The Shoulder Rehabilitation Clinic

Richard Coates

Specialist shoulder screening and rehabilitation

About

Richard Coates

Richard Qualified as a Chartered Physiotherapist in 2000, and has worked in the NHS, professional sport and private practice. He completed his MSc in 2008, and investigated the efficacy of injection therapy in the treatment of shoulder impingement. He then won the prestigious British Elbow and Shoulder Society fellowship where he investigated athlete rehabilitation and return to play systems in elite sport, with the aim of raising standards of care in non-sporting populations.Richard is now embarking on PhD research at Cardiff University, where he will be evaluating the benefits of wearable technology and Virtual Reality in the rehabilitation and assessment of shoulder pain, and how this technology can aid an athlete’s swift and effective return to their sport.

The Shoulder Rehabilitation Clinic

Contact Us

If you would like to learn more about our research or would like to find out how we can help your shoulder problem please do not hesitate to contact us using one of the methods below.
Email: [email protected]
Telephone: 01291 627226
Address: 34, Godfrey Road, Newport. South Wales.

The Shoulder Rehabilitation Clinic

Specialist Shoulder Screening and rehabilitation

Richard offers comprehensive shoulder screening and rehabiitation service for everyone form elite athletes to social athletes. This incorporates the use of different technologies to evaluate your movement strategies, muscle strength and mobility and draws on his 20 years of experience treating and managing complex shoulder injuries.if you would like an appointment or more information on this service please following the link below.

The Shoulder Rehabilitation Clinic

Research

Richard is currently a PhD candidate at Cardiff University. He is the lead investigator on a series of studies investigating the possible benefits of using wearable and Virtual Reality technology in the treatment of shoulder pain, specifically in it's use in helping athletes return to the field of play.

The Shoulder rehabilitation Clinic

Title: Can Wearable Inertial Measurement Units (IMU) and Virtual Reality Technology Aid an Athlete’s Return to Sport Following Shoulder Pain?

Aims:
The principle aim of this study is to develop a measurement tool that will help clinicians predict when a patient can return to their sport safely following an episode of shoulder pain. This could enhance athlete management, injury prevention, and rehabilitation strategies, potentially extending to non-athletic populations.Background:
Shoulder pain is a common issue for overhead athletes. Often, this pain is caused by instability at the shoulder. Historically the return to sport (RTS) decision making process has lacked scientific grounding but adopting a “Criterion Based Return to Sport” (CBRTS) using strength, range of motion and functional performance tests has been shown to reduce reoccurrence rates and revision surgery rates.Unfortunately, these tests do not detect deficits in movement quality, which may be a source of future pain and hamper a RTS. Wearable Inertial Measurement Units (IMUs) offer a solution to this problem by capturing kinematic data reliability without the need for expensive motion capture camera equipment. The field of play often represents an unpredictable environment for athletes requiring them to respond quickly to a unpredictable environment. By using Virtual Reality (VR) technology alongside the IMUs the speed and accuracy and quality of an athlete’s movement can be assessed in these unpredictable situations, potentially aiding the RTS process.Methods
The project involves two reliability studies alongside a co-design process. The first study will investigate IMU reliability, then the co-design will gather stakeholder opinions for the tool development. This reliability of the new VR and IMU measurement tool will then be assessed.
Reliability studies will use healthy and post-op shoulder stabilisation patients. The co-design will involve physiotherapists, surgeons, sport physicians, coaches, and athletes to develop the tool.Dissemination
This research will be disseminated to stakeholders via publication in open access research journals and presentation at professional conferences.
Richard is now embarking on PhD research at Cardiff University, where he will be evaluating the benefits of wearable technology and Virtual Reality in the rehabilitation and assessment of shoulder pain, and how this technology can aid an athlete’s swift and effective return to their sport.

The Shoulder Rehabilitation Clinic

IMU Research

In this research, the focus is on shoulder pain in athletes who often throw overhead. Shoulder pain is quite common among these athletes, affecting between 5-36% of them, and returning to previous performance levels after injury is inconsistent. Previous methods for deciding when athletes can return to sports haven't always been based on solid evidence. However, using a method called "Criterion Based Return to Sport" (CBRTS), which considers factors like strength, range of motion, and functional performance tests, has shown to reduce the risk of re-injury compared to traditional methods based solely on time passed since injury.But there's a catch: some studies have shown that athletes can compensate during these functional performance tests, hiding weaknesses in their strength. This highlights the importance of not just looking at the end result of a task, but also how well it's performed. Traditionally, analyzing a patient's movement involved expensive camera-based systems, which aren't practical for regular clinical use.Now, wearable devices called Inertial Measurement Units (IMUs) are being used to capture movement data. These devices are smaller, more practical, and have shown good reliability compared to camera-based systems, especially for slower tasks involving the lower body. However, their reliability in capturing upper limb movements during fast and complex activities like throwing still needs more investigation.The aim of this research is to see if IMUs can reliably measure the quality of whole-body movement during upper limb tasks and throwing activities. The hypothesis is that the data collected using IMUs will show good consistency when collected by the same tester on different occasions, by different testers on the same subject, and across different testing sessions.For the study, 26 healthy individuals who exercise regularly will be recruited. They'll perform various functional movements and throwing tasks while wearing IMUs, and their movement data will be analyzed for reliability using statistical methods.In summary, this research aims to assess whether IMUs can be a reliable tool for evaluating movement quality during shoulder rehabilitation and overhead athletic activities

