Original Research

Passive and Dynamic Shoulder Rotation Range in Uninjured and Previously Injured Overhead Throwing Athletes and the Effect of Shoulder Taping
Jenny McConnell, DPT, Cyril Donnelly, MS, Samuel Hamner, MS, James Dunne, MS, Thor Besier, PhD
Objectives: To investigate: (1) the passive and dynamic shoulder internal (IR) and external (ER) rotation range of motion (ROM) of 2 groups of asymptomatic overhead throwing athletes: one group who had never experienced shoulder symptoms and another who had shoulder symptoms 12 months ago, (2) the effect of taping on the passive and dynamic IR-ER ROM in both these groups. Design: A within-subject repeated measures analysis of variance design to determine the differences in passive and dynamic shoulder rotation range and the effect of shoulder taping on the rotation range in a group of uninjured and previously injured overhead throwing athletes. Setting: Academic institution sports medicine setting. Participants: Twenty-six overhead throwing collegiate athletes: 17 with no history of shoulder injury and 9 with previous shoulder injury. Methods: Passive shoulder ROM was measured with a goniometer with the subject in the supine position. To measure dynamic ROM, the subjects sat on a chair and threw a handball into a net. An 8-camera Vicon Motion Capture system recorded markers placed on the upper limb and trunk. Dynamic ROM was calculated with inverse kinematics by using OpenSim. Main Outcome Measurement: Shoulder IR-ER ROM. Results: Dynamic IR-ER ROM was signicantly greater than passive IR-ER ROM (P .0001). There was no difference in passive IR-ER ROM between the uninjured and previously injured overhead throwing athletes. However, there was a signicant difference in the total dynamic IR-ER ROM, whereby the overhead throwing athletes who had never experienced shoulder symptoms had less IR-ER ROM than the previously injured group (173.9 versus 196.9, respectively; P .049). Taping the shoulder increased the passive ROM in both groups of subjects (P .001), increased the dynamic IR-ER ROM in the uninjured subjects, but decreased the dynamic IR-ER ROM in the previously injured subjects, although this was not statistically signicant (P .07). Conclusions: Passive IR-ER ROM is a poor indication of dynamic shoulder function. Athletes who have had a previous shoulder injury demonstrate a greater dynamic IR-ER ROM than athletes who have never had a shoulder injury. Shoulder taping decreased the dynamic range of the previously injured athlete, so that it was nearer the dynamic range of the uninjured athlete. Shoulder taping might provide increased protection for the injured athlete by decreasing the dynamic IR-ER ROM and by facilitating better shoulder and scapular muscle control. Further studies are necessary to demonstrate whether this nding is clinically signicant. PM R 2012;4:111-116

J.M., Centre for Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia. Address correspondence to: J.M.; e-mail: jennymcconnell@bigpond.com Disclosure: nothing to disclose C.D. School of Sport Science, Exercise and Health, University of Western Australia, Perth, Australia. Disclosure: nothing to disclose S.H. Department of Mechanical Engineering, Stanford University, Palo Alto, CA. Disclosure: nothing to disclose J.D. School of Sport Science, Exercise and Health, University of Western Australia, Perth, Australia. Disclosure: nothing to disclose T.B. Human Performance Laboratory, Department of Orthopaedics, Stanford University, Palo Alto, CA. Disclosure: nothing to disclose This study was funded by the New South Wales Sporting Injuries Committee. Peer reviewers and all others who control content have no relevant nancial relationships to disclose. Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org Submitted for publication April 16, 2011; accepted November 25, 2011.

INTRODUCTION
Shoulder injuries are common in overhead throwing athletes [1-4] and account for up to 75% of the total time lost to injury in these athletes [5]. The forceful and repetitive nature of overhead throwing activities and poor scapular muscle control (scapular dyskinesis) are hypothesized to cause an anterior shift of the humeral head, which changes the rotational
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2012 by the American Academy of Physical Medicine and Rehabilitation

