Search

Elastic taping is widely used in sports medicine for correcting functional alignment and muscle recruitment. However, evidence regarding its influence on scapular dynamic positioning is scarce. This study aimed to investigate the effect of a specific kinesiotaping method on scapular kinematics in female elite handball players without shoulder complaints. 25 athletes (18.0 ± 1.5 years) active in the highest national division were recruited. All subjects received an elastic adhesive tape (K-active tape© ) with the purpose to correct scapular position. 3-dimensional scapular motion measurements were performed (Fastrak® ) during humeral elevation in the sagittal, frontal and scapular plane. The results showed that taping has a moderate to large effect (Cohen's d > 0.7) towards scapular posterior tilting, in all 3 planes of humeral movement and for all angles of elevation (mean posteriorizing effect of 4.23°, 3.23° and 4.33° respectively for elevation in the sagittal, frontal and scapular plane, p < 0.001). In addition, taping also moderately increased the scapular upward rotation at 30°, 60° and 90° of humeral abduction (mean increase of 2.90°, Cohen's d > 0.7). Together these results suggest that kinesiotape application causes positive changes in scapular motion. This could support its use in sports medicine for preventing shoulder problems in overhead athletes. [ABSTRACT FROM AUTHOR]

Muscle imbalances in the upper body can lead to ineffective movement patterns and potential injury. The purpose of this study was to investigate the muscle activity, impact, and muscle activation ratio of the serratus anterior (SA), upper trapezius (UT), lower trapezius (LT), and pectoralis major (PM) during the knee push-up plus (KPUP) exercise under various loads. Method: Electromyography assessed scapular muscle activity in 32 healthy adults (15 males, 17 females) during three KPUP variations. Results: PM and UT showed no significant activity differences across loads, whereas SA and LT did. SA activity was significantly higher in the weighted KPUP (WKPUP) 3 kg than that in KPUP and WKPUP 1 kg. LT activity was also significantly higher in WKPUP 3 kg compared to KPUP and WKPUP 1 kg, with KPUP showing higher activity than WKPUP 1 kg. PM/SA ratios remained consistent across loads, while UT/LT ratios varied significantly, being notably lower at 3 kg compared to 0 kg and 1 kg. Similarly, UT/SA ratios differed significantly among loads, being notably lower at 3 kg and 1 kg compared to 0 kg. Conclusion: WKPUP with 3 kg demonstrated significantly higher SA and LT activity compared to KPUP and WKPUP 1 kg. The lowest UT/LT ratio was observed during the WKPUP 3 kg, suggesting its effectiveness for optimizing muscle activation balance during KPUP exercises. These findings may inform the development of exercise protocols aimed at improving scapular stabilization. [ABSTRACT FROM AUTHOR]

Context: Decreased scapular upward rotation (UR) and diminished activation of the serratus anterior (SA) and lower trapezius (LT) are often observed among patients with subacromial impingement syndrome. Maintaining the elbow fully flexed during shoulder flexion may limit glenohumeral motion due to passive insufficiency of the triceps brachii and therefore facilitate greater scapular UR and increased scapular muscle activation. Objectives: To compare scapular UR, SA, upper trapezius (UT), middle trapezius, and LT activation levels between shoulder flexion with the elbow extended (Flexion-EE) to shoulder flexion with the elbow fully flexed (Flexion-EF). This study hypothesized that Flexion-EF would result in greater scapular UR, greater SA and LT activation, and a lower UT/SA and UT/LT activation ratio compared with Flexion-EE. Design: Cross-sectional study. Setting: A clinical biomechanics laboratory. Participants: Twenty-two healthy individuals. Main Outcome Measures: Scapular UR and electromyography signal of the SA, UT, middle trapezius, and LT, as well as UT/SA and UT/LT activation ratio were measured during Flexion-EE and Flexion-EF. Results: Flexion-EF resulted in greater scapular UR compared with Flexion-EE (P < .001). Flexion-EF resulted in greater S A activation, lower UT activation, and a lower UT/SA activation ratio compared with Flexion-EE (P< .001). Conclusions: Fully flexing the elbow during shoulder flexion leads to increased scapular UR primarily through greater activation of the SA. This exercise may be of value in circumstances involving diminished scapular UR, decreased activation of the SA, and an overly active UT such as among patients with subacromial impingement syndrome. [ABSTRACT FROM AUTHOR]

BACKGROUND: Daily activities that involve upper limb movements require muscle activation from different body parts by transferring forces and energy along the functional kinetic chain. The scapulae connect and transfer forces between the trunk and the upper limbs, so scapular dyskinesis may compromise the performance of the kinetic chain. OBJECTIVE: To assess the relationship between core muscle performance and shoulder pain and function in individuals with shoulder pain, with and without scapular dyskinesis. METHODS: Data was collected from 77 non-athlete adults aged between 18 and 50 years with shoulder pain, 45 had scapular dyskinesis. Core muscle performance was measured using the prone bridging test (PBT). Shoulder pain and disability were measured by the Shoulder Pain and Disability Index (SPADI), and the upper limbs' stability was assessed by the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). The peak torque of shoulder external and internal rotators was measured using an isokinetic dynamometer. Multiple linear regression models evaluated the relationship between the PBT and CKCUEST, SPADI, and shoulder rotator strength. RESULTS: Significant correlations were found between the PBT and the SPADI total score (r = – 0.522), pain domain (r = – 0.513), and disability domain (r = – 0.501); normalized score (r = 0.593), and the power (r = 0.624) of the CKCUEST; and peak torque for external (r = 0.256) and internal (r = 0.292) rotations. Scapular dyskinesis did not influence the magnitude of the correlations and predictive values. CONCLUSION: The PBT was correlated with shoulder pain and function, but scapular dyskinesis did not affect the magnitude of these relationships. [ABSTRACT FROM AUTHOR]

Background: Shoulder injuries are substantial problems in overhead athletes, and more studies are necessary to deepen the knowledge on this type of injury. The objective of this study was to compare the overall function and performance of female overhead athletes with and without a previous history of shoulder injuries. Methods: In this cross-sectional study, female overhead athletes with and without a previous shoulder injury were included. Muscular impairment, the stability of the shoulder, strength, scapular dyskinesia, functionality and sports performance were evaluated. A total of 50 females were included. Results: There were significant differences in strength (p = 0.046) and stability (p = 0.039) between groups, with a poorer score in the group with a history of shoulder injury. Regarding scapular dyskinesia, significant differences were also observed between groups (p = 0.048), with higher levels of dyskinesia in the group with previous shoulder injury. Also, muscular impairment showed significant differences between groups for the three muscles evaluated (p < 0.005). Additionally, the group without a previous shoulder injury presented with a significantly greater score in functionality (p = 0.046) and sports performance (p = 0.004). Conclusion: In conclusion, previous shoulder injuries are an important factor to take into account in female overhead athletes. Players with a history of shoulder injury present clinical impairments during the game, leading to poorer functional status and performance in sport. [ABSTRACT FROM AUTHOR]

Aims Scapula dyskinesis and reduced strength of the glenohumeral external rotator muscles are shoulder risk factors. The shoulder joint’s unstabilizing mechanisms can cause a decrease in the strength of the external rotator muscles, an imbalance of the rotator cuff muscles, and scapula dyskinesis. This study aimed to investigate the effect of an exercise program on scapula dyskinesis and the strength of glenohumeral rotator cuff muscles in overhead athletes. Materials & Methods The present quasi-experimental study with a control group and preand post-test plan was conducted on 62 female handball players (club-level, 18-25 years old) with scapula dyskinesis from 2021 to 2022 in Hamadan City, Iran. The lateral scapular slide test and hand dynamometers were used to measure scapula dyskinesis and the strength of glenohumeral rotator cuff muscles, respectively. The participants in the intervention group participated in eight weeks of three sessions of an exercise program. Data were measured before and after the intervention and were analyzed using the Mann-Whitney U test. Findings According to this test, there is a significant difference between the strength of external rotator muscles (p<0.001) in the intervention and control groups after exercises, so the strength of external rotator muscles and the strength of external/internal rotator muscles ratio (p<0.001) has increased after exercises. Also, scapula dyskinesis after exercises has decreased significantly (p=0.013). Conclusion The exercise program increases the strength of external rotator muscles and the ratio of external/internal rotator muscles and improves scapula dyskinesis in overhead athletes. [ABSTRACT FROM AUTHOR]

