TABLE OF CONTENTS
LIST OF TABLES
LIST OF FIGURES
LIST OF ABBREVATIONS USED
CHAPTER 1 INTRODUCTION
NEED OF THE STUDY
STATEMENT OF QUESTION
AIMS AND OBJECTIVES
LIMITATION OF THE STUDY
CHAPTER 2 REVIEW OF LITERATURE
CHAPTER 3 METHODOLOGY
TRAINING PROTOCOL 
CHAPTER 4 DATA ANALYSIS
CHAPTER 5 RESULTS
MEAN PERCENTAGE CALCULATION
CHAPTER 6 DISCUSSION
IMPROVEMENT IN STRENGTH
IMPROVEMENT IN COORDINATION
IMPROVEMENT IN DISABILTY
CLINICAL RELEVENCE IN PRACTICE
CHAPTER 7 CONCLUSION
CHAPTER 8 REFERENCES
APPENDIX B CONSENT FORM
APPENDIX C DATA COLLECTION FORM
APPENDIX D ASSESSMENT FORM
APPENDIX E SM- DASH
LIST OF TABLES
Table no 1: comparison of pre and post means for coordination in in both the groups
Table no2: comparison of pre and post means for subscapularis in both the groups
Table no3: comparison of pre and post means for supraspinatus in both the groups
Table no4: comparison of pre and post mean values for teres minor and infraspinatus in both the groups
Table no5: comparison of pre and post mean values for bench press in both the groups
Table no6: comparison of pre and post means of SM DASH in group 2
Table no7: comparison of the mean percentage improvement in both the groups 54
LIST OF FIGURES
Fig1: medicine ball throw ( internal rotation-start position)
Fig2: medicine ball throw (chest press)
Fig3: medicine ball throw ( external rotation – end position)
Fig4: medicine ball throw (reverse throw)
Fig5: bench press –start position
Fig6: bench press – end position
Graph1: comparison of pre and post mean value of coordination
Graph2: comparison of pre and post mean value of subscapularis
Graph3: comparison of pre and post value of supraspinatus
Graph4:comparison of pre and post value of teres minor and Infraspinatus
Graph4:comparison of pre and post mean value of bench press
Graph5:comparison of pre and post value of SM – DASH
LIST OF ABBREVATIONS USED
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Background & Objectives - To compare the mean percentage improvement in coordination, strength and disability in overhead throw athletes with partial thickness tear of the rotator cuff following plyometric training in different phases of rehabilitation.
Methods - : a total of 30 male overhead throwers suffering from partial thickness tear of the rotator cuff injury, on the basis of inclusion criteria were taken in the study. A full description of the study, including the selection process was explained to each patient. Documented consent was obtained from each patient. Group 1 consisted of athletes with history of rotator cuff injury one and half year back and group 2 included athletes with rotator cuff injury three months back. Coordination , strength and disability were assessed pre and post plyometric training for a period of three weeks and the mean percentage of improvement were compared in both the group following plyometric training.
Results -.intragroup analysis showed a significant improvement in coordination, strength with the level of significance (p<0.05).
Discussion & Conclusion – group 1 showed an improvement in the mean percentage in coordination, the strength of supraspinatus muscle , and bench press when compared to the group 2. While the group2 showed an improvement in mean percentage in the strength of the subscapularis, teres minor muscle and infraspinatus muscle when compared with the group1
KEY WORDS- Partial tear of the rotator cuff , plyometric training, overhead throwers
CHAPTER 1 INTRODUCTION
Rotator cuff tears are a common cause of shoulder pain and disability in overhead athletes. An universally accepted classification scheme for the rotator cuff disease does not exist, The depth of the tear will differentiate partial from full thickness lesions. 
A partial-thickness tear is a definite disruption of the fibres of the tendon and is not simply fraying, roughening or softening of the surface. Ellman proposed a new scheme of classification. Grade-I tears had a depth of less than 3 mm, grade II of 3 to 6 mm and grade III, involvement of more than half of the thickness of the tendon.
