{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:08:52Z","timestamp":1785427732900,"version":"3.56.0"},"reference-count":50,"publisher":"International Journal of Sports Physical Therapy","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"\n Background<\/jats:title>\n Scapular dyskinesis (SD) is a common co-morbidity with shoulder complex injuries. However, the presence of shoulder pain (SP) with SD is inconsistent, suggesting a need for individualized assessment and treatment approaches. The purpose of this case report is to describe the differential diagnosis of an athlete with SD and SP and a rehabilitation strategy integrating physical therapy (PT) with a Stroke Efficiency Rating Analysis\/Injury Risk Assessment (SER\/IRA) to identify biomechanical faults during the tennis serve.<\/jats:p>\n <\/jats:sec>\n \n Case Description<\/jats:title>\n A 23-year-old male tennis player with right SP was referred to PT by his coach. The subject\u2019s SP had been intermittent for nine years, presenting during and after serving and recently intensified, limiting his activities of daily living (ADLs). The subject was diagnosed with secondary shoulder impingement with long head of the bicep and rotator cuff tendinopathy attributed to SD. He completed a 16-week, four-phase rehabilitation program incorporating the SER\/IRA and revisions to the biomechanics of his service action, leading to symptom resolution and return to pain-free tennis and ADLs.<\/jats:p>\n <\/jats:sec>\n \n Outcomes<\/jats:title>\n The subject\u2019s pain level during and after playing tennis decreased from 8\/10 to 1\/10 following the intervention. The Upper Extremity Functional Score improved by 11 points, while the Disabilities of the Arm, Shoulder, and Hand Questionnaire (disability\/symptom and work\/sports modules) decreased by 20.87 and 56.25 points, respectively, reflecting clinically meaningful change. The subject returned to tennis and ADLs without pain and remained unrestricted six months after discharge.<\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n This case highlights the effectiveness of combining individualized stroke analysis with evidenced based rehabilitation for an individual with SD and SP. The SER\/IRA provided insight into the subject\u2019s movement quality, guided treatment progression, augmented rehabilitation, and facilitated collaboration between the physical therapist and coach. Such tools may help promote long-term pain reduction, expedite return-to-play, and optimize performance for players with SP and\/or SD.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level 4<\/jats:p>\n <\/jats:sec>","DOI":"10.26603\/001c.154590","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T22:03:39Z","timestamp":1767218619000},"source":"Crossref","is-referenced-by-count":0,"title":["Rehabilitation Incorporating a Stroke Efficiency Analysis in a Male Tennis Player with Scapular Dyskinesis: A Case Report"],"prefix":"10.26603","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3633-4025","authenticated-orcid":true,"given":"Cristina","family":"Leek","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0324fzh77","id-type":"ROR","asserted-by":"publisher"}],"name":"Long Island University","department":["Physical Therapy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1478-6663","authenticated-orcid":false,"given":"Katie","family":"Sell","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03pm18j10","id-type":"ROR","asserted-by":"publisher"}],"name":"Hofstra University","department":["Allied Health and Kinesiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"11140","published-online":{"date-parts":[[2026,1,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"319","DOI":"10.5435\/00124635-199511000-00002","article-title":"Scapular winging","volume":"3","author":"J. E. Kuhn","year":"1995","journal-title":"J Am Acad Orthop Surg"},{"issue":"7","key":"ref2","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1016\/j.jse.2012.09.010","article-title":"The effect of simulated scapular winging on glenohumeral joint translations","volume":"22","author":"A. M. Mueller","year":"2013","journal-title":"J Shoulder Elbow Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1177\/03635465980260022801","article-title":"The role of the scapula in athletic shoulder function","volume":"26","author":"W. B. Kibler","year":"1998","journal-title":"Am J Sports Med"},{"issue":"2","key":"ref4","doi-asserted-by":"publisher","first-page":"90","DOI":"10.2519\/jospt.2009.2808","article-title":"The association of scapular kinematics and glenohumeral joint pathologies","volume":"39","author":"P. M. Ludewig","year":"2009","journal-title":"J Orthop Sports Phys