Adaptive Changes on the Dominant Shoulder of Collegiate Handball Players-A Comparative Study.

Vogler, T, Schorn, D, Gosheger, G, Kurpiers, N, Schneider, K, Rickert, C, Andreou, D, and Liem, D. Adaptive changes on the dominant shoulder of collegiate handball players-A comparative study. J Strength Cond Res 33(3): 701-707, 2019-Handball players are susceptible to adaptive bony and soft-tissue changes of the dominant shoulder. Our goal was to compare the glenohumeral range of motion and posterior capsule thickness between the dominant and nondominant arm of throwing athletes and between the dominant arm of nonthrowers and throwing athletes. Twenty-three collegiate handball players and 23 nonthrowing athletes underwent an examination of the dominant and the nondominant shoulder. Humeral retroversion and posterior capsule thickness were assessed with an ultrasound examination, whereas external rotation and internal rotation were determined with a digital inclinometer. The dominant shoulder of handball players had a significantly higher external rotation compared with their nondominant shoulder and the dominant shoulder of nonthrowing athletes. Furthermore, the dominant shoulder of handball players had a significantly lower internal rotation compared with their nondominant shoulder, with no differences compared with the dominant shoulder of the nonthrowing athletes. There was a trend for an increased posterior capsule thickness and an increased humeral retroversion between the dominant and the contralateral shoulder of handball players. Moreover, we found a significant increase in the capsule thickness of the dominant shoulder of throwing athletes compared with the dominant shoulder of nonthrowers. However, there were no differences in humeral retroversion. Our analysis suggests that a comparison of the dominant shoulder of overhead throwing athletes with the dominant shoulder of nonthrowing athletes might be more appropriate than the comparison of the dominant and the nondominant shoulder to evaluate the adaptive changes on the dominant side.

Evaluation of short-term effects of three passive aquatic interventions on chronic non-specific low back pain: Study protocol for a randomized cross-over clinical trial.

BACKGROUND: Low back pain (LBP) is among the most common physical ailments and its chronic manifestation is a leading cause for disability worldwide. LBP is not attributable to a known diagnosis in 85% of the cases and therefore called chronic non-specific LBP (cnLBP). Passive immersion in warm water is commonly claimed to reduce muscular tension and pain, but not yet sufficiently investigated with regard to cnLBP. The current study compares three passive aquatic interventions regarding their effects on cnLBP: floating (resting in a supine immersed position on flotation devices), WATSU (a passive hands-on treatment, in which a practitioner stands in warm water, gently moving and massaging the client), and a Spa session. METHODS: In this randomized cross-over clinical trial, all 24 adult participants with cnLBP will undergo the three interventions in balanced order with a washout-period of at least two weeks in between. Assessments will take place at baseline and follow-up of study and immediately before and after each intervention. Assessments cover the primary outcome self-reported current pain (Visual Analog Scale, range: 0-100 mm), other self-report questionnaires (addressing, e.g., personality traits or -states), and physiological parameters (e.g., measurement of spinal range of motion). DISCUSSION: The study adds estimates of intervention-specific effect-sizes of widespread passive aquatic interventions to cnLBP. The study also points to potential underlying pain-reducing mechanisms. TRIAL REGISTRATION: The protocol was approved by the Ethics Committee of the Canton Bern (ProjectID: 2018-00461). Trial registration is intended at ClinicalTrials.gov.

Applications, indications, and effects of passive hydrotherapy WATSU (WaterShiatsu)-A systematic review and meta-analysis.

BACKGROUND: WATSU (portmanteau word: water and shiatsu) is a form of passive hydrotherapy in chest-deep thermoneutral water (35°C = 95°F = 308.15 K). It combines elements of myofascial stretching, joint mobilization, massage, and shiatsu and is reported to be used to address physical and mental issues. The objective of this systematic review (PROSPERO Registration No. CRD42016029347) and the meta-analyses was to assess the applications, indications, and the effects of WATSU to form a basis for further studies. METHODS: A search for "WATSU OR watershiatsu OR (water AND shiatsu)" was conducted without any restrictions in 32 databases. Peer reviewed original articles addressing WATSU as a stand-alone hydrotherapy were assessed for risk of bias. Quantitative data of effects on pain, physical function, and mental issues were processed in random model meta-analyses with subgroup analyses by study design. Effect sizes were expressed as Hedges's g (± 95% confidence intervals). RESULTS: Of 1,906 unique citations, 27 articles regardless of study design were assessed for risk of bias. WATSU has been applied to individuals of all ages. Indications covered acute (e.g. pregnancy related low back pain) and chronic conditions (e.g. cerebral palsy) with beneficial effects of WATSU regarding e.g. relaxation or sleep quality. Meta-analyses suggest beneficial effect sizes of WATSU on pain (overall Hedges's g = -0.71, 95% CI = -0.91 to -0.51), physical function (overall Hedges's g = -0.76, 95% CI = -1.08 to -0.44), and mental issues (overall Hedges's g = -0.68, 95% CI = -1.02 to -0.35). CONCLUSION: Various applications, indications and beneficial effects of WATSU were identified. The grade of this evidence is estimated to be low to moderate at the best. To strengthen the findings of this study, high-quality RCTs are needed.

