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

Abstract

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 90 o 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.

Shoulder MRI in asymptomatic elite volleyball athletes shows extensive pathology

“…Strong consideration should be given to non-operative management options such as exercise interventions and/or data-based interval hitting programme 21. Wright et al ,22 reviewed the literature examining ‘exercise prescriptions’ for overhead athletes with shoulder pathology, demonstrating great variability though strong evidence to support the use of single-plane, open chain upper extremity exercises performed below 90 degrees of elevation and closed upper extremity exercises.…”

Tuck Jump Assessment as an Indicator for Upper Extremity Injury

“…These latest findings between the function of the lower extremity and dysfunction of the upper extremity reiterate the importance of the clinical awareness of the pathomechanics within the kinetic chain that can hinder overhead athlete performance and increase their risk of injury 3 . A most recent review of exercise prescription for overhead athletes with shoulder pathologies suggested that rehabilitation address all aspects of injury and recovery including exercises based on local, regional, and global approaches and exercises based on the specific athletic movement 23 . Because rehabilitation programs aim to address local and global stabilizers of the lumbopelvic-hip complex (LPHC), dynamic assessments for overhead athletes should focus on the LPHC.…”

Incorporation of the Kinetic Chain Into Shoulder-Elevation Exercises: Does It Affect Scapular Muscle Activity?

“…As a part of the rehabilitation for overhead athletes, authors 7 of a recent systematic review recommended single-plane open chain exercises below 908 of shoulder elevation, including elastic resistance. For optimal scapular muscle balance, adding an elastic resistance to external rotation during an elevation exercise has been proven beneficial as it increases middle (MT) and lower (LT) trapezius activity.…”

“…For optimal scapular muscle balance, adding an elastic resistance to external rotation during an elevation exercise has been proven beneficial as it increases middle (MT) and lower (LT) trapezius activity. 8 Additionally, clinical experts advise incorporating the kinetic chain into shoulder rehabilitation exercises 7,9,10 because upper extremity performance does not depend on a single shoulder-joint movement but rather on sequenced activation of the lower to the upper kinetic chain. 2,3,7 Moreover, scapular muscle activity is influenced by incorporating the kinetic chain into shoulder exercis-es.…”

“…8 Additionally, clinical experts advise incorporating the kinetic chain into shoulder rehabilitation exercises 7,9,10 because upper extremity performance does not depend on a single shoulder-joint movement but rather on sequenced activation of the lower to the upper kinetic chain. 2,3,7 Moreover, scapular muscle activity is influenced by incorporating the kinetic chain into shoulder exercis-es. [11][12][13][14][15] De Mey et al 11 investigated the effects of lower limb position and movement on upper trapezius (UT) and LT activity during scapular-retraction variations.…”