Todd Ellenbecker

Rehab Plus Sports Therapy Scottsdale & Vice President Medical Services ATP World Tour

Objectives: To determine the most appropriate terminology and issues related to clinical reasoning, examination and treatment of the kinetic chain (KC) in people with shoulder pain by an international experts panel. Design: Delphi study METHODS: A three-round Delphi study that involved an international panel of experts with extensive clinical, t...

The aim of the present study was to analyze whether a compensatory training program including iso-inertial flywheel training could reduce shoulder imbalances in a group of asymptomatic young tennis players. After an initial evaluation, twenty-six young tennis players were assigned to either a supervised training group (FTG, n = 13) or a control gro...

Background In elite tennis players, musculoskeletal adaptations in the dominant upper extremity have been reported for range of motion, strength, and scapular biomechanics. In addition to scapular dysfunction, tightness and inflexibility of the pectoral musculature have been identified as risk factors for the development of overuse shoulder injury...

This chapter focuses on the role of isokinetics with regard to testing and training after ACL injury and reconstruction. This includes the use of isokinetics for screening, evaluation, treatment, rehabilitation, and criteria for discharge to return to sports. Specific considerations for testing after ACL reconstruction are detailed. Testing and tra...

Neuromuscular activity, organized in coordinated patterns, forms the basis of task-specific function in sports and exercise. The content and extent of these patterns may be variable, but include elements of activation/inhibition, co-activation, concentric/eccentric activation, proximal-to-distal activation, plyometric activation, and preactivation...

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...

The term physical literacy has been embraced by a number of different countries around the world. Although the concept has regained momentum over the past few decades, little has been written about specific activities that may assist in providing the foundation for physical literacy as a life-long journey. This article introduces selected physical...

Background: The characteristics of scapular muscle activities in elevation and descent exercises have yet to be elucidated to assess scapular dyskinesis. The purpose of this study was to identify the adaptation of electromyograph (EMG) activities of the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and anterior deltoid (AD) m...

Context: The appropriate resistance intensity to prescribe for shoulder rehabilitative exercise is not completely known. Excessive activation of the deltoid and upper trapezius muscles could be counterproductive for scapulohumeral rhythm during humeral elevation. Objective: To identify the effects of different exercise intensities on the scapula...

Rehabilitation of the patient with rotator cuff pathology requires a comprehensive physical examination and evidence-based rehabilitation focusing on restoring normal joint motion, scapular stabilization, and rotator cuff strength. Many patients with rotator cuff tendinitis, impingement, and partial- and full-thickness tears can return to full acti...

The act of the overhead throw, especially pitching, produces high levels of forces at the elbow joint. The elbow joint is a frequently injured region of the body in the overhead athlete due to the large amount of forces observed during the act of throwing, playing tennis, or playing golf. Injuries often occur due to the repetitive microtrauma natur...

Successful rehabilitation following reconstruction of the ulnar collateral ligament (UCL) of the elbow requires a specific procedure to regain optimal range of motion, muscular strength and endurance, and ultimately enhanced upper extremity and kinetic chain function. This requires not only specific emphasis on the elbow and distal upper extremity...

Tennis places high loads on the joints of players, with supraphysiologic forces being generated at the shoulder and elbow hundreds of times per match. Acute injuries tend to affect the lower extremity; chronic injuries usually involve the upper extremity. Commonly encountered upper extremity conditions include rotator cuff injury, internal impingem...

Plyometric exercises are frequently used to increase posterior rotator cuff and periscapular muscle strength and simulate demands and positional stresses in overhead athletes. The purpose of this study was to provide descriptive data on posterior rotator cuff and scapular muscle activation during upper extremity plyometric exercises in 90° of gleno...

Proper scapular function during humeral elevation, such as upward rotation, external rotation, and posterior tilting of the scapula, is necessary to prevent shoulder injury. However, the appropriate intensity of rehabilitation exercise for the periscapular muscles has yet to be clarified. To identify the serratus anterior, lower trapezius, infraspi...

Professional tennis places extraordinary demands on elite tennis players. Previously published profiles characterise the inherent physiological demands of tennis play and the adaptations incurred by elite-level tennis players. These include the requirement of repeated maximal level exertions during points with average durations ranging between 2 an...

