358

Shoulder Rotator Torque and Wheelchair Dependence

Differences of National Wheelchair Basketball Association
Players
John Nyland, EdD, PT, Kevin Robinson, MS, PT, David Caborn, MD, Elizabeth Knapp, BS,
Tony Brosky, PT, SCS.
ABSTRACT. Nyland J, Robinson K, Caborn D, Knapp E,
Brosky T. Shoulder rotation torque and wheelchair dependence
differences of National Wheelchair Basketball Association play-
ers. Arch Phys Med Rehabil 1997;78:358-63.
Objective: Shoulder rotator muscle imbalances can contrib-
ute to subacromial impingement. The forces and movement
patterns of wheelchair locomotion may contribute to these im-
balances. This study attempted to determine whether National
Wheelchair Basketball Association players of differing classi-
fications had significant differences (p 5 .05) in concentric
isokinetic peak shoulder rotator torque and torque ratios, and
wheelchair locomotion dependence.
Design: Fifty-seven (class 1 = 12, class 2 = 24, class 3 =
21) of 117 total tournament participants (class 1 = 25, class 2
= 49, class 3 = 43) served as the convenience sample of volun-
teers for the survey portion, and 33 of these subjects (class 1
= 11, class 2 = 12, class 3 = 10) also entered the isokinetic
portion of this study.
Setting: National wheelchair basketball tournament.
Results: Class 1 and 2 players had greater wheelchair depen-
dence than class 3 players (p 5 .05). Peak torque or torque
ratios generally did not differ among player classifications or
with other populations. Class 1 players had weaker nondominant
shoulder external rotator torque production at 60/sec (p 5 .03)
compared with other classes and at 180/sec compared with
class 3 players (p = .02), suggesting an inability to develop
the attenuation of dominance noted among other groups.
Diminished torque-producing capacity at 60/sec related to
greater wheelchair dependence among class 1 players (p =
.034).
Conclusions: Class 1 players failed to demonstrate the ac-
quired shoulder external rotator torque symmetry evident among
class 2 and 3 players (with specific weakness of the nondomi-
nant shoulder external rotators). This torque symmetry differ-
ence was related to their greater dependence on wheelchair
locomotion.
0 1997 by the American Congress of Rehabilitation Medicine
and the American Academy of Physical Medicine and Rehabili-
tation
0
RGANIZED COMPETITIVE wheelchair athletics date
back to 1948 and were developed originally as a means to
rehabilitate disabled war veterans. Individuals with congenital
From the University of Kentucky Sports Medicine Center
Submitted for publication March 8, 1996. Accepted in revised form September
6, 1996.
No commercial party having a direct or indirect interest in the subject matter
of this article has or will confer a benefit upon the authors or upon any organization
with which the authors are associated.
Reprint requests to John Nyland, EdD, PT, K437 Kentucky Clinic, University
of Kentucky Sports Medicine Center, Lexington, KY 40536.0284.
0 1997 by the American Congress of Rehabilitation Medicine and the American
Academy of Physical Medicine and Rehabilitation
0003-9993/97/7804-3934$3.00/O
deformities such as spina bifida, diseases such as polio, and
traumatic injuries such as spinal cord injury or amputation are
often active participants in wheelchair athletics. The number of
disabled athletes participating in competitive sports has rapidly
increased, and wheelchair sports have evolved from a rehabilita-
tion process to competitions on local, state, national, and inter-
national levels.- Competitive wheelchair athletes from 6 to 18
years of age form one of the fastest growing areas of wheelchair
athletics6 Increased and earlier participation in wheelchair ath-
letics raises further concern over the prevention of sports-related
injuries among this population.
THE BENEFITS OF WHEELCHAIR ATHLETICS
Disabled individuals who assume sedentary lifestyles often
have diminished functional capacity, rehabilitation potential,
and overall quality of life. A sedentary lifestyle can place the
disabled individual at greater risk for the development of cardio-
pulmonary disease, adult-onset diabetes, and hypertension.7
Regular endurance activities for individuals who depend on a
wheelchair as their primary method of locomotion may delay
the progression of these diseases, reduce the incidence of respi-
ratory infection, counter the development of osteoporosis, and
decrease the risk of calculi formation.* Increased habitual activ-
ity can also improve self-image9 and have a positive impact on
other health behaviors such as smoking or alcohol consump-
tion.
