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1.
J Shoulder Elbow Surg ; 33(8): e415-e421, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38734126

RESUMO

BACKGROUND: Physical therapy (PT) is a described first-line treatment option for glenohumeral arthritis, but its efficacy for treating this spectrum of disease is not well understood. The purpose of this study is to evaluate the opinions of expert providers-orthopedic surgeons and physical therapists-regarding the utility of PT in treating glenohumeral arthritis in different stages of radiographic severity. Our goal is to identify areas of interprofessional majority agreement as well as areas without agreement that warrant further investigation. METHODS: A 35-question survey was created and distributed via email to members of the American Shoulder and Elbow Surgeons and the American Society of Shoulder and Elbow Therapists, collecting information on demographics, professional experience, and the perceived benefit of PT for patients with different stages of glenohumeral arthritis based on radiographic severity. Survey responses were analyzed for inter-professional differences in distribution of answer choices as well as for majority agreement statements. Items with >50% agreement from a professional group were considered statements of majority agreement. RESULTS: One hundred and ninety surgeons and 39 physical therapists completed the survey. Surgeons and therapists demonstrated different distribution of answer choices in 25 of the 29 nondemographic related questions (86%). Surgeons and therapists reached the same majority statement in 8 items (28%) and reached disagreeing majority statements in 4 items (14%). They agreed on the benefits of PT for mild arthritis, the benefits of corticosteroid injections, the frequency of strengthening exercises, and that PT failure should not be required for surgical approval in patients with severe arthritis. They disagreed on the whether PT exacerbates symptoms in patients with moderate arthritis, and whether preoperative PT influences postoperative outcomes. CONCLUSION: Both surgeons and therapists agreed that PT may be less beneficial for patients with more advanced radiographic arthritis and that PT failure should not be required for insurance approval for surgical intervention in patients with severe glenohumeral arthritis. Further research is needed to determine the efficacy of PT for patients with moderate arthritis as well as the utility of preoperative PT for improving postoperative outcomes.


Assuntos
Artrite , Modalidades de Fisioterapia , Articulação do Ombro , Humanos , Articulação do Ombro/cirurgia , Artrite/terapia , Masculino , Feminino , Inquéritos e Questionários , Fisioterapeutas , Atitude do Pessoal de Saúde , Cirurgiões Ortopédicos , Resultado do Tratamento , Pessoa de Meia-Idade
2.
J Neurol Phys Ther ; 45(2): 79-86, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33675601

RESUMO

BACKGROUND AND PURPOSE: Individuals with benign paroxysmal positional vertigo (BPPV) are frequently referred to physical therapy for management, but little is known on how reliable therapists are at diagnosing BPPV. The purpose of the study was to examine the agreement between physical therapists in identifying nystagmus and diagnosing BPPV. METHODS: Thirty-eight individuals with complaints of positional vertigo, 19 from each of 2 clinics (clinics 1 and 2) that specialize in vestibular rehabilitation, had eye movements recorded using video goggles during positioning tests including supine-to-sit, supine roll, and Dix-Hallpike tests. Three therapists from each of the clinics independently observed videos, documented nystagmus characteristics of each testing position, and made a diagnosis for each case. Kappa (κ) statistics were calculated between therapists within each clinic for nystagmus identification and diagnosis. RESULTS: Clinic 1 therapists demonstrated substantial to almost perfect agreement in identifying nystagmus during positional tests (κ = 0.68-1, P < 0.005). Clinic 2 therapists showed moderate to almost perfect agreement for presence of nystagmus (κ = 0.57-1, P < 0.005). Therapists at both sites had almost perfect agreement of diagnosis side, canal, and mechanism (κ = 0.81-1, P < 0.005). DISCUSSION AND CONCLUSION: Therapists utilized observations from multiple positional tests to determine diagnoses. This was evident by occasional disagreement in nystagmus presence and characteristics, but agreement in diagnosis, including ruling out BPPV. The results may not be generalizable to all physical therapists or therapists' ability to diagnose central and atypical nystagmus presentations. Experienced physical therapists demonstrated strong agreement in diagnosing common forms of BPPV.Video Abstract available for more insight from the authors (see the Video Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A340).


