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Scapular muscle rehabilitation exercises in overhead athletes with impingement symptoms: effect of a 6-week training program on muscle recruitment and functional outcome

Kristof De Mey UGent, Lieven Danneels UGent, Barbara Cagnie UGent and Ann Cools UGent (2012) AMERICAN JOURNAL OF SPORTS MEDICINE. 40(8). p.1906-1915
abstract
Background: Previous research has identified some specific exercises to correct scapular muscle balance and onset timing in healthy subjects. However, evidence for their effectiveness in overhead athletes with impingement symptoms has been lacking until now. Hypothesis: A 6-week exercise program consisting of previously selected exercises is able to improve muscle activation and onset timing during shoulder elevation. This program may also change pain and functionality levels in overhead athletes with mild impingement symptoms. Study Design: Case series; Level of evidence, 4. Methods: Forty-seven overhead athletes with mild impingement symptoms (25 men and 22 women) were enrolled in this study. Before and after the 6-week training program, the Shoulder Pain and Disability Index (SPADI) score was individually obtained and maximum voluntary isometric contraction (MVIC) values were determined by surface electromyography. Mean muscle activation levels, muscle ratio data, and muscle onset timing were assessed for the upper (UT), middle (MT), and lower (LT) trapezius and serratus anterior (SA) muscle during arm elevation in the scapular plane. Results: Forty participants completed the exercise program. The SPADI scores significantly decreased from 29.86 +/- 17.03 during initial assessment to 11.7 +/- 13.78 during postmeasurements (P < .001). The 3 trapezius muscle parts showed increased MVIC values and decreased activation levels during arm elevation, whereas this was not the case for the SA muscle. After the training program, UT/SA significantly decreased, whereas UT/MT and UT/LT did not change (P <. 05). No differences in muscle timing between pre- and postmeasurements could be identified. The LT showed significant earlier activation compared with UT (-20.47; P < .001) and MT (-20.49; P < .001). The serratus anterior showed significant earlier activation compared with the UT (-20.74; P < .001), MT (-20.76; P < .001), and LT muscles (F = 0.27; P = .046). Conclusion: This is the first longitudinal study to demonstrate that previously selected exercises (1) improve pain and function based on SPADI scores, (2) reduce relative trapezius muscle activation, and (3) alter UT/SA ratios. However, they were unable to change the timing of the scapular muscles during arm elevation when compared before and after a 6-week training program in overhead athletes with mild impingement symptoms.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
ROTATOR MUSCLES, DISABILITY INDEX, PRIMARY-CARE, PATTERNS, PAIN, ELECTROMYOGRAPHY, DYSKINESIS, ELEVATION, scapula, MEASURING SHOULDER FUNCTION, impingement, electromyography, training, SUBACROMIAL IMPINGEMENT
journal title
AMERICAN JOURNAL OF SPORTS MEDICINE
Am. J. Sports Med.
volume
40
issue
8
pages
1906 - 1915
Web of Science type
Article
Web of Science id
000307175700029
JCR category
ORTHOPEDICS
JCR impact factor
4.439 (2012)
JCR rank
1/63 (2012)
JCR quartile
1 (2012)
ISSN
0363-5465
DOI
10.1177/0363546512453297
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
3010426
handle
http://hdl.handle.net/1854/LU-3010426
date created
2012-10-10 10:46:00
date last changed
2012-10-12 13:32:27
@article{3010426,
  abstract     = {Background: Previous research has identified some specific exercises to correct scapular muscle balance and onset timing in healthy subjects. However, evidence for their effectiveness in overhead athletes with impingement symptoms has been lacking until now. 
Hypothesis: A 6-week exercise program consisting of previously selected exercises is able to improve muscle activation and onset timing during shoulder elevation. This program may also change pain and functionality levels in overhead athletes with mild impingement symptoms. 
Study Design: Case series; Level of evidence, 4. 
