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ABSTRACT PRESENTATION 

 

63 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 4 – Issue 2 – September 2021 

 
 

Southwest Athletic Trainers’ Association Free Communications 
Abstract Presentations  
 

 
 
The following abstracts were accepted and 
presented at the 67th Southwest Athletic Trainers’ 
Association (SWATA) Symposium, 2021.  

 

Athletic Trainers’ Perceived Readiness to 
Recognize Mental Health Symptoms in 
Student Athletes 
Sumrall KM, Salisbury, H  
A.T. Still University, Mesa, AZ 
 
Context: Athletic trainers (AT) may report a lack 
of confidence in decision-making as they transition 
to professional practice. There is limited research 
on how prepared ATs feel managing mental 
health conditions in athletes. Objective: The 
purpose of this study was to explore the 
perceived readiness and confidence of master’s 
AT students, transitioning to professional practice, 
to recognize mental health symptoms and provide 
appropriate referral strategies. Design: 
Quantitative, descriptive study. Setting: Texas 
master’s AT programs. Patients or Other 
Participants: Non-probability consecutive 
sampling method. The target population was 2nd-
year master’s AT students in Texas who were 
eligible to graduate and sit for the BOC. A total 
of 33 students attempted the electronic survey; 17 
met the inclusion criteria and completed the entire 
survey for a response rate of 61%. Interventions: 
Program directors of AT programs received a 
recruitment letter asking them to distribute the 
participant recruitment letter and survey link to 
their 2nd-year master’s AT students. Students 
completed the survey via SurveyMonkeyTM. The 
adapted survey included a set of three vignettes 
with two associated multiple choice response 
questions for each vignette, and a binary scale 
with an additional “Not sure” option for assessing 
athletic trainer responsibility. A 5-point Likert 

scale was created to assess perceived readiness 
and confidence. Subject matter experts were used 
to establish face and content validity. Main 
Outcome Measures: Perceived readiness and 
confidence were the main outcome measures 
assessed. Identification of the correct mental 
health symptom and best referral option for each 
vignette was also assessed. Data analysis was 
conducted using SPSS Statistics v. 27.0. All data 
were analyzed using descriptive statistics and 
appropriate measures of central tendency and 
dispersion. Results: Normality testing was run for 
the variable, age, using the Shapiro-Wilk test (p 
< .001). The median survey participant age was 
23.00 years (IQR= 2; Min/Max = 22, 28) and 
the majority of students were female (n = 15; 
88.2%). When asked if ATs were responsible for 
implementing psychological interventions, 52.9 % 
(n =9) students incorrectly chose yes and 41.2% (n 
= 7) reported not sure. Athletic training students 
reported preparedness to recognize signs and 
symptoms of mental health conditions in athletes (n 
=11; 64.7%), but not as prepared to provide 
referral strategies. They also agreed or strongly 
agreed they had the confidence to identify an 
athlete in need of a mental health referral (n = 
10; 58.8%), but lacked confidence to manage the 
referral. Conclusions: AT students perceived 
readiness and confidence to recognize signs and 
symptoms of mental health conditions in athletes, 
but felt unprepared to provide appropriate 
referrals. The lack of preparedness and 
confidence may illustrate a need for further 
instruction in AT education programs. 

  



ABSTRACT PRESENTATION 
 

 

64 
 

Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188    Volume 4- Issue 2 – September 2021 
 

Hiring Practices Among NCAA Division I 
Head Athletic Trainers 
Cage SA*†, Winkelmann ZK‡, Warner BJ†§, Tuell 
C?, Gallegos DM* 
*The University of Texas at Tyler, Tyler TX; †The 
University of North Carolina Greensboro, 
Greensboro, NC ‡University of South Carolina, 
Columbia, SC §Grand Canyon University, Phoenix, 
AZ; ?University of Texas Health Science Center, 
Houston, TX 
 
