Lori A Michener

University of Southern California | USC · Division of Biokinesiology and Physical Therapy

Altered scapular kinematics is associated with shoulder pain. Resistance exercise is a common treatment; however, the effects of lifting an external load on scapular kinematics is limited. Understanding whether an external handheld load affects scapular kinematics in a healthy population can provide normal values utilized for comparison to individu...

This study aimed to investigate the acute effect of repeated climbing actions on functional and morphological measures of the shoulder girdle. Fifteen male indoor climbers participated in this study. All the climbers declared route level 6a+, as the best climbing grade (French climbing grade scale). Functional (range of motion - ROM and muscle stre...

Rotator cuff (RC) tendinopathy is a common recurrent cause of shoulder pain, and resistance exercise is the first-line recommended intervention. Proposed causal mechanisms of resistance exercise for patients with RC tendinopathy consist of four domains: tendon structure, neuromuscular factors, pain and sensorimotor processing, and psychosocial fact...

Low back pain is a multidimensional disorder that can originate from a variety of pain generators, including the sacroiliac (SI) joint. Although the Oswestry Disability Index (ODI) is often used in SI joint treatment studies, the effects of the SI joint on functional disability are likely different from those of other low back pain generators. Thus...

High elbow varus torque during baseball pitching has been identified as a potential cause of ulnar collateral ligament injury in baseball pitchers. In general, elbow varus torque increases as ball velocity increases across pitchers. However, studies incorporating within-subject analyses report that not all professional pitchers have a positive rela...

A clinical practice guideline on glenohumeral joint osteoarthritis was developed by an American Physical Therapy Association volunteer guideline development group that consisted of physical therapists, an occupational therapist, and a physician. The guideline was based on systematic reviews of current scientific and clinical information and accepte...

Background: Indoor climbing involves overloading the shoulder girdle, including the rotator cuff and upper trapezius muscles. This field study aimed to investigate the effects of repeated climbing bouts on morphological and mechanical measures of the upper trapezius muscle. Materials and Methods: Fifteen experienced male climbers participated in t...

SYNOPSIS: Current injury-specific return-to-performance rehabilitation programs are not comprehensive, lack intensity, and need better tailoring to the demands of sport. The vast number of rehabilitation and return to sport protocols also reflects a lack of consensus about what the best program looks like, which hinders beginning practitioners from...

Elbow injuries are a significant and increasing issue in baseball. Elbow injuries account for 16% of all injuries sustained at the professional level and collegiate level. Because of the continued rise in injury rates, loss of performance value, and medical burden, sports medicine clinicians have attempted to research the causes underlying this inj...

Objective Characterize trajectory and predictors of patient acceptable symptom state (PASS) defined recovery at 6 months. Methods Individuals with musculoskeletal shoulder pain (n = 140) completed patient-reported disability and PASS at baseline, 1 and 6 months. The PASS was categorized into 3 trajectory groups; 1.) Early Recovery (answered yes to...

Objective: The ulnar collateral ligament (UCL) supports the medial elbow against valgus torque and is commonly injured in baseball pitchers. Changes in UCL morphology and pathology occur with long-term pitching, with more severe findings at higher competition levels. We examined the bilateral differences and the relationship between UCL morphology...

Observable scapular dyskinesis is associated with biomechanical deficits. Preventative interventions aimed at correcting these deficits may aid in preventing the development and resolution of shoulder pain. Our purpose was to investigate the effects of kinesio taping (KT) on common biomechanical deficits associated with scapular dyskinesis and shou...

Background: Hip strength is an important factor for control of the lumbo-pelvic-hip complex. Deficits in hip strength may affect throwing performance and contribute to upper extremity injuries. Hypothesis: Deficits in hip abduction isometric strength would be greater in those who sustained an upper extremity injury and hip strength would predict i...

# Background Deficits in shoulder range of motion (ROM) and strength are associated with risk of arm injury in baseball players. # Purpose The purpose of this study was to assess the effectiveness of a standardized exercise program, during the fall season, on shoulder ROM and rotational strength in collegiate baseball players. # Study Design P...

Background There is a lack of standardized criteria for diagnosing Rotator Cuff Related Shoulder Pain (RCRSP). Objective To identify the most relevant clinical descriptors for diagnosing RCRSP. Methods A Delphi study was conducted through use of an international physical therapists expert panel. A 3-round Delphi survey involving an international...