Long-term outcome of arthroscopic debridement of massive irreparable rotator cuff tears.

OBJECTIVES: To evaluate the clinical and radiographic outcome of low-demand patients with massive rotator cuff tears undergoing arthroscopic debridement in mid- and long-term follow-up, as well as the rate of conversion to reverse shoulder arthroplasty. METHODS: We performed a retrospective analysis of 19 patients with a mean age at surgery of 68 years (range, 55-80 years) from a previously described consecutive cohort and after a mean follow up of 47 month (FU1) and 145 month (FU2). The functional outcome was evaluated with the VAS score, the American Shoulder and Elbow Surgeons (ASES) score, and the age- and gender-adjusted Constant (aCS) score. The radiographic outcome was classified according to the Hamada classification. Non-parametric analyses were carried out with the Mann-Whitney U for independent samples and the Wilcoxon signed-rank test for related samples. RESULTS: Five patients (26%) developed symptomatic cuff tear arthropathy and underwent reverse shoulder arthroplasty after a mean time of 63 months (range, 45-97 months). These patients were excluded from further analyses. The mean VAS score of the remaining 14 patients at FU1 was significantly lower compared to preoperatively (P = .041), while there were no significant differences between the VAS score at FU1 and FU2 (P = 1.0). The ASES score of the affected shoulder at FU1 was significantly higher compared to prior to surgery (P = .028), while there were no significant differences between the scores of the affected shoulder between FU1 and FU2 (P = .878). While the ASES score of the contralateral shoulder at FU1 was significantly higher than the score of the affected shoulder (P = .038), there were no significant differences in the ASES scores of the affected and the healthy shoulder at FU2 (P = .575). The evaluation of the aCS produced similar results. A progression of the Hamada grade was documented in 6 patients. CONCLUSIONS: Arthroscopic debridement is a safe and valid option for low-demand middle-age or elderly patients with symptomatic massive rotator cuff tears, leading to a significant pain relief and significantly improved functional outcome at mid- and long-term follow up. However, about a quarter of the patients in our cohort had to undergo reverse shoulder arthroplasty due to symptomatic cuff tear arthropathy. Furthermore, some of the remaining patients continued to undergo radiographic progression. This might be due to the natural history of their disease and/or the surgical procedure, and the clinical relevance of this finding should be evaluated in further studies.

Predictors of falls in recreational snowboard jumping: An observational study.

PURPOSE: Jumping is popular in the sport of snowboarding. Epidemiological research has shown an increased risk of injury associated with this activity. Falls are common when jumping and although there is a logical connection between falling and injury occurrence, thus far little attention has been given to factors involved in the jumping-fall relationship. The current study aimed to add to the current knowledge base by identifying predictors of falling during intentional snowboard jumping within terrain park facilities. METHODS: Seven hundred and four jumps were video recorded and qualitatively coded using a custom template of predetermined parameters related to manoeuvre choice, landing technique and jump success. RESULTS: Falling was common within the sample population at a rate of one fall for every five jump attempts. Landings made on the flat or knuckle of the snow jump as well as incorrect board positioning at landing were found to be significant predictors of falling. Additionally the choice of manoeuvre was found to influence the risk of falls, with spinning jumps associated with a greater fall risk when compared to non spinning jumps. No clear relationship was identified between jump length measures and falling risk. CONCLUSION: It is likely that jumping will remain popular in snowboarding and thus research efforts should focus on minimising the risk of injury associated with this skill. Reducing the overall incidence of falling, identified in the current study to be high, is a potential area for improvement. The potential for fall risk reduction through technique and decision making changes provides justification for further research in this area.