SHOULDER INJURY OCCURRENCE
Dependence on a wheelchair for locomotion (wheeling) and
repeated lifting of body weight during transfers place demands
on the upper extremities of the disabled that exceed those of
able-bodied persons., Wheelchair athletes rely on their upper
extremities for both propulsion and weight bearing during daily
living and sports activities.* The integrity of the upper extremi-
ties is believed to be a major determinant regarding the ultimate
level of functional independence of wheelchair athletes.*
With increased numbers of participants, and increased levels
of competition, sports-related injuries among this population
have also increased. In a 1972 survey conducted among Ameri-
can wheelchair athletes, 72% of respondents reported at least 1
injury as a result of sport participation, with soft tissue injuries
such as sprains, strains, tendinitis, and bursitis being the most
commonly reported.3 Hoeberigs and Verstappen13 reported that
42% of wheelchair basketball athletes developed upper extrem-
ity soreness during tournament play, with 34% reporting sore-
ness in the deltoid region. Among National Wheelchair Athletic
Association (NWAA) athletes, 61% of total injuries occur at
the upper extremity, with 40% of these injuries occurring at the
shoulder jointI
Shoulder injury and pain are also common among wheel-
chair-dependent nonathletes.~s~16 Bayley et alI7 reported that
33% of wheelchair-dependent paraplegic persons had chronic,
Arch Phys Med Rehabil Vol 78, April 1977
WHEELCHAIR BASKETBALL SHOULDER, Nyland 359
Class I
Complete motor loss at T7 or
above or comparable disability
where there is total loss of muscle
function originating at or above
T7.
Class II
Complete motor loss originating
at T8 and descending through
and incuding L2 where there may
be motor power of hips and
thighs. Also included in this class
are amputees with bilateral hip
disarticulation.
Class III
Al l other physical disabilities as
related to lower extremity
paralysis or paresis originating
at or below L3. Al l lower extremity
amputees are included in this
class except those with bilateral
hip disarticulation (see Class II).
Fig 1. NWBA player classifications.
persistent shoulder pain that was clinically diagnosed as sub-
acromial impingement syndrome. Despite being recognized as
a common and disabling problem, little has been written regard-
ing the cause, prevention, or treatment of shoulder problems
among wheelchair athletes.
WHEELCHAIR ATHLETIC SUBACROMIAL
IMPINGEMENT-MUSCULAR IMBALANCE
RELATIONSHIP
The primary cause of overuse injury or pain involving the
shoulders of wheelchair athletes is believed to be subacromial
impingement.* Overuse, lack of proper warm-up, glenohumeral
and scapula-thoracic dyskinesia (muscular imbalances), lack of
dynamic lumbo-pelvic postural control, axial weight bearing
forces, poor shoulder flexibility, repetitive overhead arm posi-
tioning, and fatigue may all contribute to subacromial impinge-
ment syndrome among wheelchair athletes.3~6~~1Z~15~21
Exaggerated glenohumeral internal rotation and scapular pro-
traction with downward rotation positioning is common for
wheelchair athletes both at rest and during aggressive wheeling.*
Repetitive function with the shoulder girdle in this position
reportedly promotes subacromial impingement in other ath-
letic22m24 and nonathletic populations.*
When upper extremity weight bearing increases, as during
wheelchair locomotion, changes in muscular agonist-antagonist
torque-producing ratios similar to those noted after intensive
conditioning programs may occur, often leading to greater
torque production symmetry (nondominance) between
Fig 2. IsokineticTest Positioning: (A) maximal internal rotation;(B) maxi-
mal external rotation.