Partial-thickness tears of the rotator cuff are not rare and can be a cause of unexplained pain in the shoulder giving considerable disability. Repetitive stressful loading of the rotator cuff during overhead throwing and racquet sports, through attempts of the muscles to resist humeral distraction, horizontal adduction and the other stressful shoulder motions , results only in an acute inflammatory response early on but in tendon failure in the late stages of rotator cuff injury.,,, Also the blood supply of the rotator cuff tendons is a significant factor in pathology . In 1970 Rathburn showed that shoulder position in important for proper vascular supply to the rotator cuff.
Although an accurate incidence of partial thickness rotator cuff tears is unknown  In the younger population (approximately 18-35 years), the patient most commonly is an overhead athlete involved in sports such a swimming, tennis, baseball, football, or javelin throwing. In overhead sports such as volleyball, baseball or tennis shoulder problems are very common.,, The shoulder is significantly stressed in overhead athlete , especially during distinct phases of throwing motion. Throwing motion occurs in six phases and serves as a model of shoulder motion for most overhead sports. The phases are wind-up, early cocking, late cocking acceleration, deceleration and follow-through. The phases are separated by changes in load, shoulder position and the muscle firing pattern. Ultimately the goal of the overhand throw is to convert potential energy into kinetic energy.  Athletes typically present with complaints of the posterior shoulder pain during abduction and maximum external rotation of the arm ( late cocking and acceleration phases of throwing ). During the throwing motion enormous stress is put on the dynamic and the static stabilizers of the shoulder. Symptoms maybe vague and the athlete may report only a gradual loss of velocity or control during competition often known as the dead arm syndrome.,
Volleyball is a complex discipline with high technical, tactical and athletic demands on the players. Because of this there is a need for the players to specialize early in specific tasks in the same, such as spiking or setting.  This specialization causes uniform repetitive loads for the players. A highly skilled volleyball attacker spikes about 40,000 times year. After the impact , the movement of the arm decelerates. This results in the production of dynamic eccentric forces at the posterior shoulder girdle musculature and the biceps hence a higher risk for developing shoulder pain for the attacker , which is also seen in other overhead sports including baseball or tennis., The sport of baseball is dependent on the power, speed strength and muscular endurance specifically on the upper extremity. In a baseball pitcher the ligamentous restraints about the shoulder complex are moderately sufficient in providing stabilization ; the rotator cuff muscle acts concentrically and eccentrically to produce internal and external rotational torques during the overhead throwing motion .,
There is an uncertainty as to what constitutes the best management and treatment for a patient with symptomatic shoulder, authors have suggested that conservative management including exercise therapy , activity modification, oral non-steroidal anti inflammatory medications, physical modalities for full thickness tears may also be associated with substantial improvement. Bartolozzi et al  (1994) reported good to excellent in 76% (n=68) of patients following non- surgical care for the rotator cuff tears. Findings have suggested that the inclusion of exercise therapy either as isolation or as a part of a non- operative package of care for full thickness tears of the rotator cuff tears has some benefit. In addition, the findings suggest that it would be appropriate to recommend exercise therapy for the symptomatic shoulder either traumatic or non- traumatic origin of the rotator cuff tear., Conservative treatment of full-thickness rotator cuff tears yields satisfactory results both subjectively and objectively.,
It is known that healthy tendon is a metabolically active structure that demonstrates an increase in tensile strength when subjected to progressive controlled stress. This is also observed in injured tendons. To maximize the tensile strength use eccentric phase of muscle contraction in strengthening phase of rehabilitation programs., Hence functional plyometric exercises should be given to athlete.
Plyometrics are also referred to stretch – shorten exercise. The stretch stimulus body propioceptors such as the muscle spindle and golgi tendon organs. The muscle spindle is stretch receptor located within the muscle belly. A quick stretch stimulus to the muscle spindle reflex produces a contraction of extrafusal muscle fiber in the agonist and synergist muscles. This reflex is very rapid ( .3 to .5 miliseconds). Stimulation of the GTO produces inhibition of the agonist extrafusal muscle fiber ; therefore, the GTO protect against over contraction or over stretch of the muscle. During proper plyometric exercises, the excitatory effect of the muscle spindle reflex pathways overrides the inhibition provided by the GTO. 