Context: Limited empirical evidence exists on how 
athletic trainers (ATs) are hired by NCAA 
institutions. Current legislation protects many 
demographics from discrimination during hiring, 
but these laws may not be enforced by institutions. 
Objective: The purpose of this study was to 
describe potential factors that might influence the 
hiring practices of NCAA Division I Head Athletic 
Trainers. Design: Cross-sectional design. Setting: 
Electronic survey distributed to certified athletic 
trainers. Participants: A web-based survey 
(Qualtrics) that was distributed to by email to 329 
NCAA Division I Head Athletic Trainers. A total of 
114 ATs completed the survey (response and 
completion rate=34.7%). Interventions: NCAA 
Division I Head Athletic Trainers were emailed an 
invitation to participate in an electronic survey. 
The survey included a prompt for hiring an 
assistant athletic trainer for an NCAA Division I 
athletics program, questions on demographic 
data, impact of candidate demographic factors 
on hiring practices, and impact of candidate skills 
and education on hiring practices.  After the 
collection window had closed, we calculated 
central tendencies for participant responses.  
Main Outcome Measures: Traits and 
characteristics of applicants preferred by NCAA 
Division I Head Athletic Trainers. Results: Most ATs 
reported they would be most likely to hire a 
candidate with three to five years of experience 
(90.3%). Most ATs also reported that they would 
be most likely to hire a candidate with primarily 
collegiate athletics experience (91.2%). 

Regarding education, most ATs were most likely to 
hire a candidate with a post-professional master’s 
degree in athletic training (95.6%). For 
demographic factors, most ATs responded in the 
mid-range of agreement about the impact these 
factors had on hiring practices. More athletic 
trainers stated a willingness to hire a candidate of 
a different race (50%), different religion (45.6%) 
and different sex (48.2%). Responses regarding 
sexual orientation were near the mid-range for 
both same and different sexual orientation. When 
asked about the most attractive credentials for 
candidates, ATs ranked Corrective Exercise 
Specialist, Graston Technique Certified, and 
Performance Enhancement Specialist highest. 
Conclusions: Most head athletic trainers agreed 
that three to five years of professional 
experience, previous experience with collegiate 
athletics, and a master’s degree in athletic training 
were the attributes most likely to influence a 
candidate being hired. However, many ATs 
responded toward the mid-range of agreement 
when asked about demographic factors when 
considering candidates. This may indicate an 
unwillingness to respond favorably or 
unfavorably on the topic. Future research should 
focus on assessing hiring practices in a manner that 
requires a favorable or unfavorable response. 
Athletic trainers involved in the hiring practice at 
their institutions must work to ensure that they are 
hiring the best candidate irrespective of 
demographic factors that have no bearing on 
technical standards of the position. 

  



ABSTRACT PRESENTATION 
 

 

65 
 

Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188    Volume 4- Issue 2 – September 2021 
 

Attitudes Among Collegiate Volleyball and 
Women’s Soccer Players Prior to the COVID-
19 Altered 2020-21 Season 
Gallegos DM*, Warner BJ†‡, Cage SA*† 
*University of Texas at Tyler, Tyler, TX; 
†University of North Carolina Greensboro, 
Greensboro, NC; ‡Grand Canyon University, 
Phoenix, AZ 
 
Context: In response to the global spread of 
SARS-CoV-2, the National Collegiate Athletic 
Association cancelled all 2020 winter and spring 
championships that had not been completed. 
Additionally, the majority of 2020 fall spring 
championships were rescheduled to take place in 
the spring semester of 2021. Objective: The 
purpose of this study was to describe the attitudes, 
moods, and motivations of collegiate women’s 
soccer and women’s volleyball players toward the 
alteration to the 2020-2021 season. Design: 
Cross-sectional design. Setting: Web-based 
survey. Participants: A total of 46 female 
collegiate soccer and volleyball players 
participated in this study (Age = 17.8 years ± 
1.3; Women’s Soccer = 24; Women’s Volleyball 
= 22). Interventions: Participants were sent an 
electronic survey that collected demographic 
information, assessed attitudes and motivations 
regarding the altered season, and asked items 
found on the PHQ-9 and GAD-7 to assess 
depression and anxiety related feelings. Data 
was downloaded and analyzed using 
commercially available statistics software.  Main 
Outcome Measures: Emotions experienced 
following the alteration to the 2020-2021 
competitive season, depression related symptoms, 
and anxiety related symptoms. Results: The vast 
majority of participants stated that they were 
disappointed and sad when they received news 
that the 2020-2021 season would be altered 
(Disappointed = 80.4%). In contrast, the least 
commonly experienced emotion was happiness 
(Happy = 19.6%). On the PHQ-9, the majority of 
participants reported symptoms consistent with 