extremities and imbalances between opposing muscular
groups. 19,26 Shoulder muscle imbalances with humeral head de-
pressor weakness (infraspinatus, teres minor, subscapularis,
long head of biceps brachii) in combination with repetitive axial
subacromial space loading from weight bearing may further
exacerbate subacromial impingement among wheelchair ath-
letes.19 Wheelchair propulsion selectively promotes the devel-
opment of glenohumeral joint internal rotator (pectoralis major,
teres major, latissimus dorsi, subscapularis) and scapular pro-
tractor (serratus anterior) torque-producing capacity, thereby
creating muscular imbalances.2,27
Dysfunctional sitting posture resulting from neurological
deficits or simply poor habits can adversely affect the glenohu-
meral joint through changes in scapula-thoracic articulation ori-
entation. Subtle changes in glenoid fossa alignment can evoke
compensatory muscular stabilization demands that eventually
promote joint degeneration. Paraplegic persons with complete
Table 1: Subject Demographics
NWBA
Classification
Wheelchair
Basketball
Duration of Playing
Disability Experience Height Weight
Age (yrs) km) lvrs) (cm) kg)
Class 1 (n = 12) 35.7 -C 4 14.3 i 5 ll.Oi 5 183 2 IO 8Oi 18
Class 2 (n = 24) 35.8 k 8 17.8 I 11 11.9 t 8 180 t 11 74-t 15
Class 3 (n = 21) 34.4 t 7 19.2 2 11 II.82 6 184i 10 88~ 17
Characteristics presented as mean +- SD.
p > .05.
Arch Phys Med Rehabil Vol78, April 1997
360 WHEELCHAIR BASKETBALL SHOULDER, Nyland
Table 2: Wheelchair Dependence
NWBA
Classification
Class 1 (n = 12)
Class 2 (II = 24)
Class 3 (n = 21)
Values presented as mean 2 SD.
Wheelchair Dependence
him)
93.1 k 15.0*
76.2 -t 35.4*
30.2 % 30.6
* Overall F = 26.7 (p = .OOOl); Class 1 and Class 2 r Class 3 (p 5 .05).
spinal cord lesions below the second thoracic (T-2) spinal nerve
root level can achieve partial sitting postural compensation for
decreased erector spinae muscle group function by increased
latissimus dorsi and upper trapezius muscle activationzl When
dynamic trunk control is compromised, these muscles may serve
more as postural stabilizers for the trunk than as prime movers
for the upper extremity, thereby further promoting glenohu-
meral muscular imbalances.r The ability to dynamically control
sitting posture is vital for proper scapula-thoracic and glenohu-
meral function and efficient performance of functional tasks
with the upper extremities.*l Spinal cord injured subjects tend
to sit with their pelvis tilted 15 more posteriorly than normal
subjects to enhance sitting balance in the absence of effective
dynamic lumbo-pelvic control.28 This sitting posture further pro-
motes inefficient scapula-thoracic and glenohumeral position-
ing, motion, and torque-producing capacity.25
NWBA RATING SYSTEM
According to a study performed in 1984, the National Wheel-
chair Basketball Association (NWBA) includes approximately
1,950 players on more than 16.5 mens and womens teams in
27 conferences.13 The NWBA is the oldest organization in the
United States representing athletes with locomotor impair-
ments.29 To be eligible for NWBA participation individuals
must have permanent severe leg disability or paralysis of the
lower portion of the body, as well as the potential for benefiting
from participation in wheelchair basketball, and must be denied
the opportunity to otherwise play basketball were it not for the
wheelchair adaptation. The NWBA favors a functional classifi-
cation system for its participants based on the quality and quan-
tity of active muscle and the ability to perform specific tasks
such as trunk rotation and picking a basketball up from the
floor. This functional classification system generates three
player categories, ranging from relatively higher spinal cord
injured athletes (class l), who are almost exclusively wheelchair
dependent, to any of a wide variety of other medical conditions
that generally do not result in as great a wheelchair dependence
(class 3). Class 3 players often leave their wheelchairs courtside
at the completion of play and walk around with or without other
assistive devices. Player classifications are denoted in figure 1.30
Although studies have assessed shoulder muscle torque-produc-
ing capability2*20,26 and relative wheelchair dependence,6X15 com-
parison of wheelchair basketball players based solely on their
NWBA classification has not been performed. The purpose of
this study was to determine if NWBA player classification resulted
in statistically significant differences (p 5 .05) in (1) concentric
Table 3: Peak Shoulder External Rotator (ER)
and Internal Rotator (IR) Torque
ER Peak IR Peak
ER Peak IR Peak Torque Torque
NWBA Torque Torque (Nm), (NmL
Classification (Nm), 60%~ (Nm), dO/sec 180isec 180%ec
Class 1 (n = 11) 45.8 i 9.8 74.7 k 11.7 36.9 ? 9.2 64.8 f 9.4
Class 2 In = 12) 42.2 ? 13.6 69.4 2 14.9 31.3 ? 12.1 58.0 i 13.0
Class 3 (n = IO) 41.4 k 9.4 70.2 k 13.3 31.2 2 7.2 61.3 2 9.2
Values presented as mean ? SD.