Background The paucity of longitudinal clinical studies limits our understanding of the development of shoulder pain with repetitive shoulder tasks, and its association with underlying mind and body mechanisms. Tendon thickening characterizes painful shoulder supraspinatus tendinopathy, and the perception of pain can be affected by the presence of...

Background: Thoracic spinal manipulation can improve pain and function in individuals with shoulder pain; however, the mechanisms underlying these benefits remain unclear. Here, we evaluated the effects of thoracic spinal manipulation on muscle activity, as alteration in muscle activity is a key impairment for those with shoulder pain. We also eva...

# Background Shoulder strength deficits are implicated in arm injuries and performance deficits in baseball players. # Purpose To characterize shoulder external (ER) and internal (IR) rotation strength in professional baseball players, and compare strength across player type (pitchers, position players) and geographic origin (North America, Lat...

Background Biomechanical muscle stiffness has been linked to musculoskeletal disorders. Assessing changes in muscle stiffness following DN may help elucidate a physiologic mechanism of DN. This study characterizes the effects of dry needling (DN) to the infraspinatus, erector spinae, and gastrocnemius muscles on biomechanical muscle stiffness. Met...

The prevalence of ulnar collateral ligament (UCL) injury and UCL reconstruction (UCL-R) continues to rise, causing morbidity in overhead-throwing athletes. » Postoperative rehabilitation protocols are essential for proper healing of the reconstructed ligament and safely returning athletes to competition , yet there is no uniformly accepted standard...

Background: The single-leg step down task (SLSD) is a clinical tool to assess movement and control of the lower extremity and trunk. Hip abduction weakness may impact movement quality during the SLSD, however the relationships between movement and strength are unclear. Purpose: To determine the relationship between hip abduction isometric streng...

Shoulder instability has varying mechanisms of injury, direction, and severity. Classification systems based on clustering signs and symptoms have been developed to define subgroups of shoulder instability. Despite this attempt at homogeneity, multidirectional instability (MDI) suffers from the same lack of diagnostic clarity as low back pain. In t...

Objective To characterise whether preseason screening of shoulder range of motion (ROM) is associated with the risk of shoulder and elbow injuries in overhead athletes. Design Systematic review and meta-analysis. Data sources Six electronic databases up to 22 September 2018. Eligibility criteria Inclusion criteria were (1) overhead athletes from...

The purpose of this study was to assess the effects of a standardized exercise program on shoulder ROM, shoulder and hip strength and lumbopelvic stability over the course of a playing season in collegiate baseball players.

Background: To compare the activation of shoulder and trunk muscles between six pairs of closed (CC) and open chain (OC) exercises for the upper extremity, matched for performance characteristics. The secondary aims were to compare shoulder and trunk muscle activation and shoulder activation ratios during each pair of CC and OC exercise. Methods:...

Background: Thoracic spine thrust manipulation has been shown to improve patient-rated outcomes for individuals with neck pain. However, there is limited evidence of its effectiveness in patients with cervical radiculopathy. Objectives: To compare the immediate and short-term effects of thoracic manipulation to those of a sham thoracic manipulat...

Context: Rowers are at risk for overuse injuries, including low back pain (LBP). Defining the utility of screening tests for identifying those at risk for LBP can aid in the development of guidelines for injury prevention. Objective: To determine if the Functional Movement Screen (FMS) and impairments can identify rowers at risk for developing L...

Context: Performing shoulder-abduction exercises with scapular retraction has been theorized to reduce the potential for shoulder impingement. However, objective data to support this premise are lacking. Objective: To evaluate the influence of active scapular retraction on acromiohumeral distance (AHD) at 4 shoulder-abduction angles using real-t...

Objective: To present recommendations for the diagnosis, management, outcomes, and return to play of athletes with superior labral anterior-posterior (SLAP) injuries. Background: In overhead athletes, SLAP tears are common as either acute or chronic injuries. The clinical guidelines presented here were developed based on a systematic review of t...

Background: Impaired trunk motion during pitching may be a risk factor for upper extremity injuries. Specifically, increased forces about the shoulder and elbow have been observed in pitchers with excessive contralateral trunk lean during pitching. Because of the difficulty in identifying abnormal trunk motions during a high-speed task such as pitc...

Hypothesis and background: The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Western Ontario Rotator Cuff (WORC) index are 2 widely used patient-reported questionnaires in individuals with rotator cuff (RC) tendinopathy. In contrast to the WORC index, for which the items are specific to the affected shoulder, the items of...

