Kevin E Wilk

American Sports Medicine Institute, Birmingham, Alabama, United States

Are you Kevin E Wilk?

Claim your profile

Publications (106)227.16 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: While the high rate of ulnar collateral ligament (UCL) injuries in professional baseball is widely discussed in the media and medical literature, the actual prevalence of UCL reconstruction has not been documented. The prevalence of UCL reconstruction will be higher among pitchers than nonpitchers, and Major League Baseball (MLB) pitchers will have a higher prevalence than will minor league pitchers. Descriptive epidemiology study. An online questionnaire was distributed to all 30 MLB organizations. Certified athletic trainers from each team administered the questionnaire to all players in the organization, including major league players and 6 levels of minor league players. Demographic data were compared between major and minor league players. Continuous variables (age, years of professional baseball, country of origin, etc) were compared with Student t tests (P < .05). Categorical variables (level, position, etc) were compared using chi-square analysis (P < .05). A total of 5088 professional baseball players (722 major league and 4366 minor league) participated in the survey. Pitchers represented 53% of all players, and 497 players reported at least 1 UCL reconstruction, demonstrating a prevalence rate of 10% (497 of 5088). Pitchers reported a significantly higher prevalence of UCL reconstruction (16%; 437 of 2706) than nonpitchers (3%; 60 of 2382; P < .001). Among major league pitchers, 25% (96 of 382) had a history of UCL reconstruction, while minor league pitchers showed a 15% (341 of 2324) prevalence (P < .001). Major league pitchers were also significantly older (28.8 ± 3.9 years) than minor league pitchers (22.8 ± 3.0; P < .001). The majority of major leaguers (86%) had their UCL reconstruction as professional pitchers, whereas the majority of minor league pitchers (61%) underwent their UCL reconstruction during high school and college (P < .001). The rates of UCL revision, prior elbow surgery, prior shoulder surgery, and types of UCL graft were similar between the major league and minor league pitchers. No difference in prevalence was shown between pitchers born in the United States versus Latin American countries. Pitchers have a high prevalence of UCL reconstruction in professional baseball, with 25% of major league pitchers and 15% of minor league pitchers having a history of the surgery. © 2015 The Author(s).
    The American Journal of Sports Medicine 04/2015; DOI:10.1177/0363546515580792 · 4.70 Impact Factor
  • Kevin E Wilk, Todd R Hooks
    [Show abstract] [Hide abstract]
    ABSTRACT: The overhead athlete has unique physical traits and adaptive changes as a result of the repetitive nature of throwing. An effective rehabilitation program depends on an accurate evaluation to determine the causative factors for an athlete's pathology. A treatment program is individualized with specific strengthening and flexibility exercises to achieve dynamic stability that is required for overhead function. In this article the characteristics of the throwing shoulder and specific injuries are described. The rehabilitation program is described in a multiphased approach that allows for the restoration of strength, mobility, endurance, and power to return to sporting activity. Copyright © 2015 Elsevier Inc. All rights reserved.
    Clinics in sports medicine 04/2015; 34(2):247-261. DOI:10.1016/j.csm.2014.12.010 · 2.58 Impact Factor
  • Kevin E Wilk
    [Show abstract] [Hide abstract]
    ABSTRACT: Typically, the goal of any rehabilitation program is to return the patient/athlete to the preinjury level. This is the frequently used benchmark reported in the literature when determining rehabilitation goals or describing the outcomes following anterior cruciate ligament injury or reconstruction. The first question we should ask ourselves is, "Is returning a patient to the preinjury level good enough?" J Orthop Sports Phys Ther 2014;44(9):634-635. doi:10.2519/jospt.2014.0112.
    Journal of Orthopaedic and Sports Physical Therapy 09/2014; 44(9):634-5. DOI:10.2519/jospt.2014.0112 · 2.38 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Injuries to the elbow joint in baseball pitchers appear common. There appears to be a correlation between shoulder range of motion and elbow injuries.
    The American Journal of Sports Medicine 06/2014; DOI:10.1177/0363546514538391 · 4.70 Impact Factor
  • Source
    Kevin E Wilk, Leonard C Macrina
    [Show abstract] [Hide abstract]
    ABSTRACT: The repetitive overhead motion involved in throwing is responsible for unique and sport-specific patterns of injury to the shoulder joint. Specific strengthening and flexibility plays a vital role in the ultimate function and injury prevention in the overhead-throwing athlete. The clinician must achieve a delicate balance between mobility and stability, which often presents as a significant challenge. Most shoulder injuries in the overhead thrower can be successfully treated nonoperatively to allow the athlete to return to competition. A well-structured, in-season strengthening program that is designed to maintain the athlete's strength, power, and endurance while not inhibiting with the athlete's ability to compete on a regular basis is critical.
