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Background and Aims : Anterior cruciate ligament (ACL) injury is the most common knee injuries in sports. This study aims to assess the effect of closed kinetic chain exercises on lower extremity function in football players with ACL reconstruction surgery. Methods This is a quasi-experimental study that was conducted on 22 male football players with a history of ACL injuruy referred to a hopspital from Ahvaz, Iran. They were randomly divided into two groups of 11, including exercise and control. The performance of the two groups was measured using shuttle run test, figure-of-eight hop test, hop test from side to side, and agility hop test in the pre-test and post-test phases. The exercise group performed closed kinetic chain exercises (side lunge, plie squat, hip bridge, walking backwards, front lunge, squat, and plank) for 6 weeks, 3 sessions per week, each for 35 minutes. No exercise was performed in the control group. For data analysis, repeated measures analysis of variance (ANOVA) and independent t-test were used. The significance level was set at 0.05. Results In the pre-test phase, no significant difference was observed between the two groups in the functional tests of shuttle run test, figure-of-eight hop test, side to side hop test, and agility hop test (P>0.05). In the post-test phase, the ANOVA results showed that the exercise group performed better in shuttle run test, figure-of-eight hop test, side to side hop test, and agility hop test (P≤0.05). The results of Bonferroni post hoc test showed that the exercise group in the mentioned tests, both immediately after and one month after the exercises, their performance in the mentioned tests improved (P≤0.05). Conclusion The closed kinetic chain exercise can be used to increase the lower extremity performance of male football players with ACL injury. [ABSTRACT FROM AUTHOR]

Background and Aims Today, there is an argument about the effect of various stretching movements on the performance of athletes. Therefore, this study investigated the acute effect of static and dynamic stretching on muscle activity and co-contraction of scapular stabilizer muscles during pull-ups in gymnasts. Methods According to the inclusion and exclusion criteria, 15 professional gymnasts with a mean age of 23.25±2.57 years, height of 170.93±5.88 cm, and weight of 64.54±5.06 kg were selected as research samples and divided into three subgroups (each with 5 athletes). In the pre-test, subjects performed pullup activity, and muscle activities of the serratus anterior, upper trapezius, middle trapezius, and lower trapezius muscles were measured using a biometric electromyography device. Then, each subgroup performed a different stretching protocol in each session, and a post-test was conducted like the pretest. Repeated measures analysis of variance, the Bonferroni post hoc test, and the paired t test were used to test the study hypotheses. Results The results showed that static and dynamic stretching caused a significant decrease and increase in muscle activity in both concentric and eccentric phases, respectively. Also, the results showed that dynamic stretch caused a reduction in co-contraction of the serratus anterior and middle trapezius muscles in both concentric and eccentric phases. In addition, there is a significant difference between the effect of static and dynamic stretch and between dynamic stretch and control on the co-contraction of the serratus anterior and middle trapezius muscles in the concentric and eccentric phases. Conclusion The results showed that the co-contraction of the serratus anterior and middle trapezius muscles decreased after using dynamic stretching. Therefore, considering the importance of muscle cocontraction in the occurrence of shoulder joint injuries and preventing injuries in the shoulder joint of gymnasts, it is suggested that coaches and gymnasts use dynamic stretching exercises more carefully. [ABSTRACT FROM AUTHOR]

Abstract: Chang, C-C, Chang, C-M, and Shih, Y-F. Kinetic chain exercise intervention improved spiking consistency and kinematics in volleyball players with Scapular Dyskinesis. J Strength Cond Res 36(10): 2844-2852, 2022-Scapular dyskinesis (SD) is a common problem among volleyball players with chronic shoulder pain. This randomized controlled study examined the effectiveness of kinetic chain (KC) training on neuromuscular performance of the scapula and trunk during volleyball spikes. Forty volleyball players with SD and chronic shoulder pain received 4 weeks of KC training or the conventional shoulder exercise training (CT). Shoulder pain was assessed using the visual analogue scale (VAS) every week. The kinematics and muscle activation of the shoulder and upper trunk, and proprioceptive feedback magnitude (PFM) for scapular movement consistency, were recorded at the maximum shoulder flexion (T1) and ball contact (T2) during spiking tasks. The two-way repeated measures analysis of variances was used to assess the between-group differences before and after the intervention. The results showed a significant time by group interaction for the upper trunk rotation ( p < 0.001) and PFM ( p = 0.03) at T2. The post-hoc test indicated that the KC group significantly increased contralateral rotation of the upper trunk (9.63 ± 4.19° vs. -4.25 ± 10.05°), and improved movement consistency (error: 8.88 ± 11.52° vs. 19.73 ± 12.79°) at T2 compared with the CT group. Significant time effects were also identified for VAS, scapular upward rotation (T1 and T2), upper trunk contralateral side-bending and PFM at T1, and upper trunk contralateral rotation at T2. In conclusion, both KC and CT training would relieve shoulder pain and improve scapular and trunk movement, whereas the KC program was more effective for increasing scapular movement consistency and upper trunk rotation during volleyball spikes., (Copyright © 2020 National Strength and Conditioning Association.)

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: Chronic neck pain (CNP) is a common public health problem that affects daily living activities and quality of life. There is biomechanical interdependence between the neck and scapula. Studies have shown that shoulder blade function might be related to chronic neck pain. We therefore evaluated the effects of scapular targeted therapy on neck pain and function in patients with CNP. Methods: Databases, including MEDLINE (via PubMed), EMBASE (via Ovid), Ovid, Web of Science, and Scopus, were systematically searched for randomized controlled trials published in English investigating treatment of the scapula for CNP before July 16, 2023. Results: A total of 313 participants were included from 8 RCTs. Compared with those in the control group, the intervention in the scapular treatment group exhibited greater improvement in pain intensity (standardized mean difference (SMD) = 2.55; 95% CI = 0.97 to 4.13; P = 0.002), with moderate evidence. Subgroup analysis for pain intensity revealed a significant difference between the sexes, with only the female population (SMD = 6.23, 95% CI = 4.80 to 7.65) showing better outcomes than those with both sexes (SMD = 1.07, 95% CI = 0.57 to 1.56) (p < 0.00001). However, moderate evidence demonstrated no improvement in neck disability after scapular treatment (SMD of 0.24[-0.14, 0.62] of Neck Disability Index or Northwick Park Neck Pain Questionnaire). No effect of scapular treatment was shown on the pressure pain threshold (PPT). The cervical range of motion (CROM) and electromyographic activity of neck muscles could not be conclusively evaluated due to limited support in the articles, and further study was needed. However, the patient's head forward posture appeared to be corrected after scapular treatment. Conclusion: Scapular therapy was beneficial for relieving pain intensity in patients with CNP, especially in women. Head forward posture might also be corrected with scapular therapy. However, scapular therapy may have no effect on the PPT or neck disability. However, whether scapular therapy could improve CROM and cervical muscle activation in patients with CNPs had not been determined and needed further study. [ABSTRACT FROM AUTHOR]