either moderate or severe depression (Moderate 
Depression = 15, Severe Depression = 13). 
82.6% (N=38) of participants reported 
experiencing symptoms consistent with at least 
moderate depression. On the GAD-7, all 
participants reported symptoms consistent with at 
least mild anxiety (N = 46). The majority of 
participants reported symptoms consistent with 
mild or moderate anxiety (Mild Anxiety = 16, 
Moderate Anxiety = 14). Conclusions: The 
majority of surveyed collegiate women’s soccer 
and volleyball players reported feeling 
disappointed or sad upon receiving news that the 
2020-2021 competitive season would be altered. 
Less than 20% of respondents reported feeling 
happy about this news. The majority of 
participants reported feeling symptoms consistent 
with depression and anxiety shortly after 
receiving the news that their seasons would be 
altered. As athletic trainers, coaches, and 
administrators prepare to move forward, it is 
important to consider the possible implications and 
effects the alteration of the 2020-2021 
competitive season will have on the mental health 
of student-athletes. Consideration of these factors 
may allow for intervention should student-athletes 
continue to experience these negative mood 
states. 

  



ABSTRACT PRESENTATION 
 

 

66 
 

Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188    Volume 4- Issue 2 – September 2021 
 

Effect of Tissue Flossing on Grip Strength in 
Collegiate Baseball Players 
Eilers MA*, Warner BJ*†, Gallegos DM‡, Hopper 
I‡, Cage SA†‡ 
*Grand Canyon University, Phoenix, AZ; †The 
University of North Carolina, Greensboro, 
Greensboro, NC; ‡The University of Texas at 
Tyler, Tyler, TX 
 
Context: Tissue flossing bands are a relatively 
new therapeutic modality that has increased in 
popularity in recent years.  While there is 
evidence to suggest that tissue flossing bands can 
decrease pain and increase perceived range of 
motion, there has been little research conducted to 
determine the effects of tissue flossing on muscular 
strength and performance.  Thus, the aim of this 
study was to assess the effects of a single tissue 
flossing treatment on grip strength among healthy 
collegiate baseball players.   Methods: Twenty 
apparently healthy collegiate baseball players 
(21.4 ± 1.54 years, 181.9 ± 3.56 cm, 84.5 ± 
8.56 kg) were recruited and consented to 
participate in this study.  The tissue flossing 
treatment was performed from the wrist to the 
elbow on the participant’s throwing arm.  Grip 
strength was then measured three times using a 
hand grip dynamometer both before and after 
treatment. The patient’s non-throwing hand was 
tested before and after a one minute rest period 
to serve as a control. Data analysis was 
performed using a paired samples t-test to 
determine statistical significance of differences in 
maximum grip strength before and after 
intervention for both the treatment and control 
arms, and a one sample t-test was performed to 
determine the statistical significance of 
differences in maximum grip strength between 
groups.  All statistical analyses were performed 
using SPSS Statistics Software (IBM, Armonk, NY).  
The level of significance was set at p < 0.05. 
Results: Following one round of tissue flossing 
treatment, the participants experienced a 4.3% 
decrease in grip strength (111.69 ± 16.95 to 

106.89 ± 16.19, p = 0.001).  However, 
participants did not experience a significant 
decrease in grip strength compared to the control 
arm (4.90 ± 11.12 to 1.93 ± 12.93, p = 0.143). 
None of the participants reported any adverse 
effects as a result of the tissue flossing band 
treatment other than mild soreness and redness of 
the skin that resolved within 10-15 minutes. 
Conclusions: These findings demonstrated that in 
healthy young baseball players, tissue flossing 
bands did not significantly decrease grip strength 
when compared to a healthy control. Thus, it would 
be reasonable to perform a tissue flossing band 
treatment prior to performing physical activity 
that involved gripping. Clinicians must use 
discretion when choosing a treatment option if a 
patient will be performing physical activity 
afterwards. 