    Sports medicine and arthroscopy review 06/2014; 22(2):137-150. DOI:10.1097/JSA.0000000000000020 · 1.98 Impact Factor
  • Source
    Kevin E. Wilk, Leonard C. Macrina
    [Show abstract] [Hide abstract]
    ABSTRACT: The glenohumeral joint is an inherently unstable joint that relies on the interaction of the dynamic and static stabilizers to maintain stability. Disruption of this interplay or poor development of any of these factors may result in instability, pain and a loss of function. Rehabilitation will vary based on the type of instability present and the key principles described. A comprehensive program designed to establish full range of motion, balance capsular mobility, along with maximizing muscular strength, endurance, proprioception, dynamic stability and neuromuscular control of the glenohumeral and scapulothoracic joints’ are essential. A functional approach to rehabilitation using movement patterns and sport specific positions along with an interval sport program will allow a gradual return to athletics. The focus of the program should minimize the risk of recurrence and ensure that the patient can safely return to functional activities.
    Operative Techniques in Sports Medicine 03/2014; 22(1). DOI:10.1053/j.otsm.2014.02.002 · 0.21 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Shoulder impingement is a progressive orthopedic condition that occurs as a result of altered biomechanics and/or structural abnormalities. An effective nonoperative treatment for impingement syndrome is aimed at addressing the underlying causative factor or factors that are identified after a complete and thorough evaluation. The clinician devises an effective rehabilitation program to regain full glenohumeral range of motion, reestablish dynamic rotator cuff stability, and implement a progression of resistive exercises to fully restore strength and local muscular endurance in the rotator cuff and scapular stabilizers. The clinician can introduce stresses and forces via sport-specific drills and functional activities to allow a return to activity.
    Open Access Journal of Sports Medicine 02/2014; 5:13-24. DOI:10.2147/OAJSM.S36646
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Synopsis Stretching techniques that focus on increasing posterior shoulder soft tissue flexibility are commonly incorporated into prevention and treatment programs for the overhead athlete. The cross body and sleeper stretch exercises have been described as stretching techniques to improve posterior shoulder soft tissue flexibility and increase glenohumeral internal rotation and horizontal adduction range of motion in the overhead athlete. But based on the inability to stabilize the scapula and control glenohumeral rotation with the cross body stretch and the potential for subacromial impingement with the sleeper stretch, the authors recommend modifications to both of these commonly performed stretches. This clinical commentary reviews the literature on posterior shoulder stretches, describes modifications to both of these commonly performed stretches, and outlines a strategy to maintain or improve posterior shoulder soft tissue flexibility and glenohumeral internal rotation range of motion in the overhead athlete. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther, Epub 30 October 2013. doi:10.2519/jospt.2013.4990.
    10/2013; 43(12). DOI:10.2519/jospt.2013.4990
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In most shoulder conditions a loss of glenohumeral motion results in shoulder performance impairments. However, in the overhead athlete loss of glenohumeral internal rotation, termed glenohumeral internal rotation deficiency (GIRD), is a normal phenomenon that should be expected. Without a loss of glenohumeral internal rotation the overhead athlete will not have the requisite glenohumeral external rotation needed to throw a baseball at nearly 100 miles per hour, or serve a tennis ball at velocities of 120 miles per hour or more. Not all GIRD is pathologic. The authors of this manuscript have defined two types of GIRD; one that is normal and one that is pathologic. Anatomical GIRD (aGIRD) is one that is normal in overhead athletes and is characterized by a loss of internal rotation of less than 18°-20° with symmetrical total rotational motion (TROM) bilaterally. Pathologic GIRD (pGIRD) is when there is a loss of glenohumeral internal rotation greater than 18°-20° with a corresponding loss of TROM greater than 5° when compared bilaterally. A more problematic motion restriction may be that of a loss of TROM in the glenohumeral joint. Recent evidence supports that a loss of TROM is predictive of future injury to the shoulder in professional athletes. Additionally, external rotation deficiency (ERD), the difference between external rotation (ER) of the throwing shoulder and the non-throwing shoulder of less than 5°, may be another predictor of future shoulder injury and disability. 5.