Tennis is a sport with unique, whole-body demands, played on four different surfaces that produce specific anatomical adaptations and injury profiles in its elite players. This chapter considers the injury patterns and biomechanical characteristics of tennis play and provides a tennis-specific training program template for both young developing pla...

This study examined the effects of a 6-week strength-training program on serve velocity in youth tennis players. Thirty competitive healthy and nationally ranked male junior tennis players (13 years of age) were randomly and equally divided into control and training groups. The training group performed 3 sessions (60-70 min) weekly for 6 weeks, com...

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...

Examination of the shoulder complex has long been described as challenging. This is particularly true in the examination of the overhead athlete who has structural differences when compared to a shoulder patient who is a non-athlete. Complexity with the examination is due to unique biomechanical and structural changes, multiple joint articulations,...

Context: Injuries to the tendons of the elbow occur frequently in the overhead athlete, creating a significant loss of function and dilemma to sports medicine professionals. A detailed review of the anatomy, etiology, and pathophysiology of tendon injury coupled with comprehensive evaluation and treatment information is needed for clinicians to opt...

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 u...

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...

Tsuruike, M and Ellenbecker, TS. Effects of a compression garment on shoulder external rotation force outputs during isotonic contractions. J Strength Cond Res 27(2): 519-525, 2013-The use of compression garments (CGs) has been advocated for performance enhancement and recovery in athletes. The effect of a CG on humeral rotation motor control has n...

INTRODUZIONE Le sollecitazioni esercitate dal tennis sull'organismo dei giocatori "d'élite" influenzano gli arti superiori, quelli inferiori e il tronco e possono con-durre a un adattamento muscolo-scheletrico e a caratteristiche lesioni (1-3). Gli stress ripetuti e le sequen-ze di carico nel tennis creano squili-bri muscolari specifici che richied...

INTRODUZIONE Le sollecitazioni esercitate dal tennis sull'organismo dei giocatori "d'élite" influenzano gli arti superiori, quelli inferiori e il tronco e possono con-durre a un adattamento muscolo-scheletrico e a caratteristiche lesioni (1-3). Gli stress ripetuti e le sequen-ze di carico nel tennis creano squili-bri muscolari specifici che richied...

Clinically evaluating the scapulothoracic joint is challenging. To identify scapular dyskinesis, clinicians typically observe scapular motion and congruence during self-directed upper extremity movements. However, it is unclear whether this method is reliable. We therefore determined the interrater reliability of a scapular classification system in...

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...

The tennis serve is a complex stroke characterized by a series of segmental rotations involving the entire kinetic chain. Many overhead athletes use a basic 6-stage throwing model; however, the tennis serve does provide some differences. To support the present 8-stage descriptive model, data were gathered from PubMed and SPORTDiscus databases using...

THE TENNIS SERVE IS THE MOST POWERFUL AND POTENTIALLY DOMINANT SHOT IN TENNIS, YET VERY FEW PLAYERS PERFORM THIS WITH MAXIMUM VELOCITY, POWER, OR SPIN ON A CONSISTENT BASIS. THIS ARTICLE WILL DISCUSS 3 PHASES AND 8 STAGES OF THE TENNIS SERVE WITH HIGHLIGHTED EVALUATION MARKERS THAT CAN AID THE COACH OR TRAINER IN DEVELOPING TRAINING PROGRAMS WITH S...

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...

Injuries to the adolescent elbow are common because of the repetitive overuse inherent in many overhead sport activities. The management of these patients is greatly facilitated through a greater understanding of the demands placed on the upper extremity kinetic chain during these overhead activities as well as a detailed examination and rehabilita...

Rehabilitation of the patient with glenohumeral impingement requires a complete understanding of the structures involved and the underlying mechanism creating the impingement response. A detailed clinical examination and comprehensive treatment programme including specific interventions to address pain, scapular dysfunction and rotator cuff weaknes...

Background: This article describes the best clinical tests of shoulder function and injury as identified in a recent systematic review published in the British Journal of Sports Medicine. Discussion: A description of the different tests is given, with photographs of the exact test procedure.

Evaluation of the athlete with an elbow injury involves a complete upper extremity approach and a corresponding treatment approach that addresses the identified deficiencies to restore normal function. A significant focus should be placed on the proximal aspect of the upper extremity in addition to the obvious distal injury. A detailed review of th...

