Musculoskeletal Screening Tool for the Overhead Athlete Chris

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 • 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