The effect of electromyographic (EMG) activity on agonist muscles during exercises performed on stable and unstable surfaces remains uncertain. We aimed to review the literature regarding the comparison of the EMG activity of the agonist muscles of exercises performed on stable and unstable surfaces. Eighty-six studies that evaluated the EMG activity of 1783 individuals during exercises for the lower limbs, upper limbs, and core were included. The EMG activities of the pectoralis major (SMD = 0.28 [95% CI 0.09, 0.47]) and triceps brachii muscles (SMD = 0.45 [95% CI 0.25, 0.66]) were significantly increased when the unstable device was added to the exercise. Likewise, the EMG activity of all core muscles showed a significant increase with the unstable surface during the exercises, such as the rectus abdominis (SMD = 0.51 [95% CI 0.37, 0.66]), external oblique (SMD = 0.44 [95% CI 0.28, 0.61]), internal oblique (SMD = 1.04 [95% CI 0.02, 2.07]), erector spinae (SMD = 0.37 [95% CI 0.04, 0.71]), and lumbar multifidus (SMD = 0.35 [95% CI 0.08, 0.61]). However, the lower limb muscles did not show greater EMG activity during the exercise with unstable surfaces compared to the stable surface. In conclusion, unstable conditions increase the EMG activity of some upper limb and core muscles compared to a stable surface. [ABSTRACT FROM AUTHOR]

Objective: To systematically scope the literature on posterior shoulder tightness (PST) and define a therapist-instructed and therapist-administered management framework. Design: Scoping review. Literature search: We searched MEDLINE, EMBASE, CINAHL, Scopus and Google Scholar from inception to December 2021. Study selection criteria: Peer-reviewed studies written in English, French, Greek, Japanese or Tamil, with extractable pre- and post-intervention data. Physiotherapy interventions amenable for posterior shoulder structural (muscle, capsule) causes of PST within an adult population. Data synthesis: Arksey and O'Malley's framework was implemented and the PRISMA extension for scoping reviews directed our data synthesis. The data charted from each study included authors, title, study year, location, study design; participant number, age, sex; PST intervention and parameters; patient-reported outcomes; and results. Themes were organized into therapist-instructed and therapist-administered rehabilitation strategies, as well as combined treatment methods. Results: Of 2777 articles identified from our search strategy, 21 articles were included. Therapist-instructed interventions included cross-body stretch (CBS), sleeper stretch (SS), a combination of the two and general stretching. Therapist-administered interventions included CBS, SS, instrument-assisted soft tissue mobilization (IASTM), muscle energy techniques, dry needling and Fauls protocol (12 therapist-assisted stretches). Combined interventions of tape with self-stretching and IASTM and stretching were also identified. Conclusion: Based on the current evidence, CBS and SS are the most researched treatments for PST and seem to be effective at improving PST. Furthermore, stabilization of the scapula while performing these stretches optimized the stretch targeted to the PST and ROM benefits for horizontal adduction. [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: Deficiency in scapular muscle endurance (SME) is a risk factor for rotator-cuff-related shoulder pain (RCRSP). However, the exact relationship among SME, pain, and functionality remains unclear. This study aims to compare SME, pain, and functionality in RCRSP patients to those in age-sex-matched healthy controls. Methods: Twenty-three patients with RCRSP and 23 age-sex matched healthy controls were included in the study. SME was measured using a 1-kg dynamometer. Self-reported pain level was assessed using a visual analog scale. The Functional Impairment Test-Hand, Neck, Shoulder, and Arm (FIT-HaNSA) was also used to assess functional impairment. Results: The control group had higher SME and total FIT-HaNSA scores than the patient group (P<0.05). There was a statistically significant and positive correlation between SME and FIT-HaNSA scores in both groups (P<0.05). Conclusions: SME was affected by RCRSP. Pain and functional impairment were correlated with low SME. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Kinetic chains (KCs) are primarily affected by the load of different activities that recruit muscles from different regions. We explored the effects of strengthening exercises on KCs through muscle activation. Four databases were searched from 1990 to 2019. The muscles of each KC, their surface electromyography (sEMG), and the exercises conducted were reported. We found 36 studies that presented muscle activation using the percent (%) maximal voluntary isometric contraction (MVIC) or average sEMG for nine KCs in different regions. The % MVIC is presented as the following four categories: low (≤20%), moderate (21~40%), high (41~60%), and very high (>60%). Only four studies mentioned muscle activation in more than three KCs, while the remaining studies reported inconsistent sEMG processing, lacked normalization, and muscle activation in one or two KCs. The roles of stabilizers and the base of support in overhead throwing mobility using balance exercises were examined, and the concentric phase of chin-up and lat pull-down activated the entire KC by recruiting multiple muscles. Also, deep-water running was shown to prevent the risk of falls and enhance balance and stability. In addition, low-load trunk rotations improved the muscles of the back and external oblique activation. Based on this study's findings, closed-chain exercises activate more groups of muscles in a kinetic chain than open-chain exercises. However, no closed or open chain exercise can activate optimal KCs. [ABSTRACT FROM AUTHOR]

