Browsing by Author "Roche Stephan"

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    Open Access
    Development of the shoulder return to contact continuum in rugby: an assessment framework for traumatic anterior glenohumeral joint dislocations
    (2025) Geldenhuys, Alda Grethe; Burgess, Theresa; Roche Stephan
    Rugby is a highly demanding sport, which imposes a high risk of musculoskeletal injuries, particularly due to contact events. Among these, traumatic anterior glenohumeral joint (GHJ) dislocations are among the most significant, as these injuries account for prolonged absence from sport and imposes a high risk of reinjury following return to sport (RTS). There is a need for an assessment framework to facilitate safe and time efficient RTS and in particular return to contact events in rugby. The main aims of the thesis were to explore RTS practices following musculoskeletal injuries in rugby in general and subsequently to develop a return to contact assessment framework following traumatic anterior GHJ dislocations in rugby players to guide health and sport practitioners' decisions. Methods and results To lay the groundwork, we performed a systematic review to investigate management protocols and assessment modalities utilised for RTS following musculoskeletal injuries in rugby as well as related tackle-collision team sports. A cross-sectional observational survey was subsequently conducted to investigate the views, current practices and barriers encountered by health and sport practitioners during RTS following musculoskeletal injuries in rugby settings. Sixty-four practitioners including physiotherapists, orthopaedic surgeons, biokineticists, and sports physicians participated. The criteria rated as both important and commonly utilised in each phase of RTS, namely return to non-contact, return to contact, and return to matches, included time frames, subjective, functional and sport specific criteria. Common barriers encountered by practitioners during RTS included lack of access to resources and time constraints. Due to a paucity of assessment modalities in the literature to guide RTS following upper limb injuries, a scoping review was conducted to explore any modalities utilised to evaluate shoulder and upper limb function in rugby. A range of modalities to evaluate GHJ muscle strength/power, flexibility, endurance and activation, joint ROM and laxity, proprioception and sport specific skill evaluations in rugby were identified. Although the reliability of many of these assessment modalities were established, very few studies investigated their validity and other clinimetric properties. Moreover, only a few assessment modalities demonstrated any association to injury incidence or risk factors in rugby settings. Following the broad exploration, three targeted studies were performed to develop and evaluate a return to contact assessment framework following traumatic anterior GHJ dislocations. Firstly, a three-round Delphi consensus study was conducted to formulate return to contact criteria and to identify assessment modalities to evaluate these criteria. Thirty-three practitioners including physiotherapists, orthopaedic surgeons, biokineticists and sports physicians participated. Twenty-nine out of 40 broad criteria reached consensus for inclusion (based on at least 70.0% agreement). This included subjective, clinical, and functional criteria related to the shoulder and general conditioning, time frames and rugby specific considerations. Assessment modalities such as the anterior apprehension and relocation test, visual analogue scale pain ratings and observation of functional movements were recommended to evaluate criteria. There was less clarity regarding the best way to assess rugby skills. To explore the perspectives of various stakeholders in more depth, three focus groups with 18 health and sport practitioners and five individual interviews with rugby players who experienced GHJ dislocations were conducted. Four main themes emerged. Firstly, the pathway to developing a framework was explored. Secondly, the need to reintroduce contact skills during a progressive, graduated return to contact continuum process, which moves from controlled conditions to uncontrolled conditions, was outlined. Thirdly, the need to re-assess regularly subjective, clinical, and functional criteria to guide progress along this continuum was explored. Fourthly, the potential of communication, goal setting, psychological state, and socioeconomic context to facilitate or impede return to contact and RTS as experienced by injured players were discussed. A novel assessment framework, the Shoulder Return to Contact Continuum in Rugby (Shoulder RCCR) was formulated based on an amalgamation of the findings of these studies. Finally, the face- and content validity of the assessment framework were evaluated through expert feedback. Twenty-two health and sport practitioners provided high ratings of the appropriateness, value, and feasibility of use of this framework. Additionally, seventeen of these practitioners completed a pilot clinical vignette to evaluate the theoretical utility of the framework. Based on the clinical scenario provided, a heterogenous range of return to contact decisions were reported. This may reflect the complexity and multifactorial nature of RTS decisions, difficulty with the prediction of reinjury risk and different interpretations of terminology used. Conclusion: Return to sport decisions following musculoskeletal injuries should be guided by a combination of clinical, functional, psychological and rugby specific criteria alongside time frames. A novel return to contact assessment framework, the Shoulder RCCR, was developed for rugby players with traumatic anterior glenohumeral joint dislocations. The framework provides recommendations for a holistic evaluation of players with multidisciplinary involvement. The reintroduction of rugby skills during a graduated return to contact continuum guided through regular re-assessments is recommended. The incorporation of the players' input and perceived readiness should be emphasised throughout RTS. Return to contact decisions in rugby remain complex and careful reflection and clinical reasoning is advised for of each individual case.