Assuntos
Nistagmo Patológico , Fisioterapeutas , Vertigem Posicional Paroxística Benigna/diagnóstico , Humanos , Testes de Função Vestibular
3.
Scand J Med Sci Sports ; 30(11): 2037-2043, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32767794

RESUMO

The high incidence of injury during swim training and the increasing demands of the sports make monitoring of the swimmer's training load a key concept requiring further investigation. Research has previously introduced numerous methods for the purposes of monitoring the swimmer's training load, but a narrative review discussing the strengths and limitations of each method is lacking. Consequently, this narrative review aims to summarize the monitoring strategies that have been applied in research on competitive swimmers. This knowledge can assist professionals in the field in choosing which method is appropriate in their particular setting. The results from this study showed that external training load was predominantly obtained through real-life observation of the swimmers' training volume. However, research has investigated a number of internal load monitoring tools, including blood lactate, training heart rate, and perceived effort of training. To date, blood lactate markers are still considered most accurate and especially recommended at higher levels of competitive swimming or for those at greater risk of injury. Further, mood state profiling has been suggested as an early indicator of overtraining and may be applied at the lower competitive levels of swimming. Professionals in the field should consider the individual, the aim of the current training phase, and additional logistical issues when determining the appropriate monitoring strategy in their setting.


Assuntos
Comportamento Competitivo/fisiologia , Condicionamento Físico Humano/métodos , Condicionamento Físico Humano/fisiologia , Natação/fisiologia , Afeto/fisiologia , Frequência Cardíaca , Humanos , Ácido Láctico/sangue , Percepção/fisiologia , Condicionamento Físico Humano/psicologia , Esforço Físico/fisiologia , Fatores de Risco , Natação/lesões , Natação/psicologia
4.
J Shoulder Elbow Surg ; 29(11): 2375-2384, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33070869

RESUMO

BACKGROUND: Competitive swimmers incur shoulder pain and injury. Physical characteristics such as shoulder range of motion (ROM) and endurance and tissue adaptations such as posterior capsule thickness (PCT) may be risk factors in addition to high training volume. HYPOTHESIS/PURPOSE: 1) To identify the most provocative special test and prevalence of positive special tests for shoulder impingement tests in a group of collegiate swimmers, (2) to assess shoulder pain and disability, internal rotation (IR) and external rotation, and horizontal adduction (HADD) ROM and posterior shoulder endurance longitudinally over a competitive collegiate season, and (3) determine if there is a relationship between swimming yardage, supraspinatus tendon organization, and PCT. METHODS: Thirty Division III swimmers were tested poolside at the beginning (T1), middle (T2), and end (T3) of their season. Dependent variables included pain and disability, shoulder ROM, Posterior Shoulder Endurance Test (PSET) value, and PCT. Analyses of variance with follow-up t tests compared measures over time, and Pearson correlation coefficients were performed. RESULTS: Despite increased swimming yardage, disability was reduced from T1 to T3 (P = .003). There was a reduction in bilateral IR and HADD ROM from T1 to T3. PSET values increased on the right from T1 to T3 (P = .014). There was a significant positive correlation between swimming yardage at T1 and T2 and PCT at T3 (P = .034, P = .028). CONCLUSION: A loss of shoulder IR and HADD was observed across the season concurrent with less swimming-related disability, which may indicate a favorable adaptation. Improved PSET scores over the season is consistent with prior research linking endurance and less pain and disability.


Assuntos
Adaptação Fisiológica , Manguito Rotador/fisiologia , Síndrome de Colisão do Ombro/diagnóstico , Articulação do Ombro/fisiologia , Natação/fisiologia , Adolescente , Feminino , Humanos , Masculino , Resistência Física/fisiologia , Amplitude de Movimento Articular , Fatores de Risco , Rotação , Lesões do Ombro , Dor de Ombro/etiologia , Dor de Ombro/fisiopatologia , Natação/lesões , Universidades , Adulto Jovem
5.
J Shoulder Elbow Surg ; 29(10): 2149-2162, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32534209

RESUMO

Anatomic total shoulder arthroplasty is the gold standard shoulder replacement procedure for patients with an intact rotator cuff and sufficient glenoid bone to accommodate prosthetic glenoid implant and offers reliable patient satisfaction, excellent implant longevity, and a low incidence of complications. Disparity exists in the literature regarding rehabilitation strategies following anatomic total shoulder arthroplasty. This article presents a consensus statement from experts in the field on rehabilitation following anatomic total shoulder arthroplasty. The goal of this consensus statement is to provide a current evidence-based foundation to inform the rehabilitation process after anatomic total shoulder arthroplasty. These guidelines apply to anatomic total shoulder arthroplasty (replacement of the humeral head and glenoid), hemiarthroplasty (replacing only the humeral head), and hemiarthroplasty with glenoid reaming or resurfacing. The consensus statement integrates an extensive literature review, as well as survey results of the practice patterns of members of the American Society of Shoulder and Elbow Therapists and the American Shoulder and Elbow Surgeons. Three stages of recovery are proposed, which initially protect and then gradually load soft tissue affected by the surgical procedure, such as the subscapularis, for optimal patient outcomes. The proposed guidelines should be used in collaboration with surgeon preferences and patient-specific factors.


