Chris Ham, ATC, Kerry Wilbar, ATC, Justin
Wenzel, ATC, Shannon Gordon, ATC, Tim Lee,
ATC, Jon Demarie, ATC

Research Questions
• 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?
•
Will athletes who have deficiency indicators found during a screening benefit from an appropriate core strengthening and deficiency specific treatment protocol ?

Methodology
•
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.
•
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
• A screening tool will aid in properly identifying risk factors to reduce incidence of injury
• 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
•
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
•
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)
•
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
• Assessing Kinetic Chain
– Trendelenburg Test
– Single Leg Squat

Pathological Red Flags
•
Glenohumeral Internal Rotation Deficit (GIRD)
– If the total arc of motion has a difference greater than 20 degrees, compared bilaterally, it is considered significant
•
SICK Scapula
– Asymmetrical malpositioning of the scapula
– Results in scapular dyskinesis
•
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
• 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
• 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
• 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