Ther"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1136\/bjsports-2017-097559","article-title":"Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: A systematic review and meta-analysis","volume":"52","author":"D. Hickey","year":"2018","journal-title":"Br J Sports Med"},{"issue":"3","key":"ref6","doi-asserted-by":"publisher","first-page":"558","DOI":"10.26603\/001c.74388","article-title":"Is it time to normalize scapular dyskinesis? The incidence of scapular dyskinesis in those with and without symptoms: A systematic review of the literature","volume":"18","author":"P. A. Salamh","year":"2023","journal-title":"Int J Sports Phys Ther"},{"issue":"6","key":"ref7","doi-asserted-by":"publisher","first-page":"514","DOI":"10.15406\/ipmrj.2018.03.00157","article-title":"Scapular dyskinesis: biomechanics, evaluation and treatment","volume":"3","author":"H. M. Sanchez","year":"2018","journal-title":"Int Phys Med Rehab J"},{"issue":"5","key":"ref8","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1016\/j.jse.2011.01.008","article-title":"Effects of scapular dyskinesis and scapular assistance test on subacromial space during static arm elevation","volume":"21","author":"A. L. Seitz","year":"2012","journal-title":"J Shoulder Elbow Surg"},{"issue":"6","key":"ref9","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1136\/bjsm.2008.046284","article-title":"Clinical and ultrasonographic correlation between scapular dyskinesia and subacromial space measurement among junior elite tennis players","volume":"44","author":"R. T. Silva","year":"2010","journal-title":"Br J Sports Med"},{"issue":"2","key":"ref10","doi-asserted-by":"publisher","first-page":"160","DOI":"10.4085\/1062-6050-44.2.160","article-title":"A clinical method for identifying scapular dyskinesis, part 1: Reliability","volume":"44","author":"P. McClure","year":"2009","journal-title":"J Athl Train"},{"issue":"6","key":"ref11","doi-asserted-by":"publisher","first-page":"2152","DOI":"10.1007\/s00167-023-07310-5","article-title":"Professional tennis players suffer high prevalence of shoulder alterations during the season: A possible tennis shoulder syndrome","volume":"31","author":"R. L\u00f3pez-Vidriero Tejedor","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"11","key":"ref12","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.1016\/j.arthro.2009.06.007","article-title":"Evaluation of clinical assessment methods for scapular dyskinesis","volume":"25","author":"T. L. Uhl","year":"2009","journal-title":"Arthroscopy"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.arthro.2008.08.019","article-title":"Scapular dyskinesis and SICK scapula syndrome in patients with chronic type III acromioclavicular dislocation","volume":"25","author":"S. Gumina","year":"2009","journal-title":"Arthroscopy"},{"issue":"14","key":"ref14","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1136\/bjsports-2013-092425","article-title":"Clinical implications of scapular dyskinesis in shoulder injury: The 2013 consensus statement from the \"Scapular Summit.\"","volume":"47","author":"W. B. Kibler","year":"2013","journal-title":"Br J Sports Med"},{"issue":"8","key":"ref15","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1136\/bjsports-2013-092148","article-title":"Rehabilitation of scapular dyskinesis: From the office worker to the elite overhead athlete","volume":"48","author":"A. M. Cools","year":"2014","journal-title":"Br J Sports Med"},{"issue":"3","key":"ref16","first-page":"962","article-title":"Efficacy of six weeks stability exercises on the glenohumeral joint of female tennis players with scapular dyskinesia","volume":"15","author":"S. M. Gorji","year":"2022","journal-title":"Int J Exerc Sci"},{"issue":"5","key":"ref17","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1136\/bjsports-2015-095460","article-title":"Clinical outcomes of a scapular-focused treatment in patients with subacromial pain syndrome: A systematic review","volume":"51","author":"E. A. Reijneveld","year":"2017","journal-title":"Br J Sports Med"},{"issue":"4","key":"ref18","doi-asserted-by":"publisher","first-page":"577","DOI":"10.32598\/irj.21.4.1933.1","article-title":"A systematic review and meta-analysis: The effect of scapular-focused exercise therapy on shoulder pain and function and scapular positioning in people with scapular dyskinesia","volume":"21","author":"M. Khodaverdizadeh","year":"2023","journal-title":"Iran Rehabil J"},{"issue":"5","key":"ref19","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1136\/bjsm.2005.023218","article-title":"Shoulder injuries in tennis players","volume":"40","author":"H. van der Hoeven","year":"2006","journal-title":"Br J Sports Med"},{"issue":"3S","key":"ref20","doi-asserted-by":"publisher","first-page":"S69","DOI":"10.1016\/j.pmrj.2015.11.015","article-title":"The