Assuntos
Artroplastia do Ombro/reabilitação , Terapia por Exercício/métodos , Hemiartroplastia/reabilitação , Articulação do Ombro/cirurgia , Artroplastia do Ombro/métodos , Consenso , Terapia por Exercício/normas , Cavidade Glenoide/cirurgia , Hemiartroplastia/métodos , Humanos , Cabeça do Úmero/cirurgia , Período Pós-Operatório , Articulação do Ombro/fisiopatologia
6.
J Sport Rehabil ; 29(6): 855-858, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32028256

RESUMO

CONTEXT: The latissimus dorsi plays a major role in generating the propulsive force during swimming. In addition, stiffness of this muscle may result in altered stroke biomechanics and predispose swimmers to shoulder pain. Measuring the flexibility of the latissimus dorsi can be of interest to reduce injury. However, the reliability of such measurement has not yet been investigated in competitive swimmers. OBJECTIVE: To assess the within-session intrarater and interrater reliability of a passive shoulder flexion range of motion measurement for latissimus dorsi flexibility in competitive swimmers. DESIGN: Within-session intrarater and interrater reliability. SETTING: Competitive swimming clubs in Flanders, Belgium. PARTICIPANTS: Twenty-six competitive swimmers (15.46 [2.98] y; 16 men and 10 women). INTERVENTION: Each rater performed 2 alternating (eg, left-right-left-right) measurements of passive shoulder flexion range of motion twice, with a 30-second rest period in between. MAIN OUTCOME MEASURES: The intraclass correlation coefficients were calculated to assess intrarater and interrater reliability. RESULTS: Interrater intraclass correlation coefficient ranged from .54 (95% confidence interval [CI], -.16 to .81) to .57 (95% CI, -.24 to .85). Results for the intrarater reliability ranged from .91 (95% CI, .81 to .96) to .94 (95% CI, .87 to .97). CONCLUSION: Results of this study suggest that shoulder flexion range of motion in young competitive swimmers can be measured reliably by a single rater within the same session.


Assuntos
Amplitude de Movimento Articular/fisiologia , Articulação do Ombro/fisiologia , Músculos Superficiais do Dorso/fisiologia , Natação/fisiologia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Adulto Jovem
7.
Biomed Eng Online ; 16(1): 28, 2017 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-28202066

RESUMO

BACKGROUND: Mitotic rate is routinely assessed in breast cancer cases and based on the assessment of 10 high power fields (HPF), a non-standard sample area, as per the College of American Pathologists cancer checklist. The effect of sample area variation has not been assessed. METHODS: A computer model making use of the binomial distribution was developed to calculate the misclassification rate in 1,000,000 simulated breast specimens using the extremes of field diameter (FD) and mitotic density cutoffs (3 and 8 mitoses/mm2), and for a sample area of 5 mm2. Mitotic counts were assumed to be a random sampling problem using a mitotic rate distribution derived from an experimental study (range 0-16.4 mitoses/mm2). The cellular density was 2500 cell/mm2. RESULTS: For the smallest microscopes (FD = 0.40 mm, area 1.26 mm2) 16% of cases were misclassified, compared to 9% of the largest (FD 0.69 mm, area 3.74 mm2), versus 8% for 5 mm2. An excess of 27% of score 2 cases were misclassified as 1 or 3 for the lower FD. CONCLUSION: Mitotic scores based on ten HPFs of a small field area microscope are less reliable measures of the mitotic density than in a bigger field area microscope; therefore, the sample area should be standardized. When mitotic counts are close to the cut-offs the score is less reproducible. These cases could benefit from using larger sample areas. A measure of mitotic density variation due to sampling may assist in the interpretation of the mitotic score.


Assuntos
Neoplasias da Mama/diagnóstico , Contagem de Células/normas , Mitose , Linhagem Celular Tumoral , Simulação por Computador , Feminino , Humanos , Microscopia , Reprodutibilidade dos Testes , Manejo de Espécimes
8.
Br J Sports Med ; 51(10): 775-780, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28189997

RESUMO

Shoulder pain is the most reported area of orthopaedic injury in swimmers. The so-called 'swimmers' shoulder' has been applied to a variety of complaints involving shoulder pain in swimmers without specific reference to contributing mechanisms or structures. Knowledge of dysfunctions associated with swimmers' shoulder can assist clinicians in developing rehabilitation strategies. This literature review aims at providing clinicians insight into the musculoskeletal mechanisms and impairments associated with swimmers' shoulder that could aid them in developing rehabilitation strategies. The following musculoskeletal dysfunctions will be discussed: muscle activity, strength, endurance, muscle control, range of motion, glenohumeral laxity, glenohumeral instability, shoulder posture and scapular dyskinesis. The findings in this review may have implications for swimmers, their coaches, and rehabilitation specialists working with swimmers.