p > .05.
isokinetic peak torque of the shoulder internal and external rota-
tors, (2) the ratio of dominant and nondominant concentric isoki-
netic peak torque of the shoulder internal and external rotators,
and (3) wheelchair dependence for locomotion.
Peak torque and torque ratios were also compared and con-
trasted with other populations.
METHODS
Procedures
Informed consent was obtained from each participant in the
study. Data collection took place during the 13th Annual Blue-
grass Invitational Wheelchair Basketball Tournament. Data col-
lection was coordinated by the primary investigator. The
NWBA classification was verified from tournament registration
applications at the conclusion of the tournament.
Subjects
The study population was sampled from the 117 participants
(class 1 = 25, class 2 = 49, class 3 = 43) in the basketball
tournament. Fifty-seven (class 1 = 12, class 2 = 24, class 3 =
21) players volunteered to participate in the questionnaire por-
tion of this study, which attempted to determine wheelchair
dependence as the primary mode of transportation. The follow-
ing question was used to determine wheelchair dependence:
Excluding motorized vehicles, I use a wheelchair as my pri-
mary method of transportation ? percent of the time. Re-
sponses could range from Neve? to All the Time. Before
answering this question, subjects completed a trial question un-
der the supervision of the principle investigator to become fa-
miliar with the visual analog scale (VAS) format and to increase
measurement reliability.31 Additional information was obtained
regarding the duration of disability, wheelchair basketball play-
ing experience, height, and weight. Of these subjects, 33 (class
1 = 11, class 2 = 12, class 3 = 10) players volunteered to
participate in the isokinetic portion of this study. Only subjects
who were asymptomatic for upper extremity or trunk pain par-
ticipated in this portion of the study. Isokinetic testing was
performed using a Cybex II isokinetic dynamometer and dual
channel recordera and a Biodex Upper Extremity Chair.b The
Biodex chair was used for its hydraulic lift capability, which
enabled greater ease of transfer while simultaneously enabling
replication of the test position described by Cahalan et a1.32
Table 4: Dominant (DOM) and Nondominant (NONDOM) Shoulder External Rotator (ER) and Internal Rotator (IR) Peak Torque Ratios
NWBA DOM ER/lR Peak Torque NONDOM ER/IR Peak Torque DOM ER/IR Peak Torque NONDOM ER/IR Peak Torque
Classification Ratio, 6O%ec Ratio, 60/sec Ratio, 18O/sec Ratio, 180lsec
Class 1 (n = 11) .66 k .I1 .57 i .05 .58 ? .08 .54 2 .06
Class 2 (n = 12) .60 i .I3 .59 2 .I1 .53 ? .I1 .53 i .I2
Class 3 (n = IO) .58 2 .08 .59 t .I2 .50 + .I0 54 2 .I3
Values presented as mean i SD.
p > .05.
