european college of sport science

Friday, June 26th, 2009
08:30 - 10:00
Invited symposia
IS-SM03 Evidence Based Sports Physiotherapy: the difficulty of the research paradigms
THE DIFFICULTY OF THE RESEARCH PARADIGMS IN SPORTSPHYSIOTHERAPY
CABRI, J., BAEYENS, J., VIROUX, P.
FACULDADE DE MOTRICIDADE HUMANA - UTL
The application of evidence based practice is nowadays an accepted way to treat patients more effectively. Results of the latest scientific
research are communicated to the health care providers, who may have to change their daily practice accordingly. However, in physiotherapy
in general and in sports physiotherapy more particularly, some difficulties may arise when considering the research paradigms.
Indeed, some of the assumptions researchers use (e.g. independency of observer, therapist and patient) may interact and therefore lead
to research bias. Blinding, for example, may be in some cases impossible because of the interaction between the therapist-researcher
and the patient. Furthermore, especially in RCT’s, there is much debate about the ’standard’ or ’control’ therapy, because of the inexistence
of the latter. Additionally, much controversy still exists with respect to the terminology used when considering joint kinematics. The
invited symposium is aimed at the reflection of the aforementioned problems and exemplified by the research going on in shoulder
injuries of athletes and its consequences for the practice.
FINE TUNING THE THROWING SHOULDER: BALANCING IN THE MOBILITY/STABILITY PARADOX
BAEYENS, J.P.
VRIJE UNIVERSITEIT BRUSSEL
Throwing athletes require a delicate balance of shoulder mobility and stability in order to meet the functionally high demanding loads of
their throwing skills. There is evidence that shows altered mobility patterns in the throwing shoulder. In their dominant shoulder, throwers
display increased external rotation and limited internal rotation, the latter hypothesized to be related to posterior shoulder tightness. The
external rotation gain has been thought to be advantageous in terms of ball velocity upon release. However, the altered shoulder ROM
can evolve into overuse manifestations such as subacromial impingement, internal impingement and SLAP lesions. In throwers with
borderline internal impingent, glenohumeral external rotation at 90° abduction is increased as compared to asymptomatic throwers.
Throwers with internal impingement also have significantly more internal rotation deficit compared with asymptomatic throwers.These
rotations are coupled with obligate intra articular translatons. No significant differences in anterior translation but increased anterior
stiffness in 90° external rotation at 90° abduction have been found between the throwing and non throwing shoulders in asymptomatic
professional baseball pitchers. F.i. external rotation at late cocking results in posterior humeral head translation. Throwers with minimal
anterior instability do not present this posterior translation. Enhanced superior translation and diminished posterior translation have been
demonstrated to relate to subacromial impingement.
Scapular kinematics has been a increased area of investigation in recent years. Throwers present with augmented scapular upwards
rotation, internal rotation and retraction. Increased scapular posterior tilt and upwards rotation of the scapula has been shown in throwers
with internal impingement compared to non symptomatic shoulders. In subacromial impingement, decreased upwards rotation and
posterior tilt have been shown. In subacromial impingement, a strengthening program accentuating on the scapular muscles proved to
be efficient for upwards and internal rotation, but nor for posterior tilt.
This presentation will assess an update of the scapulothoracic arthrokinematics and the intra articular kinematics of the glenohumeral
joint in context of the throwing shoulder with and without shouder problems.
FINE TUNING THE SHOULDER DURING THE PRE-SEASON CONDITIONING OF ELITE TENNIS PLAYERS; A QUESTION OF
MOBILITY OR STABILITY ?
VIROUX, P.
ATHLETES CARE - SPORT MEDICAL ADVICE CENTER
When it comes to pre-season screening in function of the conditioning program to prepare elite tennis players for their tennis-season,
evaluation must be done thoroughly and within the right context. Performance is the most important aspect for tennis coaches and
conditioning trainers. But optimal performance can only be achieved when the athlete is injury free. As a sports physical therapist integration
of a preventive strategy in this conditioning program is my main goal for my elite tennis players.
In a sport with a great biomechanical aspect like tennis, my practical work method is based upon the ‘kinetic chain theory’. Basic screening
of a players ‘posture and movement’ in relation to the players specific ‘movement patterns’ is the first step.
The combination of those results and the knowledge about the kinetic chain principles in tennis make it possible to integrate a preventive
strategy in this pre-season conditioning program.
Evidence based principles of injury prevention let us know that evaluation of previous injuries and sport specific adaptations in relation to
the known mechanisms of tennis injuries are not only important but even essential.
The very specific role of the shoulder in the kinetic chain of tennis players and the fact that shoulder injuries are still very common in elite
tennis players emphasize the importance of such a very specific evaluation method. Fine tuning the shoulder can only be done if the
balance between mobility and stability is reached.
This sport specific evaluation of the shoulder will be presented as well as the ‘ fine tuning’ strategy of this link within the kinetic chain of the
sport of tennis.
OSLO/NORWAY, JUNE 24-27, 2009 315