Amanda Gray Technical Report

1201 W California Ave Ruston, LA 71270

6 February 2015

Shared Light Foundation April Honaker, Executive Director 1009 Light Brigade Lane Cleveland, OH 44101

Dear Mrs. Honaker,

Enclosed is my technical report which provides information about the best prevention options for superior labrum anterior posterior tears in overhand throwing athletes. The research that was conducted focused heavily on the specificity of this kind of tear in overhand athletes. Due to the numerous variables of this injury, not every case is the same. However, I was able to narrow down the best prevention methods to avoid SLAP tears.

Overhand throwing athletes are especially prone to SLAP tears due to the overuse and throwing style of those kinds of sports. It is important that these kind of athletes take special precautions in the warm up and care of the shoulder joint. Emphasizing the care of the shoulder joint to young athletes can help them in their future careers and can implement a routine for shoulder warm up that they are able to follow throughout their careers.

I would like to thank the Shared Light Foundation for the opportunity to fulfill research and have a positive effect on athletes. If you have any questions regarding research or my report, I can be reached anytime at (214) 535-8970 or [email protected]. Thank you for your time and consideration.

Sincerely,

Amanda Gray

Enclosure (1): Technical Report

Shared Light Approved Research Project

6 February 2015

Amanda Gray

ENGL 303: Technical Writing

Prevention of SLAP Tears in Overhand Throwing Athletes

Prepared By: Amanda Gray, Independent Researcher

Prepared For: SLF Board of Directors

6 February 2015

Abstract

Most Effective Way to Prevent SLAP Tears in Overhand Throwing Athletes

Prepared by: Amanda Gray

6 February 2015

The purpose of this report is to address the problem of superior labrum anterior posterior tears in young overhand throwing athletes and present several options for prevention. SLAP tears are becoming a prominent shoulder injury in young athletes and can cause serious damage to other areas of the shoulder if not treated immediately. While treatment options are well known and studied, the prevention methods must be better researched. Learning the correct ways to take care of such a complex joint can be the difference in whether injury occurs or not. To find the best prevention methods, journal articles and web articles were examined and the best options were identified.

Key words: SLAP tear, ROM, Adduction, Abduction

Table of Contents

Executive Summary………………………………………………………………………1

Introduction……………………………………………………………………………….2

Methodology……………………………………………………………………………...5

Results and Discussion…………………………………………………………………...7

Conclusion………………………………………………………………………………..9

Recommendation………………………………………………………………………..10

References………………………………………………………………………………11

Appendix A: Gantt Chart……………………………………………………………….13

Appendix B: Budget Plan………………………………………………………………14

List of Illustrations

Figure 1: Sleeper Stretch………………………………………………………………....2

Figure 2: Horizontal Cross Arm Stretch……………………………………………….....7

Figure 3: The Fauls Stretching Method………………………………………………......8

Table 1: Fauls Modified Passive Shoulder Stretching Routine ……………………….....3

Executive Summary Athletes involved in an overhand throwing sport have a greater risk of obtaining a shoulder injury. The demand and stress placed on the shoulder of these kinds of athletes is a contributor to superior labrum anterior posterior tears. This kind of injury is painful and uncomfortable for the athlete, and most of the time requires surgery to resolve. This injury can be prevented by proper care of the shoulder. Proper care includes maintaining proper mobility and strength, keeping the joint flexible and stable, and executing the correct pre-game warm up stretches to properly prepare the shoulder for throwing. Following the warm up routine will reduce the risk of injury due to an unhealthy shoulder. While injury is always a possibility in competitive game play, taking the right precautions in warm ups can help lower the risk. After further research, it was concluded that three main shoulder stretches could effectively loosen and stretch the shoulder joint and prepare the athlete for throwing. Following this strict routine is imperative for an athlete who wants to play sports at the most competitive level possible. Building a strong foundation for the shoulder to continue to strengthen and gain flexibility is an important role of athletes.

Gray Recommendation Report │1

IntroductionSuperior labrum anterior posterior tears are one of the most common shoulder injuries in overhand throwing athletes. This injury is detrimental to an athlete and can cause severe pain and discomfort. Prevention methods are very important for an athlete to do to keep their shoulder strong and stable. However, certain uncontrollable factors raise the risk of this injury occurring. For an athlete to lower the risk of injury, they need to be well educated on the complexities of the shoulder joint, and go through the proper steps of prehab and warmup.