  



ABSTRACT PRESENTATION 
 

 

67 
 

Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188    Volume 4- Issue 2 – September 2021 
 

Athletic Trainers’ Perceived and Actual 
Knowledge of Cold Related Modalities 
Warner BJ*†, McKenney M*, Gallegos DM‡, 
Cage SA†‡ 
*Grand Canyon University, Phoenix, AZ; 
†University of North Carolina Greensboro, 
Greensboro, NC; ‡University of Texas at Tyler, 
Tyler, TX  
 
Context: To date, there does not appear to be a 
study published that has examined the perceived 
and actual knowledge of cold related modalities 
that athletic trainers process. Objective: The 
purpose of this study was to determine the 
perceived and actual knowledge of cold related 
modalities among athletic trainers. Design: Cross 
sectional study. Setting: Electronic, web-based 
survey sent to credentialed athletic trainers. 
Patients or Other Participants: 191 certified 
athletic trainers completed the study (age = 42 ± 
12 years, years of certified experience = 19 ± 
11 years). Interventions: Participants were sent 
an electronic survey via email that assessed 
frequency of usage, perceived knowledge, and 
actual knowledge of cold related modalities. 
Data was downloaded and analyzed using a 
commercially available statistics package (SPSS 
Version 26, IBM, Armonk, NY). Measures of central 
tendency (means, standard deviations, 
frequencies) were calculated for all survey items. 
A Pearson correlation was calculated for the 
perceived and actual knowledge items to assess 
for a knowledge gap between what one believes 
they know and what they actually know. 
Significance was set at P < .05 a priori. Main 
Outcome Measures: Usage of cold related 
modalities, perceived knowledge of cold related 
modalities, actual knowledge of cold related 
modalities. Results: The majority of athletic 
trainers reported using cold related modalities to 
treat acute, chronic, and post-operative pain. 
Regarding perceived knowledge, most 
respondents indicated some level of confidence in 
their knowledge of cold related modalities. 

Average scores on actual knowledge were 6.07 
±  out of 10 questions. No significant relationship 
was found between perceived and actual 
knowledge (r = 0.127, P = 0.081).  Conclusions: 
While the majority of athletic trainers reported 
confidence in their knowledge of cold related 
modalities, their demonstration of actual 
knowledge was not commensurate. However, 
individuals who recently participated in post-
professional continuing education related to cold 
related modalities demonstrated better actual 
knowledge of the topic than those who did not. 
This suggests that clinicians may benefit from 
continuing education interventions to improve 
knowledge of the definition, modes of action, 
indications, and contraindications of cold related 
modalities. 

  



ABSTRACT PRESENTATION 
 

 

68 
 

Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188    Volume 4- Issue 2 – September 2021 
 

Nonsurgical management of unilateral, 
nondisplaced lateral malleolus fracture in 
17-year-old outside linebacker 
Tallman, K*†, Bautista R*, Spencer B† 
*Houston Methodist Sugar Land Orthopedics & 
Sports Medicine, Sugar Land, TX; †John Foster 
Dulles High School, Sugar Land, TX 
 
Background: Ankle fractures, specifically 
unilateral fractures, are among the most common 
injuries encountered by orthopedic surgeons. 
Ankle fractures have an incidence of 187 out of 
100,000 individuals. Current treatment options 
for ankle fractures are dependent on stability of 
the ankle mortise, determined through number of 
fracture sites and ligamentous integrity. The 
management of the fracture scan either be 
surgical or nonsurgical, the majority being 
surgical. In this case report, a 17-year-
oldmaleoutside linebacker sustained a left lateral 
ankle injury during a regular season football 
game. As he attempted to make a tackle, his left 
foot got caught in the turf, he fell backwards, and 
heard a pop. He continued to play in the game, 
but the pain progressively got worse. Upon 
halftime evaluation, the injury was deemed a 
lateral ankle sprain and the student-athlete (SA) 
was taped for external support. The SA could no 
longer ambulate. The SA was given crutches post-
game and returned to the athletic training room 
the next day for further evaluation. The tuning 
fork test, squeeze test, and bump test were all 
positive, but only 2 out of 5 criteria for Ottawa 
Ankle Rules were met. Differential Diagnosis: 
Differential diagnoses include lateral ankle 
sprain, lateral malleolus fracture, and subluxation 
of peroneal muscle. Treatment: The SA was given 
a walking boot and referred to a physician for 
imaging. Radiographic images showed a 
minimally displaced, left lateral malleolus 
fracture. The SA was referred back to the athletic 
training room to complete a rehabilitation 
program. After 7 weeks of rehabilitation working 
on regaining range of motion, strength, 