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arc of the shoulder, increasing external rotation (ER) and decreasing internal rotation (IR) [6-8]. However, Kibler and Chandler [9] suggest that the decreased, rather than increased, shoulder IR and ER range of motion (ROM), due to capsular stiffness or muscle tightness, which can be measured by standard goniometric tests, causes shoulder injury in overhead throwing athletes. They speculate that muscle inexibility changes the motor ring pattern by altering muscle tension and proprioceptive feedback [5]. Other investigators have suggested that repetitive throwing causes torsional stresses within the proximal physis, which induces an adaptive remodeling response that favors humeral retroversion [10-16]. A retroverted humeral head reduces the strain on the anterior-inferior capsule and spares the joint from repeated microtrauma [10,12]. Throwers with chronic shoulder pain apparently do not exhibit this increase in retrotorsion [15], having more strain on their anterior capsules at less ER, so are more likely to develop chronic shoulder pain because of anterior instability [15]. Therefore, there is a conundrum in the literature as to whether excessive or inadequate shoulder rotation range causes shoulder injuries; perhaps one could speculate that there is an ideal amount of rotation range where the range is sufcient and the muscle control is adequate to allow an overhead throwing athlete to throw without injuring the shoulder. Clinicians evaluate shoulder internal (IR) and external (ER) ROM to determine the effectiveness of shoulder treatment and the readiness of an overhead throwing athlete to return to sport after injury. Examination usually is performed passively, with the assumption that static ROM measurements are representative of the dynamic ROM during throwing [17]. However, the incidence of shoulder reinjury is high [18]. An overhead throwing athlete may be pain free, have restored passive ROM, and be ready to return to sport, but the muscle capabilities may be insufcient to control the shoulder girdle during throwing, perhaps resulting in further injury or decreased performance. Taping the shoulder of injured overhead throwing athletes is increasingly being used to decrease pain, change shoulder range, and improve the proprioception of the joint. McConnell and McIntosh [19] found that the passive range of shoulder ER and IR in elite junior tennis players with no history of shoulder injury was increased with the application of tape over the shoulder, and hypothesized that taping the shoulder changed the starting position of shoulder rotation
Table 1. Subject characteristics Age (y) Mean (SD) All Uninjured Injured 20.2 2.6 19.4 1.5 21.6 3.9 Height (cm) Mean (SD) 184.7 8.0 184.3 6.3 185.1 11.6 Weight (kg) Mean (SD) 80.4 11.0 78.6 9.7 83.1 14.2

by centering the humeral head. However, the effectiveness of taping is widely disputed in the literature, with some investigators claiming that taping has no effect and other investigators nding signicant changes [19-24]. The application of the tape, the type of tape used, and the methodology of the studies vary greatly. Bradley et al [24] found that, although taping the shoulder was almost a routine prophylactic measure for elite Australian Rules Football players, taping did not change joint laxity, proprioception, or throwing accuracy. Because shoulder passive IR-ER ROM is an important part of the clinical shoulder examination in overhead throwing athletes and shoulder taping is being used to control anterior humeral shift, the aims of the current study were to investigate whether there was a difference between passive and dynamic IR-ER ROM in an uninjured group and in a previously injured group of elite overhead throwing college athletes and to investigate whether taping affects the static or dynamic IR-ER ROM.

METHOD Participants
Twenty-six elite overhead throwing athletes (15 men and 11 women; mean age, 20 years) from Stanford University college teams of volleyball, baseball, and tennis were selected to participate in the study from a group who expressed interest in being involved (Table 1). The subjects were excluded if they had a current shoulder injury that made them unable to play or train in their selected sport or if they could not perform a maximal-effort throw. The subjects completed a brief injury questionnaire to determine any shoulder injury history, the type of treatment received, and the amount of time spent off sport, and if they needed to modify their overhead throwing activity as a result of the shoulder injury. All of the previously injured subjects had not sought any treatment for 12 months, and none had required surgery. All the individuals provided informed written consent, and ethics approval was obtained from the institutional review board of Stanford University.

Procedure
Passive Measurement. Two measurements of passive ER and IR ROM were made by using a universal goniometer

No. Volleyball Subjects 13 (3 M, 10 F) 6 (6 F) 7 (3 M, 4 F)

No. Tennis Subjects 7 (6 M,1 F) 6 (5 M,1 F) 1 (M)

No. Baseball Subjects 6 (M) 5 (M) 1 (M)

SD standard deviation; M male; F female.

