Proaxis Therapy

Greenville, United States

Proaxis Therapy

Greenville, United States
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Sweitzer B.A.,Albert Einstein Medical Center | Thigpen C.A.,Proaxis Therapy | Shanley E.,Proaxis Therapy | Stranges G.,Pan Am Clinic | And 6 more authors.
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2012

We sought to examine the relation among glenoid morphology, glenohumeral range of motion (ROM), and history of shoulder injury in professional baseball pitchers. We studied 58 professional baseball pitchers. Internal rotation (IR) and external rotation (ER) ROM was measured at 90° of abduction. Horizontal adduction (HAdd) ROM was also measured. Glenoid superior inclination and glenoid retroversion (GRV) were then measured radiographically. Separate mixed-model analyses of variance were used to compare dependent measures between the dominant and nondominant shoulders of pitchers with or without a history of SLAP repair. Significant interaction effects were interpreted by use of a test for simple main effects (α = .05). GRV was significantly greater on the dominant side (8.7° ± 5.6°) versus nondominant side (5.5° ± 5.2°) (P = .001), whereas glenoid superior inclination was equivalent (99.5° ± 4.3° for dominant side v 99.2° ± 4.4° for nondominant side, P = .853). Post hoc analysis indicated that pitchers with a history of SLAP repair did not display an adaptive increase in dominant GRV compared with nondominant GRV (P = .016). There were no statistical differences between groups for ER (P = .29), IR (P = .39), or HAdd (P = .39). The dominant shoulder displayed greater ER (mean increase, 6.2° ± 12.2°) with a complementary decrease in IR (mean decrease, 5.8° ± 13.2°) and HAdd (mean decrease, 8.9° ± 13.7°) compared with the nondominant side. Our findings suggest that the development of increased GRV in the dominant shoulder of professional baseball pitchers may be a protective adaptive change not reflected in glenohumeral ROM measures. Level IV, therapeutic case series. © 2012 Arthroscopy Association of North America.


Shanley E.,Proaxis Therapy | Shanley E.,Hawkins Foundation | Thigpen C.A.,Proaxis Therapy | Thigpen C.A.,Hawkins Foundation | And 8 more authors.
Journal of Shoulder and Elbow Surgery | Year: 2012

Background: Pitching causes increased mechanical stress to the arm and is thought to result in alterations in range of motion (ROM) as a result of osseous and soft tissue adaptations. Understanding the factors that contribute to alterations in ROM will allow for improved understanding of the pitching shoulder. This study examined humeral torsion (HT) and shoulder mobility over 2 consecutive years. Methods: Bilateral shoulder mobility and HT were assessed in 33 asymptomatic professional pitchers over 2 spring trainings. A repeated-measures analysis of covariance was used to assess the change in motion of the dominant side/nondominant side across seasons while quantifying pre-existing HT. Prevalence of glenohumeral internal rotation deficit (GIRD) between seasons was compared with χ2 analysis, and GIRD and non-GIRD pitchers were compared with the independent t test. Results: The dominant shoulder displayed increased external rotation (11.5° ± 0.1°, P = .02) and decreased internal rotation (-8.4° ± 11.0°, P = .03) and horizontal adduction (-17.6° ± 13.8°, P = .01). The nondominant shoulder remained the same. Mean HT was significantly different (P = .001) in the dominant (10° ± 11°) arm than in the nondominant arm (23° ± 11°). A significant number of pitchers had with GIRD (P < .01) at each assessment. Conclusions: ROM was significantly altered between seasons of pitching. These changes likely resulted from soft tissue adaptations because we accounted for humeral retrotorsion. Pitchers who developed GIRD displayed a 7° increase in retrotorsion on the dominant shoulder. Changes in the pitching shoulder over time accounting for humeral retrotorsion may suggest pitching ROM is transient and should be monitored. © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.