Subacromial impingement syndrome (SIS) is one of the most common causes of shoulder pain in adults and is caused by muscle imbalance around the shoulder joint, which is referred to as secondary SIS. Centralization of the glenohumeral joint (CGH), one of the intervention methods for this, targets strengthening the control ability of the rotator cuff. Dynamic humeral centering (DHC) targets the learning of selective contractile function of the pectoralis major and latissimus dorsi as depressors of the humeral head. This study aims to determine the short-term effects of CGH and DHC on pain, disability, and grip strength in patients with secondary SIS. Forty-eight patients with secondary SIS participated in the study and were randomly allocated into three groups (CGH group (n = 16), DHC group (n = 16), and simple exercise group (n = 16)) and received the intervention for 50 min. The Constant–Murley score was used to assess shoulder pain and disability (primary outcome), and a hand-held dynamometer was used to assess grip strength (secondary outcome). Measurements were performed before the intervention and one day after the intervention. The results showed that the Constant–Murley score improved in the CGH and DHC groups. In addition, pain and disability (range of motion scores) improved in both the CGH and DHC groups. Improvements in disability (shoulder strength) and grip strength were seen only in the CGH group. Both CGH and DHC can be used as methods for short-term pain release and disability recovery in secondary SIS. In particular, CGH appears to be more effective in the short-term improvement in shoulder strength and grip strength. [ABSTRACT FROM AUTHOR]

To investigate whether scapular movement training (SMT) is superior to standardized exercises in improving scapular biomechanics, behavioral, and clinical aspects of individuals with shoulder pain. A total of 64 individuals with chronic shoulder pain were randomly assigned to receive 16 sessions of SMT or SE over 8 weeks. Outcome measures included three-dimensional scapular kinematics, muscle activity of scapulothoracic muscles, pain, disability, fear-avoidance, kinesiophobia, and self-perceived changes. Kinematics and muscle activity were assessed at baseline and after treatment, and self-reported measurements at baseline, 4, 8, and 12 weeks. SMT significantly (p < 0.05) decreased scapular internal rotation during arm elevation and lowering at sagittal and scapular planes (mean difference [MD]: ranged from 2.8 to 4.1°), and at lower angles of arm elevation and lowering at the frontal plane (MD: 3.4° and 2.4°, respectively), increased upper trapezius (UT) activity (MD: 10.3%) and decreased middle trapezius (MT) (MD: 60.4%) and serratus anterior (MD: 9.9%) activity during arm lowering compared to SE. Both groups significantly improved pain, disability, fear-avoidance, kinesiophobia, and self-perceived changes over 4 weeks, which was sustained over the remaining 8 weeks. SMT is not superior to standardized exercises in improving scapular biomechanics, behavioral, and clinical aspects of individuals with shoulder pain. NCT03528499 Scapular movement training (SMT) showed small and likely not clinically relevant changes in scapular kinematics and muscle activity compared to standardized exercises. SMT and standardized exercises presented similar improvements in pain, disability, fear-avoidance beliefs, kinesiophobia, and self-perceived change in health condition immediately following 4-weeks of treatment, which was sustained over the following 8 weeks. The changes in patient-reported outcome measures are unlikely to be associated with changes in scapular kinematics and electromyographic activity. Clinicians should consider other factors than scapular movement during the treatment of patients with shoulder pain. [ABSTRACT FROM AUTHOR]

Comparing short- and long-term effects of comprehensive physiotherapy (CP) and subacromial corticosteroid injection (SCI) on pain, disability, and quality of life in the patients with subacromial pain syndrome (SAPS). 2 × 4 randomized controlled trial. 50 participants with unilateral SAPS. Random assignment with allocation concealment into two groups labeled as 12 sessions, supervised CP (n = 22) and 1cc triamhexal SCI (n = 25). Visual Analog Scale (VAS), Shoulder Pain and Disability Index (SPADI), shortened Disabilities of Arm, Shoulder and Hand (Quick-DASH), and Western Ontario Rotator Cuff Index (WORC). Outcomes were gathered pre- and post-intervention, with three- and six-month follow-ups. Variance analysis revealed that there was a significant interaction of group-in-time for SPADI and WORC (P <.05) but not for Quick-DASH and VAS (P >.05). The independent t-test analysis showed that the mean scores of all outcome measures in CP group were lesser than SCI group via 6 months (P <.05), except for the VAS (P >.05, mean difference = −0.97, 95% confidence interval −2.11–0.15). CP results in statistically significant and potentially clinically important difference in function and quality of the life at all timeframe. Moreover, there was no between group difference in order to reduce pain. [ABSTRACT FROM AUTHOR]

BACKGROUND: While positive short-term effects from corrective exercise on neck-shoulder pain (NSP) are evident, maintenance effects after cessation of the exercise remain unknown. OBJECTIVE: The objective of the present study was to assess the lasting effects of corrective exercise in NSP and workability after a year of detraining. METHODS: A cohort study with 1-year follow-up was carried out in two previous training groups (n = 24) using a self-reported paper-based questionnaire, which was completed three times (baseline, 8-week exercise, and 1-year detraining). The subjects (mean±SD age: 39.0±6.4, 38.1±8.0) responded to the Visual Analogue Scale (VAS) for NSP as the primary outcome. A single validated item from the Workability Index determined workability as the secondary outcome. Between and within-group differences of the two groups were investigated using non-parametric tests, including 12 subjects in each group. RESULTS: The results indicated that 8-week exercise improvements in NSP and mental and physical workability were largely maintained after one year of detraining. The lasting effects of NSP and physical and mental workability were statistically identified in 8-week and 1-year follow-ups. Nevertheless, it is noticeably warranted to adhere to the exercise program. CONCLUSION: The current study indicates that a brief 8-week exercise period once per year is sufficient to reduce pain and improve workability among workers. This knowledge can make exercise interventions more feasible and cost-effective for companies aiming to improve employee health. [ABSTRACT FROM AUTHOR]

Context: The scapular retraction exercises are widely used among clinicians to balance the activity of the scapular muscles as well as the rotator cuff muscles in different shoulder abduction positions. Objectives: The aim of this study was to investigate the relationship between scapular (middle and upper trapezius) and shoulder muscles (middle deltoid and infraspinatus) activation level differences and acromiohumeral distance changes during shoulder abduction with scapular retraction. Design: Cross-sectional study. Setting: University research laboratory. Participants: Nineteen asymptomatic individuals were included (mean [SD]: age = 22.4 [1.8] y). Main Outcome Measure: The acromiohumeral distance was measured at 0° and 90° shoulder abduction when the scapula was in nonretracted and retracted position with ultrasound imaging. The relationship between muscle activation level changes and acromiohumeral distance difference was analyzed with the Pearson correlation test. Results: Middle trapezius muscle activity change correlated with acromiohumeral distance difference (r =.55, P =.02) from 0° to 90° shoulder abduction when scapula was retracted. For both nonretracted and retracted scapular positions, no correlations were found between middle deltoid, infraspinatus, and upper trapezius muscle activity changes with acromiohumeral distance differences during shoulder abduction (P >.05). Conclusions: Active scapular retraction exercise, especially focusing on the middle trapezius muscle activation, seems to be an effective treatment option to optimize the acromiohumeral distance during shoulder abduction. [ABSTRACT FROM AUTHOR]