Endovascular thrombectomy (EVT) is the most effective treatment for acute ischemic stroke caused by large vessel occlusion (LVO). Yet, long-term outcome (LTO) and health-related quality of life (HRQoL) in these patients have rarely been addressed, as opposed to modified Rankin scale (mRS) recordings. We analysed demographic data, treatment and neuroimaging parameters in 694 consecutive stroke patients in a maximum care hospital. In 138 of these patients with respect on receipt of written informed consent, LTO and HRQoL were collected over a period of 48 months after EVT using a standardised telephone survey (median 2.1 years after EVT). Age < 70 years (OR 4.82), lower NIHSS on admission (OR 1.11), NIHSS ≤ 10 after 24 h (OR 11.23) and complete recanalisation (mTICI3) (OR 7.79) were identified as independent predictors of favourable LTO. Occurrence of an infection requiring treatment within the first 72 h was recognised as a negative predictor for good long-term outcome (OR 0.22). Patients with mRS > 2 according to the telephone survey more often had complaints regarding mobility, self‐care, and usual activity domains of the HRQoL. Our results underline a sustainable positive effect of effective EVT on the quality of life in LVO stroke. Additionally, predictive parameters of outcome were identified, that may support clinical decision making in LVO stroke. [ABSTRACT FROM AUTHOR]

User-friendly rehabilitation medical devices can enhance health and the quality of life through the convergence of information communication and medical technology. Muscle contraction enables bodily movement, and the assessment of muscle strength is crucial. Muscle contraction includes isometric, isotonic, and isokinetic types. Many individuals with physical disabilities rely on wheelchairs due to lower-limb paralysis. There is a substantial correlation between the level of upper-limb functional recovery and the quality of daily life. This study aimed to design and evaluate a device that utilizes various muscle contractions to enhance the effectiveness of upper-limb rehabilitation exercises. The results from the isometric performance assessment showed percentage error rates of >30% for 5–30 kg. Correction equations were employed, and the isometric performance assessment resulted in error rates below 2.1% for 5–30 kg. Isokinetic performance assessment using video analysis evaluated a consistent wire speed from 10 cm/s to 70 cm/s with an average error rate of 0.91% across all speeds. This study demonstrates the ability to accurately measure various muscle contractions and showcases the potential for real-time feedback. This highlights how such a device could be helpful for target groups, including older adults and individuals with disabilities, during upper-limb rehabilitation exercises. [ABSTRACT FROM AUTHOR]

Introduction: There is limited credible scientific evidence regarding the impact of functional training exercises on improving the shoulder position and performance of tennis players with Scapular Dyskinesia. Therefore, this study aimed to investigate the effect of a functional training program on improving the scapular-brachial rhythm and the performance of elite tennis players with scapular dyskinesia. Methods: thirty top tennis athletes at the national level who were suffering from shoulder dyskinesia were selected purposefully and randomly and divided into two experimental and control groups of fifteen. Before and after 8 weeks of functional exercises, scapular-brachial rhythm and upper limb function were evaluated using an inclinometer and Y test. In the inferential statistics section, the analysis of the covariance test was used to compare the differences between groups, and the correlated t-test was used to compare the differences within groups. Results: The results of the paired t-test show the effect of functional exercises on the scapular-brachial rhythm at angles of zero degrees (P=0.004), 45 degrees (P<0.001), 90 degrees (P<0.001) and 135 degrees (P<0.001) and also upper limb function (P=0.002) in the experimental group. Conclusion: Considering the changes observed in the shoulder position of the subjects of the present study, it seems that the changes in the neuromuscular system have occurred, and the results indicate that the implementation of a functional training program, in addition to improving shoulder posture, can be effective in improving the performance of tennis athletes. [ABSTRACT FROM AUTHOR]

Purpose: Volleyball has a high potential for shoulder dyskinesia due to the repetitive nature of it’s movements, so the aim was to investigate electromyography analysis of shoulder girdle muscle in male volleyball players with different types of scapular dyskinesia while performing a floater serve. Methods: The current research method is the causal-comparative type. 41 volleyball players were selected non-randomly and purposefully and were divided into three groups (n=13 Pattern I, n=13 Pattern II, n=13 without scapulae dyskinesia). Electromyography of serratus anterior, upper, middle, and lower trapezius was evaluated while performing a floater serve using MyoMuscle. Results: The results showed that during the acceleration phase of the serving, there was a significant difference in EMG of the upper trapezius (p=0.009) and middle trapezius (p=0.01) between the pattern II and no-dyskinesia, and there was a significant difference in EMG of serratus anterior (p=0.007) and middle trapezius (p=0.01) between the pattern I and no-dyskinesia, Conclusion: It seems that during the acceleration phase, volleyball players with pattern II experienced an abnormal increase in upper trapezius activity and inhibition of the middle trapezius activity, while probably volleyball players with pattern I experience inhibition the activity of the middle trapezius and serratus anterior. [ABSTRACT FROM AUTHOR]

Background: Adhesive capsulitis, an idiopathic condition that can cause severe disability, is characterized by fibrosis, a reduced glenoid capsule volume, and increasing pain with loss of range of motion (ROM) in the shoulder joint. In this study the efficiency of scapular Proprioceptive Neuromuscular Facilitation (PNF) with Maitland glenohumeral mobilization in adhesive capsulitis patients. Purpose: This study was to evaluate the effectiveness of scapular Proprioceptive Neuromuscular Facilitation (PNF) mobilization with Maitland glenohumeral mobilization and) in subjects with adhesive capsulitis. Methodology: Subjects were selected from out patient department of Saveetha Medical College and Hospital among 15 subjects following inclusion and exclusion criteria. Quasi-experimental study design, Convenient sampling is the sampling method. Range of motion and the numerical pain rating scale (NPRS) two outcome measures. Both the universal goniometer for ROM and the numerical pain rating scale (NPRS), which were used as outcome measures for adhesive capsulitis, were measured before and after the 16th therapy session. For four weeks, the treatment consisted of four-week sessions. Conclusion: As a result of the findings, it was concluded that Scapular Proprioceptive Neuromuscular Facilitation with Maitland Glenohumeral Mobilization was effective in improving the Range of motion and reducing pain in Adhesive capsulitis. [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]