Seitz A.L.,Northeastern University | Reinold M.,Boston Red Sox Baseball | Schneider R.A.,Proaxis Therapy | Gill T.J.,Massachusetts General Hospital | Thigpen C.A.,Proaxis Therapy
Journal of Sport Rehabilitation | Year: 2012

Context: Differences in 3-dimensional (3D) scapular motion have been reported between healthy baseball position players and healthy nonoverhead athletic controls, as well as players diagnosed with shoulder impingement syndrome. These alterations are theorized to be the result of adaptations due to the demands of repetitive throwing. However, comparisons between the throwing and nonthrowing shoulders are commonly used to infer normal motion. Objective: The purpose of this study was to compare 3D scapular kinematics between the throwing and nonthrowing shoulders in asymptomatic professional male baseball pitchers. Design: Cross-sectional study. Setting: Laboratory. Participants: 45 asymptomatic professional baseball pitchers participating without restrictions during preseason training. Interventions: An electromagnetic tracking system was used to assess 3D scapular orientation at rest and during weighted (2.3-kg) shoulder flexion across discrete humeral-flexion angles (rest, 30°, 60°, 90°, 120°, and maximum). Main Outcome Measure: 3D scapular upward/downward rotation (UR/DR), anteroposterior (AP) tilt, and internal/external rotation (IR/ER). Separate mixed-model ANOVAs (Side × Angle) for each scapular motion were used to compare the throwing and the nonthrowing shoulder across all angles. Results: There were significant side-to-side differences with scapular UR/DR (P <.001), AP tilt (P <.001), and IR/ER (P <.001). The throwing scapula displayed greater mean UR (increase = 3.6°, SE = 0.50) and anterior/posterior tilt (increase = 2.1°, SE = 0.60) and less mean IR (decrease = 2.1°, SE = 0.66) than the nonthrowing shoulder averaged across all arm angles. Conclusions: In asymptomatic professional pitchers, the throwing shoulder's scapular position differs across all arm angles from that of the nonthrowing shoulder, but the motion does not differ. Scapular asymmetry that is consistent throughout arm elevation may be indicative not of pathology but, potentially, of a normal adaptation of the pitching shoulder. © 2012 Human Kinetics, Inc.


Garrison J.C.,Texas Health Ben Hogan Sports Medicine | Cole M.A.,Texas Health Ben Hogan Sports Medicine | Conway J.E.,Texas Health Ben Hogan Sports Medicine | MacKo M.J.,Texas Health Ben Hogan Sports Medicine | And 2 more authors.
American Journal of Sports Medicine | Year: 2012

Background: Shoulder range of motion (ROM) deficits are associated with elbow injury in baseball players. Purpose: To compare the ROM characteristics of baseball players with a diagnosed ulnar collateral ligament (UCL) tear with those of a group of age-, activity-, and position-matched healthy controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Sixty male competitive high school and collegiate baseball players participated. Thirty athletes (age [mean ± standard deviation], 18.20 ± 1.56 years) with a diagnosed UCL tear were compared with 30 (age, 18.57 ± 0.86 years) age-, activity-, and position-matched players without a UCL injury. Of the 60 participants, there were 44 pitchers, 4 catchers, 5 infielders, and 7 outfielders. Participants were measured for shoulder internal rotation (IR), external rotation (ER), and horizontal adduction (HA) at 90° of shoulder elevation. Participants were also measured for elbow extension in a seated position. Group comparisons were made between participants with and without a UCL injury using independent t tests with an a level set at P<.05. All measurements were taken bilaterally, and the differences (involved to uninvolved) were used to calculate means for all variables, including glenohumeral internal rotation deficit (GIRD), total rotational motion (TRM), HA, and elbow extension. Results: Baseball players with a UCL tear (UCLInj) exhibited significantly greater deficits in TRM compared with the control group of healthy baseball players (NUCLInj) (UCLInj = 26.67°±11.82°, NUCLInj = 0.93° ± 9.91°; P = .009). No group differences were present for GIRD (UCLInj = 12.53° ± 5.98°, NUCLInj = 13.63°±5.90°; P = .476), HA (UCLInj = 23.00°± 5.01°, NUCLInj = 23.23° ± 5.15°; P = .860), or elbow extension (UCLInj = 22.63°±7.86°, NUCLInj = 21.17°± 2.76°; P = .339). Pitchers with a UCL tear had significantly greater deficits in TRM (UCLInjPitch = 26.96°± 11.20°, NUCLInjPitch = 1.29°± 8.33°; P = .0087) and dominant shoulder ER (UCLInjPitch = 112.04° ± 14.35°, NUCLInjPitch = 121.85° ± 9.46°; P = .011) than pitchers without a UCL tear. Conclusion: A deficit in TRM is associated with a UCL tear in baseball players. Although GIRD may be prevalent in throwers, it may not be associated with a UCL injury. When examining ROM in baseball players, it is important to assess both TRM and GIRD. © 2012 The Author(s).