Context: Alterations in posture and motion patterns are thought to play a role in developing shoulder injuries in overhead athletes. Taping is widely used in the sporting population, but there are limited empirical data regarding its effectiveness. Objectives: To determine and compare the effects of rigid and kinesio taping on shoulder rotation motions, posterior shoulder tightness (PST), and posture in overhead athletes. Design: Randomized controlled trial. Setting: Athletic training rooms. Participants: Eighty-six asymptomatic elite overhead athletes. Interventions: Participants were randomly divided into 4 groups: rigid taping group (RTG) that underwent therapeutic rigid taping, kinesio taping group (KTG) that underwent therapeutic kinesio taping, placebo group that underwent placebo kinesio taping (shoulder and scapular region taping for taping groups), and control group (no taping). Main Outcome Measures: Shoulder rotation motions, PST, and head and shoulder posture were evaluated at baseline, immediately after application and 60 to 72 hours after application for all groups. Results: Glenohumeral internal rotation increased immediately (P <.001) and at 60 to 72 hours after application in the KTG (P =.01), whereas it decreased immediately after application in the RTG (P <.001). Immediately after application, total rotation range of motion increased in the KTG (P =.02) and decreased in the RTG (P <.001), and there was a difference between groups (P =.02). Immediately after application, PST increased in the RTG (P <.001); after 60 to 72 hours, it decreased in the KTG (P =.04) and increased in the RTG (P =.01). Posture outcomes did not change significantly (P >.05). Conclusions: Kinesio taping may improve and rigid taping may worsen glenohumeral internal rotation and PST in overhead athletes. For increasing total rotation range of motion, kinesio taping is superior to rigid taping. Taping did not affect posture. Short-term kinesio taping in overhead athletes may be useful to improve glenohumeral internal rotation, total rotation range of motion, and PST. [ABSTRACT FROM AUTHOR]

Introduction: Overhead movement demands optimal pelvic and scapular stability and alignment for efficient energy transfer during shoulder movements. Throughout a sports game, hyperactivity of the pelvic and scapular musculature might affect performance. As a result, we can establish goals for muscle strength and injury prevention. To study the muscles activation of posterior oblique sling muscles (POS) in different hip positions (Standing, Sitting and Lunge) with three different shoulder movements (flexion, extension & abduction) among a sportsman population. Material and methods: Muscle activation was recorded by surface electromyography in 38 male athletes of different sports cricket (bowlers)-10; baseball-9; volleyball-9; control group (recreational overhead)-10. Maximum voluntary isometric contraction (MVIC) measurements were collected in order to compare muscular activation. Every player performed shoulder flexion, abduction and extension in standing, sitting and lunge positions. Results: Significant differences in muscle activity were noted using a 3-way ANOVA and Bonferroni post hoc test. The results of the study showed statistically significant interactions between individual groups, positions and muscles with shoulder movements (p = 0.001) and a pairwise comparison between subjects showed a significant difference (p = <0.05). Conclusions: All hip position changes may be beneficial in scapular rehabilitation training because more muscles are employed. However, in shoulder extension motions, posterior oblique sling muscles are activated more than abduction muscles. While sitting, the serratus anterior is the most active muscle, more than the lower trapezius, latissimus dorsi, and gluteus maximus. [ABSTRACT FROM AUTHOR]

Context: Exercises in motor development positions are employed to activate correct muscular patterns, but the effects on the activity of antagonist muscle pairs remain unknown. Objectives: To determine the effect of using exercises in motor development positions on the activity of antagonist muscle pairs. Another aim was to analyze if introducing some facilitators modifies the muscle activity in the different studied positions. Design: Controlled laboratory study using a single-group repeated measures design. Participants: A total of 21 right handed, healthy adults aged 41 years and older (10 males and 11 females). Setting: Workers of different departments at Maz Hospital. Intervention: Surface electromyography activity of muscle antagonist pairs upper trapezius/lower trapezius, serratus anterior/pectoralis major, and external abdominal oblique/lumbar paraspinal was measured in 3 positions: rest (supine decubitus), reflex turning 1, and modified Vöjta's first position. Main Outcome Measures: Primary outcomes were mean normalized root mean square (averaged over 2 repetitions) of electromyography signals of antagonist muscle pairs in the 3 analyzed positions. Intraclass correlation coefficients (>.70) (model 3.2), type consistency, and 95% confidence interval were used to estimate the reliability and as exclusion criteria of measurements. Results: Analyzed positions had a significant effect on the activity of the muscles P <.001. There was a significant increase in the activity of the phasic musculature versus its tonic antagonists, except in the case of the external oblique/lumbar paraspinal in modified Vöjta's first position. Adding possible facilitators such as gaze, breathing, or the combination of both did not show significant changes in the level of activation of the studied muscle groups. Conclusion: Ontogenetic developmental positions can be used to facilitate and improve the activation of phasic muscles. [ABSTRACT FROM AUTHOR]

Background: Improvements in motor control of the scapular muscles are important for the prevention and rehabilitation of shoulder and elbow injuries in overhead athletes. Purpose: To clarify scapular muscle activity during multijoint compound movement exercises using fine-wire and surface electrodes. Study Design: Descriptive laboratory study. Methods: Sixteen healthy men performed 5 types of exercises (cat and dog, trunk rotation, A-exercise, T-exercise, and Y-exercise). Muscle activity was measured as percentage of maximum voluntary isometric contraction (%MVIC) by using fine-wire electrodes in the rhomboid major (Rhom) and using surface electrodes in the upper (UT), middle (MT), and lower (LT) trapezius and serratus anterior (SA) muscles. The Rhom/UT, MT/UT, LT/UT, and SA/UT muscle activity ratios were calculated. One-way analysis of variance was used to compare the %MVIC and muscle activity ratios between exercises. Results: There was no significant difference in Rhom activity between the exercises (34.6-54.2%MVIC; P =.25). LT activity was significantly greater in the trunk rotation (58.0 ± 24.6%MVIC) and Y-exercise (63.2 ± 40.1%MVIC) than in the cat and dog scapular retraction (19.6 ± 9.3%MVIC) and A-exercise (28.2 ± 14.2%MVIC) (P <.05). SA activity was significantly greater in the cat and dog scapular protraction (26.7 ± 11.0%MVIC) and Y-exercise (25.6 ± 19.3%MVIC) than in the other exercises (P <.05). The SA/UT activity ratio in the cat and dog scapular protraction exercise (9.64 ± 8.48) was significantly higher than in the other exercises (P <.05). Conclusion: All the exercises were effective for activating the Rhom. The trunk rotation and Y-exercise were effective for activating the LT, and the cat and dog scapular protraction exercise was effective for activating the SA while suppressing the UT. Clinical Relevance: These results enable exercise selection based on muscle activity characteristics (moderate [20%-50%MVIC] and high [>50%MVIC] levels contribute to muscle activation) to prevent and rehabilitate shoulder and elbow injuries. [ABSTRACT FROM AUTHOR]