The Shoulder Rehabilitation Clinic

IMU Research Frequently Asked Questions

Title: An Evaluation of Intra-tester, inter- tester and Intra session reliability study for IMU evaluation of whole-body kinematics during throwing, Functional Movement Tests and commonly used shoulder rehabilitation exercises.You are being invited to take part in a research project. Before you decide whether or not to take part, it is important for you to understand why the research is being undertaken and what it will involve. Please take time to read the following information carefully and discuss it with others, if you wish.Thank you for reading this.1. What is the purpose of this research project?
The overhead throwing activity is a complex motion that engages the whole body. It is the fastest movement a human being completes with speeds of up to 7000 per second. This means the forces going through the upper limb and shoulder can be huge. Much of the power required to perform an overhead throw is generated from the legs and torso, which is transferred to the arm to deliver an accurate throw at speed.The efficiency of the throwing motion is reliant on the whole body acting in unison, if this power is delivered in an inconsistent or awkward manner this process is disrupted, which can result in a reduction in performance and can lead to an increased risk of injury. This means that a problem with an athlete’s knee or hip could contribute to the onset of their shoulder pain. The physiotherapist responsible to treating and managing the athletes’ shoulder pain must consider the contribution of the lower limbs and torso as well as the shoulder.Analysing the quality of functional movements can be done in a specific laboratory setting. Unfortunately, these laboratories require a dedicated indoor space equipped with expensive equipment. These Laboratories are excellent at for research purposes but not practical for physiotherapists to use on in the day-to-day management of athlete injuries. This means that, until recently physiotherapists have relied on visual observation and video recording to analyse an athlete’s movement. These methods can be useful, but it is difficult to quantify the quality of movement.Inertial Measurement Units (IMU’s) present a solution to this problem. They are small wearable units, each containing a gyroscope, magnet and accelerometer, similar to that found in a modern mobile phone or smart watch. These units can be worn by the athlete, and the movements of the upper limbs, torso and lower limbs can be tracked. The amount and speed of the limbs can be recorded and the angles at joints measured to give quantifiable information to the physiotherapists. IMU’s are also portable, which means they can be used in the physiotherapy clinic or on the field of play, allowing the athlete to be assessed in a sporting environment, that replicates the environment in which they compete.Unfortunately, to date, it is unknown if these IMU’s can measure the whole-body movement during simple rehabilitation exercises, during generic movement tests designed to assess arm function or during throwing tasks. This research forms part of a PhD research program that aims to investigate if IMU’s can consistently quantify an athlete’s movement in these different scenarios. It is hoped that, if they are found capable of doing this, they will allow physiotherapists to progress an athlete back to the field of play with greater speed and precision, and with reduced risk of re-injury.2. Why have I been invited to take part?
You have been invited to take part in this research because you are a healthy individual who regularly takes place in physical exercise and do not currently suffer with shoulder pain. We need to establish if these devices reliably measure the movements of healthy individuals prior to testing them on patients recovering from shoulder pain and returning to functional activities and sports.3. Do I have to take part?
No, your participation in this research project is entirely voluntary and it is up to you to decide whether to take part. If you decide to take part, we will discuss the research project with you and ask you to sign a consent form. If you decide not to take part, you do not have to explain your reasons and it will not affect your legal rights.You are free to withdraw your consent to participate in the research project at any time, without giving a reason, even after signing the consent form. If you choose to withdraw your consent after you have participated prior to the data analysis phase, your data will be withdrawn from the study. Following the data collection phase, the collected data will go through a de-identification process. Following this it may not be possible to withdraw your personal data as it will be un-identifiable and may be part of a larger data set, but will not be distinguishable from other people’s data.4. What will taking part involve?
To take part in this research, first, you will have the IMU’s applied to your head, torso, both arms and both legs. You will then be asked to stand still for 4 seconds, walk around for 20 seconds, then stand still once again, to ensure the IMU’s are working properly, and communicating with each other. Once this is done you will be asked to conduct two exercises routinely used in shoulder rehabilitation, two movement tests that are used by physiotherapists to evaluate shoulder function, and a throwing task, aiming at a target. Each task will be performed 5 times.The study aims to investigate if the IMU record the same results each time they are used; each time the same tester uses them and when different testers use them. This means the above tests will be conducted 3 times: twice by the same user and once by a different tester.5. Will I be paid for taking part?
No. You should understand that any data you give will be as a gift and you will not benefit financially in the future should this research project lead to the development of a new treatment/method/test/assessment.6. What are the possible benefits of taking part?
Participation in this study will mean that baseline information will be obtained by your medical team. This means that, in the future, should you suffer an injury, there will be baseline measurements to which your physiotherapy can use as a reference point to aid your return to full fitness.7. What are the possible risks of taking part?