Thigpen C.A.,Proaxis Therapy | Lynch S.S.,Virginia Commonwealth University | Mihalik J.P.,University of North Carolina at Chapel Hill | Prentice W.E.,University of North Carolina at Chapel Hill | Padua D.,University of North Carolina at Chapel Hill
British Journal of Sports Medicine | Year: 2010

Objectives To examine the correction of posture, increase in strength and decrease in shoulder pain and dysfunction in varsity swimmers. Design and Setting Randomised clinical trial Participants Twenty-eight.


Thigpen C.A.,Proaxis Therapy | Thigpen C.A.,Duke University | Padua D.A.,University of North Carolina at Chapel Hill | Michener L.A.,Virginia Commonwealth University | And 4 more authors.
Journal of Electromyography and Kinesiology | Year: 2010

Forward head and rounded shoulder posture (FHRSP) is theorized to contribute to alterations in scapular kinematics and muscle activity leading to the development of shoulder pain. However, reported differences in scapular kinematics and muscle activity in those with forward head and rounded shoulder posture are confounded by the presence of shoulder pain. Therefore, the purpose of this study was to compare scapular kinematics and muscle activity in individuals free from shoulder pain, with and without FHRSP. Eighty volunteers were classified as having FHRSP or ideal posture. Scapular kinematics were collected concurrently with muscle activity from the upper and lower trapezius as well as the serratus anterior muscles during a loaded flexion and overhead reaching task using an electromagnetic tracking system and surface electromyography. Separate mixed model analyses of variance were used to compare three-dimensional scapular kinematics and muscle activity during the ascending phases of both tasks. Individuals with FHRSP displayed significantly greater scapular internal rotation with less serratus anterior activity, during both tasks as well as greater scapular upward rotation, anterior tilting during the flexion task when compared with the ideal posture group. These results provide support for the clinical hypothesis that FHRSP impacts shoulder mechanics independent of shoulder pain. © 2010 Elsevier Ltd.


Thigpen C.,Proaxis Therapy | Shanley E.,Proaxis Therapy
Journal of Sport Rehabilitation | Year: 2011

Patient Scenario: The patient presented is a high school baseball pitcher who was unable to throw because of shoulder pain. He subsequently failed nonoperative management but was able to return to pitching after surgery and successful rehabilitation. Clinical Outcomes Assessment: The Disabilities of Arm, Shoulder and Hand (DASH) and the Pennsylvania Shoulder Score (PENN) were selected as clinical outcome assessment tools to quantify the patient's perceived ability to perform common daily tasks and sport tasks and current symptoms such as pain and patient satisfaction. Clinical Decision Making: The DASH and PENN provide important information that can be used to target specific interventions, set appropriate patient goals, assess between-sessions changes in patient status, and quantify patients' functional loss. Clinical Bottom Line: Best clinical practice involves the use of clinical outcome assessment tools to garner an objective measure of the impact of a patient's disease process on functional expectations. This process should facilitate a patient-centered approach by clinicians while they select the optimal intervention strategies and establish prognostic timelines. © 2011 Human Kinetics, Inc.


Thigpen C.,Proaxis Therapy | Namdari S.,University of Pennsylvania | Baldwin K.,University of Pennsylvania
Sports Medicine and Arthroscopy Review | Year: 2012

Overhead activities require the shoulder to be exposed to and sustain repetitive loads. The segmental activation of the body's links, known as the kinetic chain, allows this to occur effectively. Proper muscle activation is achieved through generation of energy from the central segment or core, which then transfers the energy to the terminal links of the shoulder, elbow, and hand. The kinetic chain is best characterized by 3 components: optimized anatomy, reproducible efficient motor patterns, and the sequential generation of forces. However, tissue injury and anatomic deficits such as weakness and/or tightness in the leg, pelvic core, or scapular musculature can lead to overuse shoulder injuries. These injuries can be prevented and maladaptations can be detected with a thorough understanding of biomechanics of the kinetic chain as it relates to overhead activity. Copyright © 2012 by Lippincott Williams & Wilkins.