The wall-slide exercise is commonly used in clinic and research settings. Theraband positioning variations for hip exercises have been investigated and used, but Theraband positioning variations for upper extremity wall-slide exercises, although not commonly used, have not been examined. To evaluate the effect of different Theraband positions (elbow and wrist) on the activation of the scapular and shoulder muscles in wall-slide exercises and compare these variations with each other and with regular wall-slide exercises for the upper limbs. Descriptive laboratory study. University laboratory. A total of 20 participants (age = 23.8 ± 3 years, height = 176.5 ± 8.14 cm, mass = 75.3 ± 12.03 kg, body mass index = 24.23 ± 4.03) with healthy shoulders. Participants performed wall-slide exercises (regular and 2 variations: Theraband at the elbow and Theraband at the wrist) in randomized order. Surface electromyographic activity of the trapezius (upper trapezius [UT], middle trapezius [MT], and lower trapezius [LT]), infraspinatus, middle deltoid (MD), and serratus anterior (SA) muscles. Regular wall-slide exercises elicited low activity in the MD and moderate activity in the SA muscles (32% of maximal voluntary isometric contraction [MVIC] in the SA), whereas the Theraband-at-elbow and Theraband-at-wrist variations elicited low activity in the MT, LT, infraspinatus, and MD muscles and moderate activity in the SA muscle (46% and 34% of MVIC in the SA, respectively). The UT activation was absent to minimal (classified as 0% to 15% of MVIC) in all wall-slide exercise variations. The Theraband-at-wrist variation produced lower UT:MT, UT:LT, and UT:SA levels compared with the regular wall-slide exercise and Theraband-at-elbow variation. In shoulder rehabilitation, clinicians desiring to activate the scapular stabilization muscles should consider using the Theraband-at-wrist variation. Those seeking more shoulder-abduction activation and less scapular stabilization should consider using the Theraband-at-elbow variation of the upper extremity wall-slide exercise. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the acute effect of the use of stable and unstable surfaces on electromyography (EMG) activity and coactivation of the scapular and upper-limb muscles during the push-up plus (with full protraction of the scapula). Muscle activation of anterior deltoid (AD), posterior deltoid (PD), pectoralis major, biceps brachii (BB), triceps brachii (TB), upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) levels and coactivation index were determined by surface EMG in 20 young men during push-up plus performed on a stable and unstable condition (2 unstable devices applied to hands and feet). The paired t test and Cohen d were used for statistical analysis. The results showed that during the execution of the push-up plus on the unstable surface an increased EMG activity of the scapular stabilizing muscles (SA, MT, and LT) was observed, while AD and PD muscles showed a decrease. During exercise execution on the unstable surface there was a higher index of coactivation of the scapular muscles (SA-MT and UT-LT pairs). No significant differences were observed in TB-BB and AD-PD pairs. These results suggest that the push-up-plus exercise associated with unstable surfaces produced greater EMG activity levels and coactivation index of the scapular stabilizing muscle. On the other hand, the use of an unstable surface does not promote the same effect for the shoulder muscles. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of instability on the EMG activity of scapular stabilizing and upper limb muscles during exercises with axial and rotational load. Twenty male volunteers (20.9 ± 1.8 years, 174.1 ± 0.04 cm, 73.17 ± 8.77 kg) experienced in strength training participated in a crossover design. Muscle activation of anterior deltoid (AD), posterior deltoid (PD), pectoralis major (PM), biceps brachii (BB), triceps brachii (TB), upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) were determined on both conditions. Participants performed a single series of 10 repetitions of bench press and fly exercises on stable (bench) and unstable (proprioceptive disc) conditions at 60% of 1-RM. The Friedman test and post hoc Dunn's indicated that the unstable condition showed greater EMG activity for AD (P = .001) and BB (P = .002) on the fly exercise, SA (P = .001) and LT (P = .048) on the bench press, and PM (P < .002) on both exercises. These results show that using an unstable surface in exercises with rotational load provides superior EMG activity of the agonist muscles, while in exercise with axial load, the instability favors EMG activity of the scapular stabilizing muscles. [ABSTRACT FROM AUTHOR]

Introduction: Shoulder impingement syndrome (SIS), characterized by decreased acromiohumeral distance (AHD), is a promising objective outcome measure with both clinical and research utility. The purpose of this study was to evaluate and compare the effectiveness of combining exercise therapy and manual therapy with motor control exercise on AHD in overhead athletes with SIS. Material and methods: Ten overhead athletes with clinically diagnosed SIS were randomly assigned to two groups. The exercise therapy plus manual therapy (ET plus MT) group received the exercise therapy plus manual therapy regime, and the motor control exercises (MCE) group followed the motor control exercise protocol. Both groups underwent eight weeks of intervention, and AHD was evaluated at three levels of abduction (0°, 45°, 60°) with real-time ultrasound. The AHD evaluation was performed at baseline and at end of intervention (week 8). Results: AHD improvement was noted at all three levels only in the ET plus MT group and the mean difference was found to be 2.62 ± 0.18 mm (0°), 3.28 ± 0.40 mm (45°) and 3.77 ± 0.30 mm (60°). Statistical analysis performed with two-way repeated measures ANOVA (3 × 2) revealed significant group effects for AHD (0°: F (2,1.10) = 0.76, p < 0.001; 45°: F (2,0.98) = 0.80, p < 0.001; 60°: F (2,0.95) = 0.84, p < 0.001). Time effect and interaction effects were also found to be significant. Conclusions: ET plus MT appears to be a more effective rehabilitation tool than MCE since it improves AHD at 0°,45°, 60° in overhead athletes with SIS. [ABSTRACT FROM AUTHOR]

Scapular bracing can correct scapular kinematics and restore normal scapular-muscle activity. However, there is little evidence to support the beneficial effects of a figure-8 strap, a type of scapular bracing, on muscle length, scapular alignment, and muscle activity during arm-lifting exercise. Objective: To investigate the immediate effect of a figure-8 strap on pectoralis minor length, scapular alignment, and scapular upward-rotator-muscle activity. Design: Cross-sectional study. Setting: Research laboratory. Participants: Fifteen male participants (age 22.1 ± 1.9 y, weight 68.2 ± 5.7 kg, height 176.2 ± 3.3 cm) with forward shoulder posture (FSP) were examined for pectoralis minor length and scapular alignment with and without the application of a figure-8 strap. Main Outcome Measures: Pectoralis minor length was measured using the Pectoralis Minor Index (PMI), scapular alignment was measured with FSP, and upper trapezius, lower trapezius, and serratus anterior muscle activity were measured using surface electromyography while participants performed an arm-lifting exercise. Data collected with and without applying a figure-8 strap were compared using a paired t-test. Results: Applying a figure-8 strap significantly decreased the PMI (P = .005) and scapular anterior tilting (P = .000). There were no differences in the muscle activity of the upper trapezius (P = .784), lower trapezius (P = .241), and serratus anterior muscles (P = .639). Conclusions: A figure-8 strap resulted in positive changes in pectoralis minor length and scapular alignment. The results support its use as a treatment aid in managing pectoralis minor length and scapular alignment during arm-lifting exercises. [ABSTRACT FROM AUTHOR]

Scapular-retraction exercises are often prescribed to enhance scapular stabilization. To investigate upper trapezius (UT), middle trapezius (MT), and lower trapezius (LT) activities and UT/MT and UT/LT ratios during scapular-retraction exercises with elastic resistance at different shoulder-abduction angles. Descriptive laboratory study. Biomechanical analysis laboratory. Thirty-five asymptomatic individuals. Surface electromyography was used to evaluate UT, MT, and LT activities during the scapular-retraction exercise at 0°, 45°, 90°, and 120° of shoulder abduction. The mean muscle activity ranged from 15.8% to 54.7% maximal voluntary isometric contraction (MVIC) for UT, 30.5% to 51.6% MVIC for MT, and 21.4% to 25.5% MVIC for LT. A significant muscle × angle interaction was found (P <.001). Post hoc analysis revealed that the MT was more activated than the UT and LT during both retraction at 0° (P <.001 and P =.01, respectively) and 120° (P =.03 and P =.002, respectively). During retraction at 45° and 90°, the LT generated less activity than the UT (P =.02 and P =.03, respectively) and MT (P <.001 and P =.002, respectively). Further, UT/MT and UT/LT ratios during retraction at 0° were lower than at 45° (P =.03 and P =.001, respectively) and 90° (P <.001 and P <.001, respectively). Retraction at 90° resulted in a higher UT/LT ratio than at 45° (P =.004) and 120° (P =.004). Due to less UT relative to MT activity, retraction at 0°, 45°, and 120° can be preferable in early shoulder training or rehabilitation. Additionally, retraction at 90° was the most effective exercise in activating all parts of the trapezius muscle. [ABSTRACT FROM AUTHOR]