Several steps must occur in the process of diagnosis of a SLAP tear, and the first step begins with the athlete showing pain in their shoulder joint. While the first sign of pain does not automatically indicate a tear, it can often lead to one if not treated correctly. Many prevention options exist but there are a few that have proven to be the most effective. Nonsurgical prevention of SLAP lesions in throwers has focused on stretching of the tight posterior-inferior capsule that exists even in asymptomatic throwers (Burkhart and Morgan, 1). The main goal in prevention of tears focuses on posterior-inferior capsule tightness. Another goal of prevention is to allow the tissue to heal and re-establish full active shoulder motion (Muir, Mair, Nitz, Bush, and Uhl, 219).

Prevention of this injury starts when an athlete first begins to play an overhead sport. Many don’t think stretching is important, even for little league players. The strength and stability of the shoulder continues to grow on the base it is built. If a young athlete does not take care of their shoulder at a young age, they are not going to have a strong, stable shoulder at an older age of playing. One of the best proven stretches is a ‘sleeper stretch’, which can be seen in figure 1. The sleeper stretch is a focused stretch of the posterior and inferior shoulder capsule and is an essential part of the rehabilitation plan for many shoulder injuries (Unisports Sports Medicine 1).

Figure 1: Sleeper Stretch

Source: http://www.sportsmed.net.nz/patient-info/shoulder/sleeper-stretch/


As shown in figure 1, the athlete is side lying with the stretching arm flexed to 90° and elbow flexed to 90°. Stretching occurs when the forearm is passively pushed into internal rotation (Effects of Non-Assisted Posterior Shoulder Stretches, 163). It is proven that the sleeper stretches produced a statistically significant acute increase in posterior shoulder flexibility (Laudner, Sipes, and Wilson, 1).

Another focus of pre-game stretching is improving flexibility of the joint. Horizontal cross arm stretching is an additional shoulder stretch that focuses on flexibility of the posterior capsule. Scapular strength and stabilization is also a factor in shoulder strength. The cross arm stretch is one that specifically focuses on scapular stabilization, and can be an even more effective stretch when assisted by an athletic trainer or doctor.

The final prevention method is a series of stretches called the Fauls modified passive shoulder stretching routine. This routine is a mix of 12 exercises that engage critical parts of the shoulder and has proven to be successful. Table 1 shows all stretches in this routine and explains the importance of each.

Order of Stretches Stretch Importance of the Stretch Sidelying

1 Shoulder Roll Move scapula and clavicle 2 Pectoral Stretch Stretch pectoral muscles 3 Extension Stretch Achieve full extension 4 Flexion Stretch Achieve full flexion 5 Shoulder Circles Glenohumeral joint stretch

Supine 6 The Pump Stretch Achieve abduction 7 Shoulder Flexion Stretch Full flexion

8Internal Rotation Stretch Internal rotation

9External Rotation Stretch External rotation

10 Elbow Circles Stretch elbow muscles 11 Wrist Circles Stretch wrist muscles 12 Arm Waves Release tension in arm

Table 1: Fauls Modified Passive Shoulder Stretching Routine

Source: http://journals.humankinetics.com/AcuCustom/Sitename/Documents/DocumentItem/6745.pdf

These exercises are proven to effectively warm up the shoulder. Due to them being performed by an athletic trainer or doctor, it is imperative for the athlete to have an open communication with


the trainer when the stretch is too much or too painful. However, once completed, the athlete should be ready to start their throwing warmup process.

Shoulder stretching is an important part of an overhand throwers game. If they do not have a strong shoulder, performance is going to decline. Taking the necessary steps to ensure a healthy shoulder should be stressed starting at a young age. Preventing these types of tears in the shoulder joint can be the difference in how successful an athlete is throughout their playing career.

MethodologyGray Recommendation Report │4

This section discusses the steps followed in finding the most effective prevention of SLAP tears. I identified the causes, discovered the potential solutions, researched other possible causes and solutions, evaluated solutions, and drew conclusions and produced a recommendation to complete the report.

Identified the causes of SLAP tears.

Upon research, I discovered that the leading causes of SLAP tears are the loss of stability and strength of the shoulder joint, a weak scapular region, loose ligaments and tendons around the joint, poor throwing mechanics and direct injury to the shoulder such as dislocation. These tears are a dominate injury in overhand throwing athletes, and are becoming more common.