This manuscript presents practical recommendations for managing acute attacks and implementing preventive immunotherapies for neuromyelitis optica spectrum disorders (NMOSD), a rare autoimmune disease that causes severe inflammation in the central nervous system (CNS), primarily affecting the optic nerves, spinal cord, and brainstem. The pillars of NMOSD therapy are attack treatment and attack prevention to minimize the accrual of neurological disability. Aquaporin-4 immunoglobulin G antibodies (AQP4-IgG) are a diagnostic marker of the disease and play a significant role in its pathogenicity. Recent advances in understanding NMOSD have led to the development of new therapies and the completion of randomized controlled trials. Four preventive immunotherapies have now been approved for AQP4-IgG-positive NMOSD in many regions of the world: eculizumab, ravulizumab - most recently-, inebilizumab, and satralizumab. These new drugs may potentially substitute rituximab and classical immunosuppressive therapies, which were as yet the mainstay of treatment for both, AQP4-IgG-positive and -negative NMOSD. Here, the Neuromyelitis Optica Study Group (NEMOS) provides an overview of the current state of knowledge on NMOSD treatments and offers statements and practical recommendations on the therapy management and use of all available immunotherapies for this disease. Unmet needs and AQP4-IgG-negative NMOSD are also discussed. The recommendations were developed using a Delphi-based consensus method among the core author group and at expert discussions at NEMOS meetings. [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]

Objectives: Scapular-focused exercises are included in the rehabilitation of people with scapular dyskinesis (SD); yet, there is a noteworthy level of ambiguity concerning the comparative efficacy of different interventions in terms of their ability to enhance shoulder discomfort and function. This research analyzed the impact of a scapular-focused exercise schedule on shoulder pain and function of patients with scapular dyskinesia. Methods: PubMed, Medline (Ovid), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), Google Scholar, and Scopus databases were explored up until July 2021 for randomized controlled trials (RCTs) that considered the impact of scapular-focused training therapy in people with SD. Eleven RCTs, with a combined sample size of 890 participants encountered our inclusion criteria. Results: The results demonstrated a significant reduction in shoulder pain following exercise (therapy standardized mean difference [SMD]=-0.83; 95% CI, -1.44%, -0.22%; P=0.008). Moreover, exercise therapy significantly improved shoulder function (SMD=-0.62; 95% CI, -1.08%, -0.16%; P=0.008). Nevertheless, scapular-focused exercise had no significant effect on scapula positioning at any angle (0°: Mean difference [MD]=-0.44; 95% CI, -1.43%, 0.55%; P=0.38; 45°: MD=-0.17; 95% CI, -0.72%, 0.37%; P=0.53; 90°: MD=-0.25; 95% CI, -1.06%, 0.57%; P=0.56). Discussion: Scapular-based exercise therapies are effective approaches among patients with SD. It is necessary to conduct additional high-quality studies with longer periods to evaluate and validate the results reported in this study. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the relationships between some motor skills in the upper extremity region of 20 male volleyball players aged 15-18 years, competing in the 8th Group of the 2nd League of the Turkish Volleyball Federation, with and without suspended and unsuspended Push-Up (PU) bosu ball exercises applied for 3 sessions every week for 8 weeks. In addition to the normal training program, the first group was trained with unsuspended (PU) and the second group was trained with suspended (PU) for 8 weeks. Both groups performed Medicine Ball Throw to evaluate upper extremity strength, Closed Kinetic Chain Upper Extremity Stability Test to evaluate endurance and Upper Extremity Y-Balance Test to evaluate balance before and after the training program. As a result of this study, the difference values of the test results before and after the training were compared. A significant difference was found between the groups in the upper extremity right and left arm 0,000, Y Balance Test Medial dominant 0,000, and non-dominant 0,004, Superolateral dominant and non-dominant 0,000, Inferiorlateral dominant 0,024 and non-dominant 0,000, chest and overhead 0,000 Health Ball Throw test difference changes (p<0,05). Performing the applications used in classical training methods on unstable grounds can increase the motivation of volleyball athletes and contribute to their performance. As a result, it seems that unsuspended and suspended (PU) exercises can increase the levels of medicine ball throwing, closed kinetic chain upper extremity stability test and upper extremity Y-balance test with the exercises applied, although the levels are different. Further studies on the subject by increasing the number of participants in different groups and using electronic devices will be useful. [ABSTRACT FROM AUTHOR]

Background and Objectives: Computer office workers spend long periods in front of a computer, and neck and shoulder pain are common. Scapular dyskinesis (SD) is associated with neck and shoulder pain. However, SD in computer office workers has not been elucidated. We aimed to investigate the prevalence of SD, neck and shoulder pain, disability, and working hours in computer office workers. Materials and Methods: In total, 109 computer office workers participated in this study. The results of a scapular dyskinesis test (SDT), lateral scapular slide test (LSST), neck disability index (NDI), shoulder pain and disability index (SPADI), visual analog scale (VAS) scores of the neck and shoulder, and working hours were recorded. Results: Ninety-eight computer office workers (89.9%) had SD. Computer office workers with SD had significantly higher NDI (p = 0.019), neck VAS (p = 0.041), and dominant shoulder VAS scores (p = 0.043). The LSST results showed a significantly greater distance (p = 0.016) in participants with SD. Conclusions: The prevalence of SD was very high in computer office workers, and neck and shoulder pain were more prevalent in workers with obvious SD. [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]