Background: Professional bus drivers report a high prevalence of upper quadrant musculoskeletal pain which could be associated with scapular dyskinesis (SD). However, the evidence for valid and reliable screening methods for this condition is limited as SD among bus drivers is an emerging area of research. Therefore, the main aim of the study was to investigate the reliability of dynamic scapular motion test (DSMT) using video analysis as an accurate method to evaluate SD and to identify patterns of SD among bus drivers. Methods: In total, 32 bus drivers from a private bus company with unilateral upper quadrant musculoskeletal pain participated in the study. The DSMT was conducted and the SD was captured in the video during shoulder flexion–abduction movements. Two investigators analyzed the video recordings and identified the patterns of SD. The intra- and interrater reliability were determined using the percentage of agreement and weighted Kappa coefficients (Kw). Descriptive analysis was used to examine the patterns of SD. Findings: The intra- and interrater reliability of DSMT using video analysis were excellent (Kw coefficient: 0.762–0.878 and 0.87–1.00, respectively). About 56.2% and 53.1% of bus drivers presented SD with the shoulder flexion and abduction movements during DSMT. Medial border prominence (Type II pattern of SD) was identified as the common pattern of SD. Conclusion/Application to practice: The DSMT using video analysis showed excellent intra- and interrater reliability to evaluate SD. Occupational health practitioners can consider DSMT using video analysis to identify SD among people with upper quadrant musculoskeletal pain at the workplace. [ABSTRACT FROM AUTHOR]

Manual muscle tests (MMTs) are often used when assessing shoulder injuries. For the trapezius, individual MMTs are used to selectively test the upper trapezius region (UTR), middle trapezius region (MTR), and lower trapezius region (LTR). The MMTs for each region are assumed to preferentially recruit the corresponding muscle fibers and produce a maximal contraction; however, whether this is true is unknown. To determine if maximal voluntary isometric contractions (MVICs) for the upper trapezius (UT-MVIC), middle trapezius (MT-MVIC), and lower trapezius (LT-MVIC), adapted from the Kendall MMTs, recruited the corresponding trapezius regions. Crossover study. Laboratory. A total of young, healthy individuals (10 men, 9 women, 1 not listed; age = 23.9 ± 1.7 years, height = 171.4 ± 9.6 cm, mass = 75.7 ± 11.6 kg). Participants performed 3 repetitions of each MVIC. High-density surface electromyography measurements were collected from the UTR, MTR, and LTR. Root mean square (excitation) of the UTR, MTR, and LTR. We observed an increase in UTR excitation during the LT-MVIC compared with the UT-MVIC (P =.016) and MT-MVIC (P <.001). The MTR excitation increased during the MT-MVIC (P =.001) and the LT-MVIC (P <.001) compared with the UT-MVIC. We also noted an increase in MTR excitation during the LT-MVIC compared with the MT-MVIC (P <.001). The LTR excitation increased during the MT-MVIC and LT-MVIC (P values <.001) compared with the UT-MVIC. The UT-MVIC and MT-MVIC did not necessarily recruit the corresponding trapezius regions more than the other MVICs did. Rather, the LT-MVIC appeared to produce the greatest excitation of all trapezius regions. Additional research is needed; however, clinicians should be aware that maximal contractions may not always recruit the desired muscle region. [ABSTRACT FROM AUTHOR]

Background: Scapular muscle activity during shoulder exercises has been explored with surface electromyography (EMG). However, knowledge about the activity of deeper-layer scapular muscles is still limited. Purpose: To investigate EMG activation of the deeper-layer scapular stabilizers (levator scapulae [LS], rhomboid major [RM], pectoralis minor [Pm] muscles) together with superficial muscle activity (upper [UT], middle [MT], and lower trapezius [LT] and serratus anterior [SA]) during 4 exercises often used for training scapular function. Based on the amplitude EMG of the deeper-layer muscles, scapular muscle activation ratios for the 4 exercises were calculated, hereby providing knowledge of the optimal muscle balance. Study Design: Descriptive laboratory study. Methods: A total of 26 healthy participants performed 4 shoulder exercises (side-lying external rotation [ER], side-lying forward flexion, prone horizontal abduction with ER, and prone extension) while simultaneously measuring scapular muscle activity. Intramuscular electrodes were used for the deeper layer, in contrast to surface electrodes for the superficial muscles. All data were normalized to percentage of maximal voluntary isometric contraction (%MVIC), and the activation ratios (the muscle activity of the deeper layer relative to the other muscles) were calculated. A 1-way analysis of variance with Bonferroni correction was applied for statistical analysis. Results: Moderate activity was found in all exercises for the LS and RM (25%-45% MVIC). The Pm resulted in low activity during both side-lying exercises (13%-18% MVIC). Ratios involving LS or RM showed values >1 for all exercises (1.28-12.41) except for LS/MT, LS/LT, and LS/RM (0.85-0.98) during side-lying ER, and LS/MT, RM/MT and RM/LS (0.85-0.99) during side-lying forward flexion. Likewise, values <1 were found when MT (0.85) and LS (0.99) were involved with RM in the numerator during side-lying forward flexion. Ratios with Pm in the numerator showed values <1, apart from the ratios with UT and SA in the denominator. Conclusion: The study provides extended knowledge about the deeper-layer scapular muscle activity and related ratios during the 4 shoulder exercises mentioned here. Putting theory into practice, based on our results, we advise both side-lying exercises to be performed to strengthen LT and MT, even in case of hyperactivity of the Pm. However, the 4 exercises should be given carefully to patients with hyperactivity in the LS and/or RM. Clinical Relevance: The findings of this study may assist clinical decision making in exercise selection for restoring scapular function. [ABSTRACT FROM AUTHOR]

Background: Scapular dyskinesis has been considered a risk factor for athletic shoulder injury; however, findings in the prospective literature have demonstrated mixed results. Purpose: To determine if scapular dyskinesis increases the risk of shoulder injury in athletes. Study Design: Meta-analysis. Methods: A systematic search was conducted on the MEDLINE, CINAHL Plus, SPORTDiscus, and Embase databases to identify prospective studies examining scapular dyskinesis and shoulder injury risk in athletes. Studies were included if they assessed participants using a dynamic scapular assessment at baseline and monitored for the development of shoulder injury. Data from the studies were subject to meta-analysis using the Mantel-Haenszel method to produce a pooled risk ratio. Results: Seven studies were eligible for inclusion, resulting in 212 shoulder injuries observed across 923 athletes. Scapular dyskinesis was present in 46% of participants, and these athletes had an injury rate of 25%. The presence of scapular dyskinesis displayed a trend to increase the risk of shoulder injury, but this was not statistically significant (risk ratio, 1.07; 95% CI, 0.85-1.34; P =.59). Conclusion: Scapular dyskinesis was not significantly associated with the development of shoulder injury in athletes. Registration: CRD42019133089 (PROSPERO). [ABSTRACT FROM AUTHOR]