Joshi M.,University of Sydney | Thigpen C.A.,Proaxis Therapy | Bunn K.,University of North Carolina at Chapel Hill | Karas S.G.,Emory University | Padua D.A.,University of North Carolina at Chapel Hill
Journal of Athletic Training | Year: 2011

Context: Glenohumeral external rotation (GH ER) muscle fatigue might contribute to shoulder injuries in overhead athletes. Few researchers have examined the effect of such fatigue on scapular kinematics and muscle activation during a functional movement pattern. Objective: To examine the effects of GH ER muscle fatigue on upper trapezius, lower trapezius, serratus anterior, and infraspinatus muscle activation and to examine scapular kinematics during a diagonal movement task in overhead athletes. Setting: Human performance research laboratory. Design: Descriptive laboratory study. Patients or Other Participants: Our study included 25 overhead athletes (15 men, 10 women; age = 20 ± 2 years, height = 180 ± 11 cm, mass = 80 ± 11 kg) without a history of shoulder pain on the dominant side. Intervention(s): We tested the healthy, dominant shoulder through a diagonal movement task before and after a fatiguing exercise involving low-resistance, high-repetition, prone GH ER from 0° to 75° with the shoulder in 90° of abduction. Main Outcome Measure(s): Surface electromyography was used to measure muscle activity for the upper trapezius, lower trapezius, serratus anterior, and infraspinatus. An electromyographic motion analysis system was used to assess 3-dimensional scapular kinematics. Repeated-measures analyses of variance (phase × condition) were used to test for differences. Results: We found a decrease in ascending-phase and descending- phase lower trapezius activity (F1,25 = 5.098, P =.03) and an increase in descending-phase infraspinatus activity (F1,25 = 5.534, P =.03) after the fatigue protocol. We also found an increase in scapular upward rotation (F1,24 = 3.7, P =.04) postfatigue. Conclusions: The GH ER muscle fatigue protocol used in this study caused decreased lower trapezius and increased infraspinatus activation concurrent with increased scapular upward rotation range of motion during the functional task. This highlights the interdependence of scapular and glenohumeral force couples. Fatigue-induced alterations in the lower trapezius might predispose the infraspinatus to injury through chronically increased activation. © by the National Athletic Trainers' Association, Inc.


Wyland D.J.,Steadman Hawkins Clinic of the Carolinas | Pill S.G.,Steadman Hawkins Clinic of the Carolinas | Shanley E.,Proaxis Therapy | Clark J.C.,Steadman Hawkins Clinic of the Carolinas | And 4 more authors.
American Journal of Sports Medicine | Year: 2012

Background: Elite throwing athletes have increased proximal humeral retrotorsion (HRT) and glenoid retroversion (GRV) in their throwing shoulders compared with their nonthrowing shoulders. These adaptive morphologic changes are thought to be independently protective against shoulder injury; however, their relationship to each other is poorly understood. Purpose: To determine if an association exists between HRT and GRV within the same shoulders of professional pitchers. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The HRT and GRV measurements were determined using published techniques in asymptomatic bilateral shoulders of 32 professional pitchers (mean age, 23 years). Three measurements for each variable were averaged, and the reliability of the techniques was verified. The relationship between HRT and GRV within the same shoulders was determined with Pearson correlation coefficients. Paired t tests were used to compare HRT and GRV between the throwing and nonthrowing shoulder. Simple ratios were calculated between HRT and GRV. Results: Humeral retrotorsion and GRV were both significantly greater on the throwing side compared with the nonthrowing side (HRT: throwing = 9.0° ± 11.4° and nonthrowing = 22.1° ± 10.7°, P<.001; GRV: throwing = 8.6° ± 6.0° and nonthrowing = 4.9° ± 4.8°, P = .001). Within the same shoulders, there was a statistically significant positive association between HRT and GRV on the throwing side (r = 0.43, P = .016) but not on the nonthrowing side (r = 0.13, P = .50). The HRT:GRV ratio was 2.3:1 for throwing shoulders and 7:1 for nonthrowing shoulders. Conclusion: The concurrent increases in dominant shoulder HRT and GRV were observed as a 2:1 "throwers ratio." As this relationship was not observed on the nondominant shoulder, it suggests that bony adaptation of the proximal humerus and glenoid are coupled during skeletal development in the throwing shoulder. Longitudinal studies are needed to confirm this hypothesis. © 2012 The Author(s).

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