STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To compare a muscle energy technique (MET) for the glenohumeral joint (GHJ) horizontal abductors and an MET for the GHJ external rotators to improve GHJ range of motion (ROM) in baseball players. BACKGROUND: Overhead athletes often exhibit loss of GHJ ROM in internal rotation, which has been associated with shoulder pathology. Current stretching protocols aimed at improving flexibility of the posterior shoulder have resulted in inconsistent outcomes. Although utilization of MET has been hypothesized to lengthen tissue, there are limited empirical data describing the effectiveness of such stretches for treating posterior shoulder tightness. METHODS: Sixty-one Division I baseball players were randomly assigned to 1 of 3 groups: MET for the GHJ horizontal abductors (n = 19), MET for the GHJ external rotators (n = 22), and control (n = 20). We measured preintervention and postintervention GHJ horizontal adduction and internal rotation ROM, and conducted analyses of covariance, followed by Tukey honestly significant difference post hoc analysis for significant group-by-time interactions (P<.05). RESULTS: The group treated with the MET for the horizontal abductors had a significantly greater increase in GHJ horizontal adduction ROM postintervention (mean ± SD, 6.8° ± 10.5°) compared to the control group (–1.1° ± 6.8°) (P = .011) and a greater increase in internal rotation ROM postintervention (4.2° ± 5.3°) compared to the group treated with the MET for the external rotators (0.2° ± 6.3°) (P = .020) and the control group (–0.2° ± 4.0°) (P = .029). No significant differences among groups were found for any other variables (P>.05). CONCLUSION: A single application of an MET for the GHJ horizontal abductors provides immediate improvements in both GHJ horizontal adduction and internal rotation ROM in asymptomatic collegiate baseball players. Application of MET for the horizontal abductors may be useful to gain ROM in overhead athletes. LEVEL OF EVIDENCE: Therapy, level 2b-.

J Orthop Sports Phys Ther 2011;41(6):400-407, Epub 6 April 2011. doi:10.2519/jospt.2011.3292

KEY WORDS: baseball, manual therapy, pitching, rehabilitation, stretching

SYNOPSIS: This manuscript describes the consensus rehabilitation guideline developed by the American Society of Shoulder and Elbow Therapists. The purpose of this guideline is to facilitate clinical decision making during the rehabilitation of patients following arthroscopic anterior capsulolabral repair of the shoulder. This guideline is centered on the principle of the gradual application of stress to the healing capsulolabral repair through appropriate integration of range of motion, strengthening, and shoulder girdle stabilization exercises during rehabilitation and daily activities. Components of this guideline include a 0- to 4-week period of absolute immobilization, a staged recovery of full range of motion over a 3-month period, a strengthening progression beginning at postoperative week 6, and a functional progression for return to athletic or demanding work activities between postoperative months 4 and 6. This document represents the first consensus rehabilitation guideline developed by a multidisciplinary society of international rehabilitation professionals specifically for the postoperative care of patients following arthroscopic anterior capsulolabral repair of the shoulder.

J Orthop Sports Phys Ther 2010;40(3):155-168, Epub 5 February 2010. doi:10.2519/jospt.2010.3186

KEY WORDS: Bankart repair, capsular plication, postoperative rehabilitation, shoulder instability, therapeutic exercise

Study Design: Psychometric evaluation of a cross-sectional survey. Objectives: The purpose of this study was to examine the psychometric properties of reliability and validity of the Penn Shoulder Score (PSS). Background: Shoulder outcome measures are used to assess patient self-report levels of pain, satisfaction, and function. The PSS is a 100-point shoulder-specific self-report questionnaire consisting of 3 subscales of pain, satisfaction, and function. This scale has been utilized in the literature. However, the measurement properties of reliability and validity, including responsiveness, of the PSS subscales and overall scale need to be established. Methods and Measures: Patients (n = 40) with shoulder disorders undergoing a course of outpatient physical therapy completed the PSS at initial visit and again within 72 hours to assess test-retest reliability. The Constant Shoulder Score (CSS) and the American Shoulder and Elbow Surgeons Shoulder Score (ASES) were also completed at the initial visit and compared to the PSS to assess convergent construct validity. A separate cohort of patients (n = 109) completed the PSS at initial visit and 4 weeks later. These scores were used to assess internal consistency and responsiveness. Results: Reliability analysis revealed a test-retest ICC _2,1 of 0.94 (95% CI, 0.89-0.97). Internal consistency analysis revealed a Cronbach alpha of 0.93. The standard error of measurement (SEM) was ± 8.5 scale points (based on a 90% CI) and the minimal detectable change (MDC) was ± 12.1 scale points (based on a 90% CI). The minimal clinically important difference (MCID) for improvement was 11.4 points. Pearson product moment correlation coefficients between the PSS and the CSS and ASES were 0.85 and 0.87, respectively. Responsiveness analysis revealed an effect size of 1.01 and a standardized response mean of 1.27. Conclusions: This study has demonstrated that the PSS is a reliable and valid measure for reporting outcome of patients with various shoulder disorders.

J Orthop Sports Phys Ther. 2006;36(3):138-151. doi:10.2519/jospt.2006.2090

Key Words: outcome assessment, psychometrics, reliability, validity