Background: Alterations of scapular kinematics have been associated with musculoskeletal disorders of the shoulder complex. Objective: Investigate the effects of Kinesio Tape (KT) on scapular kinematics with different external loads in healthy subjects Methods: Twenty-three subjects performed abduction, scaption and flexion of their shoulders in three conditions: (1) no load (2) dumbbell and (3) elastic band resistance. KT was applied (I-shaped) over the upper trapezius muscle, and scapula kinematic data was captured and analyzed based on Euler angles. The situations and interactions of the different loads and KT were compared using a repeated measures two-way ANOVA. KT decreased the upward rotation during the movements of abduction, scaption and flexion of the shoulder. Results: There was an effect of load in all evaluated movements, but there was no interaction between the load and the KT. Conclusion: KT and load showed effects on scapula kinematics. Regardless of the load condition (no load, dumbbell or elastic resistance), the effects of the KT on scapula kinematics will be the same in healthy subjects. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to assess the inter-rater reliability of selected static, semi-dynamic, and dynamic test assessment methods for evaluation of scapular positioning and function. Methods: A standardized three-phase (i.e. training, overall agreement, and actual study) protocol for reliability studies was applied on 41 overhead sports participants, aged 18–56 (22 with obvious scapular winging, classified as visibility of the medial or inferior angle border of scapula). Ten scapular test assessment methods (two static, three semi-dynamic, and five dynamic) were evaluated. Results: Bland–Altman plots showed no funnel effects, although systematic bias and significant differences between raters were present in three of the methods. ICC values ranged from 0.71 to 0.80 for the static test assessment methods and from 0.25–0.92 for the semi-dynamic test assessment methods. Three of the five dynamic test assessment methods had ICCs of 0.47–0.68. For the two remaining dynamic test assessment methods, kappa varied between −0.034 and 0.71. Using PABAK, kappa increased to 0.54–0.86. Conclusion: Four scapular test assessment methods (Upper horizontal distance, Lower horizontal distance at max shoulder flexion, Acromial distance, and Winging scapula) showed satisfactory inter-rater reliability. Simple visual observational methods and quantitative distance measurements have better reliability between clinicians than more complex measurements and may be better suited for use in clinical practice. [ABSTRACT FROM AUTHOR]

Context: Scapular rehabilitation exercises should focus on selective activation of weaker muscles and minimal activation of hyperactive muscles. For rehabilitation of overhead athletes, single-plane open chain exercises below 908 of shoulder elevation are often recommended. Moreover, incorporating the kinetic chain in shoulder rehabilitation exercises is advised and has been suggested to influence scapular muscle activity levels. Objective: To study the influence of kinetic chain incorporation during 5 variations of a shoulder-elevation exercise on scapular muscle activity. Design: Cross-sectional study. Setting: University laboratory. Patients or Other Participants: Thirty-one asymptomatic participants (15 men, 16 women). Main Outcome Measure(s): The electromyographic activity of the upper (UT), middle (MT), and lower (LT) trapezius, and serratus anterior was determined during 5 variations of bilateral elevation with external rotation: (1) open-hand position (reference exercise), (2) closed-hand position, (3) dynamic bipedal squat, (4) static unipedal squat, and (5) dynamic unipedal squat on the contralateral leg. All data were normalized as a percentage of maximal voluntary isometric contraction (MVIC). Results: A closed-hand position (exercise 2) instead of an open-hand position (exercise 1) resulted in lower MT (mean difference - 3.44% MVIC) and LT (mean difference - 7.76% MVIC) activity. Incorporating the lower limb (exercises 3-5) increased UT activity when compared with exercise 1 (mean differences - 3.67, 2.68, 5.02% MVIC, respectively), which in general resulted in increased UT:MT ratios. Additionally, LT activity decreased when a dynamic unipedal squat was added (mean difference: 4.90% MVIC). For the serratus anterior, the greatest activity occurred during elevation in a static unipedal squat position (exercise 4, 22.90% MVIC). Conclusions: Incorporating the kinetic chain during shoulderelevation exercises influenced scapular muscle activity and ratios. In particular, incorporating the lower limb resulted in more UT activity, whereas the open-hand position increased MT and LT activity. [ABSTRACT FROM AUTHOR]

Context: Subacromial impingement syndrome (SIS) is associated with scapular dyskinesis, or imbalanced scapular muscle activity. Evidence has shown that feedback can improve scapular control in patients with SIS. However, it is unknown whether real-time video feedback or electromyography (EMG) biofeedback is optimal for improving scapular kinematics and muscle activity during a functional task. Objective: To compare the effects of video and EMG feedback sessions on absolute muscle activity (upper trapezius [UT], lower trapezius [LT], serratus anterior), muscle balance ratios (UT/LT, UT/serratus anterior), and scapular kinematics (anterior-posterior tilt, external-internal rotation, upward rotation) in SIS participants during arm elevation and lowering. Design: Randomized controlled clinical trial. Setting: Research laboratory. Patients or Other Participants: Overhead athletes who were diagnosed with SIS and who also exhibited scapular dyskinesis (N = 41). Main Outcome Measure(s): Three-dimensional kinematics and EMG were recorded before and after feedback training. Results: Lower trapezius muscle activity increased (4.2%- 18%, P, .011) and UT/LT decreased (0.56-1.17, P, .013) in the EMG biofeedback training group as compared with those in the video feedback training group. Scapular upward rotation during arm elevation was higher in the video group than in the EMG group after feedback training (2.38, P = .024). Conclusions: The EMG biofeedback improved muscle control and video feedback improved the correction of scapular upward rotation in patients with SIS. Trial Registration Number: ClinicalTrials.gov: NCT03252444. [ABSTRACT FROM AUTHOR]

Copyright of Fisioterapia e Pesquisa is the property of Universidade de Sao Paulo, Faculdade de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Patient-related outcome measures are often used for assessing and determining management efficacy of shoulder impingement syndrome (SIS) in overhead athletes. This study was undertaken to examine the psychometric properties (structural validity, convergent validity, internal consistency, test-retest reliability, and minimal detectable change) and perform partial confirmatory factor analysis (PCFA) of the Hindi SPADI. Eighty male athletes with a mean age of 21.5 ± 2.20 years were enrolled in the study. Hindi SPADI test-retest reproducibility was calculated by intraclass correlation coefficient (ICC2,1), and Cronbach alpha helped determine internal consistency of the index. Pearson correlation coefficient compared the Hindi SPADI with the Hindi DASH scale to determine convergent validity, while the measurement error was calculated by minimal detectable change (MDC95). Exploratory factor analysis utilized for assessing the structural validity of the index gave a five-factor solution, which explained 70.03% of the variances. The test-retest reliability (ICC2,1), internal consistency, and convergent validity were found to be high, at 0.87, 0.75, and 0.94, respectively. The MDC95 was calculated to be 14.20. Additionally, the PCFA confirmed the five-factor solution with fit indices. This Hindi version of SPADI demonstrated satisfactory psychometric properties in overhead athletes with shoulder impingement syndrome. [ABSTRACT FROM AUTHOR]

Objective: Recent evidence has demonstrated that group-based physiotherapy interventions for musculoskeletal pain can have similar clinical outcomes compared to one-to-one treatment. This study qualitatively explored the experiences of individuals who participated in a physiotherapist-led group exercise class for people with nonspecific shoulder pain (NSSP). Methods: Semi-structured interviews were carried out with 23 people with NSSP, who had recently participated in a 6-week structured exercise class. All recorded verbal data were transcribed verbatim. Transcripts of interview data were verified by participants and analyzed using thematic analysis. Results: The exercise class was positively evaluated by all participants. Four themes emerged from the data: (1) the participant’s experiences of support, motivation, and learning from peers; (2) the preference for an exercise class compared to individual physiotherapy; (3) the physiotherapist as an educator and facilitator; and (4) beliefs about pain and exercise. Conclusion: Among those interviewed, the exercise class was described as providing an environment conducive to the development of relationships, friendships, humor and fun, gaining mastery of their exercises, and encouraging the transition toward self-management of their pain. For those who had previous experience of one-to-one physiotherapy, the exercise class was evaluated as the preferred mode of physiotherapy delivery. The findings of this study support a move away from traditional one-on-one physiotherapy sessions to the potentially more cost-effective group setting. [ABSTRACT FROM AUTHOR]