For kinematic studies of the shoulder, electromagnetic sensors are commonly placed on the humerus, scapula, and trunk. The trunk sensor is used to describe humeral and scapular kinematics with respect to the trunk. There are two common trunk sensor placements, the sternum or third thoracic vertebrae (T3). It is currently unclear if placement of the...

Study Design Cross-sectional. Background The scapular dyskinesis test (SDT) has demonstrated reliability and validity, but the utility for clinical decision-making is unclear. Objectives Characterize the prevalence of scapular dyskinesis in participants with and without shoulder pain, and to determine the influence of blinding to the presence of sh...

http://www.wcpt.org/wcpt2017/FS-16

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...

Study design: Cross-sectional cohort. Introduction: Tendon collagen organization can be estimated by peak spatial frequency radius (PSFR) on ultrasound images. Characterizing PSFR can define the contribution of collagen disruption to shoulder symptoms. Purpose of the study: The purpose of this was to characterize the (1) supraspinatus tendon P...

Study Design Secondary analysis of a randomized controlled trial. Background Prognostic variables identifying patients with shoulder pain who are likely to respond to cervicothoracic (CT) manipulation have been reported, however they have yet to be validated. Objective To examine the validity of previously reported prognostic variables in predictin...

Shoulder pain is the most reported area of orthopaedic injury in swimmers. The so-called 'swimmers' shoulder' has been applied to a variety of complaints involving shoulder pain in swimmers without specific reference to contributing mechanisms or structures. Knowledge of dysfunctions associated with swimmers' shoulder can assist clinicians in devel...

Background: The full can test is theorized to produce compressive loads on the supraspinatus tendon within the subacromial space. Characterizing the width of the subacromial outlet, scapular orientation, and shoulder pain during the full can test will improve the mechanistic understanding of the positive full can test. Methods: Cross-sectional r...

The labelling of non-traumatic shoulder pain related to the structures of the subacromial space has been debated for many years. Historically, labelling of shoulder diagnoses and exploring theories about the underlying causes of shoulder pain are interrelated. Many authors use the phrase ‘syndrome’ describing a combination of findings, often occurr...

TTBACKGROUND: Cervicothoracic manual therapy has been shown to improve pain and disability in individuals with shoulder pain, but the incremental effects of manual therapy in addition to exercise therapy have not been investigated in a randomized controlled trial. TTOBJECTIVES: To compare the effects of cervicothoracic manual therapy and exercise t...

Purpose: To examine the effects of neuromuscular electrical stimulation (NMES) and blood flow restricted (BFR) exercise on wrist extensors cross-sectional area (CSA), torque and hand functions compared NMES only in individuals with incomplete tetraplegia. The acute effect of an acute bout of NMES with BFR on flow mediated dilation (FMD) was compar...

Objective To systematically review the literature on the clinical outcomes of scapular-focused treatments in participants with subacromial pain syndrome (SPS). Design Systematic literature review. Studies were appraised by two reviewers using the Physiotherapy Evidence Database (PEDro) scale, and a best-evidence synthesis was performed. Data source...

Background: Coordinated muscle activity is needed for synchronized joint motion and stability. Characterizing relative scapular muscle activity deficits in participants with shoulder pain will provide foundational knowledge to develop rehabilitation programs. Methods: Participants were recruited with subacromial pain syndrome and an asymptomatic...

Background: Evidence is needed to develop effective educational programs for promoting evidence based practice (EBP) and knowledge translation (KT) in physical therapy. This study reports long-term outcomes from a feasibility assessment of an educational program designed to promote the integration of research evidence into physical therapist pract...

The majority of muscles have distinct tendinous attachments to bones; however, only a few tendons develop painful conditions. That simple observation prompts us to ask a few questions. Are there commonalities in morphology and pathology among the painful tendons? What contributes to the propensity for pathology in some, but not all, tendons? And, c...

Biomechanical measures are used to characterize the mechanisms of treatment for shoulder pain. The objective was to characterize test-retest reliability and measurement error of shoulder surface electromyographic(sEMG) and kinematic measures. Individuals(n = 12) with subacromial pain syndrome were tested at 2 visits. Five repetitions of shoulder sc...

Background: The purpose of this investigation was to characterize the scapular position and scapular muscle activation during the empty can (EC) and full can (FC) exercises. The EC exercise has been shown to produce scapular kinematics associated with the mechanism leading to subacromial impingement syndrome (SAIS) but has not been investigated in...