Background: Evaluation of outcome after stroke is largely based on assessment of gross function 3 months after stroke onset using scales such as mRS. Cognitive or social functions, level of symptom burden or emotional health are not usually assessed, nor are data available on long-term functional outcomes years after stroke. Methods: Analysis of 1141 patients with AIS treated with IVT from two major German university hospitals between 2017 and 2020. Patient characteristics and short-term outcome were analysed from patient records. Long-term outcome of 228 patients with prior written informed consent was assessed via telephone survey using mRS and PROMs (EQ-5D-5L, EQ-VAS) 2.5 years after stroke. Results: Predictors of excellent to good long-term outcome were younger age, event to door time ≤ 2 h, NIHSS ≤ 6 on admission and NIHSS ≤ 6 after IVT. Stroke recurrence was a negative predictor. Predictors of excellent quality of life at 2.5 years included age < 73 years, lower NIHSS after IVT, absence of hypertension. Quality of life was rated in all dimensions with a medium score of 1 and a medium EQ-VAS of 70, representing the good general health status of this stroke population. Conclusion: Main predictors of an excellent to good long-term outcome and excellent QoL 2.5 years after stroke are younger age, lower NIHSS, and event to door time ≤ 2 h. Research on long-term outcome after disease and treatment is of utmost importance, as it has the ability to reveal the patient true functional outcome and quality of life and to provide information on the status of independence and self-esteem. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the results of the transfer of the lower trapezius with a graft from hamstring tendons in the treatment of irreparable rotator cuff tears. Level IV; Case Series; Treatment Study. Methods: Ten patients diagnosed with irreparable tears of the supraspinatus and infraspinatus tendons, were evaluated retrospectively -preoperatively, 6 and 12 months postoperatively. They underwent transfer of the prolonged lower trapezius with an autologous graft of the knee flexor tendons. Results: The Shoulder Subjective Value increased from 47 (preoperative) to 71 (1 year after surgery), American Shoulder and Elbow Surgeons Score increased from 26.63 to 75.24. Pain improved from 7.9 to 2.5 on the Visual Analogue Scale. The mean lateral rotation improved from 31° to 51°, flexion from 84° to 122°, and abduction from 76° to 101°. These results have not changed significantly between 6 and 12 months. Discussion: The transfer of the lower trapezius with autologous grafts from the hamstring tendons showed good results in patients under 65 years of age with irreparable rotator cuff tears. Longer follow-up and a greater number of cases are necessary to confirm the efficacy of the transfer. [ABSTRACT FROM AUTHOR]

Context: Serratus anterior tightness is associated with scapular dyskinesis and overall shoulder dysfunction, which affects the range of motion. The most effective intervention to stretch the serratus anterior is unknown. Objective: To evaluate the effect of a therapist-administered novel serratus anterior stretch (SAS) on shoulder range of motion. Method: This study recruited 30 healthy subjects of age 21.20 (1.69) years, height 1.65 (0.11) m, and weight 60.90 (10.36) kg in equal ratio of males and females who scored 1 or 2 on the shoulder mobility test of functional movement screening. A single intervention of a novel SAS was applied to the shoulder. Outcome variables before and after the SAS included the following: shoulder ROM (flexion, abduction, internal rotation, and external rotation) and functional movements of reaching up behind the back and reaching down behind the neck. Results: A paired t test was used to analyze the data. Following the acute SAS intervention, all shoulder ROM improved significantly (P <.000). The change in internal rotation was 6.00° (7.47°), external rotation was 5.66° (9.35°), abduction was 13.50° (11.82°), flexion was 20° (13.33°), reaching up behind the back was 5.10 (2.21) cm, and reaching down behind the neck was 5.41 (2.89) cm. The most marked improvement was in reaching up behind the back (24.48%) and reaching down behind the neck (22.78%). A very large effect size (>1) was observed across most of the variables. Conclusion: An acute SAS intervention improves shoulder mobility in healthy individuals. It is recommended for the trial on the prevention and rehabilitation of shoulder pathologies with restriction in shoulder mobility. [ABSTRACT FROM AUTHOR]

Several operative procedures have been described for treating a Kim lesion. However, no physical therapy intervention has been documented as conservative treatment for these cases. The purpose of this report was to describe a physical therapy management protocol for an athlete with a Kim lesion. A 22-year-old female volleyball athlete presented to physical therapy with an 8-month history of right shoulder pain when performing the serve and attack sports gestures. Pain was 5/10 on the visual analogue scale (VAS). Pain was localized along the glenohumeral joint, around the long head of the biceps brachii tendon, and at the subscapularis tendon insertion. Shoulder range of motion (ROM) was limited to flexion (150°), abduction (158°), and internal rotation (80°). Kim lesion was confirmed by clinical tests (Kim test and Jerk test) and via magnetic resonance imaging. Shoulder functional outcomes were verified through the University of California Los Angeles (UCLA) shoulder rating scale. Upper extremity sensorimotor control was verified in bimanual support by stabilometry on a baropodometer. Core function was assessed through a plank test and a side plank test. The 8-week course of treatment included manual therapy, physical agents, shoulder and scapular mobilizations, resistance and sensorimotor exercises, core strengthening, and functional exercises. Physical therapy interventions resulted in a decrease in VAS pain (3/10), an increase in shoulder ROM (10.8°) and in UCLA shoulder score (from 22 to 33 points), a reduction in the center of pressure displacement (27–56%), and an increase in plank test (45%) and side plank test (21–29%) performance. The athlete had a full return to sport after the treatment. We concluded that the protocol used for conservative management of Kim lesion resulted in clinical satisfactory physical and functional outcomes for the athlete. [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]

BACKGROUND: The Y exercise is a therapeutic exercise facilitating lower trapezius muscle activity. OBJECTIVE: To identify the effects of scapular movement cues (posterior tilt vs. posterior tilt with adduction/depression) on trapezius muscle activity during Y exercise. METHODS: Fifteen healthy men without current shoulder pain performed general Y exercise; Y exercise with cues for scapular posterior tilt; and Y exercise with cues for scapular posterior tilt, adduction, and depression. Electromyography (EMG) data for the trapezius muscles were collected during Y exercise. The posterior tilt angle of the scapula was measured in the prone position with and without cues for scapular posterior tilt using an inclinometer application. RESULTS: The greatest lower trapezius muscle activity was observed during Y exercise with cues for scapular posterior tilt, while the greatest EMG activity of the upper trapezius was observed during Y exercise with cues for scapular posterior tilt, adduction, and depression (p < 0.05). Middle trapezius muscle activity did not significantly differ among the three Y exercise conditions (p = 0.175). Cues for scapular posterior tilt significantly increased the scapular posterior tilt angle in the prone shoulder abduction position (p = 0.007). CONCLUSION: Cues for scapular posterior tilt were most effective in facilitating lower trapezius muscle activity during Y exercise. [ABSTRACT FROM AUTHOR]