proprioception, and neuromuscular control, the SA 
was cleared for participation and was able to 
play in the last football game of the season. 
Uniqueness: Most lateral ankle fractures are 
treated surgically, but because there was no 
displacement or ligamentous disruption in this 
case, the fracture was treated nonsurgically. 
Conclusion: Minimally displaced lateral ankle 
fractures that are treated nonsurgically have 
excellent outcomes. A thorough examination and 
evaluation is vital in overall ankle management. 
The best rehabilitation program depends on a lot 
of factors, but the stability and mobility of the 
ankle should be considered along with the pain 
levels with weight bearing, time elapsed from 
injury, bone quality, and risk factors for healing. 
While radiographic imaging is the gold standard 
when fractures are suspected, examination 
findings by an athletic trainer can play an 
important role in identification and triage. 

  



ABSTRACT PRESENTATION 
 

 

69 
 

Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188    Volume 4- Issue 2 – September 2021 
 

Treatment and Management of Complex 
Knee Injury: A Case Report  
Braunreiter K*, Kerwin S† 
*Houston Methodist Sugar Land Orthopedics & 
Sports Medicine, Sugar Land, TX, †Fort Bend 
Austin High School, Richmond, TX 
 
Background: The “unhappy triad” injury includes 
tears of the anterior cruciate ligament, medial 
collateral ligament, and medial meniscus. There is 
limited research on the prevalence and outcome 
of this injury. The unique surgical repair consisting 
of lateral extra-articular tenodesis (LET) was 
utilized to reinforce the anterior cruciate ligament 
repair (ACLR) and to prevent rerupture. Due to this 
extensive surgery, the patient struggled to regain 
full range of motion and quadriceps activation. 
This case is a Level 2 case study that explores the 
different interventions used to address the 
aforementioned objective deficits and return him 
safely to play. Patient: The patient is an 18-year-
old male soccer player that presents to physical 
therapy and the athletic training room for 
postoperative rehabilitation after ACLR, LET, MCL 
repair, and medial meniscus repair. The initial 
injury was non-contact and occurred while playing 
soccer; He reports planting his left leg and feeling 
his knee shift. He denies feeling or hearing a pop. 
Swelling in the knee was present and he was 
unable to continue playing. Upon examination, the 
knee was not tender to palpation, loss of range of 
motion was not significant, and Valgus and Varus 
stress tests were negative; Lachman’s was positive. 
Differential Diagnosis: The differential diagnosis 
of this injury was ACL tear with MCL and medial 
meniscus involvement; and ACL tear with 
concomitant chondral injury. The physician’s 
assessment, including MRI imaging, revealed a 
torn ACL with MCL sprain and medial meniscus 
tear. Treatment: Surgical repair was performed 
2.5 weeks after the initial injury and consisted of 
bone-patellar tendon-bone ACL reconstruction 
with lateral extra-articular tenodesis, MCL and 
medial meniscus repairs. The patient began 