Discovered potential solutions for SLAP tears.

I narrowed down the possible solutions for preventing SLAP tears to three main methods. The sleeper stretch, horizontal cross arm stretch, and the Fauls modified passive shoulder stretching routine. These three techniques can greatly increase shoulder flexibility and stability and reduce the risk of injury if performed before any type of throwing. Implementing this pre-game routine into an athlete’s warm up will form stretching habits making it easier to complete all aspects of stretching each time.

Researched other possible problems and solutions.

In researching other problems and solutions, I found that if a shoulder has limited strength and mobility, day to day activities such as lifting an object or doing overhead activities repeatedly can lead to a tear. The shoulder joint is a very complex part of the body and it requires the proper care and conditioning to stay healthy and strong. This injury is not just limited to overhand throwing athletes. Tears can occur in day-to-day life and can happen to those who have never played a sport.

Evaluated solutions and compared data.

Narrowing down all causes and solutions of this tear made it simple to narrow down the prevention methods that best suit overhand throwing athletes. The research proved that the combination of these three stretches will greatly improve flexibility and stability, which are key parts of a healthy shoulder.

Drew conclusions and presented a recommendation.


After compiling all data, the best prevention methods were narrowed down to three shoulder stretches. I found that these were the best options for athletes to have a strong shoulder that will last through the long demanding season. These pre-game routines will be most effective if they are implemented at a young age, and continued throughout the athlete’s career.

Results and Discussion Gray Recommendation Report │6

The results have been combined with discussion to ensure understanding and correct interpretation of the data. The results are based on the three types of stretching that have been narrowed down.

The Sleeper Stretch

Athletes who participate in overhead activities requiring ballistic shoulder rotation such as baseball, softball, tennis, and volleyball routinely present with posterior shoulder tightness (Laudner, Sipes, and Wilson 1). The sleeper stretch has proven to be effective in lengthening and loosening the soft tissues in the posterior part of the shoulder. While the sleeper stretch is widely known, variations may be applied to better fit specific athletes or specific injuries. The pathological cascade which results in the SLAP lesion consists of posterior inferior capsular tightness (Abrams and Safran 311). This stretch specifically targets these trouble areas in the shoulder.

The Horizontal Cross Arm Stretch

The horizontal cross arm stretch is another stretch that focuses on the flexibility of the posterior capsule. However, this stretch also works the scapular region of the back, which is a big contributor to the stability of the shoulder. The cross arm stretch can be performed by moving the arm into horizontal adduction. This stretch has been shown to be superior for stretching the posterior capsule and for increasing internal ROM (Caldwell, Williams, Diekhoff, and McAdams 1). The cross body stretch was also shown to improve internal rotation of the shoulder joint and reduce overall tightness. Figure 2 shows the horizontal cross arm stretch.

Figure 2: Horizontal Cross Arm Stretch

Source: http://www.physio-pedia.com/Internal_Impingement_of_the_Shoulder

The Fauls Modified Passive Shoulder Stretching Routine


This method is compiled of twelve different stretches that are proven to overall improve shoulder ROM, flexibility, and stability. The Fauls method of stretching is performed by a trainer or doctor and focuses on isolating the shoulder joint in different positions. The Fauls routine provided gains in the throwing shoulder of athletes. This includes increases in shoulder range of motion and decreases in shoulder tightness (Gorman 1). This stretching process puts an emphasis on reaching all muscles involved specifically in throwing to better aid overhand throwing athletes. Figure three shows one of the stretches involved in the Fauls method.

Figure 3: The Fauls Stretching Method

Source: https://www.mc.uky.edu/athletic_training/publications%20folder/The%20Fauls%20Shoulder%20Stretch.pdf

The Fauls stretching system can have a great impact on an athlete’s shoulder flexibility. When used daily, shoulder flexibility will improve, and tightness and tension will decrease, improving the ability of the shoulder to perform at a top level consistently.

Conclusions


Each of these stretches give an athlete ample flexibility and gives them a greater chance of keeping a healthy shoulder if they are implemented into an everyday routine. The greatest resource an athlete has is usually him or herself, and they have the ability to take their shoulder treatment and care into their own hands. The results show that conducting these stretches daily will improve the condition of the shoulder, and reduce the risk of superior labrum anterior posterior tears. The three stretches work together and collectively increase flexibility and stability which will lead to the ability of the shoulder to gain strength, and be able to last through a long demanding season.