A plyometric activity is divided into the following phases- The eccentric or the setting phase the athlete mentally prepares for the activity and lasts till the stretch stimulus is initiated. The second phase of the plyometric response is the amortization phase. This phase is the amount of time undergoing the yielding eccentric contraction and initiating a concentric overcoming force. The final phase is the concentric response phase. During this phase the athletes concentrates on the effect of the exercise and prepares for initiating the second repetition. It has been documented that he faster a muscle is loaded eccentrically, the greater concentric force is produced. Explosive plyometric training can improve neural efficiency and thereby increase neuromuscular performance. ,,
Plyometric can help players to strengthen the skills and to increase power which are also referred to as “explosive - reactive” power training, neural adaptations usually occur when athletes respond or react as a result of improved coordination between the CNS signal and proprioceptive feedback . A more complex reflex mechanism can be initiated during plyometric exercise and helps in motor coordination , these reflex mechanism called “length feedback” and “force feedback” result from neural signals generated by muscle receptors that project back to the muscle origin as well as the other muscles. Together these feedback induced during the loading phase of a plyometric activity have the potential to improve neuromuscular coordination.
To reproduce the explosive power needed in most athletic events, the concept of plyometric a form of exercise includes a quick powerful movement involving an eccentric muscular pre stretching prior to a concentric muscle contraction, resulting in activation of the stretch shortening cycle. Plyometric soon became known to athletes and coaches as exercises aimed at linking strength with speed of movement to produce power .,, Recently, it has been incorporated into several sports and recreational training programs. Because upper extremity plyometric exercises have also been introduced into upper extremity rehabilitation programs, there is a need to determine the effects of plyometric training of the upper extremity on various performance parameters.
Plyometric training with weighted balls can be used to enhance strength and proprioception by reproducing the physiologic stretch-shortening cycle of muscle in sport-specific shoulder positions. By catching and throwing a weighted ball(0.91 to 4.5 kg [2 to l0 lb]), the adductors and internal rotators are eccentrically loaded, and thus stretched, followed by a concentric shortening phase. A principle to consider this is that the embryologically classified muscles group 1 ( fast twitch) include the flexors , adductors and internal rotators , group 2 muscle ( tonic) include external rotators and abductors . The group 1 muscles are influenced more by the type 1a phasic nerve endings resulting in a greater chance of being facilitated by the plyometric mechanism , hence these group 1 muscles are important to focus in a plyometric drill.  Catching the ball from a vertical drop eccentrically loads the posterior cuff and scapular decelerators. These exercises appear to enhance muscle performance by neuromuscular control. Initially, concentric activity may be used in an activity simulating a chest pass. The athlete is gradually progressed into sport-specific positions. A medicine ball may be thrown manually to the patient. In this way, the velocity can be varied (varying the force of impact).,
Significant neuromuscular benefits and neural adaptation may be attained if they are implemented early in the rehabilitation program. Neural adaptations occur via synchronous firing of the motor neuron to the spinal cord and project back to the muscle origin , these feedback induced during the loading phase of plyometric training have the potential to improve neuromuscular coordination. 