Context: Performing shoulder-abduction exercises with scapular retraction has been theorized to reduce the potential for shoulder impingement. However, objective data to support this premise are lacking. Objective: To evaluate the influence of active scapular retraction on acromiohumeral distance (AHD) at 4 shoulder-abduction angles using real-time ultrasound. Design: Cross-sectional study. Setting: University laboratory. Patients or Other Participants: Twenty asymptomatic individuals (10 men, 10 women; age = 22.9 ± 2.8 years, height = 169.3 ± 9.5 cm, mass = 65.5 ± 12.9 kg) were recruited. Main Outcome Measure(s): Real-time ultrasound images of AHD were obtained during nonretracted and retracted scapular conditions at 0°, 45°, 60°, and 90° of shoulder abduction. A 2-factor analysis of variance with repeated measures was used to evaluate the influence of shoulder retraction on AHD across shoulder-abduction angles. Results: A scapular-retraction condition 3 shoulder-abduction--angle interaction for AHD was found (F3,57 = 4.56, P = .006). The AHD was smaller at 0° (10.5 versus 11.2 mm, respectively; t19 = 2.22, P = .04) but larger at 90° (9.4 versus 8.7 mm, respectively; t19 = -2.30, P = .04) of shoulder abduction during the retracted than the nonretracted condition. No differences in AHD were observed between conditions at 458 (t19 = 1.45, P = .16) and 60° (t19 = 1.17, P = .86) of abduction. Conclusions: The observed differences in AHD at 0° and 90° of shoulder abduction were small and did not exceed the established minimal detectable change for either angle. Our findings suggest that active scapular retraction during shoulder abduction has a minimal influence on AHD at 08 and 908 in healthy individuals. Further investigations are needed to determine whether scapular retraction influences AHD in individuals with subacromial impingement. [ABSTRACT FROM AUTHOR]

Background: Progressive biceps loading is recommended in the nonoperative and operative rehabilitation of biceps-related disorders. Previous researchers have proposed a continuum of exercises with low to moderate biceps loads to be used in the early and intermediate phases of rehabilitation. A progression of exercises with moderate to high biceps loads to be used in the more advanced phases of rehabilitation is lacking. Purpose: To describe a progression of exercises with progressive moderate to high loads on the biceps brachii (BB) based on electromyographic (EMG) analysis. Study Design: Controlled laboratory study. Methods: The EMG activity of BB and triceps brachii; upper trapezius, middle trapezius, and lower trapezius; and serratus anterior was determined with surface electromyography in 30 asymptomatic participants during 11 exercises. Results: Of the 11 exercises, 4 (arm shake with an Xco-trainer, lateral pull-down in pronation, chest shake with an Xco-trainer, lateral pull-down in supination) showed low (<20% maximal voluntary isometric contraction [MVIC]), 5 (pull-up in pronation with Redcord, air punch, forward flexion in supination, pull-up in supination with Redcord, inclined biceps curl) showed moderate (between 20%-50% MVIC), and 2 (throwing forward flexion, reverse punch) showed high (>50% MVIC) EMG activity in the BB. These exercises were ranked with an increasing level of activity in the BB. Conclusion: The continuum of exercises with moderate to high biceps activity may be applied in the more advanced phases of treatment for biceps disorders. In addition, biceps muscle activity may be targeted by (1) sagittal plane elevation; (2) elbow flexion with supination, without upper arm support; (3) biceps contraction from an elongated position; or (4) high-velocity, explosive exercises. Clinical Relevance: These findings may assist clinicians to select appropriate exercises to be used in the more advanced phases of nonoperative or postoperative rehabilitation of overhead athletes with biceps-related injuries. [ABSTRACT FROM AUTHOR]

Background: Recent investigations in handball athletes point to the need to carry out rehabilitation programs that aim to improve the instability of the glenohumeral joint, widely used in the various tasks of this modality. Objectives: To evaluate the immediate and short-term effects of a neurofunctional elastic bandage (NEB) on muscular strength, range of motion and pain intensity in the glenohumeral joint in handball athletes with shoulder dysfunction. Method: This study was composed of 20 professional male handball athletes who presented shoulder pain at rest and dysfunction of the shoulder, divided into two groups; experimental (n = 10) and placebo (n = 10). Before and one hour after the application of NEB the following were evaluated: maximal isometric muscular strength during movements of the glenohumeral joint (load cell), the range of motion (ROM) of the glenohumeral joint (fleximetry), pain intensity in the shoulder at rest and during movement, and the pressure pain threshold (algometry). NEB was maintained for 72 hours in all volunteers, during which a diary of shoulder pain was recorded for the short-term assessment. We used the ANOVA two-way repeated measures considering the possibility of group by time interaction, adopting a 5% level for significant differences. The treatment effect size was analyzed by means of Cohen's d values. Results: There was no group by time interaction for any of the variables (p> 0.05), however, there was a large effect of the treatment for reducing pain in the experimental group after the application of NEB in the short-term period (d = 0.83). Conclusion: There were no significant effects on muscular strength, range of motion or pain intensity in the shoulder in handball athletes immediately after implementation of NEB. [ABSTRACT FROM AUTHOR]

Introduction: The complex shoulder joint is equipped with the greater joint mobility of the body, however, is commonly injured in repetitive, sport or occupational activities. Shoulder Impact Syndrome (SIS) is one of the most common injuries affecting the shoulder, thus causing limitations in its functionality. Several strategies have been used by physiotherapy for prevention and rehabilitation of SIS, one of them is the Kinesio Taping (KT). However, even with its abundant use there is still no clear evidence of its benefits. Objective: The aim of the study was to examine the effect of KT on myoelectric activity and the level of pain in patients with SIS. Method: Seven women with SIS participated, which performed the flexion and shoulder abduction up to 90° with and without KT. During the gestures, the pain level and surface electromyography data of the upper trapezoid, middle deltoid and anterior serratus were acquired. The treatment of the electromyography data was performed in the BIOMEC-SAS software and presented as percentage values of the maximum voluntary contraction. To compare the myoelectric activity and pain levels, it was performed, respectively, one way ANOVA and the Wilcoxon test (α <0.05). Results: Pain reductions were observed and myoelectric activity of upper trapezius (46.0±34.4% MVIC to 35.6 ± 19.5% MVIC) and middle deltoid (39.0±11.5% MVIC to 35.2±12.5% MVIC) in motion abduction use of KT. No changes were observed in the signs during flexion movement. Conclusion: Finally, the KT generated a reduction in the level of pain and myoelectric activity of the middle deltoid and upper trapezius in the movement of abduction in patients with SIS. [ABSTRACT FROM AUTHOR]

Context: Sport-specific adaptations at the glenohumeral joint could occur in adolescent athletes because they start participating in high-performance sports in early childhood. Objective: To investigate shoulder-rotator strength, internal-rotation (IR) and external-rotation (ER) range of motion (ROM), and acromiohumeral distance (AHD) in asymptomatic adolescent volleyball attackers to determine if they have risk factors for injury. Design: Cross-sectional study. Setting: University laboratory. Participants: Thirty-nine adolescent high school-aged vol-leyball attackers (22 boys, 17 girls; age = 16.0 ± 1.4 years, height = 179.2 ± 9.0 cm, mass = 67.1 ± 10.9 kg, body mass index = 20.7 ± 2.6 kg/m²). Main Outcome Measure(s): Shoulder IR and ER ROM, total-rotation ROM, glenohumeral IR deficit, AHD, and concen-tric and eccentric strength of the shoulder internal and external rotators were tested bilaterally. Results: External-rotation ROM was greater (t38 = 4.92, P < .001), but IR ROM (t38 =-8.61, P < .001) and total ROM (t38 = -3.55, P = .01) were less in the dominant shoulder, and 15 athletes had a glenohumeral IR deficit (IR ROM loss > 18°). We observed greater concentric internal-rotator (t38 = 2.89, P = .006) and eccentric external-rotator (t38 = 2.65, P = .01) strength in the dominant than in the nondominant shoulder. The AHD was less in the dominant shoulder (t38 = -3.60, P < .001). Conclusions: Adolescent volleyball attackers demonstrat-ed decreased IR ROM, total ROM, and AHD and increased ER ROM in their dominant shoulder. Therefore, routine screening of adolescent athletes and designing training programs for hazardous adaptive changes could be important in preventing shoulder injuries. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine activations of selected scapular stabilizing musculature while performing an overhead throw with a hold (not releasing the ball) in two different throwing positions--standing with a crow hop and kneeling on the ipsilateral knee. Surface electromyography was used to examine activations of throwing side lower trapezius (LT), middle trapezius (MT), serratus anterior (SA), and upper trapezius (UT). Muscle activations were recorded while performing the overhead throw with holds while in two throwing positions. MANOVA results revealed no significant differences between the two throwing conditions and muscle activations of LT, MT, SA, and UT: F(8.124) = .804, p = .600; Wilks's Λ = .904, partial η² = .049. Although no significant differences were observed in the scapular stabilizers between the two conditions, moderate (21-50 % MVIC) to high (> 50 % MVIC) activations of each muscle were present, indicating that nonrelease throws may be beneficial for scapular stabilization in throwers. [ABSTRACT FROM AUTHOR]

