The Monday Memo
October 1, 2018 PITT DPT STUDENTS
Protect That Cuff
To no surprise, it has been supported through research that participation in sport leads to an increased risk of injury. More specifically, it has been shown that participation in sports leads to a 2.3 times greater risk of a rotator cuff tear in the paraplegic population1. Overhead sports have also been shown to have a 2.3 times increase in the likelihood of suffering a rotator cuff tear in wheelchair users2. This increased risk may come from muscular imbalances created by the mechanism of wheelchair propulsion and manipulation, as well as overuse and fatigue.
To reduce the risk of injury, it is important to incorporate significant rotator cuff strengthening and scapular stabilization training. This can be done through a series of exercises that recruit the rotator cuff muscles: infraspinatus, supraspinatus, subscapularis, and teres minor. Additionally, including movements that load the rhomboids and serratus anterior will aid in scapular stabilization. So how do we go about training these muscular groups? Luckily, significant research has been done on this subject and we are able to prescribe exercises that will target this area.
A commonly used program titled “Throwers 10” does just this. While many programs can be found that vary in an intervention or two, they all essentially aim to train the rotator cuff and surrounding musculature. Two Pitt Physical Therapy students, Christen Chiesa and Kevin Nguyen created an adapted thrower’s 10 program, the Wheeler’s 10, that can be found below. This exercise series is adapted from Wilk et al3 and is designed to improve strength, power, and endurance in arm and shoulder muscles for wheelchair users and adaptive athletes.
1. Pepke, W., Brunner, M., Abel, R. et al. Orthopedist (2018) Risk factors for rotator cuff ruptures in paraplegics 47: 561. https://doi.org/10.1007/s00132-018-3546-3
2. Akbar M1, Brunner M1, Ewerbeck V1, Wiedenhöfer B1, Grieser T1, Bruckner T2, Loew M3, Raiss P4. Archives of Physical Medicine and Rehabilitation Volume 96, Issue 3, March 2015, Pages 484-488, https://doi.org/10.1016/j.apmr.2014.09.032
3. Kevin E. Wilk, A. J. Yenchak, Christopher A. Arrigo & James R. Andrews (2011) The Advanced Throwers Ten Exercise Program: A New Exercise Series for Enhanced Dynamic Shoulder Control in the Overhead Throwing Athlete, The Physician and Sportsmedicine, 39:4, 90-97, DOI: 10.3810/psm.2011.11.1943
-Jim Tersak, SPT, CSCS