Study design: Randomized controlled trial. Objectives: To determine if thoracic spinal manipulative therapy (SMT) alters thoracic kinematics, thoracic excursion, and scapular kinematics compared to a sham SMT in individuals with subacromial impingement syndrome, and also to compare changes in patient-reported outcomes between treatment groups....

Approximately 6 million youngsters play organized baseball yearly, and injuries are common. Defining of risk factors for injuries in the throwing shoulder has largely been confined to the professional thrower. Unfortunately, these risk factors apply to only 1% of pitchers at risk for injury. Risk factors for injury in youth pitchers have received f...

Study design: Single-blind randomized trial. Objectives: To compare the effects of cervical and shoulder thrust manipulation (TM) and exercise on pain sensitivity, and to explore associations with clinical outcomes in patients with shoulder pain. Background: Experimental studies indicate that spinal TM has an influence on central pain processe...

Thoracic SMT can improve symptoms in patients with subacromial impingement syndrome. However, at this time the mechanisms of SMT are not well established. It is possible that changes in pain sensitivity may occur following SMT. To assess the immediate pain response in patients with shoulder pain following thoracic spinal manipulative therapy (SMT)...

Shoulder disorders are a common musculoskeletal problem causing pain and functional loss. Traditionally, diagnostic categories are based on a pathoanatomic medical model aimed at identifying the pathologic tissue(s). However, the pathoanatomic model may not provide diagnostic categories that effectively guide treatment decision-making in rehabilita...

Objectives To characterize scapular kinematics and shoulder muscle activity in those with and without visually identified scapular dyskinesis in patients with subacromial impingement syndrome. Design Cross-sectional study. Setting Movement analysis laboratory. Participants Participants with subacromial impingement syndrome (n=38) were visually c...

The evidence to guide use of spinal manipulative therapy (SMT) for patients with shoulder pain is limited. A validated sham comparator is needed to ascertain the unique effects of SMT. We investigated the plausibility of a thoracic sham-SMT comparator for SMT in patients with shoulder pain. Participants(n=56) with subacromial impingement syndrome w...

Background Many patient-reported outcome measures (PROs) for shoulder dysfunctions have acceptable psychometric properties. However, the large number of measures that are available present clinicians and researchers with dilemmas in PRO selection. This study set out to determine the perceived importance of PROs, the measures currently used by physi...

Background: Many patient-reported outcome measures (PROs) for shoulder dysfunctions have acceptable psychometric properties. The present study examined current PRO usage and perceived importance. Methods: Delegates at the 2010 International Congress of Shoulder and Elbow Therapists were invited to participate in this cross-sectional observationa...

This study aimed to compare muscle activity in individuals with isolated acromioclavicular osteoarthritis (ACO), ACO associated with rotator cuff disease (ACO+RCD), and controls. Seventy-four participants (23 isolated ACO, 25 ACO+RCD, 26 controls) took part in this study. Disability was assessed with the Disabilities of the Arm, Shoulder and Hand (...

Most spine patient-reported outcome measures are divided into neck and back subregions. This prevents their use in the assessment of the whole spine. By contrast, whole-spine patient-reported outcome measures assess the spine from cervical to lumbar as a single kinetic chain. However, existing whole-spine patient-reported outcomes have been critiqu...

Clinimetric evaluation of measurement tools used in hand therapy to assess activity and participation Dear Editor:—We wish to commend your journal on the recent publication of the article by Schoneveld et al.1 and the supplementary commentary by Powell and Wietlisbach.2 However, we would like to bring your readers’ attention to three points that ar...

The primary objectives of the current study were to i) determine the intra-rater reliability and precision of the ultrasound cross-sectional area (CSA) measurements of the wrist extensors in individuals with spinal cord injury (SCI); and ii) determine if tetraplegia has a negative influence on the reliability and precision for these measurements. R...

1) To identify English Language published patient-reported upper extremity outcome measures used in breast cancer research and 2) To examine construct validity and responsiveness in patient-reported upper extremity outcome measures used in breast cancer research. PubMed, CINAHL and ProQuest MEDLINE(®) databases were searched up to February 5, 2013....

This study characterized the impairments of range of motion, three-dimensional scapulo-thoracic kinematics, isokinetic muscle performance and disability in a patient with Parsonage-Turner Syndrome. The patient had a history of 2.5-years of shoulder pain, and electroneurodiagnostic testing indicative of suprascapular neuropathy. The patient-rated Di...

Purpose: To characterize the supraspinatus tendon thickness, subacromial space, and the relationship between tendon thickness and subacromial space to further elucidate the mechanisms of subacromial impingement syndrome. Methods: In a single-blind cross-sectional study, subjects were recruited with subacromial impingement syndrome (n = 20) and a...