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Figure 1. Shoulder taping.

on the throwing arm. Total IR-ER ROM was determined by adding ER and IR ROM. The subjects were placed in the supine position, with the shoulder abducted to 90. Passive IR-ER ROM measurements were repeated with and without shoulder taping (no tape and tape conditions) by using the taping protocol of McConnell and McIntosh [19] (Figure 1). The goniometer axis was aligned with the distal tip of the olecranon, and the stationary arm was maintained in a vertical position. The moving arm of the goniometer was aligned with the lateral aspect of the ulna. The glenohumeral joint was passively rotated until scapulothoracic movement occurred, as determined by visual inspection [17,25]. All measurements were made by one examiner (J.M.). Goniometric assessment has been demonstrated to be a valid and reliable method of measuring passive shoulder ROM [3,17,25]. Dynamic Measurement. The subjects were seated on a chair, with a seat-belt restraint around their waist, and threw a handball into a net. The use of the seated throw better isolated the movement of the shoulder and decreased the variability of the throwing action of the athletes from different sports. The subjects warmed up for 1 minute by gradually increasing their throwing intensity; they were asked to perform 3 maximal throws. The average of the 3 throws was used for data analysis. Throwing trials were repeated under the tape and no tape conditions. The subjects rested for 5 minutes between the 2 conditions and performed the same warm-up for each condition. The dynamic and passive testing as well as the tape and no tape conditions were randomly assigned. An 8-camera Vicon Motion Capture system (Oxford Metrics, Oxford, UK), operating at a rate of 120 Hz, recorded

markers placed on the upper limb and trunk. Anatomical markers were placed on the following locations: the anterior and posterior superior iliac spine of the pelvis, sternal notch, spinous process of C7, distal clavicle of the throwing arm, styloid process of the ulna, and styloid process of the radius. Clusters of 3 markers were placed on the upper arm and forearm of the throwing limb. These marker clusters were used to track the motion of the arm during the throw. A static calibration trial was captured before the throwing trials, which included markers placed on the medial and lateral epicondyles of the humerus (to dene the elbow joint center); on the radial and ulnar styloid processes (to dene the wrist-joint center); acromion process; and anterior and superior aspects of the shoulder, approximately 2 cm below the acromion (to dene the shoulder-joint center). A kinematic model of the upper limb [26] was scaled to match the estimated joint centers from the static calibration trial, and inverse kinematics was used to estimate the motions of the shoulder (3 degrees of freedom), and elbow (2 degrees of freedom) by using OpenSim software [27]. Kinematic variables of rotation were determined just after full cock, when peak ER of the shoulder occurred, and at zero elbow velocity after ball release, when the shoulder demonstrated the greatest amount of IR. Total dynamic IR-ER ROM was determined by adding the dynamic ER and dynamic IR.

Statistical Analysis
Analysis of variance (2 2 repeated measures) were performed on the data to determine the effects of type of motion and tape on the IR-ER range, as well as any interaction effect of previous injury status. Each subject served as his or her own control, because athletes of different overhead throwing sports participated in the study. Measurements for each subject were obtained for the passive and dynamic IR-ER movement and for the tape and no tape conditions. Condence intervals of 95% for difference and an of P .05 were used to determine statistically signicant differences between active and passive conditions. Independent t-tests were used to determine whether there were any differences between the uninjured and the previously injured subjects in passive and dynamic IR-ER ROM (statistical signicance of P .05 was set for any differences between uninjured and previously injured subjects). Statistical analyses were performed by using SPSS v17.0 (SPSS Inc, Chicago IL).

RESULTS
Shoulder ER was greater during throwing than when measured passively with the subject supine on a table (P .0001), but dynamic shoulder IR was less than passive IR (P .02) (Table 2). The dynamic IR-ER ROM was greater than the passive IR-ER ROM (182 versus 143). There was no difference (P .91) in passive IR-ER ROM between the previously injured and unin-

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Table 2. Means and standard deviations (SD) of passive and dynamic shoulder rotation range of motion Passive, Mean (SD) Total range of motion (all) Total range of motion (uninjured) Total range of motion (previously injured) Shoulder maximum external rotation (all) Shoulder internal rotation (all) 143.3 15.2 143.8 16.4 142.2 13.3 89.4 11.9 53.9 6.9 Dynamic, Mean (SD) 181.9 28.8 173.9 27.9 196.9 25.5 135.2 19.8 47.0 19.1 P Value .0001 .001 .0001 .0001 .02

