Nice article here by Chris Butler, PT. Chris brought together his own personal experience with his athletes as well as some of the literature on cutting. It's important to note the importance of re-teaching cutting post op ACL. It's apparent that many athletes "cut" wrong to begin with and re-training the cut to be a safe movement is vital in post-op rehabilitation, especially with ACL.
Chris did a good job of putting a visual together as well which I thought was a nice touch to his article. Reading the research on the biomechanics of the cutting motion is one thing, but to see it in a picture or video can be very helpful for those visual learners.
Some additional clinical suggestions:
- When re-teaching cutting/lateral movements, don't allow the athlete to increase the speed until they can master a slower speed first.
- Have the patient use a mirror for visual feedback. Add a foam roller standing up as a "marker" for where you want the athlete to begin the cut so that they have a visual feedback of where their shoulders are in relation to the foam roller. This is especially useful for those athletes who don't get their trunk over their hips, knees, and ankles when first starting to re-learn the cut.
- If the athlete is still initiating the lateral movement from his/her shoulders vs the hips, practice manual cueing/resistance to the hips as the athlete is about to initiate the lateral direction. Break down the movement and have the athlete perform a single leg squat and then push off and hop to the side. Make sure they use their hips rather than shoulders to initiate the movement.
- Another way to assist with poor initiation during cutting is to stand on the athletes' cutting leg side and gently pull on the athletes shirt to make sure they are not leaning away to soon when initiating the cut.
Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement
Interesting study on internal impingement. However, no baseball players in this study, which make up a good bulk of the internal impingement patients.
Determine if improvement in GIRD and/or decreased PST after a course of physical therapy are associated with a resolution of symptoms in patients with internal impingement. They hypothesized that symptom resolution would be associated with internal impingement.
Cohort Study. 22 patients (11 men, 11 women). Age 41+/- 13 years. Dx of internal impingement determined by: + relocation test, + posterior impingement sign, posterior GHJ line tenderness, MRI= posterosuperior glenoid labrum lesion
- Posterior shoulder tightness (PST)
- ER ROM
- Simple shoulder test
- In the clinic 3x/week for tx
- Manual mobilization and stretching of posterior shoulder
- Grade IV posterior glides in scapular plan and max GHJ IR, AAROM cross-chest adduction, sleep stretch, scapular stabilization and strengthening exercises
- 12 patients (55%) had COMPLETE resolution of symptoms
- 10 patients (45%) had some RESIDUAL symptoms
- GIRD, PST and loss of ER ROM all significantly improved after the period of PT
- Average improvement in PST was 27 deg
- Average improvement in GIRD was 26 deg
- Prior to treatment, PST was associated with lower Simple shoulder test scores
- Improvement in PST was greater in patients who had complete resolution of symptoms vs patients with residual symptoms
- Improvements in GIRD and loss of ER ROM were unrelated to outcome
Things to consider:
- Patients who had complete resolution of symptoms tended to have greater PST before treatment
- No baseball players included in study
- 5 patients had non-dominant arm involved
- Complete resolution of symptoms= 12 on Simple shoulder test
Tyler, TF et al. Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement. American Journal of Sports Medicine 2010. 38(1); 114-119