Methods: Forty-seven overhead athletes with mild impingement symptoms (25 men and 22 women) were enrolled in this study. Before and after the 6-week training program, the Shoulder Pain and Disability Index (SPADI) score was individually obtained and maximum voluntary isometric contraction (MVIC) values were determined by surface electromyography. Mean muscle activation levels, muscle ratio data, and muscle onset timing were assessed for the upper (UT), middle (MT), and lower (LT) trapezius and serratus anterior (SA) muscle during arm elevation in the scapular plane. 
Results: Forty participants completed the exercise program. The SPADI scores significantly decreased from 29.86 +/- 17.03 during initial assessment to 11.7 +/- 13.78 during postmeasurements (P {\textlangle} .001). The 3 trapezius muscle parts showed increased MVIC values and decreased activation levels during arm elevation, whereas this was not the case for the SA muscle. After the training program, UT/SA significantly decreased, whereas UT/MT and UT/LT did not change (P {\textlangle}. 05). No differences in muscle timing between pre- and postmeasurements could be identified. The LT showed significant earlier activation compared with UT (-20.47; P {\textlangle} .001) and MT (-20.49; P {\textlangle} .001). The serratus anterior showed significant earlier activation compared with the UT (-20.74; P {\textlangle} .001), MT (-20.76; P {\textlangle} .001), and LT muscles (F = 0.27; P = .046). 
Conclusion: This is the first longitudinal study to demonstrate that previously selected exercises (1) improve pain and function based on SPADI scores, (2) reduce relative trapezius muscle activation, and (3) alter UT/SA ratios. However, they were unable to change the timing of the scapular muscles during arm elevation when compared before and after a 6-week training program in overhead athletes with mild impingement symptoms.},
  author       = {De Mey, Kristof and Danneels, Lieven and Cagnie, Barbara and Cools, Ann},
  issn         = {0363-5465},
  journal      = {AMERICAN JOURNAL OF SPORTS MEDICINE},
  keyword      = {ROTATOR MUSCLES,DISABILITY INDEX,PRIMARY-CARE,PATTERNS,PAIN,ELECTROMYOGRAPHY,DYSKINESIS,ELEVATION,scapula,MEASURING SHOULDER FUNCTION,impingement,electromyography,training,SUBACROMIAL IMPINGEMENT},
  language     = {eng},
  number       = {8},
  pages        = {1906--1915},
  title        = {Scapular muscle rehabilitation exercises in overhead athletes with impingement symptoms: effect of a 6-week training program on muscle recruitment and functional outcome},
  url          = {http://dx.doi.org/10.1177/0363546512453297},
  volume       = {40},
  year         = {2012},
}

Chicago
De Mey, Kristof, Lieven Danneels, Barbara Cagnie, and Ann Cools. 2012. “Scapular Muscle Rehabilitation Exercises in Overhead Athletes with Impingement Symptoms: Effect of a 6-week Training Program on Muscle Recruitment and Functional Outcome.” American Journal of Sports Medicine 40 (8): 1906–1915.
APA
De Mey, Kristof, Danneels, L., Cagnie, B., & Cools, A. (2012). Scapular muscle rehabilitation exercises in overhead athletes with impingement symptoms: effect of a 6-week training program on muscle recruitment and functional outcome. AMERICAN JOURNAL OF SPORTS MEDICINE, 40(8), 1906–1915.
Vancouver
1.
De Mey K, Danneels L, Cagnie B, Cools A. Scapular muscle rehabilitation exercises in overhead athletes with impingement symptoms: effect of a 6-week training program on muscle recruitment and functional outcome. AMERICAN JOURNAL OF SPORTS MEDICINE. 2012;40(8):1906–15.
MLA
De Mey, Kristof, Lieven Danneels, Barbara Cagnie, et al. “Scapular Muscle Rehabilitation Exercises in Overhead Athletes with Impingement Symptoms: Effect of a 6-week Training Program on Muscle Recruitment and Functional Outcome.” AMERICAN JOURNAL OF SPORTS MEDICINE 40.8 (2012): 1906–1915. Print.