Papers by Todd Ellenbecker
JSES international, 2022
Background The electromyography (EMG) activity of the teres minor (TMi) and infraspinatus (IS) mu... more Background The electromyography (EMG) activity of the teres minor (TMi) and infraspinatus (IS) muscle has been demonstrated to vary depending on the arm position, such as in the coronal or scapular position, during intervention exercises. This may be reflected by different EMG activities demonstrated between the TMi and IS muscle during the acceleration and deceleration phases of the pitching motion. Tenderness in the scapular attachment site of the TMi muscle is often seen in baseball pitchers after pitching but not the attachment site of the IS muscle. However, few studies have investigated an interaction between TMi and IS muscle activity across different resistance exercises with different arm positions. The purpose of this study was to identify the feature of TMi and IS muscle activity in the presence of manual resistance applied in the prone position. Methods Eighteen collegiate baseball players volunteered their participation. Raw EMG amplitudes of the TMi, IS, posterior deltoid, middle deltoid, and upper trapezius muscles on the dominant shoulder were measured during intervention exercises. All subjects performed manual isometric resistance exercises: horizontal abduction (HABD) and external rotation (ER) of the glenohumeral joint with 40% of the manual maximum strength test in prone. The subjects also performed each of the HABD and ER resistance exercises with the arm actively positioned at 0° and 45° of ER of the glenohumeral joint in the coronal and scapular planes. Results Both TMi and IS muscle activities significantly increased with the arm positioned at 45° of ER compared with 0° of ER regardless of the exercise (P < .05). TMi activity was significantly greater with HABD resistance than IS muscle activity regardless of the arm positions, whereas it was significantly less with ER resistance than IS muscle activity. Conclusion The findings of this study indicated that the TMi and IS muscles were most highly activated during the HABD resistance with the arm actively positioned at 45° of ER in the coronal plane. The results of this study have clinical implications regarding the careful selection of arm position in both exercise and clinical examination for the TMi and IS muscles.
Springer eBooks, 2017
Scapular dyskinesis presenting in patients with shoulder pain may have multiple causes related to... more Scapular dyskinesis presenting in patients with shoulder pain may have multiple causes related to shoulder impairments or may simply be an incidental finding. The physical examination should assess the impairments related to scapular dyskinesis in order to develop an appropriate rehabilitation program. The key impairments to examine are soft tissue tightness or laxity, muscular deficits of weakness or control, scapular position or movement faults, and the kinetic chain. This chapter will describe treatment and exercise protocols for flexibility deficits and muscular deficits related to the scapula. Attention is also given to the rehabilitation of scapular dyskinesis in the overhead athlete. The selection of key impairments, rehabilitation guidelines for selection, and progression were based on evidence and clinical experience of the authors. The outcomes and effectiveness of scapula-focused rehabilitation programs are presented.
JSES international, May 1, 2021
Background The teres minor (TMi) muscle exposed relatively high activity during the acceleration ... more Background The teres minor (TMi) muscle exposed relatively high activity during the acceleration and deceleration phases of the throwing motion, compared with the infraspinatus muscle. However, few studies have identified TMi muscle activity in intervention exercises. The purpose of this study was to investigate TMi muscle activities in different horizontal adduction positions in the quadruped horizontal abduction exercise. This study hypothesized that TMi muscle activity would differ in response to resistance application across different horizontal adduction positions. Materials and methods Nineteen collegiate baseball players volunteered their participation. Raw electromyography activity of the TMi muscle along with 7 different muscles attached to the scapula on the dominant-side were collected, and normalized by each of the corresponding maximum voluntary isometric contractions. All subjects performed manual isometric resistance horizontal abduction exercises at 90° and 135° of abduction with 3 horizontal adduction angles in the quadruped position: 1) coronal, 2) scapular, and 3) sagittal plane. Electromyography data were also collected from rhythmical concentric contraction of horizontal abduction at 90° of abduction in the quadruped position. Results TMi muscle activity was significantly greater with the arm positioned in the coronal plane than that of the scapular and sagittal planes (41, 26, and 17% maximum voluntary isometric contraction, respectively) (P < .05). Conclusion The present study demonstrated that TMi muscle activity varied depending on horizontal adduction positions.
