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Professional and amateur athletes alike are burdened by shoulder injuries. 7,44,48,49,78,88 Shoulder pain affects athlete performance, training, and daily life. 61,64 More than half of elite collegiate American football players sustain at least 1 shoulder injury during their career. 48 Shoulder injuries are a problem for athletes in sports as diverse as rugby, 54 baseball, 34 handball, 20 diving, 73 water polo, 73 and kayaking. 41 Yet, there is a lack of quality evidence to guide clinicians, athletes, and coaches in managing shoulder injury risk or return to sport (RTS) post injury. The absence of quality evidence hinders those who wish to produce clinical practice guidelines. Previous consensus statements have targeted specific shoulder pathologies 4,31,60,89 and the scapula. 50 However, questions remain: • Which exercises are most appropriate for supporting primary prevention of shoulder injury in athletes? • Does screening for muscle weakness, such as a loss of rotational strength in the shoulder, hold value for athletes? • Which load management measures are relevant for the athlete with shoulder injury?U SYNOPSIS: There is an absence of high-quality evidence to support rehabilitation and return-tosport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sport. We developed the consensus via a 2-round Delphi process (involving more than 40 content and methods experts) and an in-person meeting. This consensus statement provides guidance with respect to load and risk management, supporting athlete shoulder rehabilitation, and decision making during the return-to-sport process. This statement is designed to offer clinicians the flexibility to apply principle-based approaches to managing the return-to-sport process within a variety of sporting backgrounds. The principles and consensus of experts working across multiple sports may provide a template for developing additional sport-specific guidance in the future.

BackgroundPhysical activity promotion in people with Chronic Obstructive Pulmonary Disease (COPD) is focus of research and public health. Patient-centred interventions like counselling are promising approaches to help patients reducing sedentary behaviour. Aim of the present study is to investigate if a physical activity counselling program during pulmonary rehabilitation increases physical activity level in daily life in people with COPD.MethodsA two-armed, single blind randomised controlled trial including 56 people with COPD will be conducted in an outpatient pulmonary rehabilitation. Patients will participate in a 12-week-rehabilitation program; individuals randomized to the interventional group will additionally participate in five counselling sessions with a physiotherapist, based on the principles of motivational interviewing. The participants’ physical activity level will be measured using an accelerometer (SenseWear Pro®) before, directly and 3 months after pulmonary rehabilitation. Semi-structured interviews will be conducted to learn more about barriers and facilitators regarding daily physical activity.DiscussionIf the strategy successfully improves the physical activity level in people with COPD, counselling might be implemented in pulmonary rehabilitation.Trial registrationClinical Trials.gov NCT02455206 (05/21/2015), Swiss National Trails Portal SNCTP000001426 (05/21/2015).

Quadriceps atrophy and morphological change is a known phenomenon that can impact significantly on strength and functional performance in patients with acute or chronic presentations conditions. Real‐time ultrasound (RTUS) imaging is a noninvasive valid and reliable method of quantifying quadriceps muscle anatomy and architecture. To date, there is a paucity of normative data on the architectural properties of superficial and deep components of the quadriceps muscle group to inform assessment and evaluation of intervention programs. The aims of this study were to (1) quantify the anatomical architectural properties of the quadriceps muscle group (rectus femoris, vastus intermedius, and vastus lateralis) using RTUS in healthy older adults and (2) to determine the relationship between RTUS muscle parameters and measures of quadriceps muscle strength. Thirty middle aged to older males and females (age range 55–79 years; mean age =59.9 ± 7.08 years) were recruited. Quadriceps muscle thickness, cross‐sectional area, pennation angle, and echogenicity were measured using RTUS. Quadriceps strength was measured using hand‐held dynamometry. For the RTUS‐derived quadriceps morphological data, rectus femoris mean results; circumference 9.3 cm; CSA 4.6 cm2; thickness 1.5 cm; echogenicity 100.2 pixels. Vastus intermedius mean results; thickness 1.8 cm; echogenicity 99.1 pixels. Vastus lateralis thickness 1.9 cm; pennation angle 17.3°; fascicle length 7.0 cm. Quadriceps force was significantly correlated only with rectus femoris circumference (r = 0.48, p = 0.007), RF echogenicity (r = 0.38, p = 0.037), VI echogenicity (r = 0.43, p = 0.018), and VL fascicle length (r = 0.43, p = 0.019). Quadriceps force was best predicted by a three‐variable model (adjusted R2 = 0.46, p < 0.001) which included rectus femoris echogenicity (B = 0.43, p = 0.005), vastus lateralis fascicle length (B = 0.33, p = 0.025) and rectus femoris circumference (B = 0.31, p = 0.041). Thus respectively, rectus femoris echogenicity explains 43%, vastus lateralis fascicle length explains 33% and rectus femoris circumference explains 31% of the variance of quadriceps force. The study findings suggest that RTUS measures were reliable and further research is warranted to establish whether these could be used as surrogate measures for quadriceps strength in adults to inform exercise and rehabilitation programs.