Jenna Sieve, SPT, Sara Peterson-Baker, SPT, and Marisa Blackwell, SPT
This is a thought provoking poster and well done.
What would be your recommendation as clinicians as far as balancing exercise and stretching to maximize ROM, while maintaining joint integrity in the shoulder?
In regards to this specific study, we believe it would be important for any older adult or athlete to participate in a variety of different activities. Differences between shoulder flexibility are significant between athletes of sports with differing requirements. By participating in sports with overhead motion, you are likely to keep your shoulder ROM due to actually using the joint through it’s full range during play. We did not specifically ask our athletes about completion of a stretching program. It is important for all athletes to balance exercise and stretching. As we age, flexibility has been shown to decrease, making stretching a very important piece to any physical activity routine.
With an age range of 50+, do you feel that the younger athletes were generally more flexible and tended to weight the averages toward more flexible or were there similarities across the age ranges?
Overall, flexibility decreases with age as shown in the other group’s study “Flexibility of the Aging Athlete.” We didn’t separate athletes out by sport and age, so therefore it’s difficult to say what influence the younger athlete’s increased flexibility had on the results. Also, you could look at the quantity of athletes within each sport and age group, as that could also influence the results. We looked at just flexibility and sport, so theoretically, if there was a true difference between athletes in each sports, those differences seen between age groups should not make a huge influence.
I found it very interesting that golfers were lacking flexibility in all 3 measurements. Was this a surprise to you as well? You did mention golf cart use is required in play so this could account for some decreased strength and cardiovascular benefits from carrying your bag and walking the course, but is the limited end-range motion age-related or is this something these players could improve? I would think the demands of the activity would require greater than average shoulder ROM and at least average lower extremity flexibility if the athletes wanted to perform efficiently and effectively, but did you find they still performed well even with these deficits? Sorry if this is confusing, I just found this topic very interesting!
We did find it interesting that golf scored below average for all three measurements. First, this may be due to the nature of the sport being a leisure activity. Second, the position of the sport is flexed, which would contribute to the decreased amount of shoulder flexion and decreased hip flexor length. Golf also does not require increased gastrocnemius length to be successful within the sport. We are unable to comment on the overall performance of the athletes as we did not look at how they scored or placed in comparison to their screen results.
What do you feel was the biggest limitation in your study or an area you would like to expand on in the future when working with senior athletes? Since these individuals would do extremely well on the Berg or Tinetti, is there another functional test or other measurements (other than gastrocnemius length) that you found during your research to determine fall risk for senior athletes?
One of the biggest limitations that we found in our study was relying on athlete report of injury and falls of the last year. Since the National Senior Games are every two years, we should have asked about the injury or falls in the last 2 years but also with that, we cannot guarantee reliable reporting of incidents. During the screen, we also assess gait speed during normal pace and fast pace which is a good outcome measure to help determine risk of falls. Since these individuals are higher functioning, we found this was an area that helped to better determine risk of falling. Also, balance testing with multiple variables also was a measure we found to help determine fall risk.
Overall, great job! I find this topic to be very interesting. In fact, I had the opportunity myself to participate in a very similar study. In our research we noticed that there was three common trends associated with flexibility: age, gender, and joints. In the research it is shown that as age increases their is a greater decline in flexibility seen in men than women. When analyzing flexibility by sport did your research team consider the gender differences? If not do you believe the results would be significantly different if the results were further analyzed by gender differences. Also, in regards to shoulder flexibility in golf and tennis was their a significant difference in range of motion when comparing the athletes dominant arm vs his/her non dominant arm due to the fact that more shoulder flexion is required on the dominant side to complete a swinging motion?
