Exercise prescription for overhead athletes with shoulder pathology: a systematic review with best evidence synthesis.

OBJECTIVE: To produce a best evidence synthesis of exercise prescription used when treating shoulder pathology in the overhead athlete. DESIGN: A systematic review of exercises used in overhead athletes including case studies and clinical commentaries. DATA SOURCES: MEDLINE, PubMed, SPORTDiscus and CINAHL from database inception through July 8, 2016. METHODS: We examined data from randomised controlled trials and prospective cohort (level I-IV evidence) studies that addressed exercise intervention in the rehabilitation of the overhead athlete with shoulder pathology. Case studies and clinical commentaries (level V evidence) were examined to account for expert opinion-based research. Data were combined using best evidence synthesis and graded (A-F) recommendations (Centre for Evidence-Based Medicine). RESULTS: There were 33 unique exercises in six level I-IV studies that met our inclusion criteria. Most exercises were single-plane, upper extremity exercises performed below 90o of elevation. There were 102 unique exercises in 33 level V studies that met our inclusion criteria. These exercises emphasised plyometrics, kinetic chain and sport-specific training. CONCLUSIONS AND RELEVANCE: Overall, evidence for exercise interventions in overhead athletes with shoulder pathology is dominated by expert opinion (grade D). There is great variability between exercise approaches suggested by experts and those investigated in research studies and the overall level of evidence is low. The strongest available evidence (level B) supports the use of single-plane, open chain upper extremity exercises performed below 90° of elevation and closed chain upper extremity exercises. Clinical expert pieces support a more advanced, global treatment approach consistent with the complex, multidimensional nature of sport.

Clinician-friendly physical performance tests in athletes part 3: a systematic review of measurement properties and correlations to injury for tests in the upper extremity.

OBJECTIVE: In parts 1 and 2 of this systematic review, the methodological quality as well as the quality of the measurement properties of physical performance tests (PPTs) of the lower extremity in athletes was assessed. In this study, part 3, PPTs of the upper extremity in athletes are examined. METHODS: Database and hand searches were conducted to identify primary literature addressing the use of upper extremity PPTs in athletes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist was used to critique the methodological quality of each paper. The Terwee Scale was used to analyse the quality of the measurement properties of each test. RESULTS: 11 articles that examined 6 PPTs were identified. The 6 PPTs were: closed kinetic chain upper extremity stability test (CKCUEST), seated shot put (2 hands), unilateral seated shot put, medicine ball throw, modified push-up test and 1-arm hop test. Best evidence synthesis provided moderate positive evidence for the CKCUEST and unilateral seated shot put. Limited positive evidence was available for the medicine ball throw and 1-arm hop test. CONCLUSIONS: There are a limited number of upper extremity PPTs used as part of musculoskeletal screening examinations, or as outcome measures in athletic populations. The CKCUEST and unilateral seated shot put are 2 promising PPTs based on moderate evidence. However, the utility of the PPTs in injured populations is unsubstantiated in literature and warrants further investigation.

Do currently prescribed exercises reflect contributing pathomechanics associated with femoroacetabular impingement syndrome? A scoping review.

OBJECTIVE: Research reports limited, mixed evidence on the effectiveness of physiotherapy management in the treatment of femoroacetabular impingement (FAI) syndrome. The purpose of this review was to (1) identify what therapeutic exercises are being utilized in the non-surgical management of patients with FAI syndrome; (2) map the extent to which reported exercises reflect contributory pathomechanics associated with FAI syndrome. DESIGN: Scoping Review. METHODS: MEDLINE, PubMed, CINAHL, SPORTDiscus, and PEDRO electronic databases were searched for studies that implemented a non-surgical, exercise-based treatment approach in patients with FAI syndrome. Exercises were extracted and analyzed according to elements recognized as contributing to the pathomechanics associated with FAI syndrome. RESULTS: 24 studies fulfilled the inclusion criteria. 453 exercises were extracted. Uniplanar exercises accounted for 338/453 or 74.6% of all reported exercises whereas triplanar exercises accounted for 21/453 or 4.6% of all exercises. Non-weight bearing exercises accounted for 220/453 or 48.6% of all exercises. CONCLUSION: The majority of therapeutic exercises were classified as sagittal, uniplanar exercises, utilizing a concentric exercise approach. These findings highlight that exercises utilizing triplanar, eccentric hip control, in a single limb weightbearing position are considerably underrepresented.