    10/2013; 8(5):537-53.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The overhead athlete presents with a unique profile that may predispose them to specific pathology. Injury to the superior aspect of the glenoid labrum (SLAP lesions) poses a significant challenge to the rehabilitation specialist due to the complex nature and wide variety of etiological factors associated with these lesions. A thorough clinical evaluation and proper identification of the extent of labral injury is important in order to determine the most appropriate non-operative and/or surgical management. Postoperative rehabilitation is based on the specific surgical procedure that has been performed, as well as the extent, location, and mechanism of labral pathology and associated lesions. Emphasis is placed on protecting the healing labrum while gradually restoring range of motion, strength, and dynamic stability of the glenohumeral joint. The purpose of this paper is to provide an overview of the anatomy and pathomechanics of SLAP lesions and review specific clinical examination techniques used to identify these lesions in the overhead athlete. Furthermore, a review of the current surgical management and postoperative rehabilitation guidelines is provided. 5.
    10/2013; 8(5):579-600.
  • Source
    Kevin E Wilk, Leonard C Macrina
    [Show abstract] [Hide abstract]
    ABSTRACT: There exists a wide range of shoulder instabilities, from subtle subluxations (as seen in overhead athletes) to gross instability. An appropriate rehabilitation program plays a vital role in the successful outcome following an episode of shoulder instability. Nonoperative rehabilitation is often implemented for patients diagnosed with various shoulder instabilities. Based on the classification system of glenohumeral instability and several key factors, a nonoperative rehabilitation program may be developed. This article discusses these factors, and the nonoperative rehabilitation and postoperative programs designed to return patients to their previous level of function. In addition, a rehabilitation program that focuses on restoring strength, improved posture, scapula stability, neuromuscular control and proprioception will be emphasized.
    Clinics in sports medicine 10/2013; 32(4):865-914. DOI:10.1016/j.csm.2013.07.017 · 2.58 Impact Factor
  • 09/2013; 1(4 Suppl). DOI:10.1177/2325967113S00096
  • E Lyle Cain, John Andrachuk, Kevin E Wilk
    [Show abstract] [Hide abstract]
    ABSTRACT: The patient was a 23-year-old male professional American football player who played wide receiver. He injured his right shoulder 3 days earlier during practice, diving to catch a pass and landing on his right arm while it was outstretched overhead. When he landed on the ground, the patient reported that he felt his right shoulder dislocate. Based on the patient's mechanism of injury and the findings of a physical examination by an orthopaedic surgeon and a physical therapist, radiographs and magnetic resonance imaging were ordered. Though the radiographs were interpreted as normal, magnetic resonance imaging revealed full-thickness infraspinatus and teres minor tendon tears at their insertion sites on the humerus.J Orthop Sports Phys Ther 2013;43(8):583. doi:10.2519/jospt.2013.0414.
    08/2013; 43(8):583. DOI:10.2519/jospt.2013.0414
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: STUDY DESIGN: Case report. BACKGROUND: Traumatic glenohumeral dislocations with concomitant rotator cuff and capsular injuries present a unique and challenging surgical and rehabilitative condition, particularly in the overhead-throwing athlete. Multiple injuries of the shoulder complex create the potential for complications in the course of recovery and place a full return to high-level sport at risk. The purpose of this case report is to present the multi-phased rehabilitation approach of an elite professional quarterback status post acute 330-degree capsulolabral reconstruction and rotator cuff repair as a result of a luxatio erecta injury. CASE DESCRIPTION: A 26-year-old male professional football player, playing quarterback, sustained a right luxatio erecta shoulder dislocation while trying to recover a fumble during a regular season game. The injury occurred when he was hit in the back of his throwing shoulder, which was in an abducted and externally rotated position while lying on the ground. Five days post-injury, he underwent a 330-degree capsulolabral repair with concomitant rotator cuff repair and subacromial decompression. He completed 28 weeks of a multi-phased rehabilitation program. OUTCOMES: The patient returned to the play in the National Football League 8 months later, for the start of the next season, during which he had his most productive year as a professional quarterback, leading the league in passing yards and finishing third in the league for the number of touchdowns. Since the injury, the patient has played 6 consecutive seasons, starting over 96 consecutive regular season games, and maintaining a very high level of play. DISCUSSION: This case report highlights the clinical-decision making process and management of this rare, severe injury. LEVEL OF EVIDENCE: Therapy, level 4. J Orthop Sports Phys Ther. Epub 12 February 2013. doi:10.2519/jospt.2013.3726.