The International journal of sports physical therapy, May 1, 2020
Background and Purpose The return to play percentage of baseball pitchers who have undergone isol... more Background and Purpose The return to play percentage of baseball pitchers who have undergone isolated superior labrum anterior-posterior (SLAP) repair has been reported to be less than 60%. Scapular dyskinesis (SD), characterized by scapular prominence during dynamic scapulohumeral movements, may be used to assist in diagnosing a baseball pitcher with shoulder pathology including a SLAP lesion. The purpose of this case report was to describe the use of the SD test to assess the scapular muscles and report EMG findings in a college baseball pitcher diagnosed with a Type 2 posterior SLAP lesion. Case Description The subject was a NCAA-D1 senior collegiate baseball right hand 3/4 slot pitcher (21 years old) with a primary complaint of pain in the anterior portion of the shoulder during the entire fall practice season, which was attributed to labral surgery performed when he was a senior in high school. No positive clinical testing of the patient was found including: the sulcus sign, tests of gross instability, and the load & shift test. A Type II posterior SLAP lesion was identified via magnetic resonance imaging. The subject presented with glenohuemral internal rotation deficit (GIRD). The SD test identified moderate to severe prominence of scapular medial boarder in shoulder flexion/extension (FLX/EXT). Furthermore, surface EMG analyses indicated that the lower trapezius (LT) muscle was abruptly inhibited on the dominant side during the descending phase of FLX, compared with the non-dominant side. Additionally, a remarkably higher ratio of upper trapezius to LT muscle EMG activity on the dominant side compared to that of the non-dominant side was identified during the descending phase from flexion. Discussion After identification of SD, an off season conservative treatment program allowed him to compete in his last college baseball season, appearing 22 times out of the bullpen in which he was credited four wins with a 3.70 earned run average (ERA) in 41.1 innings in 57 games. The SD test may play a critical role in identifying rehabilitation potential and guide the focus of the rehabilitation program to improve scapulothoracic stability and mobility for unilateral repetitive overhead athletes. Particularly the descending phase during sagittal plane motion (FLX/EXT) may effectively accentuate the scapular prominence during movement, portentially due to LT muscle activity inhibition. Level of Evidence 5 Case Report.
Human Kinetics eBooks, 2017
In Sport Therapy for the Shoulder: Evaluation, Rehabilitation, and Return to Sport, readers will ... more In Sport Therapy for the Shoulder: Evaluation, Rehabilitation, and Return to Sport, readers will learn about best practices and evidence-based guidelines for assessing and treating patients’ shoulder injuries for re-entry into sport. Written by renowned physical therapists Todd S. Ellenbecker and Kevin E. Wilk, this text is a key resource for physical therapists, athletic trainers, sport chiropractors, massage therapists, strength and conditioning professionals, personal trainers, and other clinicians in sports medicine who work with patients recovering from shoulder injuries.
International Journal of Sports Physical Therapy
Background A pattern of scapular dyskinesis on the dominant side has been demonstrated to be asso... more Background A pattern of scapular dyskinesis on the dominant side has been demonstrated to be associated with a decrease in throwing arm conditions identified by a self-report outcome assessment in collegiate baseball pitchers during the course of a single season. However, it is unclear if symptomatic shoulders in baseball pitchers may be associated with the presence of scapular dyskinesis. Purpose To study the relationship between the presence of scapular dyskinesis and throwing-related injury in collegiate baseball pitchers during each respective course of up to four subsequent seasons. Methods A single Division 1 National Collegiate Athletic Association team participated in this study over a four-year-period. The scapular dyskinesis test was implemented during the preseason for baseball pitchers. Players were followed throughout each respective season to track the incidence of throwing-related upper extremity injuries. Results A total of 36 collegiate baseball pitchers (height: 18...
British Journal of Sports Medicine, 2020
The IOC has proposed standard methods for recording and reporting of data for injury and illness ... more The IOC has proposed standard methods for recording and reporting of data for injury and illness in sport. The IOC consensus statement authors anticipated that sport-specific statements would provide further recommendations. This statement is the tennis-specific extension of the partner IOC statement. The International Tennis Federation Sport Science and Medicine Committee, in collaboration with selected external experts, met in June 2019 to consider athlete health monitoring issues specific to tennis. Once the IOC consensus statement was finalised, the tennis-specific consensus was drafted and agreed on by the members over three iterations. Compared with the IOC consensus statement, the tennis consensus contains tennis-specific information on injury mechanism, mode of onset, injury classification, injury duration, capturing and reporting exposure, reporting risk and study population. Our recommendations apply to able-bodied as well as wheelchair tennis players. Where applicable, sp...