Arch Phys Med Rehabil Vol78, April 1977
WHEELCHAIR BASKETBALL SHOULDER, Nyland 361
Table 5: Nondominant (NONDOM)/Dominant (DOM) External Rotator (ER) and Internal Rotator (IR) Peak Torque Ratios
NWBA NONDOM/DOM ER Peak Torque NONDOMiDOM IR Peak Torque NONDOMiDOM ER Peak Torque NONDOMiDOM IR Peak Torque
Classification Ratio, 607s~ Ratio, 60%~ Ratio, 180lsec Ratio, l80lsec
Class 1 (n = 11) .77 2 .11* .91 i .I4 .84 k .14+ .93 i .I4
Class 2 (n = 12) .97 ir .24 1.0 f .I6 1.04 F .24 1.04 2 .I8
Class 3 (II = IO) 1.0 k .I3 .98 ir .I9 1.16 z .30 1.0 -t .I7
* NONDOM/DOM ER Peak Torque Ratio, 60/sec, overall F = 4.9 (p = .Ol). Differences from Class 2 (p = .03), Class 3 (p = .02).
NONDOM/DOM ER Peak Torque Ratio, l$O/sec, overall F = 4.5 (p = .04). Differences from Class 2 (p = .ll), Class 3 (p = ,021.
Torso and forearm stabilization straps were used. Test position-
ing and motion pattern are presented in figure 2. During isoki-
netic testing, the upper extremity which was tested first was
randomly selected. Before determination of peak shoulder inter-
nal or external rotator torque, each subject performed three
submaximal practice repetitions. Following this, each subject
was instructed to perform five repetitions with maximal effort.
This procedure was performed initially at 60lsec and then at
180/sec. Standard recorder settings were used for damping,
chart speed, and torque scale.33 This procedure was then re-
peated for the opposite upper extremity. Following completion
of isokinetic testing, peak torque values were manually mea-
sured per manufacturers protocol.33
Statistical Methods
Means and standard deviations were calculated for each vari-
able. Median and range values were also determined for the
wheelchair dependence variable. One-way analysis of variance
(ANOVA) tests were employed to determine whether significant
differences existed among the mean torque variables and wheel-
chair dependence values of each NWBA classification. When
a significant F value occurred, Tukey Honest Significant Differ-
ence post hoc comparisons were employed to specify how the
groups differed from each other. A probability level of p 5 .05
was chosen for all statistical procedures to demonstrate statisti-
cal significance.
RESULTS
Age, duration of disability, wheelchair sports experience,
height, and weight were not significantly different among player
classifications (table 1). Class 1 and 2 players depended on
wheelchairs as their primary mode of transportation to a greater
extent than class 3 players (p 5 .05) (table 2).
Comparisons of peak shoulder external or internal rotator
torque at 60/sec and lSO/sec failed to reveal statistically sig-
nificant differences among player classifications (table 3). The
dominant upper extremity was defined as that which the subject
preferred to use while shooting a basketball. Comparisons of
dominant or nondominant peak shoulder external/internal rota-
tor torque ratios at 60/sec and lXO/sec failed to reveal signifi-
cant differences among player classifications (table 4).
Comparisons of nondominant/dominant peak shoulder exter-
nal and internal rotator torque ratios at 60/sec and 180/sec
found statistically significant decreases in external rotator torque
on the nondominant shoulder for class 1 players compared to
class 2 and 3 players at 60/sec, and compared to class 3 players
at lSO/sec (table 5). Comparisons of nondominant/dominant
peak shoulder external rotator torque and NWBA player classi-
fication by wheelchair dependence found significant differences
at 60/sec between class 1 players and other classes (table 6)
(fig 3).
DISCUSSION
Comparisons were made among peak shoulder external and
internal rotator torque (table 3), dominant and nondominant
shoulder external/internal rotator peak torque ratios (table 4),
and nondominantldominant shoulder external and internal rota-
tor peak torque ratios (table 5). Comparisons were also made
with other studies22,23,32,346 for peak shoulder external and inter-
nal rotator torque (table 7) dominant and nondominant shoulder
external/internal rotator peak torque ratios (table 8),22,23,32,34-3g
and nondominant/dominant shoulder external and internal rota-
tor peak torque ratios (table 9).22~23*32,34~36 Studies were chosen
that used similar isokinetic testing procedures and positions
including shoulder positioning (although slight differences in
shoulder flexion and abduction angles did occur, and varying
isokinetic devices were used).