Do exercises for patellofemoral pain reflect common injury mechanisms? A systematic review.

OBJECTIVES: Current best evidence has reported that therapeutic exercise programs that are designed to treat patellofemoral pain (PFP) should include both hip and knee specific exercises. The purpose of this review was to (1) examine the quality/comprehensiveness of exercise reporting in this field; (2) quantify the extent to which individual exercises comprised task-specific elements (single limb stance; eccentric control of the hip; rotational z-axis control) most likely to address key pathomechanics associated with PFP. DESIGN: Systematic review: a systematic survey of RCTs. METHODS: PubMed, CINAHL, Medline, Physiotherapy Evidence Database (PEDro) and SPORT Discus databases were searched for randomized controlled trials that addressed PFP utilizing a proximal control hip focused rehabilitation paradigm. The therapeutic exercise programs were evaluated, and each individual exercise was extracted for analysis. Quality assessments included the PEDro Scale and the Consensus on Exercise Reporting Template (CERT) was utilized to score the reporting of the interventions. RESULTS: 19 studies were included in the final analysis. 178 total exercises were extracted from the proximal hip and knee rehabilitation programs. The exercises were analyzed for the inclusion of elements that align with reported underlying biomechanical mechanisms. CONCLUSIONS: The vast majority of the exercises were sagittal plane, concentric, non-weight bearing exercises, whereas multiplanar exercises, single limb weightbearing, and exercises where loading was directed around the longitudinal z-axis, were considerably under-represented. Current exercises for PFP utilize simplistic frameworks that lack progression into more task specific exercise, and are not reflective of the complex injury etiology.

Real-time test-retest and interrater reliability of select physical performance measures in physically active college-aged students.

BACKGROUND: A new 16-item physical performance measure screening battery (16-PPM) was developed in order to expand on established movement based qualitatively scored functional screening batteries to encompass a broader spectrum of quantitatively scored functional constructs such as strength, endurance, and power. PURPOSE/HYPOTHESIS: The purpose of this study was quantify the real-time tests-retest and expert versus novice interrater reliability of the 16-PPM screen on a group of physically active college-aged individuals. The authors' hypothesized that the test-retest and interrater reliability of quantitatively-scored performance measures would be highly correlated (ICC ≥ 0.75) and that qualitatively-scored movement screening tests would be moderately correlated (K w = 0.41-0.60). STUDY DESIGN: Cohort reliability study. METHODS: Nineteen (8 males, 11 females) healthy physically active college-aged students completed the 16-PPM on two days, one week apart. RESULTS: The majority of the quantitatively scored components of the 16-PPMs demonstrated good expert-novice interrater reliability (ICC > 0.75), while qualitatively scored tests had moderate (K w = 0.41-0.60) to substantial (K w = 0.61-0.80) agreement. Test-retest reliability was consistent between raters, with most quantitatively scored PPMs exhibiting superior reliability to the qualitatively scored PPMs. CONCLUSIONS: The 16-PPM test items showed good test-retest and interrater reliability. However, results indicate that expert raters may be more reliable than novice raters for qualitatively scored tests. The validity of this 16-PPM needs to be determined in future studies. CLINICAL RELEVANCE: Physical performance screening batteries may be used to help identify individuals at risk for future athletic injury; however, current PPMs that rely on qualitatively scored movement screens have exhibited inconsistent and questionable injury prediction validity. The addition of reliable quantitatively scored PPMs may complement qualitatively scored PPMs to improve the battery's predictive ability. LEVEL OF EVIDENCE: Level III.