The importance of the scapular stabilizing muscles has led to an increased interest in quantitative measurements of their strength. Few studies have measured isometric or concentric isokinetic forces. Additionally, limited reports exist on the reliability of objective measures for testing scapular protraction and retraction muscle strength or scapu...

THE DESIGN OF STRENGTH AND CONDITIONING PROGRAMS SPECIFIC TO TENNIS HAS RECEIVED SIGNIFICANT ATTENTION, PARTICULARLY OVER THE PAST 25 YEARS. MUCH OF THE AVAILABLE RESEARCH IS BASED ON OUR KNOWLEDGE OF THE PHYSIOLOGICAL DEMANDS OF TENNIS. LESS IS KNOWN ABOUT THE LINK BETWEEN THE ACTUAL STROKES (SERVES, FOREHANDS, AND BACKHANDS) AND THE SPECIFIC TRAI...

A TENNIS-SPECIFIC STRENGTH AND CONDITIONING PROGRAM CAN PLAY A KEY ROLE IN PREVENTING COMMON INJURIES IN TENNIS PLAYERS. THE INFORMATION PROVIDED IN THIS ARTICLE IDENTIFIES COMMON TENNIS INJURIES AND THE TENNIS DEMANDS AND MUSCULAR IMBALANCES THAT MAY PLAY A ROLE IN CAUSING THEM. SPECIFIC EXERCISES ARE SUGGESTED BASED ON THESE SPORT-SPECIFIC MUSCUL...

Injuries to the ulnar collateral ligament (UCL) in throwing athletes frequently occurs from the repetitive valgus loading of the elbow during the throwing motion, which often results in surgical reconstruction of the UCL requiring a structured postoperative rehabilitation program. Several methods are currently used and recommended for UCL reconstru...

Chondrolysis has been observed after shoulder arthroscopy and results in severe glenohumeral complications. Twenty three cases of post-arthroscopic glenohumeral chondrolysis, occurring between 2005-2006, are reported following a variety of arthroscopic shoulder procedures. Presenting complaints, signs and symptoms, associated operative findings, an...

EFFICIENT DECELERATION IS PARAMOUNT TO ALLOW FOR FAST AND EXPLOSIVE CHANGES OF DIRECTION. BECAUSE MOST TENNIS POINTS HAVE BETWEEN 3 AND 7 CHANGES OF DIRECTIONS, THE DEVELOPMENT OF THE COMPONENTS IN CHANGE OF DIRECTION MOVEMENTS IS A MAJOR COMPONENT OF COMPETITIVE PLAY. TRAINING FOR TENNIS REQUIRES A STRONG UNDERSTANDING NOT ONLY OF THE ACCELERATION...

Case report. Management of glenohumeral joint osteoarthritis in young, active patients is challenging due to the significant functional limitations and progression of the disease, coupled with the limited lifespan of prosthetic implants presently in use. The purpose of this report is to present the detailed rehabilitation program and outcome of a p...

To measure short-term post surgery glenohumeral internal and external rotation strength, shoulder range of motion (ROM), and subjective self-report ratings following arthroscopic superior labral (SLAP) repair. Physical therapists provide rehabilitation for patients following arthroscopic repair of the superior labrum. Little research has been publi...

Stability of the shoulder joint emanates from numerous mechanisms including articular geometry, static restraints (capsuloligamentous tissue), dynamic (muscular) stabilizers, and intra-articular forces. Capsuloligamentous structures not only provide mechanical restraint to joint subluxation, but also provide vital sensory feedback information that...

Cementless humeral resurfacing arthroplasty is a bone-conserving arthroplasty option for patients with glenohumeral arthritis. It has been successful in the older patient population. However, data regarding the results of arthroplasty in younger, more active patients are lacking. We report the two-year results of this procedure in active patients w...

Tennis requires repetitive multidirectional movement patterns that can lead to lower extremity injury. Knowledge of population and age-specific strength parameters can be used during performance enhancement training and rehabilitation of tennis players. The purpose of this study was to generate population and age-specific descriptive profiles of co...

Repetitive loading to the hip joint in athletes has been reported as a factor in the development of degenerative joint disease and intra-articular injury. Little information is available on the bilateral symmetry of hip rotational measures in unilaterally dominant upper extremity athletes. Side-to-side differences in hip joint range of motion may b...