Peak shoulder rotator torques reported in this investigation
compared favorably with previous reports of wheelchair athletes
and other populations (table 7). Peak dominant and nondomi-
nant shoulder external/internal rotator torque ratios (table 4)
also compared favorably with previous studies of wheelchair
athletes, and other populations (table 8).
NondominantIdominant peak shoulder external rotator torque
results for class 1 wheelchair basketball players revealed statisti-
cal differences when compared to class 2 and 3 players (table
5) and when compared to other athletic populations (table 9).
These results indicate that although class 1 wheelchair basket-
ball players fail to demonstrate significant differences in peak
torque capacity compared to class 2 or 3 players, they demon-
strate a lack of the acquired bilateral shoulder external rotator
torque symmetry (attenuation of dominance) reportedly com-
mon among other wheelchair athletes2,26 with weaker nondomi-
nant shoulder external rotators (table 8). Comparisons of non-
dominant/dominant peak shoulder external rotation torque at
60isec and NWBA player classification by wheelchair depen-
dence provided further evidence of differences between class 1
players and other player classes (table 6) (fig 3).
Although not primarily assessed in this study, faulty sitting
posture may contribute more to the development of glenohu-
meral joint muscular imbalances among class 1 players more
than other wheelchair basketball players. Lesions at or above
Table 6: Class Comparisons of Wheelchair Dependence Versus Nondominant/Dominant External Rotator Torque Ratios at 60lsec
SOUrCe Wheelchair Dependence Sum-of-Squares Degrees of Freedom F Ratio P
Class 1 External Rotator Ratio (n = 11) 95.6 t 4.4 78.2 1 6.3 .034*
Class 2 External Rotator Ratio (n = 12) 66.9 i 25.9 1953.4 1 3.6 ,086
Class 3 External Rotator Ratio (n = IO) 23.9 ir 16 9.941 1 ,035 .86
Wheelchair dependence values presented as mean 2 SD.
* p I .05.
Arch Phys Med Rehabil Vol 78, April 1997
WHEELCHAIR BASKETBALL SHOULDER, Nyland
0
0
0
0
Fig 3. Relation of wheelchair dependence and nondominantldominant
external rotator torque at 60lsec to player classification.
the seventh thoracic (T-7) spinal nerve root level (class 1 by
definition) can produce greater and more variable dynamic trunk
control and shoulder mobility deficits than either of the other
two player classifications. Concurrently, any loss of normal
neural function above the T-7 spinal nerve root level may also
Table 7: Peak Shoulder External Rotator (ER) and Internal Rotator (IR) Torque Comparisons
affect both intrinsic and extrinsic shoulder girdle muscle torque
producing capacity. When normal innervation is compromised,
scapula-thoracic and glenohumeral muscular imbalances may
result, increasing susceptibility to subacromial impingement.
Because of their greater wheelchair dependence, and potentially
more impaired dynamic trunk control, class 1 wheelchair bas-
ketball players may be especially susceptible to subacromial
impingement from glenohumeral joint muscular imbalances.
CONCLUSIONS
This studv found that:
1.
2.
3.
Differences did not exist among the concentric isokinetic
peak shoulder rotator torque or nondominantidominant
torque ratios of differing NWBA player classifications or
other populations;
Differences did exist in nondominant/dominant external
rotator torque ratios, with class 1 wheelchair basketball
players failing to demonstrate the symmetry of external
rotator torque (attenuation of dominance) demonstrated
by class 2 or 3 wheelchair basketball players or other
populations, with specific weakness of the nondominant
glenohumeral joint external rotators;
Class 1 wheelchair basketball players were more depen-
dent on wheelchairs as their primary mode of transporta-
tion than either class 2 or 3 players, and this dependence
related to differences in nondominant external rotator
torque-producing capacity.