Thank you Clay,
In response to your first question about gender. We didn’t analyze out data by looking at gender differences as that wasn’t one of the purposes we had developed at the beginning of our study. However, you raise a good point in that for further research within this area, one could look at the difference of flexibility by sport and gender to see if there is any difference between the two variables. To address your question about shoulder flexibility, when we first ran the data, we looked at dominant shoulder flexibility compared to average shoulder flexibility and saw no significant difference between running either set of data so we chose to use the average shoulder flexibility as we were also using the average hip and ankle measurements. If there would have been a significant difference, we would have definitely ran the dominant shoulder data and included it in our research.
In rural South Dakota, a large majority of our patients are seniors, but very few of them could be considered athletes. I’m interested to know if your research into this special geriatric population has changed the way you treat less active geriatric patients in your clinicals thus far?
Being able to work with senior athletes definitely changed my perspective of what the aging person is capable of if they continue to stay active. In my personal opinion, I have not drastically changed the way I treat non-active seniors; as most of them are so deconditioned and weak that they physically would not be capable of more challenging exercises. However, it has changed the way I educate them about the importance of exercise and how it can prolong independence and good health. For older adults that are not considered geriatric, I use it to motivate them to continue doing what they are doing, and tell them that just because they are getting older does not mean that they have to stop being active.
How do you think your results would change if you broke down the groups by age/gender rather than by sport? Basically, do you think senior athletes still decrease in function as they age and do you think the decrease is as quick as patients in the same age group who are more sedentary?
The other group that studied senior athletes and flexibility looked more into the trend associated with age and gender. They found that in general, flexibility decreases with age. This happens in the general population and in senior athletes, however remaining active has shown a slower progression. The more active we can keep our patients as they age, the more likely they are to maintain their flexibility, or at least not progress as fast as someone who is not active.
Especially important is that your study confirms the importance of flexibility in fall prevention. Falls continue to be the number one cause of death in the senior population and having lost my very healthy mother and very healthy active neighbor to falls when they were both just 73 has made me so aware of this. Our patients do not have to be senior athletes to reduce this risk factor but interesting to find that even when testing just senior athletes that they still need flexibility not just activity to be in the reduced fall risk group.
I think you did a nice job in most all aspects of this study. Clearly stated information. Why did you decide on 4 different hypothesis instead of focus on one aspect of the study?
Originally, we started with a completely different hypothesis and found nothing when the data was run. From here we looked at the past other research projects our advisor had completed using the National Senior Games data. The other studies had looked at how reliable and valid the screening measures we performed at the games were but not how the results from the screen actually affected the individual. Once we dove into the data, we became interested in all the different aspects since no one had yet analyzed them. We may have been a little overzealous but we also felt like this was opening the door to further research within this area.
Great job! One question I have is if the sport affects the flexibility or if flexibilty affects the sport. For example, do athletes with poor shoulder ROM choose to participate in swimmming? Would patients with poor shoulder ROM have increased pain, decreased effeciency and thus less enjoyment in the sport of swimming and thus choose to participate in a different sport that would not require them to move in planes of movement that they found difficult?
This is an interesting and complex question as there are many factors that can affect a person’s flexibility. We did not specifically examine this relationship in this research, but we did look at the relationship between recent injury and flexibility. The results showed that there was no significant relationship between lower extremity injury and flexibility; and the relationship between shoulder injury and flexibility was found to be clinically insignificant. Again there were too many factors that could affect these results, such as did the injury cause a decrease in ROM or did the decreased ROM lead to an injury. However, it would be interesting to see if people chose sports based on what they are capable of doing physically versus what they enjoy doing.
With the knowledge you’ve gained from completing this study, is there anything that you would decide do differently if you were to perform the study again? If you were to make changes, what would they be and for what reason?
I think something that we have discussed as a team was how we ask about fall history. We asked participants if they had fallen in the past year, however this may have skewed our results as the National Senior Games are performed every 2 years. We may have gotten a more accurate fall history if asked if they had fallen in the past 2 years. It also would have been very interesting to compare multi sport athletes vs single sport athletes, however this could be another study in itself. We also could’ve taken into account how often they are performing their sport, and if that affected their ROM. It may make a difference if they are practicing daily vs once a week.
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