Plyometric exercises have been added to a typical training program such as weight training or team practices, and then compared with the typical programme. Some authors have found plyometric exercises to be beneficial adjunct to traditional training methods of training. VOSSEN and KRAMER  suggest that plyometric training may be advantageous for developing upper-body power and strength. Whether or not plyometric exercise results in superior improvements in athletic performance remains to be determine. Athletes and coaches should be cautious when incorporating plyometric training into their programs. If proper care is not taken, the potential for injury increases. However, if safety precautions are taken, realistic exercises are chosen, and adequate rest is included, athletes can significantly improve their power and strength with plyometric training.,
Many research studies have documented the effectiveness of plyometric training on increasing power in the lower extremities.,,, No research studies have documented the effectiveness of plyometric training on the upper extremities. Several studies used plyometric training and have shown that it improves power output and increases explosiveness by training the muscles to do more work in a shorter amount of time . Research is also needed to validate the assumption that plyometric exercise promotes a return to sport for injured athletes and to examine whether plyometric exercise is useful in the prevention of re injury., Further more , research is needed to delineate whether plyometric exercise imparts additional benefits beyond the combination of other rehabilitation interventions (strength, balance, proprioception, and interval sport activities) and to determine the most effective application of plyometric exercise. Despite the lack of evidence documenting the effectiveness of plyometric exercise in rehabilitation, the clinical success of properly applied plyometric exercise warrants the continued use and research of this therapeutic intervention. ,,,
Courtney peters and Steven Z George  in their study showed a meaning improvement in the SM-DASH following a sports specific plyometric rehabilitation programme, with an additional benefit of returning the athlete back to the specific sport.,, The current literature provides limited evidence supporting sports specific plyometric rehabilitation for young throwing athletes.
NEED OF THE STUDY
There is a large body of scientific literature that supports the use of plyometric exercise to enhance athletic performance, evidence is sparse regarding the effectiveness of plyometric exercise in promoting a quick and safe return to sports after injury. Consequently , specific exercise should be an intricate part of every upper extremity training programme to facilitate a complete return to athletic participation. The purpose of this study is to explain the basis of stretch shortening exercise and to present a philosophy for utilizing the stretch reflex to produce an explosive reaction in the upper extremity of post injured athletes in different phases of rehabilitation for their safe return to sports.
STATEMENT OF QUESTION
Is there a mean percentage improvement in the coordination, strength and disability in overhead throwing athletes with partial thickness tear of the rotator cuff after plyometric training in different phases of rehabilitation?
AIMS AND OBJECTIVES
To compare the mean percentage improvement in coordination , strength and disability in overhead throw athletes with partial thickness tear of the rotator cuff following plyometric training in different phases of rehabilitation.
Research hypothesis 1
There may a mean percentage improvement in coordination in overhead throwing athletes with partial thickness tear of the rotator cuff following plyometric training in different phases of rehabilitation.
Research hypothesis 2
There may a mean percentage improvement in strength in overhead throw athletes with partial thickness tear of the rotator cuff following plyometric training in different phases of rehabilitation.
Null hypothesis 1
There may be no mean percentage improvement in coordination in overhead throw athletes with partial thickness tear of the rotator cuff following plyometric training in different phases of rehabilitation
Null hypothesis 2
There may be no mean percentage improvement in strength in overhead throw athlete with partial thickness tear of the rotator cuff following plyometric training in different phases of rehabilitation.
Plyometric exercise is a popular form of training commonly used to enhance athletic performance. The stretch-shortening cycle, which involves stretch of the muscle-tendon unit immediately followed by shortening, is an integral to plyometric training. The stretch- shortening cycle enhances the ability of the muscle-tendon unit to produce maximal force in the shortest period of time, prompting the use of plyometric exercise as a bridge between pure strength and sports-related speed.
LIMITATION OF THE STUDY
1. The entire kinetic chain includes the trunk ,elbow, wrist and the lower extremities which should be significantly strengthened. Kinetic chain abnormalities including pelvic abductor weakness, lead leg quad tightness and hip internal rotation loss which should also be recognised. Proximal kinetic chain abnormalities evoke distal limb “catch up” and merely increase the demand on the shoulder. The strengthening of the lower extremities and core muscle exercises were not performed in our study
2. Since in our current study, the subjects in group1 had returned to sports, appropriate progression via volume , and intensity should have been considered and the use of therabands and sports cords should have been considered in the warm up phase in order to work on the flexibility of the rotator cuff muscles.