physical therapy 2 days post-op with treatment 
consisting of manual techniques to target range of 
motion and blood flow restriction to promote 
quadriceps strength and hypertrophy. Due to 
weight-bearing precautions, the Alter-G machine 
was utilized to aid in gait training. According to 
an ACLR study, the knee should have full range of 
motion at week 6. The patient still lacked 43 
degrees at week 6. Outcomes: There are no 
specific guidelines for return to play after an 
ACLR, LET, MCL repair, and medial meniscus 
repair, therefore, a unique treatment plan was 
created by the treating physical therapist and 
athletic trainer to meet the patient’s needs. The 
patient achieved full extension and continues to 
lack 5 degrees of flexion at 7 months. 
Conclusions: The complexity of the surgical 
repair and the patient's response to the 
interventions created challenges. 
Recommendations for clinical practice include 
implementing early interventions of blood flow 
restriction to inhibit muscle atrophy, Alter-G to 
initiate early gait training and more manual 
techniques to improve range of motion. Clinical 
Bottom Line: This case stresses the importance of 
involving the entire medical team (physician, 
athletic trainer, physical therapist) in the care of 
the patient as well as the ability to find ways to 
be creative with rehabilitation when there are 
protocols inhibiting traditional interventions. 

  



ABSTRACT PRESENTATION 
 

 

70 
 

Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188    Volume 4- Issue 2 – September 2021 
 

Evaluation and Treatment of the Water-polo 
player with Anterior Glenohumeral 
Instability  
Zimmerman M  
Houston Methodist Willowbrook Hospital, 
Houston, TX 
 
Background: Glenohumeral (GH) instability is a 
common shoulder condition with a range of 
characteristics from laxity within the GH joint to 
complete dislocation of the humerus. The GH joint 
is held in place by static and dynamic stabilizers 
that need to be functioning appropriately to 
center the humerus in the glenoid fossa. Acquired 
shoulder instability is defined as chronic stress of 
the humerus in an externally rotated and 
abducted position on the shoulder joint from 
repetitive overhead (OH) sports causing anterior 
instability of the shoulder. Diagnosing shoulder 
instability is reliant on the patient’s history and 
physical examination findings during testing. 
Using a combination of anterior apprehension, 
relocation, sulcus sign, and load and shift tests are 
recommended in the clinical examination to 
effectively diagnose GH instability. Current 
evidence treating non-operative shoulder 
instability starts with restoring ROM with the use 
of mobilization techniques, followed by 
strengthening exercises targeting the serratus 
anterior (SA), rhomboids, deltoids, and rotator 
cuff to improve overall stability. The purpose of 
this case is to show that manual therapy followed 
by specific therapeutic exercise is effective in 
treating acquired anterior shoulder instability in 
an adolescent water polo player. Patient: The 
subject is a seventeen-year-old female water 
polo player who has been suffering from left 
shoulder pain for two months. Her pain is 
intermittent throughout the day but worsens with 
swimming and the late cocking phase of her throw. 
She has no specific mechanism of injury (MOI). She 
rated her pain a dull and achy 5/10 at rest and 
a sharp 9/10 pain while throwing during practice. 
Her pain starts on the anterior aspect of the 

shoulder at rest and moves to the 
superior/posterior aspect during movement. She 
complains about neck stiffness with any movement 
along with shoulder pain. She reported no 
radiating symptoms down her back or arm. She 
reported no popping or clicking within the 
shoulder. She was unable to sleep on the left side 
and is frequently woken up due to the pain. Her 
goal for treatment is to learn how to manage her 
pain if the pain comes back after being treated. 
She also wants to be able to practice and 
participate in games pain-free. Treatment: 
Treatment consisted of manual intervention and 
therapeutic exercise throughout four sessions. 
Manual techniques performed included: soft tissue 
stripping of the pectoralis (pec) minor, lattisimus 
dorsi (lats), upper trapezius (traps), and 
subscapularis (subscap), inferior and posterior 
mobilization GH mobilizations, thoracic gapping 
and manipulations. The goals of manual therapy 
was to improve the patient’s ROM and postural 
deficits. The posterior mobilizations were used to 
increase flexion and internal rotation while the 
inferior mobilizations were utilized to increase 
abduction and flexion at 0-60 degrees. 
Therapeutic exercises targeting thoracic mobility, 
internal and external rotation. While 
strengthening and stability exercises were aimed 
towards the rotator cuff, deltoid, serratus anterior, 
and rhomboids. Outcomes: By the end of all four 
sessions every deficit was addressed. She has 
been able to fully participate in practices and 
games completely without pain. Her functionality 
score progressed from a 49% to a 96.3% in two 
weeks. All the patient’s goals were completed 
showing increased strength and stability within the 
GH joint. Conclusion During the four-session 
rehabilitation program, this case showed that 
acquired anterior GH instability can be treated 
with the previous techniques to increase stability 
within the dynamic stabilizers of the GH joint. 
Clinical bottom line: The results shown in this case 
of a water-polo player with acquired anterior GH 
instability showed that manual therapy and 



ABSTRACT PRESENTATION 
 

 

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Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188    Volume 4- Issue 2 – September 2021 
 

specific exercise can efficiently treat acquired 
instability with only four visits.   