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    Open Access
    The musculoskeletal profile of female adolescent elite water polo players and the factors affecting throwing performance.
    (2024) Verwey, Lianne; Gray, Janine; Roche Stephan
    Water polo is a popular water-based sport and a physically challenging game. Water polo demands extreme glenohumeral joint ranges of motion while throwing overhead, which is an entire-body movement requiring accuracy and precision. Water polo is unique as it loads the shoulder in four different ways, where players are required to swim explosively, pass and shoot the ball as well as wrestle with opponents and defend attempts at goal. A marked paucity of research exists regarding the factors affecting throwing performance in this vulnerable population. To date, there is also limited evidence on the musculoskeletal profile of female adolescent water polo players and whether it is comparable to that of other overhead athletes. An overview of the literature (Chapter 2) describes the biomechanics of throwing in overhead sports, and the unique features of throwing biomechanics in water polo. Water polo players are required to throw from an unstable base of support and utilise an egg-beater kick which necessitates different kinetic chain contributions. Further, the parameters of throwing performance and the factors influencing it are discussed. While several studies have analysed musculoskeletal predictors of throwing performance in other overhead sports, very little is known about water polo, especially adolescent females. There are some common factors affecting throwing performance amongst overhead athletes, including anthropometric variables such as gender, age, height and body mass index, which all affect throwing speed and/or throwing accuracy. Range of motion of the glenohumeral joint, hip and knee joints as well as the thoracic spine have all been correlated with throwing speed in other overhead sports. Upper limb strength of the glenohumeral rotators, pectoralis minor muscle, wrist flexors, elbow extensors and grip strength have also been associated with throwing speed. Further, medicine ball throws also predicted throwing speed in cricket, handball and tennis. Lower limb strength in the form of hip abduction and abdominal strength as well as lower limb power were also found to influence throwing speed. There are also some unique variables to water polo which include extrinsic factors such as the presence of a goalkeeper, distance from the goalposts and different environmental conditions, which may affect throwing performance. The musculoskeletal profiles of overhead athletes appear to share features, but there are also unique variables seen in the different overhead sports. Water polo players do not appear to follow the typical ‘thrower's paradox' described for baseballers. Instead, they are found to largely preserve their glenohumeral internal rotation range of motion and have lower glenohumeral external to internal 16 rotator strength ratios. Therefore, the musculoskeletal variables found amongst baseballers are unique and cannot be directly extrapolated to other sports, including water polo. The musculoskeletal profile of female adolescent water polo players and the relationship between these variables and throwing performance have not been well described in the literature. Chapter 3 is the research chapter and describes the musculoskeletal profile of female adolescent water polo players and the musculoskeletal contributors to throwing performance in this population. Age group related changes in musculoskeletal variables and side-to-side asymmetries were investigated. There were three steps in the data collection process. Firstly, informed assent/consent and basic demographic information was obtained after participants had been selected for a regional representative team. Participants completed the Kerlan-Jobe Orthopaedic Clinic questionnaire to assess shoulder functionality. Secondly, a battery of musculoskeletal screening tests was conducted. Anthropometry, pain-provocation tests (Hawkins/Kennedy, Empty Can and Full Can), glenohumeral rotational range of motion, upward scapula rotation, scapular and glenohumeral strength measurements, pectoralis minor length and medicine ball throw tests were included. Finally, participants performed throwing speed and throwing accuracy tests in the pool which were measured with a radar gun and the number of targets hit, respectively. All the collected data was grouped together and analysed using SPSS 28.0 (IBM, Armonk, New York, USA). The condition for statistical significance was set as p