3. The sample size is small
4. No control group
5. The training protocol should have been for a longer duration
6. Follow up should have been done
Independent variable –
1. plyometric training protocol
3. The SM-DASH score - (Beaton et al 2001), the test-retest reliability us high over a five day period (ICC-0.96). The SM-DASH has good construct, validity and negligible ceiling and floor effects. It can discriminate between different levels of clinician and patient related levels of severity, and between those who can and cannot work due to upper limb problem ,
Organization of the chapters
Chapter 2 deals with the review of literature of the previous studies done, Chapter 3 deals with the methodology of the study, Chapter 4 deals with the data analysis, Chapter 5 deals with the compilation of results obtained after analysis, Chapter 6 deals with the discussion obtained by results, Chapter 7 deals with the conclusion the study makes regarding the hypothesis, Chapter 7 deals with the references and at the end are appendices with master chart, data collection form, assessment form, consent form, the SM-DASH questionnaire
CHAPTER 2 REVIEW OF LITERATURE
PARTIAL THICKNESS TEAR OF THE ROTATOR CUFF
Ellman H and Synder JL, 1991, reviewed about the depth of tear of a partial thickness tear- rotator cuff disease and tendon rupture according to their findings partial thickness tear can be present on either the artilcular or bursal surface, or they can be intra substance. The average thickness of the normal tendon of the rotator cuff is 10 to 12 mm3. Ellman developed a classification system based on the location (articular, bursal and intratendinous) and depth ( grade 1 :<3mm, grade 2 :3-6mm, grade3 : < 6mm) of the tear based on arthroscopic findings. Synder et all based on tear location and size (0-4, normal to tear >3cm) in 31 patients who underwent bursoscopy. Synder JL described a shoulder pain in athletes who engage in excessive throwing which was referred as PAINT ( partial articular tears with intra-tendinous extension).
INCIDENCE AND PREVALENCE
Lohr , Uhthoff and Fukuda, May 2011 , discussed about incidence of partial thickness rotator cuff tears put forward by various researchers. Although an accurate incidence of partial thickness tear of the rotator cuff in unknown , an estimation had been made from various imaging and cadaveric studies. Sher et al reported that 4% of individuals younger than 40 years old showed partial and full thickness tear of the rotator cuff on MRI. Lohr and Uhthoff found an incidence of 32% for partial thickness tear of the rotator cuff in 306 cadaveric studies. Fukuda reported 13% partial thickness tear of the supraspinatus tears, 18% bursal side partial thickness supraspinatus tear 55% intratendious partial thickness supraspinatus tear in 249 cadaveric studies. Those occurring in young overhead athletes resulting from repetitive micro trauma or internal impingement are included to allow their different causes to be recognised, which may necessitate specific treatment. Overhead throw athletes exhibit a high incidence of age related partial thickness tear. In addition they are unwilling to modify their activities hence there are high demands on the rotator cuff which predispose them to recurrent episodes of anterior , rotator cuff related shoulder pain.
Wang HK and Cochrane (2001) , studied the incidence and prevalence of shoulder sports injuries. The study concluded that twenty seven out of fifty nine athletes had history of sports specific shoulder injury with a total of 29 injuries been reported. Cuff muscle pathology was predominant in these injuries (14/29). Furthermore, spiking was the major action during which a shoulder injury first occurred in top level volleyball male players. These injuries resulted in prolonged shoulder pain symptoms.
FUNCTIONS OF THE ROTATOR CUFF MUSCLES
Scott F and Nadler (2004), discussed about the role of the rotator cuff as an important dynamic stabilizer of the shoulder joint. The rotator cuff muscles assists with some shoulder motion, but their main function is compression of the humeral head on the glenoid to provide stability to the joint. These muscles are regarded as “force couples” in that they work synergistically to carry out a particular movement. The main function of thr supraspinatus is to stabilize the GH joint as deltoid abducts the arm. The infraspinatus and teres minor assists with external rotation of the shoulder. The subscapularis participates in the internal rotation of the shoulder, although the pectoralis are the prime movers.
David L Glaser, Jerry S. Sher , 1991,discussed about the function of the rotator cuff, its disorders contributing to rotator cuff disease , the rotator cuff comprises of a group of muscles that are small in size and cross-sectional area when compared with the more superficial structures, such as trapezius, deltoid, pectoralis major, latissimus dorsi. Since they lie deep in the shoulder and in close proximity to the centre of rotation of the glenohumeral joint, these muscles are collectively unable to generate the same degree of torque as the larger and more superficial muscles, the very short lever arm from the centre of rotation accounts for observable differences in the generated force hence maintenance of a stable glenohumeral fulcrum during active arm motion is one function that is important and well suited to the rotator cuff.