Assuntos
Articulação do Ombro/fisiopatologia , Dor de Ombro/fisiopatologia , Ombro/fisiopatologia , Humanos , Instabilidade Articular/fisiopatologia , Músculo Esquelético/fisiopatologia , Amplitude de Movimento Articular , Escápula/fisiopatologia , Natação
9.
J Sport Rehabil ; 24(4): 353-62, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26204528

RESUMO

CONTEXT: Youth- through masters-level competitive swimmers incur significant shoulder pain. Risk factors associated with shoulder pain include high swimming yardage, a lack of cross-training, decreased shoulder strength and reduced core endurance, and limited posterior shoulder and pectoral length. Since training, swimming exposure, and physical-performance measures have all been associated with shoulder pain, the methods used to train swimmers may influence the development of shoulder pain, yet studies delineating training methods are lacking. OBJECTIVES: To identify in-water and dry-land practices among youth- through masters-level swimmers in the United States (US) and describe the potential effects of training practices on swimmers' shoulders. DESIGN: A Web-based survey was developed to identify common training practices in 5 areas: quantification of swimming and dry-land training and in-water techniques such as kicking drills, upper-body stretching, shoulder and core strengthening, and cross-training. PARTICIPANTS: 156 swim-team coaches or captains of youth, high school, and college swim teams and 196 masters swimmers participated (N = 352). There was geographic representation from across the US. RESULTS: Responses indicated diverse training practices. However, most respondents used kicking drills, which may provoke shoulder pain due to prolonged poor positioning. High yardage swum by high school and college teams increases their risk of shoulder tendinopathy. Stretching and strengthening exercises and dosages commonly used were inconsistent with current research recommendations and lacked specificity in terms of addressing typical mobility restrictions and muscle weaknesses described in the swimming literature. Core strengthening and cross-training are frequently performed. CONCLUSIONS: Several areas of in-water and dry-land practice were identified that may put swimmers' shoulders at risk for injury. Further research regarding the safety and efficacy of training programs is recommended to determine optimal methods of injury prevention and performance enhancement.


Assuntos
Traumatismos em Atletas/etiologia , Educação/métodos , Lesões do Ombro , Dor de Ombro/etiologia , Natação/fisiologia , Água , Adolescente , Criança , Humanos , Fatores de Risco , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
10.
J Sport Rehabil ; 23(1): 65-75, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23945068

RESUMO

CONTEXT: The prevalence of shoulder pain in the competitive swimming population has been reported to be as high as 91%. Female collegiate swimmers have a reported shoulder-injury rate 3 times greater than their male counterparts. There has been little information on how to best prevent shoulder pain in this population. The purpose of this study was to examine if differences exist in shoulder range of motion, upper-extremity strength, core endurance, and pectoralis minor length in NCAA Division I female swimmers with and without shoulder pain and disability. METHODS: NCAA Division I females (N = 37) currently swimming completed a brief survey that included the pain subscale of the Penn Shoulder Score (PSS) and the sports/performing arts module of the Disabilities of the Arm, Shoulder, and Hand (DASH) Outcome Measure. Passive range of motion for shoulder internal rotation (IR) and external rotation (ER) at 90° abduction was measured using a digital inclinometer. Strength was measured using a handheld dynamometer for scapular depression and adduction, scapular adduction, IR, and ER. Core endurance was assessed using the side-bridge and prone-bridge tests. Pectoralis minor muscle length was assessed in both a resting and a stretched position using the PALM palpation meter. All measures were taken on the dominant and nondominant arms. RESULTS: Participants were classified as positive for pain and disability if the following 2 criteria were met: The DASH sports module score was >6/20 points and the PSS strenuous pain score was ≥4/10. If these criteria were not met, participants were classified as negative for pain and disability. Significant differences were found between the 2 groups on the dominant side for pectoralis muscle length at rest (P = .003) and stretch (P = .029). CONCLUSIONS: The results provide preliminary evidence regarding an association between a decrease in pectoralis minor length and shoulder pain and disability in Division I female swimmers.