Diagnosis and Intervention of Posterior 
Shoulder Impingement in a Non-Throwing 
Athlete 
Orrick K  
Houston Methodist Willowbrook Hospital, 
Houston, TX 
 
Background: Posterior impingement, also 
commonly called internal impingement, is 
identified by a repetitive compression of the 
posterosuperior aspect of the glenoid by the 
greater tuberosity of the humeral head when 
the arm is in an abducted and externally 
rotated position. There are multiple possible 
causes of this impingement. One of the most 
frequent contributors is scapular dyskinesis, 
where the scapula does not track properly with 
overhead movement due to weakness. Other 
contributors include kinetic chain instabilities 
found in the spine, core, and lower extremity, 
as well as glenohumeral instability causing a 
shift in the humeral head. Posterior impingement 
is commonly seen in upper extremity athletes 
during the late cocking and early acceleration 
phase of throwing, however this level two case 
report looks at the dysfunction in the less 
commonly occurring sport of volleyball. Patient: 
The patient is a fifteen-year-old female 
volleyball athlete that came to the athletic 
training facility complaining of left posterior 
shoulder pain. She has been playing the sport 
for 2 years, and claims the pain started around 
two years ago. At the time of evaluation the 
patient was in the off-season and was 
preparing to play in the upcoming season. The 
patient reported moderate pain at rest which 
increased to major pain while performing 
overhead movement. Her most recent season 
saw the greatest increase in pain, and the 
athlete attributed it to an increase in hitting and 
serving. The patient reported frequent popping 
in the shoulder, but no pain accompanied it. 
With passive movement, the patient had pain at 
end range in external and internal rotation, and 
actively had pain with flexion and abduction 
twenty degrees before end range. Patient 
presented as well was a lack of scapular 

upward rotation during shoulder movement, 
and the patient reported no pain with flexion 
when assisted with scapular upward rotation. A 
load and shift test presented with a grade 2 on 
the involved side. The posterior impingement 
test was performed and found to be positive. 
This led to a diagnosis of posterior shoulder 
impingement, caused by scapular dyskinesis 
and glenohumeral instability. Treatment: 
Treatment was focused on improving 
glenohumeral stability and activating the 
upward rotators of the scapula to improve the 
dyskinesis. Initially, manual therapy was used to 
mobilize the scapula into upward rotation and 
decrease tension in the latissimus dorsi and 
upper trapezius. Therapeutic exercise consisted 
of strengthening of the upward rotators, 
focusing on functional positions and overhead 
activities to mimic athletic play. Glenohumeral 
stability was improved through closed kinetic 
chain exercises for the shoulder. With the 
patient being a volleyball athlete, a larger 
importance was placed on overhead stability 
with the elbow in near full extension when 
compared to the typical throwing athlete with 
posterior impingement. Outcomes: The patient 
progressed well, with manual and exercise 
therapy interventions improving the patient 
back to pain free active daily living. 
Rehabilitation is still ongoing to return to a 
competitive level, however sport specific 
activity has been performed by the athlete pain 
free for short amounts of time. Conclusions: 
Overall the patient’s progression was in line 
with current research, however modifications to 
rehabilitation needed to be made to fit the 
athlete’s sport. Research for posterior 
impingement is centered on throwing athletes, 
and does not take into account the different 
demands of volleyball. While the patient 
herself did not have an atypical presentation, 
her sport called for an atypical approach when 
forming a rehabilitation plan based on current 
research. This approach placed a greater 
emphasis on stabilization in overhead activities, 
especially in situations where power is needed 
to generate the force for serving and hitting. 