Isokinetics and Exercise Science, 1996
ABSTRACT
Journal of Shoulder and Elbow Surgery, 2016
Background: The characteristics of scapular muscle activities in elevation and descent exercises ... more Background: The characteristics of scapular muscle activities in elevation and descent exercises have yet to be elucidated to assess scapular dyskinesis. The purpose of this study was to identify the adaptation of electromyograph (EMG) activities of the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and anterior deltoid (AD) muscles with different weight loads in flexion (FLX) and abduction (ABD) in collegiate baseball players. Materials and methods: Twenty eight individuals, including 13 pitchers, were tested. Normalized EMG signals for the UT, LT, SA, AD muscle of the both the dominant (DOM) and nondominant (NON) side were blocked at every 1 second during each of the exercises. A 3-way repeated analysis of variance design was used to identify differences in the mean values between DOM and NON and between FLX and ABD for DOM. Results: The mean EMG value of the UT in the DOM was significantly less than that of the NON for all joint angles (P < .01), whereas the mean EMG value of the LT in the DOM was significantly greater than that of the NON (P < .01). In contrast, no difference in the SA EMG activity was determined between DOM and NON. However, the mean EMG value of SA in FLX was significantly greater than in ABD (P < .01). Conclusion: This study identified an apparent adaptation of scapular muscle activities in the currently advocated scapular dyskinesis test for healthy active overhead athletes who are vulnerable to shoulder pathologies.
Journal of athletic training, 2016
The appropriate resistance intensity to prescribe for shoulder rehabilitative exercise is not com... more The appropriate resistance intensity to prescribe for shoulder rehabilitative exercise is not completely known. Excessive activation of the deltoid and upper trapezius muscles could be counterproductive for scapulohumeral rhythm during humeral elevation. To identify the effects of different exercise intensities on the scapular muscles during a free-motion "robbery" exercise performed in different degrees of shoulder abduction in seated and standing positions. Descriptive laboratory study. Kinesiology Adapted Physical Education Laboratory. A total of 15 healthy male college students (age = 20.5 ± 2.2 years, height = 174.5 ± 5.3 cm, mass = 63.8 ± 6.0 kg). Participants performed 5 repetitions of a randomized exercise sequence of the robbery exercise in 2 body positions (seated, standing), 2 shoulder-abducted positions (W [20°], 90/90 [90°]) at 3 intensities (0%, 3%, and 7% body weight). Electromyographic (EMG) activity of the upper trapezius, lower trapezius, serratus anterio...
The Athlete's Shoulder, 2009
International journal of sports physical therapy, 2012
Injury rates for softball players are similar to baseball players yet information regarding risk ... more Injury rates for softball players are similar to baseball players yet information regarding risk factors, pitching, and physical characteristics for high school windmill softball pitchers is limited. This information is needed to guide prevention, training, and rehabilitation efforts. The purpose of this study was to report descriptive data regarding the physical characteristics and pitching volume experienced by high school softball pitchers during one academic season. A secondary aim was to track and describe upper extremity injuries suffered by high school softball pitchers throughout the course of the 2009 season. Twelve uninjured female softball pitchers (13-18y) from 5 Greenville, South Carolina high schools participated. Prior to the 2009 season, the pitchers' shoulder internal, external, total arc of rotation and horizontal adduction PROM was measured. During the 10-week season, aggregate pitch counts (pitch volume) and occurrence of upper extremity injury were tracked f...
North American journal of sports physical therapy : NAJSPT, 2009
The importance of the scapular stabilizing muscles has led to an increased interest in quantitati... more The importance of the scapular stabilizing muscles has led to an increased interest in quantitative measurements of their strength. Few studies have measured isometric or concentric isokinetic forces. Additionally, limited reports exist on the reliability of objective measures for testing scapular protraction and retraction muscle strength or scapular testing that does not involve the glenohumeral joint. To determine the reliability of four new methods of measuring the maximal isometric strength of key scapular stabilizing muscles for the actions of protraction and retraction, both with and without the involvement of the glenohumeral (GH) joint. The Isobex® stationary tension dynamometer was used to measure the maximal isometric force (kg) on thirty healthy females (ages 22-26 years). Three measures were taken for each method that was sequentially randomized for three separate testing sessions on three nonconsecutive days. Intraclass correlations (ICC2,3) for intrasession reliabilit...