Assuntos
Músculos Peitorais/anatomia & histologia , Músculos Peitorais/fisiopatologia , Articulação do Ombro/fisiopatologia , Dor de Ombro/fisiopatologia , Natação/fisiologia , Adolescente , Estudos Transversais , Avaliação da Deficiência , Teste de Esforço , Feminino , Lateralidade Funcional , Humanos , Força Muscular , Tamanho do Órgão , Resistência Física , Amplitude de Movimento Articular , Rotação , Inquéritos e Questionários , Natação/lesões , Extremidade Superior/fisiopatologia , Adulto Jovem
11.
Int J Sports Phys Ther ; 19(1): 1381-1397, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38179580

RESUMO

BACKGROUND: Swimming is enjoyed by athletes of all ages, and shoulder pain is a common problem. Clinicians identify impairments which impact shoulder pain and these impairments may differ depending on the swimmer's age competition level. PURPOSE: The purpose of this study was to investigate objective measures utilized to assess swimmers and assess the relationship of test values to shoulder pain in distinct age groups/competition levels. A secondary aim was to report normative/expected values for these tests. DESIGN: Systematic review. METHODS: PRISMA methodology was employed to assess studies evaluating clinical tests and measures associated with shoulder pain for swimmers in varied age competition levels. The Methodological Index for Non-Randomized Studies instrument was used to evaluate the quality of the included studies, and a qualitative synthesis of findings was conducted to determine the strength of the evidence in four age competition levels for nine objective measures. Distinct cut points for proposed measures were identified. RESULTS: Twenty-seven studies were included in the analysis and the majority were of moderate quality in adolescent/adult swimmers. Youth swimmers had limited evidence for the development of shoulder pain associated with scapular position/dyskinesia, weakness of periscapular muscles, low endurance of core muscles, and moderate evidence for shoulder pain associated with laxity and altered range of motion (ROM). Adolescent/adult swimmers demonstrated limited evidence for a positive association between developing shoulder pain if there is a low eccentric ER:concentric IR ratio, and moderate evidence for pectoralis minor tightness and glenohumeral laxity. There were limited studies regarding masters swimmers to derive conclusive evidence. Cut points were identified from the included studies but these have not been validated in other studies. CONCLUSION: Swimmers of various ages may have different objective clinical tests and measures associated with the risk for developing shoulder pain. More studies are needed to fully understand risk factors for shoulder pain in the masters swim competition level, and to validate recommended cut points for various tests and measures. Key level of evidence: 3, Systematic review of mostly Level 3 studies.

12.
J Strength Cond Res ; 26(4): 982-8, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22371093

RESUMO

Music has been shown to be a useful adjunct for many forms of exercise and has been observed to improve athletic performance in some settings. Nonetheless, because of the limited availability of practical applications of sound conduction in water, there are few studies of the effects of music on swimming athletes. The SwiMP3 is a novel device that uses bone conduction as a method to circumvent the obstacles to transmitting high fidelity sound in an aquatic environment. Thus, we studied the influence of music on swimming performance and enjoyment using the SwiMP3. Twenty-four competitive swimmers participated in a randomized crossover design study in which they completed timed swimming trials with and without the use of music delivered via bone conduction with the SwiMP3. Each participant swam four 50-m trials and one 800-m trial and then completed a physical enjoyment survey. Statistically significant improvements in swimming performance times were found in both the 50-m (0.32 seconds; p = 0.013) and 800-m (6.5 seconds; p = 0.031) trials with music using the SwiMP3. There was no significant improvement in physical enjoyment with the device as measured by a validated assessment tool. Bone-conducted music appears to have a salutary influence on swimming performance in a practice environment among competitive adult swimmers.


Assuntos
Desempenho Atlético/fisiologia , Condução Óssea/fisiologia , Música , Natação/fisiologia , Adolescente , Adulto , Atletas , Estudos Cross-Over , Feminino , Humanos , MP3-Player , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
Int J Sports Phys Ther ; 16(2): 579-590, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33842053

RESUMO

In-pool return to swim protocols have been described for swimmers returning from being deactivated from swimming due to a shoulder injury who have full shoulder strength. Many swimmers actively participate in swim practice and competition with shoulder pain and experience deficits in performance. There are multiple reported risk factors associated with shoulder pain among swimmers, including training errors and physical impairments. These include pool and dry-land training errors, weakness in the scapular stabilizers and rotator cuff, and muscle tightness. A need exists for dry-land rehabilitation programs for impairments common to swimmers that can be performed in a traditional outpatient physical therapy setting. The purpose of this clinical commentary is to present a protocol using neuromuscular electrical stimulation (NMES), taping, strengthening, and stretching to address impairments that are common among swimmers while allowing continued active participation in practice and competition. LEVEL OF EVIDENCE: Level 5.