  



ABSTRACT PRESENTATION 
 

 

72 
 

Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188    Volume 4- Issue 2 – September 2021 
 

Cervical Kyphosis in a Collegiate Baseball 
Player 
Trail LE*, Warner BJ†‡, Gallegos DM§ 
‡University of North Carolina Greensboro, 
Greensboro, NC; §University of Texas at Tyler, 
Tyler, TX 
 
Background: A 21-year-old collegiate 
baseball player reported to the athletic 
training staff complaining of pain along the 
superior angle of the scapula, decreased 
shoulder range of motion, and transient 
numbness and tingling in the 4th and 5th digits of 
his right hand.  Physical evaluation revealed 
substantial spasm and rigidity of the upper 
trapezius and scapular stabilizer musculature, 
along with myofascial adhesions in the 
rhomboids and levator scapulae, in addition to 
weakness with shoulder abduction and external 
rotation.  All thoracic outlet syndrome testing 
yielded no positive tests.  Thorough patient 
history revealed a history of shoulder 
arthroscopy the previous summer to address 
minor fraying of the rotator cuff after which the 
patient reported participating in minimal 
therapeutic exercise.  At this time, the patient 
was advised to begin icing following every 
practice, along over the counter NSAIDs as 
directed.  The patient was also instructed to 
begin therapeutic exercise on a daily basis with 
the athletic training staff. Differential 
Diagnosis: Scapular dyskinesis, scar tissue 
following improper rehabilitation of shoulder 
arthroscopy, general deconditioning of the 
shoulder musculature. Treatment: Day 1, patient 
began therapeutic exercises with the athletic 
training staff aimed at addressing scapular 
stabilizer weakness and decreased shoulder 
range of motion.  During exercise, patient 
reported increased pain along the superior 
angle of the scapula when performing shoulder 
abduction with dumbbells.  This exercise was 
discontinued at this time while the remainder of 
the therapeutic exercise program was 
continued. Day 2, patient reported that his 
shoulder and the surrounding musculature felt 
fatigued, but did not feel sore.  Following re-
evaluation, it was determined that the fatigue 
was a normal response to therapeutic exercise 
following deconditioning and exercise was 

continued.  Day 5, patient began seeing the 
team chiropractor during regular weekly clinics.  
Evaluation from the team chiropractor 
confirmed both weakness and tightness of the 
shoulder musculature.  At this time the patient 
was informed that they would be referred to 
the team physician if their symptoms worsened 
or did not significantly improve two weeks after 
the initial evaluation.  Day 9, patient reported 
worsening symptoms during practice.  Patient 
was then removed from team activities and 
scheduled to see the team physician.  Day 10, 
upon evaluation, the team physician concurred 
with the evaluation of poor scapular stabilizer 
strength while also diagnosing the patient with 
poor postural stabilization of the cervical spine.  
Following the updated diagnosis, the patient’s 
therapeutic exercise plan was revised to 
address the new found weakness.  Day 14, 
during treatment at the team chiropractor’s 
office cervical spine x-rays were obtained that 
revealed cervical kyphosis.  With this new 
finding, patient began undergoing dry needling 
and cupping treatments in an attempt to 
address tight anterior musculature while 
continuing to address weakness.  Day 21, 
patient continued current treatment plan, and 
presented with an increase in strength and 
range of motion.  Throughout the remainder of 
the season, the patient continued treatment and 
rehabilitation plan and was able to participate 
in practices and competitions with minimal 
symptoms.  Uniqueness: While cervical 
kyphosis is not a unique diagnosis in and of 
itself, the continued participation in competitive 
intercollegiate activity is noteworthy.  
Furthermore, patients suffering from cervical 
kyphosis often require surgical intervention to 
be able to maintain quality of life. In this case, 
the patient was able to continue with activities 
of daily living through the utilization of 
conservative measures. Conclusions: When 
treating a patient with an uncommon condition 
in their population, it is paramount that the 
clinician exhaust all resources to find proper 
treatment to address all associated 
pathologies.  Should a clinician be treating a 
condition they are unfamiliar with, evaluation 
and re-evaluation of outcomes is crucial for an 
optimal prognosis. 

 


