers. A prospective study

Dancers experience significant more low back pain (LBP) than non-dancers and are at increased risk of developing musculoskeletal injuries. Literature concerning the relationship between joint hypermobility and injury in dancers remains controversial. The purpose of this study was therefore to examine whether lumbopelvic movement control and/or generalized joint hypermobility would predict injuries in dancers. Four clinical tests examining the control of lumbopelvic movement during active hip movements were used in combination with joint hypermobility assessment in 32 dancers. Occurrence of musculoskeletal injuries, requiring time away from dancing, was recorded during a 6-month prospective study. Logistic regression analysis was used to predict the probability of developing lower limb and/or lumbar spine injuries. Twenty-six injuries were registered in 32 dancers. Forty-four percent of the dancers were hypermobile. A logistic regression model using two movement control tests, correctly allocated 78% of the dancers. The results suggest that the outcome of two lumbopelvic movement control tests is associated with an increased risk of developing lower extremities or lumbar spine injuries in dancers. Neither generalized joint hypermobility, evaluated with the Beighton score, nor a history of LBP was predictive of injuries. Further study of these interactions is required.

A new perspective on risk assessment

Pre-season screening is routinely promoted as part of either an injury risk management strategy or as a performance enhancement strategy. Many of these processes focus on testing joint range, muscle strength (both power and endurance) and testing muscle extensibility. Although some functional tests based on work specific tasks and sport specific skills are applied they are specific to one task or a sport specific skill. It seems that the clinical outcomes of asymptomatic function, normal range of joint motion (isolated testing) and normal muscle strength (isolated testing) are not adequate rehabilitation end points to prevent recurrence. This Masterclass explores assessment and retraining from a new perspective in an attempt to address multiple muscle interactions acting on multiple joints in functionally orientated tasks. The assessment is based on the specific assessment of the site and direction of uncontrolled movement, under low and high threshold loading at different joint systems within functionally orientated tasks. From this assessment, a specific retraining programme can be developed and implemented.

Scapular positioning and motor control in children and adults: A laboratory study using clinical measures ☆ ☆☆

INTRODUCTION The scapular muscular system is the major determinant of scapular positioning. In addition, strength and muscular endurance develops from childhood through adolescence. It is not known whether differences in scapular positioning and motor control between adults and children may exist. METHODS Ninety-two shoulders of 46 adults (mean = 39.4; 18-86 years; SD = 22.5), and 116 shoulders of 59 children (mean = 11.6; 6-17 years; SD = 3.5), were included in the study. Scapular positioning data were collected using a clinical assessment protocol including visual observation of titling and winging, measurement of forward shoulder posture, measurement of scapular upward rotation, and the Kinetic Medial Rotation Test (KMRT). RESULTS The observation protocol for scapular winging and tilting did not show significant differences between adults and children. After controlling for height, forward shoulder posture (relaxed (0.28 cm/cm (0.06) vs. 0.31 cm/cm (0.07) and retracted (0.15 cm/cm (0.05) vs. 0.20 cm/cm (0.06)) were significantly smaller in children than in adults (P < 0.01). In addition, children showed greater scapular upward rotation (18.6°; SD 9.6°) than adults (14.5°; SD 10.9°) at 90° shoulder abduction. No significant differences were seen between children (19% positive test) and adults (24% positive test) using the KMRT. CONCLUSION Children and adults show significant but small differences in scapular upward rotation and forward shoulder posture. These data provide useful reference values using a clinical protocol.

The assessment of movement health in clinical practice: A multidimensional perspective

This masterclass takes a multidimensional approach to movement assessment in clinical practice. It seeks to provide innovative views on both emerging and more established methods of assessing movement within the world of movement health, injury prevention and rehabilitation. A historical perspective of the value and complexity of human movement, the role of a physical therapist in function of movement health evaluation across the entire lifespan and a critical appraisal of the current evidence-based approach to identify individual relevant movement patterns is presented. To assist a physical therapist in their role as a movement system specialist, a clinical-oriented overview of current movement-based approaches is proposed within this multidimensional perspective to facilitate the translation of science into practice and vice versa. A Movement Evaluation Model is presented and focuses on the measurable movement outcome of resultants on numerous interactions of individual, environmental and task constraints. The model blends the analysis of preferred movement strategies with a battery of cognitive movement control tests to assist clinical judgement as to how to optimize movement health across an individual lifespan.

Objective classification of scapular kinematics in participants with movement faults of the scapula on clinical assessment

The aim of this study was to assess the potential of employing a classification tool to objectively classify participants with clinically assessed movement faults (MFs) of the scapula. Six participants with a history of shoulder pain with MFs of the scapula and 12 healthy participants with no movement faults (NMFs) performed a flexion movement control test of the scapula, while scapular kinematic data were collected. Principal component scores and discrete kinematic variables were used as input into a classifier. Five out of the six participants with a history of pain were successfully classified as having scapular MFs with an accuracy of 72%. Variables related to the upward rotation of the scapula had the most influence on the classification. The results of the study demonstrate the potential of adopting a multivariate approach in objective classification of participants with altered scapular kinematics in pathological groups.

Scapular kinematics in professional wheelchair tennis players

Background Participating in wheelchair tennis increases the demands placed on the shoulder and could increase the risk of developing shoulder pain and injury that might be associated with differences in scapular kinematics. The aim of the study was to examine the presence of shoulder pain and scapular kinematics in professional wheelchair tennis players. Method Scapular kinematics were obtained in 11 professional wheelchair tennis players, 16 people with shoulder impingement and 16 people without shoulder impingement during humeral elevation and lowering. Clinical examination of the wheelchair tennis players was undertaken using the Wheelchair Users Shoulder Disability Index (WUSPI) and clinical signs of shoulder impingement. Findings The WUSPI questionnaire (mean = 28 SD 13.8) demonstrated wheelchair tennis participants experienced little shoulder pain and clinical examination revealed negative impingement tests. Wheelchair tennis players had greater scapular posterior tilt during humeral elevation (3.9° SE 1.71; P = 0.048) and lowering (4.3° SE 1.8; P = 0.04) on the dominant compared to non‐dominant side. The dominant scapulae of wheelchair tennis players were significantly (P = 0.014) more upwardly rotated (21° SD 6.7) than the scapulae of people with shoulder impingement (14.1° SD 7.0) during scapular plane humeral elevation. Interpretation This first study of scapular kinematics in professional wheelchair tennis athletes demonstrated bilateral asymmetries and differences to able‐bodied participants with shoulder impingement. Understanding the role of sport participation on shoulder function in wheelchair users would assist in the development of preventative and treatment exercise programmes for wheelchair users at risk of shoulder injury and pain. HighlightsAbsence of shoulder pain and impingement in professional wheelchair tennis playersBilateral asymmetry in scapular kinematics in wheelchair tennis playersDifferences in scapular kinematics to persons with and without shoulder impingement