Athletic examinations and conditioning programs of wheel-
chair basketball players before participation should place partic-
ular emphasis on functionally evaluating the entire shoulder
joint complex, with emphasis on glenohumeral external rotator
and scapular retractor function as integrated members of a
global kinetic chain that has an origin primarily from a sitting
position. Class 1 players may be at greater risk for developing
glenohumeral muscular imbalances than their class 2 or 3 coun-
terparts because of greater wheelchair dependence, inherently
Reference Citations
ER Peak Torque (Nm),
60%X
IR Peak Torque (Nm),
60%~
ER Peak Torque (Nmt,
180%ec
IR Peak Torque (Nm),
18O/sec
Brown et aP4 (Male Baseball)
Cahalan et ai3 (Healthy Adults)
Hageman et all5 (Healthy Adults)
Leroux et alI6 (Healthy Adults)
McMaster et al* (Healthy Males) (Male Water Polo)
McMaster et alz3 (Healthy Males) (Male Swimmers)
NA NA 39.7 k 7.1 56.9 k 9.9
35.3 k 8.1 62.4 2 19.0 27.1 +- 5.4 54.2 ? 17.6
30.6 2 5.3 48.6 i 11.0 26.7 k 7.1 42.3 + 8.3
32.1 -+ 1.9 43.6 i 4.0 29.3 + 2.1 39.0 t 3.7
NA NA 37.1 i 8.7 56.7 i 12.7
46.8 2 10.7 89.3 i 23.3
NA NA 37.1 2 8.7 56.7 + 12.7
38.6 f 10.8 89.9 i 27.1
Values presented as mean t SD. NA = not applicable.
Table 8: Dominant (DOM) and Nondominant (NONDOM) External Rotator IER) Internal Rotator (IR) Peak Torque Ratio Comparisons
DOM EWIR Peak
Torque Ratio,
60%~
DOM ERilR Peak
NONDOM ER/IR Peak
Torque Ratio, 60%x
Torque Ratio,
180%~
NONDOM ERilR Peak
Torque Ratio,
180/sec Reference Citations
Brown et al34 (Male Baseball) NA
Cahalan et a13 (Healthy Adults) .56
Greenfield et alz7 (Healthy Adults) .a2
Hageman et aP5 (Healthy Adults) .63
Leroux et a13 (Healthy Adults) .74
McMaster et alz2 (Healthy Males) (Male Water Polo) NA
McMaster et a? (Healthy Males) (Male Swimmers) NA
Soderberg et al38 (Healthy Males)
Walmsley et alz9 (Healthy Females)
.60 NA
.63 NA
Mean values presented. NA = not applicable.
NA
.60
NA
NA
.80
NA
NA
.70 .72
.48 .54
NA NA
.59 NA
.72 .80
.65 .66
.55 .56
.65 .66
.45 .55
.61 NA
.60 NA
Arch Phys Med Rehabil Vol78, April 1977
WHEELCHAIR BASKETBALL SHOULDER, Nyland 363
Table 9: NONDOM/DOM External Rotator (ER) and Internal Rotator (IR) Peak Torque Ratio Comparisons
NONDOM/DOM ER Peak NONDOMiDOM IR Peak NONDOMIDOM ER Peak NONDOM/DOM IR Peak
Reference Citations Torque Ratio, 60%~
Brown et al34 (Male Baseball) NA
Cahalan et a13 (Healthy Adults) 1.0
Leroux et a136 (Healthy Adults) 1.0
McMaster et al** (Healthy Males) (Male Water Polo) NA
McMaster et alz3 (Healthy Males) (Male Swimmers) NA
Mean values presented. NA = not applicable.
less trunk control, and a lack of acquired shoulder external
rotator torque symmetry (as noted among class 2 and 3 players)
with specific weakness of the nondominant glenohumeral exter-
nal rotators. Further research is necessary with greater subject
numbers while attempting to establish the clinical significance
of these findings with functional capacity.
1.
2.
3.
4.
5.
6.
I.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17
18.
19.
20
21
22
Strauss R. Sports medicine. Philadelphia: WB Saunders, 1984.
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Suppliers
a. Cybex Division of Lumex, Inc., 2100 Smithtown Avenue, Ronkon-
koma, NY 11779.
b. Biodex Medical Systems, Inc., 20 Ramsay Road, Shirley, NY 11967-
0702.
Arch Phys Med Rehabil Vol78, April 1997