    02/2013; DOI:10.2519/jospt.2013.3726
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the 10 years since the current concept series entitled "The Disabled Throwing Shoulder: Spectrum of Pathology" was conceived and written, many studies have been reported that add much more information to the understanding of the disabled throwing shoulder (DTS). The editors of Arthroscopy and the authors of the original series believed that an update to the original series would be beneficial to provide an organized overview of current knowledge that could update the thought process regarding this problem, provide better assessment and treatment guidelines, and guide further research. A dedicated meeting, including current published researchers and experienced clinicians in this subject, was organized by the Shoulder Center of Kentucky. The meeting was organized around 5 areas of the DTS that were highlighted in the original series and appear to be key in creating the DTS spectrum and to understanding and treating the DTS: (1) the role of the kinetic chain; (2) the role and clinical evaluation of the scapula; (3) the role of deficits in glenohumeral rotation, glenohumeral internal rotation deficit, and total range-of-motion deficit in the causation of labral injury and DTS; (4) the role of superior labral (SLAP) injuries and rotator cuff injuries; and (5) the composition and progression of rehabilitation protocols for functional restoration of the DTS. The meeting consisted of presentations within each area, followed by discussions, and resulted in summaries regarding what is known in each area, what is not known but thought to be important, and strategies to implement and enlarge the knowledge base.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 01/2013; 29(1):141-161.e26. DOI:10.1016/j.arthro.2012.10.009 · 3.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND:An olecranon stress fracture is a rare injury associated with valgus extension overload in baseball players. No long-term outcomes studies have been published documenting the results of surgical fixation of olecranon stress fractures with or without concomitant injuries in baseball players. HYPOTHESIS:Open reduction and internal fixation (ORIF) of an olecranon stress fracture will reliably produce bony union and allow a successful return to the previous level of activity in competitive baseball players. STUDY DESIGN:Case series; Level of evidence, 4. METHODS:Twenty-five patients treated with ORIF for an olecranon stress fracture at least 2 years earlier (range, 2-10.14 years) were retrospectively contacted to complete a telephone survey; 18 of 25 (72%) patients responded. Data were collected to determine the return to play rate, level of arm pain, and overall arm function. RESULTS:All 18 stress fractures went on to successful union; 17 of 18 (94%) athletes returned to baseball at or above their previous level. Average return to play time was 29 weeks. The numeric analog pain score was 0.2 at rest and 0.3 when throwing at the time of follow-up, at an average 6.2 years (range, 2.0-10.14 years) after surgery. The average score at follow-up on the Disabilities of the Arm, Shoulder and Hand Outcome Measure-shortened version (QuickDASH) was 4.1 (range, 0-27.3). Ten (56%) patients required 13 additional future surgeries on their throwing arm; 7 surgeries in 6 (33%) patients were not related to the index surgery. Six of 18 (33%) patients underwent hardware removal, with 2 (11%) for infection. CONCLUSION:Open reduction and internal fixation of olecranon stress fractures in competitive baseball players has a high rate of success in returning players to or above their former level of play and allows for good elbow function at an average of 6.2 years postoperatively. However, these patients are at high risk for additional future surgeries on their throwing arm.
    The American Journal of Sports Medicine 12/2012; DOI:10.1177/0363546512469089 · 4.70 Impact Factor
  • Source
    Kevin E Wilk
    09/2012; 4(5):376. DOI:10.1177/1941738112454827
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cruciate ligament injuries are common and may lead to dysfunction if not rehabilitated. Understanding how to progress anterior cruciate ligament and posterior cruciate ligament loading, early after injury or reconstruction, helps clinicians prescribe rehabilitation exercises in a safe manner to enhance recovery. Commonly prescribed therapeutic exercises include both weight-bearing exercise and non-weight-bearing exercise. This review was written to summarize and provide an update on the available literature on cruciate ligament loading during commonly used therapeutic exercises. In general, weight-bearing exercise produces smaller loads on the anterior cruciate ligament and posterior cruciate ligament compared with non-weight-bearing exercise. The anterior cruciate ligament is loaded less at higher knee angles (i.e. 50-100 degrees). Squatting and lunging with a more forward trunk tilt and moving the resistance pad proximally on the leg during the seated knee extension unloads the anterior cruciate ligament. The posterior cruciate ligament is less loaded at lower knee angles (i.e. 0-50 degrees), and may be progressed from level ground walking to a one-leg squat, lunges, wall squat, leg press, and the two-leg squat (from smallest to greatest). Exercise type and technique variation affect cruciate ligament loading, such that the clinician may prescribe therapeutic exercises to progress ligament loading safely, while ensuring optimal recovery of the musculoskeletal system.
    Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine 09/2012; 226(9):670-80. DOI:10.1177/0954411912451839 · 1.14 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The activities required during overhead sports, particularly during baseball pitching, produce large forces at the elbow joint. Injuries to the elbow joint frequently occur in the overhead athlete because of the large amount of forces observed during the act of throwing, playing tennis, or playing golf. Injuries may result because of repetitive overuse, leading to tissue failure. Rehabilitation following injury or surgery to the throwing elbow is vital to fully restore normal function and return the athlete to competition as quickly and safely as possible. Rehabilitation of the elbow, whether following injury or postsurgical, must follow a progressive and sequential order, building on the previous phase, to ensure that healing tissues are not compromised. Emphasis is placed on restoring full motion, muscular strength, and neuromuscular control while gradually applying loads to healing tissue. In addition, when one is creating a rehabilitation plan for athletes, it is imperative to treat the entire upper extremity, core, and legs to create and dissipate the forces generated at each joint.
    09/2012; 4(5):404-14. DOI:10.1177/1941738112455006
  • [Show abstract] [Hide abstract]
    ABSTRACT: Throwing velocity is an important baseball performance variable for baseball pitchers, because greater throwing velocity results in less time for hitters to make a decision to swing. Throwing velocity is also an important baseball performance variable for position players, because greater throwing velocity results in decreased time for a runner to advance to the next base. This study compared the effects of 3 baseball-specific 6-week training programs on maximum throwing velocity. Sixty-eight high school baseball players 14-17 years of age were randomly and equally divided into 3 training groups and a nontraining control group. The 3 training groups were the Throwers Ten (TT), Keiser Pneumatic (KP), and Plyometric (PLY). Each training group trained 3 d·wk(-1) for 6 weeks, which comprised approximately 5-10 minutes for warm-up, 45 minutes of resistance training, and 5-10 for cool-down. Throwing velocity was assessed before (pretest) and just after (posttest) the 6-week training program for all the subjects. A 2-factor repeated measures analysis of variance with post hoc paired t-tests was used to assess throwing velocity differences (p < 0.05). Compared with pretest throwing velocity values, posttest throwing velocity values were significantly greater in the TT group (1.7% increase), the KP group (1.2% increase), and the PLY group (2.0% increase) but not significantly different in the control group. These results demonstrate that all 3 training programs were effective in increasing throwing velocity in high school baseball players, but the results of this study did not demonstrate that 1 resistance training program was more effective than another resistance training program in increasing throwing velocity.
    The Journal of Strength and Conditioning Research 04/2012; 26(7):1767-81. DOI:10.1519/JSC.0b013e3182578301 · 1.86 Impact Factor

Publication Stats

3k Citations
227.16 Total Impact Points

Institutions

  • 1996–2015
    • American Sports Medicine Institute
      Birmingham, Alabama, United States
  • 2009–2014
    • California State University, Sacramento
      • Department of Physical Therapy
      Sacramento, California, United States
    • Massachusetts General Hospital
      • Department of Orthopaedic Surgery
      Boston, MA, United States
  • 2009–2012
    • University of Alabama at Birmingham
      Birmingham, Alabama, United States
  • 2006
    • Northeastern University
      Boston, Massachusetts, United States
  • 2002–2006
    • University of Florida
      • • Department of Applied Physiology and Kinesiology
      • • College of Health and Human Performance
      Gainesville, FL, United States
    • University of Nebraska at Kearney
      Kearney, Nebraska, United States
  • 2000
    • Marquette University
      • Department of Physical Therapy
      Milwaukee, Wisconsin, United States
  • 1996–1999
    • HealthSouth
      Birmingham, Alabama, United States
  • 1993–1995
    • Cincinnati Sports Medicine and Orthopaedic Center
      Cincinnati, Ohio, United States