14.
Am J Sports Med ; 49(1): 154-161, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33211610

RESUMO

BACKGROUND: Knowledge of predictors for shoulder pain in swimmers can assist professionals working with the athlete in developing optimal prevention strategies. However, study methodology and limited available data have constrained a comprehensive understanding of which factors cause shoulder pain. PURPOSE: To investigate risk factors and develop and internally validate a multivariable prognostic model for the prediction of shoulder pain in swimmers. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 201 pain-free club- to international-level competitive swimmers were followed for 2 consecutive seasons. The cohort consisted of 96 male (mean ± SD age, 13.9 ± 2.2 years) and 105 female (13.9 ± 2.2 years) swimmers. Demographic, sport-specific, and musculoskeletal characteristics were assessed every 6 months. Swim-training exposure was observed prospectively. Shoulder pain interfering with training was the primary outcome. Multiple imputation was used to cope with missing data. The final model was estimated using multivariable logistic regression. We applied bootstrapping to internally validate the model and correct for overoptimism. RESULTS: A total of 42 new cases of shoulder pain were recorded during the study. Average duration of follow-up was 1.1 years. Predictors included in the final model were acute:chronic workload ratio (odds ratio [OR], 4.31; 95% CI, 1.00-18.54), competitive level (OR, 0.19; 95% CI, 0.06-0.63), shoulder flexion range of motion, posterior shoulder muscle endurance (OR, 0.96; 95% CI, 0.92-0.99), and hand entry position error (OR, 0.37; 95% CI, 0.16-0.91). After internal validation, this model maintained good calibration and discriminative power (area under the receiver operating characteristic curve, 0.71; 95% CI, 0.60-0.94). CONCLUSION: Our model consists of parameters that are readily measurable in a swimming setting, allowing the identification of swimmers at risk for shoulder pain. Multivariable logistic regression showed the strongest predictors for shoulder pain were regional competitive swimming level, acute:chronic workload ratio, posterior shoulder muscle endurance, and hand entry error.


Assuntos
Dor de Ombro/diagnóstico , Ombro/fisiopatologia , Inquéritos e Questionários/normas , Natação , Adolescente , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Dor de Ombro/etiologia
15.
J Athl Train ; 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33848358

RESUMO

CONTEXT: Supraspinatus tendinopathy and shoulder pain are common in competitive youth swimmers; however, no studies have investigated clinical and structural factors contributing to shoulder pain and disability in master level swimmers. OBJECTIVE: The objectives of this study were: 1) to determine the prevalence of shoulder pain and disability in master level swimmers, 2) to identify the most provocative special tests for shoulder pain, and 3) to determine if shoulder clinical and tissue specific measures, training variables and volume vary between those with and without shoulder pain, dissatisfaction and disability. DESIGN: Cross-sectional. SETTING: Collegiate swimming facilities. PATIENTS OR OTHER PARTICIPANTS: Thirty-nine adult masters level swimmers were evaluated and included in the data analysis. MAIN OUTCOME MEASURES: A survey of demographics, training, and pain and disability ratings using the Penn Shoulder Score and Disability of Arm Shoulder Hand sports module. Swimmers underwent a clinical exam including shoulder passive range of motion (PROM), posterior shoulder endurance test (PSET), supraspinatus tendon structure and posterior capsule thickness. One-way ANOVAs were used to compare demographics, clinical and structural findings between those with significant pain, dissatisfaction and disability (+PDD) and those without (-PDD). RESULTS: Fifteen percent of subjects reported pain at rest, 28% with normal activities (eating, dressing), and 69% with strenuous activities (sports) and 50% reported disability. The +PDD group had less shoulder internal rotation (10°), less ER (8°), and completed less yardage per day and per year. There were significant differences in the supraspinatus tendon structure between the +PDD and -PDD groups. CONCLUSION: Masters swimmers with pain and disability are able to self-limit yardage and likely why they recorded less yardage. The reduced shoulder motion (IR and ER) without posterior capsule differences may be due to rotator cuff muscle/tendon restrictions and the supraspinatus tendon structure may indicate degeneration caused by previous overuse resulting in pain.

16.
Biomacromolecules ; 11(12): 3325-31, 2010 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-20961143

RESUMO

Long-range electrostatic interactions are generally assigned a subordinate role in the high-affinity binding of proteins by glycosaminoglycans, the most highly charged biopolyelectrolytes. The discovery of high and low sulfation domains in heparan sulfates, however, suggests selectivity via complementarity of their linear sulfation patterns with protein charge patterns. We examined how charge sequences in anionic/nonionic copolymers affect their binding to a protein with prominent charge anisotropy. Experiments and united-atom Monte Carlo simulations, together with Delphi electrostatic modeling for the protein, confirm strongest binding when polyanion sequences allow for optimization of repulsive and attractive electrostatics. Simulations also importantly identified retention of considerable polyion conformational freedom, even for strong binding. The selective affinity for heparins of high and low charge density found for this protein is consistent with nonspecific binding to distinctly different protein charge domains. These findings suggest a more nuanced view of specificity than previously proposed for heparinoid-binding proteins.