kinetic chain revisited: New concepts on throwing mechanics and injury","volume":"8","author":"S.K. Chu","year":"2016","journal-title":"PM R"},{"issue":"1","key":"ref21","doi-asserted-by":"publisher","first-page":"853037","DOI":"10.1155\/2012\/853037","article-title":"Kinetic chain rehabilitation: A theoretical framework","volume":"2012","author":"A. Sciascia","year":"2012","journal-title":"Rehabil Res Pract"},{"issue":"7","key":"ref22","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1136\/bjsports-2012-091175","article-title":"Injury trend analysis from the US Open tennis championships between 1994 and 2009","volume":"48","author":"K. Sell","year":"2014","journal-title":"Br J Sports Med"},{"issue":"4","key":"ref23","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1016\/j.csm.2008.07.007","article-title":"Injury patterns and biomechanics of the athlete's shoulder","volume":"27","author":"D. Lintner","year":"2008","journal-title":"Clin Sports Med."},{"issue":"3","key":"ref24","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1080\/24748668.2020.1761672","article-title":"Influence of scapular dyskinesis, kinesiotaping and fatigue on tennis serve performance","volume":"20","author":"C. Tooth","year":"2020","journal-title":"Int J Perform Anal Sport"},{"issue":"8","key":"ref25","doi-asserted-by":"publisher","first-page":"e0290320","DOI":"10.1371\/journal.pone.0290320","article-title":"Biomechanical analyses of different serve and groundstroke techniques in tennis: A systematic scoping review","volume":"18","author":"J. Lambrich","year":"2023","journal-title":"PLoS One"},{"issue":"3","key":"ref26","first-page":"27","article-title":"A novel stroke efficiency rating (SER) with an injury risk assessment (IRA) for on-court stroke evaluation in junior and elite competitive tennis players","volume":"22","author":"N. Jayanthi","year":"2023","journal-title":"J Med Sci Tennis"},{"key":"ref27","article-title":"Frequently asked questions for physical therapy","author":"New York State Education Department","year":"2012","journal-title":"New York State Education Department, Office of the Professions"},{"issue":"1","key":"ref28","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1123\/jsr.20.1.115","article-title":"Responsiveness of the numeric pain rating scale in patients with shoulder pain and the effect of surgical status","volume":"20","author":"L. A. Michener","year":"2011","journal-title":"J Sport Rehabil"},{"key":"ref29","article-title":"Upper extremity functional index","author":"Physiopedia","year":"2025"},{"key":"ref30","article-title":"DASH outcome measure","author":"Physiopedia","year":"2025"},{"issue":"3","key":"ref31","doi-asserted-by":"publisher","first-page":"243","DOI":"10.3138\/ptc.2013-45","article-title":"Reliability and validity of two versions of the upper extremity functional index","volume":"66","author":"B. M. Chesworth","year":"2014","journal-title":"Phys Ther Can"},{"issue":"1","key":"ref32","doi-asserted-by":"publisher","first-page":"30","DOI":"10.2519\/jospt.2014.4893","article-title":"Minimal clinically important difference of the Disabilities of the Arm, Shoulder and Hand outcome measure (DASH) and its shortened version (QuickDASH)","volume":"44","author":"F. Franchignoni","year":"2014","journal-title":"J Orthop Sports Phys Ther"},{"issue":"7","key":"ref33","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1136\/bjsports-2012-091164","article-title":"Epidemiology of musculoskeletal injury in the tennis player","volume":"46","author":"G. D. Abrams","year":"2012","journal-title":"Br J Sports Med"},{"issue":"2","key":"ref34","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1016\/j.apergo.2008.04.005","article-title":"DASH questionnaire for the analysis of musculoskeletal symptoms in industry workers: A validity and reliability study","volume":"40","author":"A. Kitis","year":"2009","journal-title":"Appl Ergon"},{"issue":"3","key":"ref35","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1053\/jhsu.2002.32964","article-title":"Evaluation of the construct validity of the DASH questionnaire by correlation to the SF-36","volume":"27","author":"N. F. SooHoo","year":"2002","journal-title":"J Hand Surg"},{"issue":"1","key":"ref36","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.jht.2016.06.008","article-title":"A user's survey of the clinical application and content validity of the DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure","volume":"30","author":"C. A. Kennedy","year":"2017","journal-title":"J Hand Ther"},{"issue":"4","key":"ref37","doi-asserted-by":"publisher","first-page":"2325967117700019","DOI":"10.1177\/232596711770001944","article-title":"The functional arm scale for throwers (FAST)\u2014part II: Reliability and validity of an upper extremity region-specific and population-specific patient-reported outcome scale for throwing athletes","volume":"5","author":"K. C. Huxel Bliven","year":"2017","journal-title":"Orthop J Sports Med"},{"issue":"7","key":"ref38","doi-asserted-by":"publisher","first-page":"453","DOI":"10.3109\/09593985.2014.899414","article-title":"Measurement properties of existing clinical assessment methods evaluating scapular positioning and function. A systematic review","volume":"30","author":"C. M. Larsen","year":"2014","journal-title":"Physio Theory Pract"},{"issue":"2","key":"ref39","doi-asserted-by":"publisher","first-page":"117","DOI":"10.26603\/001c.31727","article-title":"Current views of scapular dyskinesis and its possible clinical relevance","volume":"17","author":"A. Sciascia","year":"2022","journal-title":"Int J Sports Phys Therapy"},{"issue":"6","key":"ref40","doi-asserted-by":"publisher","first-page":"e1261","DOI":"10.1016\/j.clbc.2018.02.008","article-title":"Estimating the reliability and validity of the upper extremity functional index in women after breast cancer surgery","volume":"18","author":"J. M. Binkley","year":"2018","journal-title":"Clin Breast Cancer"},{"issue":"4","key":"ref41","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1177\/175899830100600401","article-title":"The DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure: What do we know about it now?","volume":"6","author":"D. E. Beaton","year":"2001","journal-title":"Br J Hand Ther"},{"key":"ref42","first-page":"329","article-title":"A kinetic chain approach for shoulder rehabilitation","volume":"35","author":"J. McMullen","year":"2000","journal-title":"J Athl Train"},{"key":"ref43","series-title":"Rehabilitation of Musculoskeletal Injuries","article-title":"Shoulder and arm","author":"P. A. Houglum","year":"2023","edition":"5"},{"issue":"1","key":"ref44","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12178-018-9452-9","article-title":"Epidemiology of injuries in tennis players","volume":"11","author":"M. C. Fu","year":"2018","journal-title":"Curr Rev Musculoskelet Med"},{"issue":"4","key":"ref45","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1519\/SSC.0b013e3181af65e1","article-title":"Biomechanics of the tennis groundstrokes: Implications for strength training","volume":"31","author":"E. P. Roetert","year":"2009","journal-title":"Strength Cond J"},{"issue":"5","key":"ref46","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1136\/bjsm.2005.023184","article-title":"Tennis injuries: Occurrence, aetiology, and prevention","volume":"40","author":"B. M. Pluim","year":"2006","journal-title":"Br J Sports Med"},{"issue":"2","key":"ref47","doi-asserted-by":"publisher","first-page":"142","DOI":"10.5435\/00124635-200303000-00008","article-title":"Scapular dyskinesis and its relation to shoulder pain","volume":"11","author":"B. W. Kibler","year":"2003","journal-title":"J Am Acad Orthop Surg"},{"issue":"4","key":"ref48","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1007\/s12178-019-09591-1","article-title":"Evaluation and management of scapular dyskinesis in overhead athletes","volume":"12","author":"W. B. Kibler","year":"2019","journal-title":"Curr Rev Musculoskelet Med"},{"issue":"6","key":"ref49","doi-asserted-by":"publisher","first-page":"364","DOI":"10.5435\/JAAOS-20-06-364","article-title":"Scapular dyskinesis and its relation to shoulder injury","volume":"20","author":"W. B. Kibler","year":"2012","journal-title":"J Am Acad Orthop Surg"},{"issue":"6","key":"ref50","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1007\/s12178-020-09672-6","article-title":"Scapular dyskinesis and the kinetic chain: Recognizing dysfunction and treating injury in the tennis athlete","volume":"13","author":"S. S. Saini","year":"2020","journal-title":"Curr Rev Musculoskelet Med"}],"container-title":["International Journal of Sports Physical Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ijspt.scholasticahq.com\/article\/154590-rehabilitation-incorporating-a-stroke-efficiency-analysis-in-a-male-tennis-player-with-scapular-dyskinesis-a-case-report","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T22:03:51Z","timestamp":1767218631000},"score":1,"resource":{"primary":{"URL":"https:\/\/ijspt.scholasticahq.com\/article\/154590-rehabilitation-incorporating-a-stroke-efficiency-analysis-in-a-male-tennis-player-with-scapular-dyskinesis-a-case-report"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,1]]},"references-count":50,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.26603\/001c.154590","relation":{},"ISSN":["2159-2896"],"issn-type":[{"value":"2159-2896","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,1]]}}}