Purpose: Scapular dyskinesis is a common problem in athletes, especially overhead sports such as volleyball and basketball. The biomechanical and neurocognitive impairments are involved in the occurrence of the scapular dyskinesis. Based on previous studies about the whole-body vibration (WBV) effects on the athletes training, musculoskeletal injuries and neuromuscular responses, the current study focused on the investigation immediate effectiveness of WBV on neurocognitive parameters (reaction time and anticipatory skill) in overheads athletes with and without scapular dyskinesis. Methods: Thirty athletes with (n = 15) and without (n = 15) scapular dyskinesis participated in this interventional-observational study. The WBV applied with 30 Hz frequency and 5 mm amplitude in the modified push-up position in two groups. The scapular dyskinesis and neurocognitive parameters were recorded by the Caliper test and the Speed Anticipation Reaction Time (SART) system. Results: The Caliper measurement in three positions of arm significantly reduced after the WBV in the athletes with scapular dyskinesis (P < 0.005). The auditory complex choice reaction time significantly declined after the WBV between two groups (P = 0.042). Also, there was a correlation between the visual complex choice reaction time and 0 degree of abduction in both groups (P = 0.022). Conclusion: The WBV in the modified push-up position has immediately positive effects on neurologic and cognition skills in athletes with and without scapular dyskinesis. Based on these findings, WBV may have good potential for improved outcomes such as neurocognitive abilities and correction of scapular dyskinesia. [ABSTRACT FROM AUTHOR]

Background and Objectives: Upper crossed syndrome (UCS) is a common musculoskeletal condition that is characterized by tightness and weakness of the muscles of the neck, shoulders, and upper back. The aim of this current study is to summarize and provide an overview of the treatment in patients with UCS. Materials and Methods: A MEDLINE (PubMed), Cochrane library, Embase, Scopus, and Web of Science database search was conducted for English-language articles about upper crossed syndrome that were published until 19 January 2023. To identify potentially relevant articles, the following key search phrases were combined: "upper crossed syndrome", "upper cross syndrome", "diagnosis", and "treatment". A total of 233 articles were identified. After reading the titles and abstracts and assessing their eligibility based on the full-text articles, 11 articles were finally included in this review. The risk of bias (RoB) was assessed using RoB-2 and ROBINS-I for the randomized controlled trials (RCTs) and the non-randomized clinical trial (non-RCT), respectively. Results: Among eleven studies that investigated the effect of treatment programs for UCS, five studies compared the therapeutic effect of exercise programs with controls, whereas six compared different rehabilitative treatment strategies, such as the muscle energy technique, soft-tissue mobilization, and stretching exercises. In addition, regarding the study design, ten studies were RCTs and only one study was a prospective observational study. Conclusions: Treatment programs including various types of exercises and techniques to correct an abnormal posture and restore neuromuscular imbalances are effective for decreasing pain and improving neck disabilities and postural deviations in patients with UCS. [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]

Background and Objectives: Neck and shoulder injuries are common in Brazilian ju-jitsu (BJJ) athletes, and scapular dyskinesis (SD) is associated with these injuries. This study aimed to investigate the prevalence of SD in BJJ athletes, their neck and shoulder function and strength, and the BJJ training period. Materials and Methods: Forty-eight BJJ athletes participated in the study. Years of experience with BJJ, belt, shoulder internal and external rotation strength, neck strength, neck disability index (NDI), and SD were measured. Results: Approximately 31 BJJ athletes (64.6%) showed SD, and the nondominant arm showed a more obvious SD (n = 22, 45.8%) than the dominant arm (n = 18, 37.5%). Those with over five years of BJJ training experience showed a significantly higher rate of SD (p = 0.006) than those with less than five years of experience. Shoulder isometric internal rotation strength was significantly weaker in the obvious SD group than in the normal SD group (p = 0.014). Neck isometric strength and NDI did not differ significantly between individuals with or without SD. Conclusions: SD was common among BJJ athletes, and more experienced BJJ athletes exhibited higher rates of SD. Shoulder rotational strength was weaker with SD. Further studies are necessary on the neck and shoulders of BJJ athletes with SD. [ABSTRACT FROM AUTHOR]

Taping is a popular approach and is often used as part of a multifactorial injury prevention programme for athletes. The aim of this study was to evaluate the current literature regarding the effects of shoulder taping in overhead athletes. Literature search was performed related to rotational range of motion (RoM), posterior shoulder tightness (PST), kinematics, muscular activity, acromiohumeral distance (AHD), proprioception, strength, and performance. Twenty studies were eligible. The majority of the applied taping methods were scapular and humeral head repositioning taping. Across all studies, there was limited to moderate evidence in favour of taping in overhead athletes with regard to rotational RoM, AHD, proprioception, and altering scapular kinematics, while taping did not enhance PST, muscular activity, shoulder strength, and performance. Therefore, the current evidence showed taping can alter some of the investigated factors that may have a therapeutic or preventive role. However, in the management of the athlete shoulder, taping-only approaches should not be focused on, and taping can be integrated in a more comprehensive approach for the overhead athletes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Scapular muscles changes, as increased upper trapezius activity and decreased middle and lower trapezius and serratus anterior muscle activity, have been demonstrated in shoulder pain specific or non-specific conditions. Shoulder external rotation exercises have been recommended to improve scapular activity in shoulder pain. OBJECTIVE: To evaluate the relative scapular muscles activity during multi-joint exercises combining shoulder external rotation, trunk rotation and scapular squeeze. METHODS: Forty-one participants with and without shoulder pain were assessed in a cross-sectional study. They performed isometric multi-joint exercises at 0 ∘ and 90 ∘ of shoulder abduction with and without support. The relative activity of upper, middle, and lower trapezius and serratus anterior (upper/middle and lower portions) was measured through electromyography. The scapular muscular balance was assessed by the ratio between relative activity of the upper trapezius and the other muscles. RESULTS: Both groups presented similar results. The exercise at 90 ∘ abduction led to increased relative muscle activity against maximal voluntary contraction in both groups for upper trapezius (with support: 4% MVIC, p = 0.001 or 15% MVIC, p < 0.0001; and without support: 11% MVIC, p < 0.0001 or 13%, p < 0.0001, for asymptomatic and symptomatic group, respectively) and lower trapezius (with support: 66% MVIC, p < 0.0001 or 62% MVIC, p < 0.0001, for asymptomatic and symptomatic group, [ABSTRACT FROM AUTHOR]