Lohr JF, 1990 ,in the article discussed The micro vascular pattern in supraspinatus of the rotator cuff of the shoulder. The blood supply of the rotator cuff tendons is a significant factor in pathology , There is a critical zone in the supraspinatus tendon where the tenous blood supply are localized in the proximity of insertion point into the greater from tuberosity. The “watershed” area of decreased blood supply is particularly vulnerable to repetitive stresses of overhead throwing and sports motion. The shoulder position is important for proper vascular supply to the rotator cuff , “wringing out” describes the reduced blood supply that occurs with shoulder adduction. Repeated stressful loading during overhead throwing sports , through attempts of the muscles resists humeral distraction, horizontal adduction and the other stressful shoulder motion results in acute inflammatory response early on , but in tendon failure in the late stages of rotator cuff injury.
ALTERED MECHANICS IN THROWING
John A Scolaro , John D Kelly ,2010, discussed throwers or athletes who engage in repetitive overhead motions, are a unique subset of athletes that experience distinct injuries of the shoulder. The shoulder of the throwing athlete adapts to stresses which are placed on it. Excessive external rotation with a loss of internal rotation occurs with repetitive throwing. This increase in rotation develops from both an alteration in the soft tissue stabilizers of the shoulder as well as osseous changes which may occur in the throwing athlete. This constellation of changes can be maladaptive when they result in injury or damage to structures such as the labrum or the rotator cuff. Material changes in both the anterior and posterior glenohumeral capsule occur with repetitive overhead motions. These capsular changes may change shoulder kinematics and subsequently contribute to both labrum and rotator cuff tears.
Scott F Nadler , Andrew L Sherman and Gerard A Malanga ,2004 ,discussed about specific sports injuries in the shoulder joint, the shoulder is a complex joint with a large degree of motion in multiple planes. Although it is considered a ball-in-socket joint, the shoulder lacks the inherent bone stability that are found in the other joints. The static and dynamic stabilizers are needed and are vital for maintaining shoulder stability. Four types of sports activities lead to shoulder injury. Throwing and racquet throwing most often have injuries related to muscle and tendon overuse secondary to poor throwing/hitting mechanics. Rarely , these athletes have acute tears of the dynamic stabilizers, athletes involved in high –contact sports are subjected to injuries such as acute muscle and tendon tears leading to secondary impingement. Repetitive shoulder movement over a time results in shearing forces across the joints, the rotator cuff muscles assist with some shoulder motion, but their main function is to provide stability of the shoulder joint. Weakness or insufficiency of the rotator cuff on repeated overhead throwing results in increased demands on the static stabilizers. Hence the static stabilizers began to fail. Humeral head migration occurs with resultant rotator cuff tears, tendinitis and pain.
A Kuglar , M Kruger, 1996, studied about the Muscular imbalance and shoulder pain in volleyball attackers . 30 competitive volleyball attackers (mean age 25) were included in the study, 15 suffering shoulder pain and 15 had no history of shoulder pain. A standardized clinical examination was performed according to Brunner and Habermeyer, concentration specially on the shoulder depression, tender points, crepitation ,arm girth, active and passive range of motion and muscle strength. Shoulder tests were also performed including the 0degree abduction test, 90 degree supraspinatus test in internal and external rotation , resisted internal and external rotation with 90 degree flexed elbow beside the trunk and the impingement test according to Neer, Yergasons test and the palm up test. Ultrasound examination were performed with a7.5 MHZ linear scanner. Statistical analysis were done using the Wilcoxon rank sum test. The study concluded that volleyball attackers have a different muscular pattern and capsular pattern at the playing shoulder compared to the opposite shoulder. Their playing shoulder is depressed , scapula lateralized and dorsal muscles and the posterior and inferior part of the shoulder capsule shortened. These differences were more significant in volleyball players with shoulder pain then the volleyball player with no shoulder pain. The possible mechanism might be that the tightened posterior and inferior structures combined with shoulder depression lead to a disturbance of the gliding and rolling motion of the humeral head hence causing pain. These imbalances may lead to a disturbed movement pattern at the playing shoulder in volleyball attackers.
