Active Shoulder Flexion Limitations and Correlation to Lumbar Pathology in FemaleGymnasts

 C. A. Foss MD, DC, CCSP M.S.ed., A.T.,C. Advanced Sports Medicine & Physical Therapy Center, Riverdale, NJ.

OBJECTIVE:  The objective of this study was to evaluate the correlation of lumbar pathology with limitations in active shoulder flexion within female gymnasts.  In doing this, the significance of functional movement deficits and possible links to pathology were demonstrated.

SUBJECTS/METHODS:  78 Female gymnasts ages eight to seventeen were goniometrically measured in prone active shoulder flexion.  Each gymnast was given a dowel and instructed to lie prone on a mat with her arms straight at all times out over her head. The gymnast was to place her hands shoulder width apart on the dowel. Chin was positioned on the mat at all times to prevent lumbar extension. Scapular tipping was controlled by instructing the gymnast to keep her axilla (“armpits”) facing the mat. Lumbar extension as well as scapular tipping were prohibited and closely monitored.  The gymnast was then instructed to raise her arms straight up as far as she could.  Measurements were then taken at that range and recorded.   History of low back pathology was also questioned and recorded for each gymnast. 

MEASUREMENTS: Active shoulder flexion was goniometrically measured with the patient prone. Lumbar extension and scapular tipping were not permitted as described above.  The data was evaluated for a relationship between the degree of shoulder flexion and incidence of reported lumbar pathology.

RESULTS:  In the 78 gymnasts tested, range of motion in prone active shoulder flexion varied between 150 - 211 degrees. With the mean being 177.5 degrees. The median of 180.5 degrees and the mode was 168 degrees. 62 gymnasts presented with active prone shoulder flexion of 180 degrees or less with and incidence of injury of 30 of the 62 gymnasts.  This presents with a lumbar injury incidence of 48.38 percent. 17 gymnasts tested above 180 degrees of active prone shoulder flexion with an incidence of injury reported in 6 gymnasts.  This presents with a lumbar incidence of 35.29 percent. 

CONCLUSION:  Gymnasts with less than 180 degrees of active shoulder flexion demonstrated greater incidence of lumbar injury than those with more than180 degrees of active shoulder flexion.  Additional research is necessary to further evaluate the functional movement deficits, and the predisposition to injury in a sport that is dominated with lumbar pathology. Due to normal glenohumeral movement limitations it is possible that the answer to decreasing lumbar injury in extension type sports is to enhance the scapulothoracic mobility, which enhances the ability to move the arm into greater degrees of shoulder flexion. 

An interesting note was that in the tested group, six gymnasts reported having a history of spondylolysis in the recent past. Of these six gymnasts, five tested between 161-168 of active prone shoulder flexion, which is below the mean of 177.5 degrees. It would be interesting to further evaluate this group.

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