jured subjects (144o versus 143, respectively). However, the previously injured subjects exhibited greater dynamic IR-ER ROM than the uninjured subjects (196.9 versus 173.9, respectively; P .049) (Table 2). When the previously injured and uninjured groups were considered together, taping had a signicant effect on the total shoulder IR-ER ROM (P .012). Shoulder taping increased the passive IR-ER range for both the uninjured and previously injured groups (144-154 and 143-156, respectively; P .001), and increased the dynamic IR-ER range of the uninjured group (174 to 180), but shoulder taping decreased the dynamic rotation range of the uninjured group (197 to 190 ) (Figure 2). Although there was a trend toward an interaction effect with injury, it was not signicant (P .07), whereby the uninjured experienced an increase in range for both the passive and dynamic conditions, but the previously injured responded differently to the tape application, depending on the movement condition, with an increase in range passively and a decrease in range dynamically.

DISCUSSION
Passive shoulder IR-ER ROM is often used as an indicator of shoulder function and an athletes susceptibility to injury [4,7,27-29]. Our results of passive IR-ER ROM in the shoulder are similar to those of Ellenbecker et al [4], who found that the

total IR-ER ROM in the dominant shoulder in elite baseball players was approximately 146, and those of McConnell and McIntosh [19], who found that, in elite junior tennis players, the range was approximately 136. Contrary to the assumption of Scher et al [17], we have shown that passive IR-ER ROM in the shoulder underestimates the dynamic IR-ER ROM of the shoulder used in throwing, at least in a seated position. During passive measurement in supine, the scapula is stabilized on the plinth, but, dynamically, the scapula is free to move with the shoulder girdle muscles, exercising control over the joint and contributing to shoulder ROM. In addition, the fast angular velocities during throwing result in much greater IR-ER ROM than what is measured passively. Although there was no difference passively in the rotation range of our uninjured and previously injured subjects, which is similar to the ndings by Scher et al [17], who also found no difference in rotation range in baseball pitchers with and without a history of shoulder injury, the difference in dynamic range between the uninjured and previously injured was marked, which suggests that the previously injured subject may have inadequate eccentric internal and external rotator muscle control for the throwing activity [30-33] and/or scapular dyskinesis [2,7,10,34,35]. Scapular dyskinesis is believed to affect athletic performance, which makes the shoulder more susceptible to reinjury [8,34,35]. Alteration in scapular coordination has been

Figure 2. Means and standard deviations of the passive and dynamic total rotation range of motion in no tape and taped conditions in (i) uninjured and (ii) previously injured subjects.

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suggested to cause an increase in anterior translation of the humerus, which may increase the stress on the anterior stabilizing structures of the glenohumeral articulation, thereby increasing the risk of shoulder problems [2,7, 10,34,35]. Subtle changes in scapular motion could prove to be detrimental to athletes who repetitively elevate their arms overhead, which leads to chronic damage of the surrounding soft tissue and bone [10]. The previously injured subjects in our study demonstrated almost 15% more dynamic IR-ER ROM than the uninjured subjects, which perhaps places them at greater risk for reinjury. Thus, clinicians should establish, before returning an athlete to sport, whether that athlete has adequate dynamic glenohumeral and scapulothoracic control, because a more stable platform for the upper extremity can only enhance performance and minimize injury recurrence [35]. In our study, the specic application of shoulder tape increased the dynamic shoulder IR-ER ROM in the uninjured by 6 and decreased the ROM in the previously injured individuals by 7. The uninjured subjects may be at risk for injury, particularly if the dynamic ER ROM is insufcient so that more strain is placed on the anterior capsule of the shoulder and increases the likelihood of shoulder injury. The previously injured subjects, who were pain free at the time of testing and were actively participating in their sports, may have inadequate passive and dynamic structures, which were not stabilizing the humeral head, which in turn allowed an increase in humeral translation. In addition, any laxity in the passive stabilizers may increase the control required by the rotator cuff and lead to fatigue and dysfunction of the dynamic stabilizers [30]. Perhaps there is an ideal dynamic rotation range for the throwing shoulder, where the passive structures are not being excessively strained and the active structures have adequate control. Taping the shoulder may control the translation of the humeral head by changing the rotational axis and hence the starting position of the joint. Taping the shoulder also could improve the input to the stabilizing muscles around the shoulder and minimize muscle fatigue and the risk of reinjury, particularly when the athlete rst returns to sport. Dynamic imaging techniques would be necessary to accurately assess the relationship between shoulder IR-ER ROM and soft tissue structures [36]. A limitation of this study is that we tested only a relatively small number of athletes from a variety of sports. Most of the previously injured subjects were volleyball players, and a greater number of volleyball players were previously injured than uninjured compared with tennis and baseball players, among whom the opposite was true; this may have inuenced the dynamic ROM results. Secondly, a seated throw enabled us to standardize the throwing technique, but it may have not represented how the athletes use their upper arms during their sport, because the lower limbs were eliminated from the throwing action, so the testing protocol may have altered the IR-ER ROM required at the shoulder. Further,