Introduction: Scapular dyskinesis is commonly associated with subacromial pain syndrome (SAPS). Addressing scapular dyskinesis is widely accepted as an important component of shoulder rehabilitation. Our previous randomized controlled trial showed that Yi Jin Bang (YJB) exercises could effectively manage SAPS, but scapular motions and muscle activity during YJB exercises remain unknown. This study examined scapular kinematics synchronously with scapular muscle activation during YJB exercises. Methods: Thirty healthy participants with no shoulder complaints were enrolled in this study. Three-dimensional (3D) scapular kinematics and electromyography (EMG) activation of the upper trapezius, middle trapezius, lower trapezius, serratus anterior, anterior deltoid, middle deltoid, and posterior deltoid were synchronously measured during nine YJB movements. Results: During all YJB movements, the scapula was upwardly rotated and anteriorly tilted, with more upward rotation and a similar or less anterior tilt than the mean resting scapular angle. Column rotation, arm crossover, shoulder support circle, and armpit support high lift generated more internal rotation than the mean resting scapular angle, with the angles of internal rotation significantly greater than the other five movements (p < 0.001). Regarding EMG activity, all YJB movements elicited low activity (1.42%–19.19% maximal voluntary isometric contraction [MVIC]) from the upper trapezius and posterior deltoid and low to moderate activity (0.52%–29.50% MVIC) from the middle trapezius, lower trapezius, serratus anterior, anterior deltoid, and middle deltoid. Conclusion: YJB exercises could be useful in the middle to later phases of shoulder rehabilitation. For patients with insufficient external rotation, some YJB movements should be prescribed with caution. [ABSTRACT FROM AUTHOR]

Rotator cuff (RC) tendinopathy is a common recurrent cause of shoulder pain, and resistance exercise is the first-line recommended intervention. Proposed causal mechanisms of resistance exercise for patients with RC tendinopathy consist of four domains: tendon structure, neuromuscular factors, pain and sensorimotor processing, and psychosocial factors. Tendon structure plays a role in RC tendinopathy, with decreased stiffness, increased thickness, and collagen disorganization. Neuromuscular performance deficits of altered kinematics, muscle activation, and force are present in RC tendinopathy, but advanced methods of assessing muscle performance are needed to fully assess these factors. Psychological factors of depression, anxiety, pain catastrophizing, treatment expectations, and self-efficacy are present and predict patient-reported outcomes. Central nervous system dysfunctions also exist, specifically altered pain and sensorimotor processing. Resisted exercise may normalize these factors, but limited evidence exists to explain the relationship of the four proposed domains to trajectory of recovery and defining persistent deficits limiting outcomes. Clinicians and researchers can use this model to understand how exercise mediates change in patient outcomes, develop subgroups to deliver patient-specific approach for treatment and define metrics to track recovery over time. Supporting evidence is limited, indicating the need for future studies characterizing mechanisms of recovery with exercise for RC tendinopathy. [ABSTRACT FROM AUTHOR]

Volleyball players develop shoulder sports-related adaptations due to repetitive overhead motions. It is essential to differentiate between these sports-related adaptations and pathological patterns in clinical assessments, particularly on scapular resting posture and scapulohumeral rhythm. Using an electromagnetic tracking system, the 3D shoulder kinematics of 30 male elite asymptomatic volleyball players and a matching control group were recorded at rest and in eight humeral elevation positions, in 15-degree increments from 15 to 120 degrees. The results indicated that the dominant scapular resting posture of the volleyball group was more anteriorly tilted than the control group (Volleyball: mean = −12.02°, STD = 4.16°; Control: mean = −7.45°, STD = 5.42°; Mean difference = 4.57°; STD = 6.85°; CI95% = 2.1° to 7.1°). The scapulohumeral rhythm in the volleyball group showed greater scapular internal rotation (Volleyball: mean = 41.60°, STD = 9.14°; Control: mean = 35.60°, STD = 6.03°; mean difference = 6.02°, STD = 1.47°; CI95% = 4.80° to 7.25°) and anterior tilt (Volleyball: mean = −9.10°, STD = 5.87°; mean = −2.3°, STD = 9.18°; mean difference = 6.88°, STD = 0.66°; CI95% = 6.34° to 7.43°). These findings suggest that volleyball players have developed a sports-related scapular adaptive pattern. This information may be valuable for clinical assessment and rehabilitation planning in injured volleyball players and may aid in the decision-making process for determining a safe return-to-play after a shoulder injury. [ABSTRACT FROM AUTHOR]

In this manuscript, a pyridyl containing porphyrin, C46H36N8O4 (denoted as Tris@NTPP) and its derived polyoxometalate-porphyrin hybrid, [C4H9)4N]3[C41H26N7NHCO(NH)C(OCH2)3MnMo6 O18(OCH2)3C(NH)CONHN7 H26C41] (denoted as NTPP@POM) in which two pyridyl containing porphyrin moieties hanged onto one Anderson polyoxometalate, have been successfully synthesized and thoroughly characterized. Fluorescence quenching was observed in NTPP@POM as compared with its precursor Tris@NTPP inferring the transfer of electron/energy from porphyrin moiety to POM moiety. NTPP@POM showed notably enhanced nonlinear absorption (β = 2.32 × 10–5 esu) than Tris@NTPP (β = 0.73 × 10–5 esu). These NLO responses were associated with fluorescence decay mechanism which oriented the singlet excited(*S) states and triplet excited(*T) states of Tris@NTPP and NTPP@POM. Life time decay studies revealed that NTPP@POM (τ2 = 5.32 ns) were stayed for shorter time in excited triplet state than Tris@NTPP (τ2 = 10 ns), implying shorter life time led towards higher NLO responses. [ABSTRACT FROM AUTHOR]