Dillman. CJ and Andrews, 1993, in the article- kinetics of pitching with implications about injury mechanism, discussed about the altered mechanics in over- head throwers shoulder that predisposed to a shoulder injury. Dynamic neuromuscular stabilizers of the shoulder are imperative in the prevention of shoulder injury in the over-head throwing athletes. The ligamentous restraints about the shoulder complex are moderately sufficient in providing the static stabilization, but the dynamic stabilization was required to prevent glenohumeral translation during the over-head throw activity. During over -head throw motion, strong eccentric force production by the shoulder external rotators plays a vital role in the prevention of shoulder injuries caused by excessive glenohumeral translation. The shoulder external rotator musculature is functionally responsible for the eccentric deceleration of the rapidly moving throwing arm and if not strong enough to do so, the athlete would predispose to a shoulder injury.
Minoru Tanaka, Shiro Tabata ,2010, studied the Factors related to the successful outcome of conservative management for rotator cuff tears .This study included 123 shoulders in 118 patients with full thickness tears of the rotator cuff diagnosed by MRI. All the patients were treated conservatively ( rest, NSAIDS, subacromial injections )for atleast 3 months. Clinical symptoms improved in 65 shoulders in 62 patients by conservative treatment but remained unchanged or aggravated in 58 shoulders who underwent a surgical repair. According to previous reports, the success rates of conservative management can vary widely , Brown reported that 87% of patients who had rotator cuff tears with full range of abduction at initial examination regained full function by conservative management and also concluded that the success rate of conservative management was 70%. Tabata also reported a high percentage (82%) of recovery after conservative treatment. In this study four factors correlated very well with the successful outcome following conservative management 1). A preserved external range of motion ( more than 52 degree), 2) negative impingement sign 3) little or no atrophy of the supraspinatus muscle and 4) preserved intramuscular tendon of the supraspinatus. These muscles seem to keep the humeral head well centred in the glenoid cavity and prevent impingement between the humeral head and acromion. Intact intramuscular tendon of the supraspinatus may indicate the potential to respond well to the conservative management.
Roberta Ainsworth and Jeremy S Lewis ,2007, studied the systemic review of Exercise therapy for the conservative management for full thickness tears of the rotator cuff According to the review the conservative management including exercise therapy is often considered as the first management approach for patients with full thickness tears of the rotator cuff. Off all the range of shoulder pathologies disorders of the rotator cuff was considered to be the most common. Exercise therapy ( strengthening and stretching ) when included as a part of a treatment programme, has beneficial effects for patients who have symptomatic shoulder shoulders and radiological evidence of the rotator cuff tear. It was also reviewed that it was not possible to determine if exercise alone exercise in combination with other interventions that offers the greatest benefit. In addition , guidance as to the most appropriate exercise therapy , including duration , intensity and number of repetitions remains speculative. There is also an uncertainty as when to start and how to progress the exercise therapy program. There is also no proper guidance to follow to inform clinicians whether exercise therapy has to be specific or general in nature, it is unclear why exercise therapy may be having a beneficial effect. Other investigations have reported that the presence and size of the tear maybe less important than the presence of pain. This may also help to explain why individuals with full thickness tears but without shoulder pain are able to function normally, conservative management , including exercise therapy for rotator cuff tear may also be associated with substantial improvement. As such , it is essential that appropriate validated outcome measures are conducted to begin to address the considerable deficiencies in the knowledge base regarding the best management practice for this common and disabling condition. In the current study, plyometric drills will be given to the healthy athletes and those suffering from partial thickness tear of the rotator cuff who were treated conservatively for at least three months. Athletes suffering from partial thickness tear of the rotator cuff their level of disability will be checked using the DASH sports module pre and post training.
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