* STUDY DESIGN: Randomized controlled trial. * OBJECTIVE: To evaluate the effects of an exercise protocol, with and without manual therapy, on scapular kinematics, function, pain, and mechanical sensitivity in individuals with shoulder impingement syndrome. *BACKGROUND: Stretching and strengthening exercises have been shown to effectively decrease pain and disability in individuals with shoulder impingement syndrome. There is still conflicting evidence regarding the efficacy of adding manual therapy to an exercise therapy regimen. * METHODS: Forty-six patients were assigned to 1 of 2 groups, one of which received a 4-week intervention of stretching and strengthening exercises (exercise alone) and the other the same intervention, supplemented by manual therapy targeting the shoulder and cervical spine (exercise plus manual therapy). All outcomes were measured preintervention and postintervention at 4 weeks. Outcome measures were scapular kinematics in the scapular and sagittal planes during arm elevation, function as determined through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, pain as assessed with a visual analog scale, and mechanical sensitivity as assessed with pressure pain threshold. * RESULTS: Independent of the intervention group, small, clinically irrelevant changes in scapular kinematics were observed postintervention. A significant group-by-time interaction effect (P = .001) was found for scapular anterior tilt during elevation in the sagittal plane, with a 3.0° increase (95% confidence interval [CI]: -1.5°, 7.5°) relative to baseline in the exercise-plus-manual therapy group compared to a decrease of 0.3° (95% CI: -4.2°, 4.8°) in the exercise-alone group. Pain, mechanical sensitivity, and the DASH score improved similarly for both groups by the end of the intervention period. *CONCLUSION: Adding manual therapy to an exercise protocol did not enhance improvements in scapular kinematics, function, and pain in individuals with shoulder impingement syndrome. The noted improvements in pain and function are not likely explained by changes in scapular kinematics. The study is registered at www.clinicaltrials.gov (NCT02035618). * LEVEL OF EVIDENCE: Therapy, level 1b-. [ABSTRACT FROM AUTHOR]

The article discusses the study by the author to identify the serratus anterior, lower trapezius, infraspinatus, and posterior deltoid muscle activities during two free-motion exercises. It mentions comparison of the muscle activities with isometric contractions during quadruped shoulder flexion and external rotation and abduction of the glenohumeral joint. It reports that interactions in electromyographic activity were observed between intensities and exercises.

Context: Tennis requires repetitive overhead movements that can lead to upper extremity injury. The scapula and the shoulder play a vital role in injury-free playing. Scapular dysfunction and glenohumeral changes in strength and range of motion (ROM) have been associated with shoulder injury in the overhead athlete. Objective: To compare scapular position and strength and shoulder ROM and strength between Swedish elite tennis players of 3 age categories (,14, 14-16, and .16 years). Design: Cross-sectional study. Setting: Tennis training sports facilities. Patients or Other Participants: Fifty-nine adolescent Swedish elite tennis players (ages 10-20 years) selected based on their national ranking. Main Outcome Measure(s): We used a clinical screening protocol with a digital inclinometer and a handheld dynamometer to measure scapular upward rotation at several angles of arm elevation, isometric scapular muscle strength, glenohumeral ROM, and isometric rotator cuff strength. Results: Players older than 16 years showed less scapular upward rotation on the dominant side at 908 and 1808 (P , .05). Although all absolute scapular muscle strength values increased with age, there was no change in the body-weight–normalized strength of the middle (P = .9) and lower (P = .81) trapezius or serratus anterior (P = .17). Glenohumeral internal-rotation ROM and total ROM tended to decrease, but this finding was not statistically significant (P = .052 and P = .06, respectively). Whereas normalized internal-rotator strength increased from 14 to 16 years to older than 16 years (P = .009), normalized external-rotator and supraspinatus strength remained unchanged. Conclusions: Age-related changes in shoulder and scapular strength and ROM were apparent in elite adolescent tennis players. Future authors should examine the association of these adaptations with performance data and injury incidence. [ABSTRACT FROM AUTHOR]

The article presents a study conducted to analyze the relationship between an athlete's sex and performance in upper quarter Y balance test (YBT-UQ) for swimmers. It mentions that 43 males and 54 female National Collegiate Athletic Association Division I college swimmers were analysed for their YBT-UQ performance of left and right limbs in the medial, inferolateral, and superolateral directions. It was concluded that average scores in the medial and inferolateral direction were higher for men.

The article reports on research which was conducted to investigate shoulder muscle activation levels during four closed kinetic chain exercises performed with and without Redcord slings (RS). Researchers evaluated 47 subjects who performed half push-ups (HPU), knee push-ups (KPU), knee prone bridging plus (KPBP) and pull ups. They found that an increase in pectroalis major muscle activation was seen when using the RS with HPU and KPBP and that there was a decrease in serratus anterior muscle activation in KPU and KPBP.

BACKGROUND: Specificity plays an important role in the design of strength training protocols. One of the paramount factors is the range of motion (ROM). OBJECTIVE: To explore limited range of motion (ROM) strength training using a closed chain upper extremity push pull motion. Range specific effects and transferability (strength gains outside the trained ROM) were investigated. METHOD: 45 healthy women (18-50 ± 4.2) randomly assigned to one of three groups: Full ROM group, Limited ROM group, Control group. Training and testing were conducted using a closed chain attachment of an isokinetic dynamometer, at a constant linear velocity of 12.22 cm/s (corresponding to the dynamometer angular velocity of 60°/sec) and a second condition of 36.67 cm/s (corresponding to the dynamometer angular velocity of 180°/sec). Training lasted 6 weeks X 2 days per week, through either full or limited ROM, representing a middle segment of the linear displacement of the handle through the full ROM. Peak force and work data were evaluated. RESULTS: Significant gains in peak force and work values at full ROM and all sub ranges were noted for both training groups. Transferability of strength was demonstrated for limited ROM training, whereas specificity could be demonstrated only under the condition of range X velocity interaction. CONCLUSION: Our findings support the use of limited ROM training in the upper extremity and are in agreement with previous data regarding the knee extensors. Limited ROM training may be used early on in upper extremity rehabilitation. Particularly, the suggested protocol may be safely applied to scapular rehabilitation. [ABSTRACT FROM AUTHOR]

The article discusses research investigating muscle activity during a shoulder resistance training bout in novice individuals. Topics include an overview of the study's experimental design, results of normalized electromyographic (nEMG) activity and median power frequency (MPF) measurements, and the study's conclusion regarding the use of 15 repetitions maximum (RM) in shoulder resistance exercises on upper extremity muscle activity.