Background: Maintaining scapular mechanics is important for upper extremity functionality and posture. Determining the extent to which the scapular stabilizer muscles affect the scapular position may guide the creation of an exercise program for people with scapular dyskinesis. Hypothesis: The serratus anterior (SA), upper trapezius (UT), middle trapezius (MT), and lower trapezius (LT) muscles play different roles on scapular position when humeral elevation increase. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: A total of 70 women aged 40 to 65 years (mean age, 49 ± 7 years) who met the inclusion criteria were included in the study. Isometric muscle strength of the SA, UT, MT, and LT was evaluated with a handheld dynamometer. For assessment of scapular position, the lateral scapular slide test (LSST) was used. Multiple stepwise regression analysis was used to evaluate scapular parameters. Results: There were positive and statistically significant correlations between the isometric muscle strength of the SA, UT, MT, and LT muscles and the values at different humerus positions in the LSST (P < 0.05). The UT and SA muscles greatly affected the changes in the position of the inferior region of the scapula (R 2 > 24.5%). The LT (11.3%) in neutral position, MT (25.4%) with arm abducted at 45°, and SA (34.5%) with arm abducted 90° had a major effect on the changes in the mediolateral position of the scapula. Conclusion: While the LT muscle affects the mediolateral position of the scapula to a large extent, the strength of the MT and SA muscles becomes effective as the shoulder elevation increases. SA and UT muscle strength have a greater effect on the position of the inferior region of the scapula. Clinical Relevance: Dyskinesis can be observed at different levels of the scapula; therefore, it is important to determine at which level the dyskinesis is more prominent for each individual and consequently to form a personalized exercise program to increase function and control dyskinesis. [ABSTRACT FROM AUTHOR]

The effects of a compensatory training program adding an isoinertial device in the shoulder function on young tennis players. J Strength Cond Res 37(5): 1096–1103, 2023—The aim of this study was to analyze whether a compensatory training program, including isoinertial flywheel training, could reduce shoulder imbalances in a group of asymptomatic young tennis players. After an initial evaluation, 26 young tennis players were assigned to either a supervised flywheel training group (FTG, n = 13) or a control group (CG, n = 13). Shoulder passive internal (IR) and external rotation (ER) range of motion (ROM) as well as shoulder IR and ER maximal isometric strength were measured before and after a 12-week training intervention, performed 3 times per week. After the intervention, results showed significant changes for IR (p < 0.001, effect size [ES] = 1.83) and ER (p < 0.001, ES = 1.77) on the dominant (D) side, and IR on the nondominant (ND) side (p < 0.001, ES = 2.24) in the FTG compared with the CG. Regarding the ROM values, results showed that the FTG achieved significantly greater increases for the IR ROM (p < 0.001, ES = 3.32) and total ROM (TROM) (p = 0.004, ES = 1.39) on the D and ND sides (IR ROM: p = 0.002, ES = 1.53; TROM: p < 0.001, ES = 2.35) than the CG. Moreover, the CG displayed larger decrements in ER ROM (p = 0.016, ES = 1.12) on the ND side after the training period than the FTG. The conducted compensatory training program was effective to increase the ER strength and IR mobility of the FTG players, which led to a reduction in the glenohumeral imbalances. [ABSTRACT FROM AUTHOR]

Dvir, Z and Müller, S. Multiple-joint isokinetic dynamometry: a critical review. J Strength Cond Res 34(2): 587-601, 2020-Angular isokinetic dynamometry (AID) is widely regarded as the gold standard for dynamic muscle performance testing. Based on the rotational movement of its actuator, AID targets "single-joint" (knee, shoulder, hip, etc.) configurations namely measurement of muscle potential while it moves the lever arm-limb assembly ostensibly around a single fixed axis. On the other hand, the application of multiple-joint isokinetic dynamometry (MID) is relatively narrow, both in research and in practice. This situation is due, possibly, to the fact that these dynamometers are generally more limited in scope namely to testing/conditioning of combined hip, knee, ankle motion (leg press), combined shoulder, elbow motion, and lifting motion patterns, despite the fact that all 3 are associated with higher functionality. However, with the emerging importance of MID, this critical review takes a fresh look at its various aspects including the terminology and classification of multiple-joint isokinetic dynamometers; the problem of scaling namely the need to adjust the range of motion and linear velocities to subjective anthropometric measures; specific technical and methodological issues that underlie the valid application of these dynamometers; available reference values; and the reproducibility of MID-based test findings. Analysis of these topics indicates that MID may validly and effectively be applied for the assessment and conditioning of specific muscle action patterns. However, there is a clear need for standardization of tests and for conditioning protocols alongside research into the use of this method in various clinical cohorts.

Context: Isolated infraspinatus atrophy (IIA) is a common condition among overhead activity athletes, which affects the hitting shoulder and is caused by suprascapular nerve injury. The loss of infraspinatus function could lead to altered activity of the glenohumeral and scapulothoracic (ST) muscles and compromise the optimal shoulder function. Objective: To assess the surface electromyographic (sEMG) activity patterns, relationships, and response latencies of relevant shoulder girdle muscles in professional volleyball players with IIA and in healthy control players. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: Twenty-four male professional volleyball players (12 players with diagnosed IIA and 12 healthy players) recruited from local volleyball teams. Intervention(s): sEMG activity of anterior, middle, and posterior deltoid; upper, middle, and lower trapezius; and serratus anterior (SA) was recorded and evaluated during a movement of shoulder abduction in the scapular plane, monitored with an optoelectronic motion capture system. Main Outcome Measure(s): sEMG activity, relationships, and response latencies of the selected muscles were analyzed with analysis of variance models to highlight statistical differences within and between groups. Results: Athletes with IIA demonstrated significant higher deltoid and trapezius muscles activity and lower SA activity compared with the contralateral shoulder and healthy athletes. The shoulder with IIA also showed a higher activity ratio between the upper trapezius and other ST muscles in addition to anticipated activation of the upper trapezius and delayed activation of the SA, with regard to the onset of shoulder movement. Conclusions: This study highlighted altered shoulder muscle activity levels, ST muscles imbalances, and abnormal ST recruitment patterns in the hitting shoulder of professional volleyball players with IIA, secondary to suprascapular nerve neuropathy. Such shoulder girdle muscles' impairments may compromise the optimal scapulohumeral rhythm and function, increasing the risk of acute and overuse shoulder injuries. [ABSTRACT FROM AUTHOR]