Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
A Kinematic Analysis of Shoulder Instability and the Role of Core Stability
Nick Hassler and Will Kerr
Shoulder AnatomyBones
• Scapula (shoulder blade)• Clavicle• Humerus
Joints• AC Joint• Glenohumeral Joint (ball & socket)
• Labrum
Muscles• Rotator Cuff (4 muscles)• Deltoid• Trapezius• Pectorals
Shoulder Instability• What is it?
• The structures that surround the shoulder joint become stretched or torn allowing the humeral head to move away from the shoulder socket
• How does it occur?• Sudden traumatic injury• Previous injuries (dislocations and tears)• Repetitive use
Injuries and Treatment• Resulting injuries
• Subluxation (partial dislocation)• Dislocation• Stretched ligaments and joints puts individual at higher risk for variety of tears and
fractures• Current treatment options
• Physical therapy• Surgical procedures
• Capsule tightening• Ligament repairs• Labral repair (Bankart repair)
ImpactNumber of People
• Instability has a variety of sources• Athletic, workplace, leisure activities
• Number of sports involving shoulder activity
Cost Considerations• Physical therapy ($20-$120 per session)• Surgical cost (upwards of $20,000)• Workers compensation fees
Additional Factors• Easy to overlook due to lack of immediate pain• Heightened risk for more severe injuries• Preventing you from doing things you love
Research GoalsTo analyze the relationship between core strength and shoulder instability in order to provide a novel approach to minimizing shoulder instability.
Hypothesis: Shoulder stability will increase with the implementation of a core strengthening protocol.
Previous StudiesSaeterbakken 2011
• Core stability training program of progressively unstable closed kinetic chain
• Major Findings → Maximal throwing velocity increased (4.9%) in experimental group
• Shortcomings → No difference between core strength and core stability and influence of each on performance variables
Previous Studies• Core stability was found to be lower in
participants with shoulder dysfunction compared to healthy participants
• Major Findings → overhead athletes with shoulder dysfunction had non‐optimal core stability
• Shortcomings → Small sample and potentially drew a false conclusion from the correlations shown
[3] Hazar, et al
Research MethodsMeasured variables:
• Humeral head position• Glenohumeral Joint Forces• Core Activation
Measurement Methods:• X-Ray → Joint Positioning (statically)• Motion Capture → Joint Positioning (dynamically)• Motion Capture/Force Plates → Force• EMG → Core Activation
Proposed Testing ProtocolParticipants:
• 1000 NCAA overhead athletes• 500 male/500 female• Age: 18 - 24• No previous traumatic shoulder injuries• Half of participants will not participate in progressive core protocol (control group)
Length of Study:• 12 months
• Evaluating variables every 3 months• Protocol frequency: 2 times per week
Proposed Testing ProtocolProgressive Core Protocol:
Core Strengthening: (closed kinetic chain)A. unstable sling exerciseB. modified side plank
Core Stability: (open kinetic chain)C. Bosu ball weighted squatD. exercise ball balance
http://www.youtube.com/watch?v=A2OSQx1dK5k
Data Analysis● Humeral Head Position
○ Evaluate changes in glenohumeral positioning and compare to control group
● Joint Forces○ Magnitude and direction of resultant force in the
glenohumeral joint ● Core Activation
○ Percentage of activation of core muscles
Evaluation Tasks● Neutral position (positioning)● Front raise (forces)● Side raise (forces)● Bosu ball balance (core
activation)
Expected ResultsWe expect that the experimental group will experience better shoulder stability compared to the control group:
• Less movement of the humeral head with respect to the glenoid• More optimal glenohumeral positioning• Less variation of force directions• Higher level of core activation
Future ImpactsIncreasing shoulder longevity in overhead sport athletes
• Decreasing chronic shoulder injuries• Providing a low impact means for improving shoulder health • Reduced medical costs
References[1] Brumitt, J., Dale, R.B., 2009. Integrating Shoulder and Core Exercises When Rehabilitating Athletes Performing Overhead Activities. North
American Journal of Sports Physical Therapy 4, 132–138.[2] Emery, C.A., 2005. Effectiveness of a home-based balance-training program in reducing sports-related injuries among healthy adolescents:
a cluster randomized controlled trial. Canadian Medical Association Journal 172, 749–754. doi:10.1503/cmaj.1040805[3] Hazar, Z., Ulug, N., Yuksel, I., 2014. Is There a Relation Between Shoulder Dysfunction and Core Instability? Orthopaedic Journal of Sports
Medicine 2, 8–13. doi:10.1177/2325967114s00173[4] Mısırlıoğlu, T.Ö., 2018. Does a core stabilization exercise program have a role on shoulder rehabilitation? A comparative study in young
females. Turkish Journal of Physical Medicine and Rehabilitation 64, 328–336. doi:10.5606/tftrd.2018.1418[5] Page, P., 2011. SHOULDER MUSCLE IMBALANCE AND SUBACROMIAL IMPINGEMENT SYNDROME IN OVERHEAD ATHLETES.
International Journal of Sports Physical Theraphy 6, 51–58.[6] Saeterbakken, A.H., Tillaar, R.V.D., Seiler, S., 2011. Effect of Core Stability Training on Throwing Velocity in Female Handball Players.
Journal of Strength and Conditioning Research 25, 712–718. doi:10.1519/jsc.0b013e3181cc227e[7] Silfies, S.P., Ebaugh, D., Pontillo, M., Butowicz, C.M., 2015. Critical review of the impact of core stability on upper extremity athletic injury
and performance. Brazilian Journal of Physical Therapy 19, 360–368. doi:10.1590/bjpt-rbf.2014.0108[8] Swanik, K.A., Lephart, S.M., Swanik, C., Lephart, S.P., Stone, D.A., Fu, F.H., 2002. The effects of shoulder plyometric training on
proprioception and selected muscle performance characteristics. Journal of Shoulder and Elbow Surgery 11, 579–586. doi:10.1067/mse.2002.127303
[9] Wilk, K.E., Meister, K., Andrews, J.R., 2002. Current Concepts in the Rehabilitation of the Overhead Throwing Athlete. The American Journal of Sports Medicine 30, 136–151. doi:10.1177/03635465020300011201
[10] Yaggie, J.A., Campbell, B.M., 2006. Effects Of Balance Training On Selected Skills. Journal of Strength and Conditioning Research 20, 422–428. doi:10.1519/00124278-200605000-00031
Questions?