Objective: A high prevalence of neovascularity in lower extremity tendinopathies has been reported. Neovascularity in those with rotator cuff tendinopathy exclusively has not been examined. The objective was to determine the prevalence of neovascularization in patients with rotator cuff tendinopathy compared with asymptomatic controls. Design: S...

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF)...

The second international consensus conference on the scapula was held in Lexington Kentucky. The purpose of the conference was to update, present and discuss the accumulated knowledge regarding scapular involvement in various shoulder injuries and highlight the clinical implications for the evaluation and treatment of shoulder injuries. The areas c...

The impact upper extremity impairments (UE) have on UE function in breast cancer survivors (BCS) is unclear. The purpose of this study was to evaluate the associations between upper extremity active range of motion (AROM), passive range of motion (PROM), and strength with self-reported function in BCS. BCS (n = 24) completed the Disabilities of Arm...

Objectives (1) To identify English-language published patient-reported upper extremity outcome measures used in breast cancer research and (2) to examine construct validity and responsiveness in patient-reported upper extremity outcome measures used in breast cancer research. Data Sources PubMed, Cumulative Index to Nursing and Allied Health Liter...

Objective: To define for 2 shoulder outcomes scales the substantial clinical benefit (SCB)-a metric that defines the change amount associated with patient perception of a large meaningful improvement and that can be used to interpret change over time in the outcome score. Design: Cohort. Setting: Clinic. Participants: Patients (N=74) with sh...

Objective To systematically review and critique the evidence regarding the diagnostic accuracy of physical examination tests for the scapula in patients with shoulder disorders. Methods A systematic, computerised literature search of PubMED, EMBASE, CINAHL and the Cochrane Library databases (from database inception through January 2012) using keywo...

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 regardi...

Prior studies indicate thoracic spinal manipulative therapy (SMT) improves shoulder pain and disability. However, these studies are limited by no control or sham-treatment group. A valid sham comparator for thoracic SMT is needed. Subjects (n=69) without shoulder pain were randomized to one of three groups: thoracic SMT, sham-SMT, or sham-ultrasoun...

To update our previously published systematic review and meta-analysis by subjecting the literature on shoulder physical examination (ShPE) to careful analysis in order to determine each tests clinical utility. This review is an update of previous work, therefore the terms in the Medline and CINAHL search strategies remained the same with the excep...

Context: The literature does not present a consistent pattern of altered scapular kinematics in patients with shoulder-impingement syndrome (SIS). Objectives: To perform meta-analyses of published comparative studies to determine the consistent differences in scapular kinematics between subjects with SIS and controls. In addition, the purpose wa...

Context: The prevalence of shoulder pain among competitive swimmers is high, but no guidelines exist to reduce shoulder injuries. Elucidating differences between swimmers with and without shoulder pain can serve as a basis for the development of a program to prevent shoulder injury that might lead to pain and dysfunction. Objective: To determine...

Controlled laboratory study. To determine the effect of the modified scapular assistance test (SAT) on 3-dimensional shoulder kinematics, strength, and linear measures of subacromial space in patients with subacromial impingement syndrome (SAIS). Abnormal scapular kinematics have been identified in patients with SAIS. Increased scapular upward rota...

Participation in high school sports has grown 16.1% over the last decade, but few studies have compared the overall injury risks in girls' softball and boys' baseball. To examine the incidence of injury in high school softball and baseball players. Cohort study. Greenville, South Carolina, high schools. Softball and baseball players (n = 247) from...

Existing lower-limb, region-specific, patient-reported outcome measures have clinimetric limitations, including limitations in psychometric characteristics (eg, lack of internal consistency, lack of responsiveness, measurement error) and the lack of reported practical and general characteristics. A new patient-reported outcome measure, the Lower Li...

Type I superior labrum anterior-posterior (SLAP) lesions involve degenerative fraying and probably are not the cause of shoulder pain. Type II to IV SLAP lesions are tears of the labrum. To determine the diagnostic accuracy of patient history and the active compression, anterior slide, and crank tests for type I and type II to IV SLAP lesions. Coho...

Range of motion deficits in shoulder external rotation (ER), internal rotation (IR), total rotation range of motion (ER + IR), and horizontal adduction (HA) have been retrospectively associated with overhand athletes' arm injuries. The authors expected the incidence of upper extremity injury in high school softball and baseball players with side-to...