Recommendations


Recommendations for this topic are based on the research found, and can be distributed as follows:

Shared Light Foundation

The research proves that these three stretches can collectively improve the shoulder joint of overhand throwing athletes. Further research and testing can support this theory even further, and implementing these techniques into young athletes can positively impact the future of their athletic career. Going further with this research would mean educating athletes about their shoulder joints and enhancing their understanding of the importance of pre-game stretching and how to properly care for their shoulders throughout their career.

Coaches

It is imperative that this information be distributed and shared with coaches. The coach is the boss of the team. Proper pre-game stretching and management starts with them, and the coach needs to have the best understanding of the shoulder to be able to share with athletes the importance of keeping a healthy shoulder. When coaches fully understand the complexity of the joint and the importance of stretching, they will be able to effectively teach their athletes and implement a stretching routine in their program.

I would like to thank the Shared Light Foundation for approving my research and aiding in the spread of knowledge of the shoulder joint. I strongly believe that this research will impact athletes and aid them in keeping a healthy and injury free shoulder throughout their athletic careers. If you have any questions, comments, or suggestions, you can reach me anytime at (214) 535-8970 or by email at [email protected].

References


Abrams, Geoffrey, and Marc Safran. "British Journal of Sports Medicine." N.p., 2009. Web. 1 Feb.

2015.

Caldwell, Joshua, Bryan McAdams, Phillip Williams, and Gary Diekhoff. "Internal Impingement of the

Shoulder." Physiopedia. N.p., n.d. Web. 1 Feb. 2015.

Gorman, Fitzalan. "The Best Stretches for Athletes." Healthy Living. AZ Central, n.d. Web. 01 Feb.

2015.

Laudner, Kevin G., Robert C. Sipes, and James T. Wilson. "The Acute Effects of Sleeper Stretches on

Shoulder Range of Motion." Journal of Athletic Training. The National Athletic Trainers'

Association, Inc, July-Aug. 2008. Web. 1 Feb. 2015.

Madaleno, James A. "The Fauls Shoulder Stretch." A Tip From The Field (n.d.): n. pag. Fall 1981.

Web. 1 Feb. 2015.

Muir, Tiffany, Scott Mair, Arthur Nitz, Heather Bush, and Timothy Uhl. "Muscle Activation Levels."

N.p., 6 Feb. 2012. Web. 1 Feb. 2015.

Oyama, Sakiki, Candice Goerger, Benjamin Goerger, Scott Lephart, and Joseph Myers. Effects of Non-

Assisted Posterior Shoulder Stretches on Shoulder Range of Motion Among Collegiate Baseball

Pitchers(n.d.): n. pag. Athletic Training and Sports Health Care, 2010. Web. 1 Feb. 2015.

Sauers, Eric, Anna August, and Alison Snyder. "Human Kinetics." Fauls Stretching Routine Produces

Acute Gains in Throwing Shoulder Mobility in Collegiate Baseball Players (n.d.): n. pag. 2007.

Web. 1 Feb. 2015.

"Sleeper Stretch." Unisports Sports Medicine. N.p., n.d. Web. 1 Feb. 2015.

"Treatments & Procedures; Joint Replacement - Shoulder." Cleveland Clinic. Cleveland Clinic, 2009.

Web. 1 Feb. 2015.

<http://my.clevelandclinic.org/health/treatments_and_procedures/hic_Total_Shoulder_Joint_Rep

lacement>.

Yellin, Joshua, and Jeffrey J. Peterson. "MR Arthrography." Applied Radiology. N.p., 16 Sept. 2010.

Web. 1 Feb. 2015. <http%3A%2F%2Fwww.appliedradiology.com%2Farticles%2Fmr-

arthrography>.


Appendix A: Gantt Chart


DatesTask 22-Jan-15 24-Jan-15 29-Jan-15 31-Jan-15 6-Jan-15Task 1: Identified problems Task 2: Identified solutions Task 3: Establish questions Task 4: Expand research Task 5: Evaluate/Compare solutions Task 6: Draw conclusions Task 7: Complete and submit

Appendix B: Budget Plan



Item Cost/Hour Hours Cost Labor $10 $60 $600 Laptop $380 Printer $80 Ink $65 Paper $10 Bulk Printing $30

Total $1,165