tennis and volleyball are not considered classic throwing sports, such as baseball; so, to minimize the effect of potential throwing familiarity, we used a standard handball, which was an unfamiliar ball type for all of the athletes in this study. However, none of the athletes commented on the ball or had any difculty throwing, and all of the athletes were allowed to throw for 1 minute before data collection.

CONCLUSIONS
Passive shoulder IR-ER ROM is a poor estimate of dynamic rotation function during throwing. Better clinical methods to assess dynamic shoulder IR-ER ROM during throwing would facilitate improved diagnosis and monitoring of throwingrelated shoulder injury. Athletes who have had a previous shoulder injury demonstrated a greater dynamic shoulder IR-ER ROM than athletes who had never had a shoulder injury. Shoulder taping increased the passive IR-ER ROM of overhead throwing athletes regardless of previous injury status and increased the dynamic IR-ER ROM of uninjured overhead throwing athletes. Taping decreased the dynamic IR-ER ROM of previously injured athletes. Thus, although passive IR-ER ROM was not different in the uninjured and previously injured overhead throwing athletes, the application of shoulder taping meant that the increased dynamic IR-ER ROM of the previously injured overhead throwing athletes came closer to the decreased dynamic IR-ER ROM of the uninjured athletes. Shoulder taping might provide increased protection for the injured athlete by decreasing the dynamic IR-ER ROM and by facilitating better shoulder and scapular muscle control. Further studies are necessary to demonstrate whether this nding is clinically signicant.

ACKNOWLEDGMENTS
The authors thank Rebecca Shultz from the human performance laboratory at Stanford University for data collection, Roger Adams from the University of Sydney for his statistical help, Eitan Gelber for his enthusiasm for organizing the subjects, and the Stanford athletes for being involved in the study.

REFERENCES
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7. Van der Hoeven H, Kibler W. Shoulder injuries in tennis players. Br J Sports Med 2006;40:435-440. 8. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: Spectrum of pathology. Part I: Pathoanatomy and biomechanics. Arthroscopy 2003;19:404-420. 9. Kibler WB, Chandler TJ. Range of motion in junior tennis players participating in an injury risk modication program. J Sci Med Sport 2003;6:51-62. 10. Borsa PA, Laudner KG, Sauers EL. Mobility and stability adaptations in the shoulder of the overhead athlete: A theoretical and evidence-based perspective. Sports Med 2008;38:17-36. 11. Edelsten G. The development of humeral head retrotorsion. J Shoulder Elbow Surg 2000;9:316-318. 12. Osbahr DC, Cannon DL, Speer KP. Retroversion of the humerus in the throwing shoulder of college baseball pitchers. Am J Sports Med 2002;30:347-353. 13. Taylor RE, Zheng C, Jackson RP, et al. The phenomenon of twisted growth: Humeral torsion in dominant arms of high performance tennis players. Comput Methods Biomech Biomed Engin 2009;12:83-93. 14. Schwab LM, Blanch P. Humeral torsion and passive shoulder range in elite volleyball players. Phys Ther Sport 2009;10:51-56. 15. Pieper HG. Humeral torsion in the throwing arm of handball players. Am J Sports Med 1998;26:247-253. 16. Sabick MB, Kim YK, Torry MR, et al. Biomechanics of the shoulder in youth baseball pitchers: Implications for the development of proximal humeral epiphysiolysis and humeral retrotorsion. Am J Sports Med 2005;33:1716-1722. 17. Scher S, Anderson K, Weber N, et al. Associations among hip and shoulder range of motion and shoulder injury in professional baseball players. J Athl Train 2010;45:191-197. 18. Rauh MJ, Macera CA, Ji M, Wiksten DL. Subsequent injury patterns in girls high school sports. J Athl Train 2007;42:486-489. 19. McConnell J, McIntosh B. The effect of tape on glenohumeral rotation range of motion in elite junior tennis players. Clin J Sport Med 2009; 19:90-94. 20. Thelen MD, Dauber JA, Stoneman PD. The clinical efcacy of kinesio tape for shoulder pain: A randomized, double-blinded, clinical trial. J Orthop Sports Phys Ther 2008;38:389-395. 21. Cools AM, Witvrouw EE, Danneels LA, Cambier DC. Does taping inuence electromyographic muscle activity in the scapular rotators in healthy shoulders? Man Ther 2002;7:154-162. 22. Alexander CM, Stynes S, Thomas A, et al. Does tape facilitate or inhibit the lower bres of trapezius? Man Ther 2003;8:37-41. 23. Lin JJ, Hung CJ, Yang PL. The effects of scapular taping on electromyographic muscle activity and proprioception feedback in healthy shoulders. J Orthop Res 2011;29:53-57.