Medicine & Science in Sports & Exercise, 2002
The amount of glenohumeral joint internal and external rotation used during overhead sport activi... more The amount of glenohumeral joint internal and external rotation used during overhead sport activities has been measured experimentally by sports scientists. Clinical measurement of glenohumeral joint internal and external rotation using goniometry is an integral part of a shoulder evaluation after injury or surgery or during preseason or preventative musculoskeletal screenings. Purpose: This study measured glenohumeral joint internal and external rotation in two groups of unilaterally dominant upper extremity athletes to compare the total arc of rotational range of motion between the dominant and nondominant extremities. Methods: A total of 163 elite athletes (117 male junior tennis players and 46 male baseball pitchers) were measured for glenohumeral joint internal and external rotation at 90°of abduction. Total rotation range of motion was calculated by summing internal and external rotation measures in each extremity. Results: An ANOVA with post hoc testing revealed no significant difference (P Ͼ 0.05) between extremities in baseball pitchers for total rotation range of motion (145.7 vs 146.9), whereas significantly less (P Ͻ 0.001) dominant arm total rotation range of motion was identified in the elite junior tennis players (149.1 vs 158.2). Conclusion: This study has identified unique glenohumeral joint rotational patterning in unilaterally dominant upper extremity athletes that has ramifications for rehabilitation after injury and for both injury prevention and performance enhancement.
Medicine & Science in Sports & Exercise, 1998
Journal of Strength and Conditioning Research, 2000
This study longitudinally examined shoulder internal rotation (IR), external rotation (ER), and t... more This study longitudinally examined shoulder internal rotation (IR), external rotation (ER), and total rotation (TROT) in the dominant (D) and nondominant (ND) arms of 44 nationally ranked junior tennis players aged 14-17 years. Analyses conducted across the 4 age groups revealed a significant main effect of age for IR ranges of motion (ROMs; p Ͻ 0.05) but not for ER ROMs. Follow-up analyses on D, IR ROMs revealed a significant increase between age 14 and both ages 15 and 16 (p Ͻ 0.05) and revealed a slight decrease at age 17. Follow-up analyses for ND, IR ROMs showed no significant difference between ages 14 and 15 but showed a significant difference between age 14 and both ages 16 and 17 (p Ͻ 0.05). An additional analysis conducted on TROT revealed a significant main effect of age for ND ROMs (p Ͻ 0.05) but not for D ROMs. The results suggest a significant increase in ND, TROT ROMs between ages 14 and 16 that subsequently remains stable.
Clinics in Sports Medicine, 2010
Injuries to the elbow occur frequently in the overhead athlete due to the repetitive loads and fo... more Injuries to the elbow occur frequently in the overhead athlete due to the repetitive loads and forceful muscular activations inherent in throwing, hitting, serving, and spiking. 1,2 The most common injuries in the athlete include humeral epicondylitis, valgus extension overload, and ulnar collateral ligament injury. 3,4 The initial upper extremity evaluation including radiographs is the critical first step in early recognition and diagnosis of elbow injury, and allows for the referral to physical therapy whereby a comprehensive rehabilitation program can be initiated. The purpose of this article is to review the common elbow injuries in the overhead athlete and clinical tests used to confirm them, in addition to providing key concepts in the rehabilitation programs used to treat individuals with elbow injury and return them to high-level overhead activity. COMMON INJURIES IN THE ATHLETE'S ELBOW One of the most common overuse injuries of the elbow is humeral epicondylitis. 5,6 The repetitive overuse reported as one of the primary causative factors is particularly evident in the history of many athletic patients with elbow dysfunction. Epidemiologic research on adult tennis players reports incidences of humeral epicondylitis ranging from 35% to 50%. 7-11 This incidence is actually far greater than that reported in elite junior players (11%-12%) (United States Tennis Association, unpublished data, 1992). 12 Reported in the literature as early as 1873 by Runge, 13 humeral epicondylitis or ''tennis elbow'' as it is more popularly known, has been extensively studied by many investigators. Cyriax, 14 in 1936, listed 26 causes of tennis elbow, and an extensive study of this overuse disorder by Goldie 15 in 1964 reported hypervascularization
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Papers by Todd Ellenbecker