Assuntos
Heparina/química , Polímeros/química , Ligação Proteica , Proteínas/química , Eletricidade Estática , Simulação por Computador , Polieletrólitos , Conformação Proteica
17.
J Orthop Sports Phys Ther ; 40(8): 474-93, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20710088

RESUMO

STUDY DESIGN: Case series. BACKGROUND: Few studies have defined the dosage and specific techniques of manual therapy and exercise for rehabilitation for patients with subacromial impingement syndrome. This case series describes a standardized treatment program for subacromial impingement syndrome and the time course and outcomes over a 12-week period. CASE DESCRIPTION: Ten patients (age range, 19-70 years) with subacromial impingement syndrome defined by inclusion and exclusion criteria were treated with a standardized protocol for 10 visits over 6 to 8 weeks. The protocol included a 3-phase progressive strengthening program, manual stretching, thrust and nonthrust manipulation to the shoulder and spine, patient education, activity modification, and a daily home exercise program of stretching and strengthening. Patients completed a history and measures of impairments and functional disability at 2, 4, 6, and 12 weeks. OUTCOMES: Treatment success was defined as both a 50% improvement on the Disabilities of the Arm, Shoulder, and Hand (DASH) score and a global rating of change of at least "moderately better." At 6 weeks, 6 of 10 patients had a successful (mean +/- SD) DASH outcome score (initial, 33.9 +/- 16.2; 6 weeks, 8.1 +/- 9.2). At 12 weeks, 8 of 10 patients had a successful DASH outcome score (initial, 33.1 +/- 14; 12 weeks, 8.3 +/- 6.4). As a group, the largest improvement was in the first 2 weeks. The most common impairments for all 10 patients were rotator cuff and trapezius muscle weakness (10 of 10 patients), limited shoulder internal rotation motion (8 of 10 patients), and reduced kyphosis of the midthoracic area (7 of 10 patients). DISCUSSION: A program aimed at strengthening rotator cuff and scapular muscles, with stretching and manual therapy aimed at thoracic spine and the posterior and inferior soft-tissue structures of the glenohumeral joint appeared to be successful in the majority of patients. This case series describes a comprehensive impairment-based treatment which resulted in symptomatic and functional improvement in 8 of 10 patients in 6 to 12 weeks. LEVEL OF EVIDENCE: Therapy, level 4.


Assuntos
Terapia por Exercício , Manipulação Ortopédica , Síndrome de Colisão do Ombro/terapia , Adulto , Idoso , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Medição da Dor , Educação de Pacientes como Assunto , Adulto Jovem
18.
J Athl Train ; 55(1): 32-41, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31935141

RESUMO

BACKGROUND: Competitive swimmers are exposed to enormous volumes of swim training that may overload the soft tissue structures and contribute to shoulder pain. An understanding of training factors associated with the injury is needed before practice guidelines can be developed. OBJECTIVES: To investigate the relationship between swim-training volume and shoulder pain and to determine swim-training volume and shoulder pain prevalence across the life span of the competitive swimmer. DATA SOURCES: Relevant studies within PubMed, Web of Science, and MEDLINE. STUDY SELECTION: Studies that assessed the relationship between a defined amount of swim training and shoulder pain in competitive swimmers. DATA EXTRACTION: Twelve studies (N = 1460 participants) met the criteria. Swimmers were grouped by age for analysis: young (<15 years), adolescent (15-17 years), adult (18-22 years), and masters (23-77 years). DATA SYNTHESIS: Adolescent swimmers showed the highest rates of shoulder pain (91.3%) compared with other age groups (range = 19.4%-70.3%). The greatest swim-training volumes were reported in adolescent (17.27 ± 5.25 h/wk) and adult (26.8 ± 4.8 h/wk) swimmers. Differences in exposure were present between swimmers with and those without shoulder pain in both the adolescent (P = .01) and masters (P = .02) groups. In adolescent swimmers, the weekly swim-training volume (P < .005, P = .01) and years active in competitive swimming (P < .01) correlated significantly with supraspinatus tendon thickness, and all swimmers with tendon thickening experienced shoulder pain. CONCLUSIONS: Evidence suggests that swim-training volume was associated with shoulder pain in adolescent competitive swimmers (level II conclusion). Year-round monitoring of the athlete's swim training is encouraged to maintain a well-balanced program. Developing athletes should be aware of and avoid a sudden and large increase in swimming volume. However, additional high-quality studies are needed to determine cutoff values in order to make data-based decisions regarding the influence of swim training.