The risks of taking part in this research study is small. The exercises being used as part of this research are used in the early stages of a rehabilitation program and are not strenuous. The Functional Movement tests are used to help assess a patient’s ability to return to their sport following injury, your score is based on the effort you deliver which is under your control. The throwing tasks should be familiar and well-practiced as part of your normal training schedule. The environment, where this research will take place, will also undergo a risk assessment to ensure it is safe to all participants and unlikely to cause harmIf you are uncomfortable with any of the movements, feel any pain, or are anxious that any of the movements may cause you pain you can refuse to do the test or movement.8. Will my taking part in this research project be kept confidential?
All information collected from (or about) you during the research project will be kept confidential and any personal information you provide will be managed in accordance with data protection legislation. Please see ‘What will happen to my Personal Data?’ (below) for further information.9. What will happen to my Personal Data?
By participating in this project, you will be providing us with some Personal Data, including your name, email and telephone number which will be recorded on the consent form you have signed. This personal data will be used to organise data collection sessions, and to give feedback on the progress of this study.All measurement taken during the data collection phase of this study will be de-identified for use during data analysis, write up and publication of the research. Your data will not be identifiable once the de-identification process has been completed.Cardiff University is the Data Controller for this project and is committed to respecting and protecting your Personal Data in accordance with your expectations and Data Protection legislation. Further information about Data Protection, including:
• your rights
• the University’s Data Protection Policy and broad data management principles; and
• how to contact the University’s Data Protection Officer and/or the Information Commissioner’s Officecan be found at https://www.cardiff.ac.uk/public-information/policies-and-procedures/data-protection.
The University’s overarching Data Protection Notice for research participants is available at https://www.cardiff.ac.uk/public-information/policies-and-procedures/data-protection/research-participants-data-protection-notice.If you do not have access to the internet and/or otherwise require this information in another format, please let us know.In accordance with Data Protection legislation, we are required to inform you of our lawful basis for collecting and processing your Personal Data. The lawful basis we are relying on as part of the research project is article 6(1)(e) of the UK GDPR, namely that the processing of your Personal Data is necessary for the performance of our public task.After 48 hours, the research team will de-identify the measurements and personal data it has collected from, or about, you in connection with this research project, with the exception of your consent form which will contain your name, telephone number and email address. Your consent form will be retained securely for 5 years after the completion of the research project as stipulated by Cardiff University’s Records Retention Schedules. This information may be accessed by members of the research team and, where necessary, by members of the University’s governance and audit teams or by regulatory authorities.As referenced in Section 3 above, If you choose to withdraw from this project. The data collected during the research will be withdrawn from the study. However, once the data has been de-identified, it may not be possible to specifically identify your personal results. This could mean withdrawal of this data may not be possible.10. What happens to the data and results at the end of the research project?
All de-identified data and information will be kept for a minimum of 5 years following completion of the research project, in accordance with the University Records Retention Schedules. However, this data but may be published in support of the research project and/or retained indefinitely, where it is likely to have continuing value for research purposes.It is our intention to publish the results of this research project in academic journals or other similar forums and to present findings at conferences. Publication is likely to occur in an open access, peer revieed journal in 2025. You will be informed of publication via email, with a link so you can read the final published article if you wish.The data and results of this project will also be used as part of my dissertation and available to specific members of teaching staff within Cardiff University and examiners. The data and results will not otherwise be published.Participants will not be identified in any write-up, report, publication or presentation arising from this project.11. What if there is a problem?If you have any concerns about how you have been approached or treated during this research or if you otherwise wish to make a complaint, please contact the lead researcher, Richard Coates in the first instance. If your complaint is not managed to your satisfaction, please contact the Chair of the School Research Ethics Committee, Jennifer Davies.If you are harmed by taking part in this research project, there are no special compensation arrangements. If you are harmed due to someone's negligence, you may have grounds for legal action, but you may have to pay for it.12. Who is organising and funding this research project?
The research is organised by the Lead Investigator, Richard Coates, along with his supervisors, Dr Mohammad Al-Amri and Dr Kate Button at the School of Healthcare Science, Cardiff University. The research is currently self-funded by Richard Coates.13. Who has reviewed this research project?
This research project has been reviewed and given a favourable opinion by the School of Healthcare Sciences Ethics Committee at Cardiff University.14. Further information and contact details
Should you have any questions relating to this research project, you may contact us during normal working hours:Richard Coates
Email: [email protected]
Tel: 07966899198Thank you for considering taking part in this research project. If you decide to participate, you will be given a copy of the Participant Information Sheet and a signed consent form to keep for your records.