24. Bradley T, Baldwick C, Fischer D, Murrell GA. Effect of taping on the shoulders of Australian football players. Br J Sports Med 2009;43:735738. 25. Awan R, Smith J, Boon AJ. Measuring shoulder internal rotation range of motion: A comparison of 3 techniques. Arch Phys Med Rehabil 2002;83:1229-1234. 26. Holzbaur KRS, Murray WM, Delp SL. A model of the upper extremity for simulating musculoskeletal surgery and analyzing neuromuscular control. Ann Biomed Eng 2005;33:829-840. 27. Delp SL, Anderson FC, Arnold AS, et al. OpenSim: Open-source software to create and analyze dynamic simulations of movement. IEEE Trans Biomed Eng 2007;55:1940-1950. 28. Park SS, Loebenberg ML, Rokito AS, Zuckerman JD. The shoulder in baseball pitching: Biomechanics and related injuriesPart 1 [review]. Bull Hosp Joint Dis 2002-2003;61:68-79. 29. Dwelly PM, Tripp BL, Tripp PA, et al. Glenohumeral rotational range of motion in collegiate overhead-throwing athletes during an athletic season. J Athl Train 2009;44:611-616. 30. Stickley CD, Hetzler RK, Freemyer BG, Kimura IF. Isokinetic peak torque ratios and shoulder injury history in adolescent female volleyball athletes. J Athl Train 2008;43:571-577. 31. Glousman R, Jobe F, Tibone J, et al. Dynamic electromyographic analysis of the throwing shoulder with glenohumeral instability. J Bone Joint Surg Am 1988;70:220-226. 32. Lee SB, Kim KJ, ODriscoll SW, et al. Dynamic glenohumeral stability provided by the rotator cuff muscles in the mid-range and end-range of motion. A study in cadavers. J Bone Joint Surg Am 2000;82:849-857. 33. Labriola JE, Lee TQ, Debski RE, McMahon PJ. Stability and instability of the glenohumeral joint: The role of shoulder muscles. J Shoulder Elbow Surg 2005;14(Suppl S):32S-38S. 34. Kibler WB, Sciascia A. Current concepts: Scapular dyskinesis. Br J Sports Med 2010;44:300-305. 35. Thomas SJ, Swanik KA, Swanik CB, Kelly JD. Internal rotation decits affect scapular positioning in baseball players. Clin Orthop Relat Res 2010;468:1551-1557. 36. Bey MJ, Zauel R, Brock SK, Tashman S. Validation of a new modelbased tracking technique for measuring three-dimensional, in vivo glenohumeral joint kinematics. J Biomech Eng 2006;128:604-609. This CME activity is designated for 1.0 AMA PRA Category 1 Credit and can be completed online at me.aapmr.org. Log on to www.me.aapmr.org, go to Lifelong Learning (CME) and select Journal-based CME from the drop down menu. This activity is FREE to AAPM&R members and $25 for non-members.

CME Question In which group and state of subjects did the authors report a decrease in the internal and external range of motion (IR-ER ROM) post taping? a. b. c. d. dynamic IR-ER ROM in the previously injured athletes passive IR-ER ROM in the previously injured athletes dynamic IR-ER ROM in the previously uninjured athletes passive IR-ER ROM in the previously uninjured athletes

Answer online at me.aapmr.org