Assuntos
Transtornos Traumáticos Cumulativos , Dor de Ombro , Natação , Atletas/estatística & dados numéricos , Transtornos Traumáticos Cumulativos/diagnóstico , Transtornos Traumáticos Cumulativos/epidemiologia , Transtornos Traumáticos Cumulativos/etiologia , Humanos , Dor de Ombro/diagnóstico , Dor de Ombro/epidemiologia , Dor de Ombro/etiologia , Natação/lesões , Natação/fisiologia
19.
J Orthop Sports Phys Ther ; 38(1): 4-11, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18357656

RESUMO

STUDY DESIGN: Two group, repeated measures design. OBJECTIVES: To determine whether manually repositioning the scapula using the Scapula Reposition Test (SRT) reduces pain and increases shoulder elevation strength in athletes with and without positive signs of shoulder impingement. BACKGROUND: Symptom alteration tests may be useful in determining a subset of those with shoulder pathology who may benefit from interventions aimed at improving scapular motion abnormalities. METHODS AND MEASURES: One hundred forty-two college athletes underwent testing for clinical signs of shoulder impingement. Tests provoking symptoms were repeated with the scapula manually repositioned into greater retraction and posterior tilt. A numeric rating scale was used to measure symptom intensity under both conditions. Isometric shoulder elevation strength was measured using a mounted dynamometer with the scapula in its natural position and with manual repositioning. A paired t test was used to compare the strength between positions. The frequency of a significant increase in strength with scapular repositioning, defined as the minimal detectable change (90% confidence interval), was also assessed. RESULTS: Of the 98 athletes with a positive impingement test, 46 had reduced pain with scapular repositioning. Although repositioning produced an increase in strength in both the impingement (P=.001) and non-impingement groups (P=.012), a significant increase in strength was found with repositioning in only 26% of athletes with, and 29% of athletes without positive signs for shoulder impingement. CONCLUSION: The SRT is a simple clinical test that may potentially be useful in an impairment based classification approach to shoulder problems.


Assuntos
Traumatismos em Atletas/diagnóstico , Contração Muscular , Força Muscular , Postura , Escápula , Síndrome de Colisão do Ombro/diagnóstico , Medicina Esportiva , Adulto , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/prevenção & controle , Teste de Esforço , Feminino , Nível de Saúde , Indicadores Básicos de Saúde , Humanos , Masculino , Modalidades de Fisioterapia , Síndrome de Colisão do Ombro/fisiopatologia , Síndrome de Colisão do Ombro/prevenção & controle , Dor de Ombro/fisiopatologia , Dor de Ombro/prevenção & controle
20.
Phys Ther Sport ; 32: 140-144, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29793122

RESUMO

OBJECTIVES: Measuring thoracic spine mobility can be of interest to competitive swimmers as it has been associated with shoulder girdle function and scapular position in subjects with and without shoulder pain. At present, no reliability data of thoracic spine mobility measurements are available in the swimming population. This study aims to evaluate the within-session intra- and interrater reliability of the "lumbar-locked rotation test" for thoracic spine rotation in competitive swimmers aged 10 to 18 years. This reliability study is part of a larger prospective cohort study investigating potential risk factors for the development of shoulder pain in competitive swimmers. DESIGN: Within-session, intra- and inter-rater reliability. SETTING: Competitive swimming clubs in Belgium. PARTICIPANTS: 21 competitive swimmers. MAIN OUTCOME MEASURES: Intra- and inter-rater reliability of the lumbar-locked thoracic rotation test. RESULTS: Intraclass correlation coefficients (ICCs) ranged from 0.91 (95% CI 0.78 to 0.96) to 0.96 (0.89-0.98) for intra-rater reliability. Results for inter-rater reliability ranged from 0.89 (0.72-0.95) to 0.86 (0.65-0.94) respectively for right and left thoracic rotation. CONCLUSION: Results suggest good to excellent reliability of the lumbar-locked thoracic rotation test, indicating this test can be used reliably in clinical practice.


Assuntos
Região Lombossacral/fisiologia , Amplitude de Movimento Articular , Coluna Vertebral/fisiologia , Natação , Adolescente , Atletas , Criança , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Risco , Rotação , Dor de Ombro/diagnóstico , Dor de Ombro/fisiopatologia
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