Retrospective chart review. To measure short-term postsurgery glenohumeral internal rotation and external rotation strength, shoulder range of motion (ROM), and subjective self-report ratings following mini-open rotator cuff repair of full-thickness rotator cuff tears. Physical therapists provide rehabilitation for patients following mini-open rota...

In tennis, injuries to the elbow and wrist occur secondary to the repetitive nature of play and are seen at increasingly young ages. Isokinetic testing can be used to determine muscular strength levels, but dominant/non-dominant and agonist/antagonist relations are needed for meaningful interpretation of the results. To determine whether there are...

The purpose of this descriptive study was to determine whether bilateral differences exist in concentric and eccentric shoulder internal and external rotation strength in high school aged baseball pitchers. Thirty-nine high school aged baseball pitchers were bilaterally tested for concentric and eccentric internal and external rotation muscle perfo...

The changes in stroke production in the modern game of tennis have increased the demands on trunk rotation in elite tennis players. Unlike the shoulder, where unilateral strength adaptations have been identified, no study to date has objectively quantified side to side rotational trunk strength in elite tennis players. One hundred nine elite tennis...

Rotator cuff function is critical to the overhead athlete. Rotator cuff power is felt to be important in the overhead athlete during the throwing motion. Little research exists regarding torque acceleration energy (TAE) in overhead athletes. Twenty-five males were divided into 2 groups consisting of overhead athletes (pitchers) (n = 12) and nonover...

Rotator cuff function is critical to the overhead athlete. Rotator cuff power is felt to be important in the overhead athlete during the throwing motion. Little research exists regarding torque acceleration energy (TAE) in overhead athletes. Twenty-five males were divided into 2 groups consisting of overhead athletes (pitchers) (n = 12) and nonover...

Practical, clinically focused, and highly illustrated, this new guide includes content not covered in any other book, presented in a user-friendly format. Part I introduces the concepts of subjective evaluation, observation/posture, related referral joint testing, neurovascular testing, palpation, and range of motion testing. Part II comprises the...

Isokinetic strength testing provides objective and reliable muscular performance data on elite tennis players; however, such data are not highly correlated with performance on a multiple-joint kinetic chain activity such as the tennis serve. In this brief review, an overview of the muscular performance characteristics generated through isokinetic t...

The high incidence of overuse shoulder injuries in elite junior tennis players is often attributed to both the high repetitive stresses inherent in the game, as well as muscular imbalances in the humeral rotators. The purpose of this study was to isokinetically measure concentric glenohumeral joint internal and external rotation strength, to develo...

Descriptive study. To determine whether bilateral differences exist in concentric elbow flexion and extension strength in elite junior tennis players. The repetitive nature of tennis frequently produces upper extremity overuse injuries. Prior research has identified tennis-specific strength adaptation in the dominant shoulder and distal upper extre...

The amount of glenohumeral joint internal and external rotation used during overhead sport activities has been measured experimentally by sports scientists. Clinical measurement of glenohumeral joint internal and external rotation using goniometry is an integral part of a shoulder evaluation after injury or surgery or during preseason or preventati...

The purpose of this study was to determine the intrarater and interrater reliability of a manual anterior humeral head translation test. Fifteen subjects were positioned lying in a supine position with their identity shielded from examiners. A standard manual anterior humeral head translation test was performed and repeated with the glenohumeral jo...

In the June 2002 issue of JOSPT, an example of a rehabilitation protocol developed based on information derived from basic scientific research and previous clinical experience is published. This article demonstrates the important responsibility that we have as physical therapists and providers of postoperative rehabilitation to apply knowledge gain...

Glenohumeral osteoarthritis is a relatively uncommon type of osteoarthritis characterized by loss of anterior or forward flexion. Assessing range of motion, impingement, and strength, combined with radiologic imaging, can help determine the extent of damage. Published studies focus primarily on surgical treatment, but commonly used nonsurgical appr...

The purpose of this study was to examine the effects of a 4-month season of collegiate tennis on glenohumeral joint internal and external rotation strength and range of motion in female collegiate tennis players. Eleven female collegiate tennis players were isokinetically tested to assess glenohumeral joint internal and external rotation strength w...