The effect of early range of motion and power exercises in overhead athletes with a slap lesion repair

Superior Labrum Anterior to Posterior (SLAP) tears are a common injury seen in the overhead athlete population and are described as injury to the superior portion of the glenoid labrum from 10 o’clock to 2 o’clock when referencing the face of a clock. Erikson et al. (2006) propose two accepted theories of mechanism of injury which include the eccentric load that occurs at the long head of the biceps tendon (LHBT) during the deceleration phase of throwing as it pulls on the superior portion of the labrum. Since the LHBT originates on the supra-glenoid tubercle (50%) and the superior labrum (50%) itself, there may be a separation of both structures causing a tear. The other proposed mechanism occurs during the late-cocking phase of throwing that causes a torsional force between the LHBT and the superior aspect of the labrum which may also result in a tear as the athlete prepares to enter the acceleration phase (Erikson et al, 2016). It is likely that a combination of eccentric load during the deceleration phase and torsional forces during the late cocking phase result in a SLAP tear. It is important to distinguish between types of SLAP tears. There are 4 recognized types of SLAP tears but as many as 10 sub-types have been identified in the literature (Snyder et al., 1990). Since type two tears are most common in overhead athletes, they will be the focus of this study. We will construct a rehabilitation protocol based on the most current literature; add one range of motion (ROM) modality and one power output modality for a total of two groups (control and experimental) in a between group experimental design. The control group will be progressed through a rehabilitation protocol as deemed standard by the author and orthopedic surgeons. The experimental group will include the addition of proprioceptive neuromuscular facilitation patterns D1 and D2 starting in week 5 and the addition of the push press week 20 at a rep scheme of 5 sets of 5 repetitions. The purpose of PNF will be to increase ROM and the purpose of the push press will be to increase strength and power output. The working hypothesis of the author is that through the addition of the two modalities the experimental group will have better functional outcomes as measured by the Kerland-Jobe Orthopedic Clinic Shoulder Score (KJOC) and UCLA shoulder score. The subjects were chosen from two universities due to their classification as overhead athletes (convenience sampling). A total of 15 (n=15) subjects were recruited voluntarily from two division 2 baseball programs. Each of the 15 participants had a type 2 SLAP tear repair and was no longer than 2 weeks post-surgery at the time of recruitment. All exercises and progressions were supervised by a certified Athletic Trainer with at least 3 years’ experience in their field.