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Evidence-based rehabilitation of athletes with glenohumeral instability

Ann Cools (UGent) , Dorien Borms (UGent) , Birgit Castelein (UGent) , Fran Vanderstukken (UGent) and Fredrik Johansson (UGent)
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Organization
Abstract
To give an overview of current knowledge and guidelines with respect to evidence-based rehabilitation of athletes with glenohumeral instability. This narrative review combines scientific evidence with clinical guidelines based on the current literature to highlight the different components of the rehabilitation of glenohumeral instability. Depending on the specific characteristics of the instability pattern, the severity, recurrence, and direction, the therapeutic approach may be adapted to the needs and demands of the athlete. In general, attention should go to (1) restoration of rotator cuff strength and inter-muscular balance, focusing on the eccentric capacity of the external rotators, (2) normalization of rotational range of motion with special attention to the internal rotation ROM, (3) optimization of the flexibility and muscle performance of the scapular muscles, and (4) gradually increasing the functional sport-specific load on the shoulder girdle. The functional kinetic chain should be implemented throughout all stages of the rehabilitation program. Return to play should be based on subjective assessment as well as objective measurements of ROM, strength, and function. This paper summarizes evidence-based guidelines for treatment of glenohumeral instability. These guidelines may assist the clinician in the prevention and rehabilitation of the overhead athlete. Expert opinion, Level V.
Keywords
POSTERIOR SHOULDER TIGHTNESS, SERRATUS ANTERIOR MUSCLES, RESTING, SCAPULAR POSTURE, TENNIS PLAYERS, MULTIDIRECTIONAL INSTABILITY, IMPINGEMENT SYMPTOMS, ELECTROMYOGRAPHIC ANALYSIS, ACROMIOHUMERAL, DISTANCE, INTERNAL IMPINGEMENT, CLINICAL-ASSESSMENT, Shoulder instability, Rehabilitation, Exercise

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MLA
Cools, Ann, Dorien Borms, Birgit Castelein, et al. “Evidence-based Rehabilitation of Athletes with Glenohumeral Instability.” KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY 24.2 (2016): 382–389. Print.
APA
Cools, Ann, Borms, D., Castelein, B., Vanderstukken, F., & Johansson, F. (2016). Evidence-based rehabilitation of athletes with glenohumeral instability. KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, 24(2), 382–389.
Chicago author-date
Cools, Ann, Dorien Borms, Birgit Castelein, Fran Vanderstukken, and Fredrik Johansson. 2016. “Evidence-based Rehabilitation of Athletes with Glenohumeral Instability.” Knee Surgery Sports Traumatology Arthroscopy 24 (2): 382–389.
Chicago author-date (all authors)
Cools, Ann, Dorien Borms, Birgit Castelein, Fran Vanderstukken, and Fredrik Johansson. 2016. “Evidence-based Rehabilitation of Athletes with Glenohumeral Instability.” Knee Surgery Sports Traumatology Arthroscopy 24 (2): 382–389.
Vancouver
1.
Cools A, Borms D, Castelein B, Vanderstukken F, Johansson F. Evidence-based rehabilitation of athletes with glenohumeral instability. KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY. 2016;24(2):382–9.
IEEE
[1]
A. Cools, D. Borms, B. Castelein, F. Vanderstukken, and F. Johansson, “Evidence-based rehabilitation of athletes with glenohumeral instability,” KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, vol. 24, no. 2, pp. 382–389, 2016.
@article{8506220,
  abstract     = {To give an overview of current knowledge and guidelines with respect to evidence-based rehabilitation of athletes with glenohumeral instability. 
This narrative review combines scientific evidence with clinical guidelines based on the current literature to highlight the different components of the rehabilitation of glenohumeral instability. 
Depending on the specific characteristics of the instability pattern, the severity, recurrence, and direction, the therapeutic approach may be adapted to the needs and demands of the athlete. In general, attention should go to (1) restoration of rotator cuff strength and inter-muscular balance, focusing on the eccentric capacity of the external rotators, (2) normalization of rotational range of motion with special attention to the internal rotation ROM, (3) optimization of the flexibility and muscle performance of the scapular muscles, and (4) gradually increasing the functional sport-specific load on the shoulder girdle. The functional kinetic chain should be implemented throughout all stages of the rehabilitation program. Return to play should be based on subjective assessment as well as objective measurements of ROM, strength, and function. 
This paper summarizes evidence-based guidelines for treatment of glenohumeral instability. These guidelines may assist the clinician in the prevention and rehabilitation of the overhead athlete. 
Expert opinion, Level V.},
  author       = {Cools, Ann and Borms, Dorien and Castelein, Birgit and Vanderstukken, Fran and Johansson, Fredrik},
  issn         = {0942-2056},
  journal      = {KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY},
  keywords     = {POSTERIOR SHOULDER TIGHTNESS,SERRATUS ANTERIOR MUSCLES,RESTING,SCAPULAR POSTURE,TENNIS PLAYERS,MULTIDIRECTIONAL INSTABILITY,IMPINGEMENT SYMPTOMS,ELECTROMYOGRAPHIC ANALYSIS,ACROMIOHUMERAL,DISTANCE,INTERNAL IMPINGEMENT,CLINICAL-ASSESSMENT,Shoulder instability,Rehabilitation,Exercise},
  language     = {eng},
  number       = {2},
  pages        = {382--389},
  title        = {Evidence-based rehabilitation of athletes with glenohumeral instability},
  url          = {http://dx.doi.org/10.1007/s00167-015-3940-x},
  volume       = {24},
  year         = {2016},
}

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