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Rehabilitation exercises for athletes with biceps disorders and SLAP lesions: a continuum of exercises with increasing loads on the biceps

Ann Cools UGent, Dorien Borms UGent, Simon Cottens, Marcia Himpe, Stijn Meersdom and Barbara Cagnie UGent (2014) AMERICAN JOURNAL OF SPORTS MEDICINE. 42(6). p.1315-1322
abstract
Background: Although rehabilitation exercises are recommended in the nonoperative and postoperative treatment of biceps-related disorders and superior labrum anterior-posterior (SLAP) lesions in overhead athletes, a progressive exercise protocol with controlled low to moderate loads on the biceps has not yet been described. Purpose: To describe a continuum of exercises with progressive low to moderate loads on the biceps based on electromyographic (EMG) analysis. Study Design: Descriptive laboratory study. Methods: Using surface electromyography, the EMG activity of 8 muscles (upper [UT], middle [MT], and lower [LT] trapezius; serratus anterior [SA]; anterior [AD] and posterior [PD] portions of the deltoid; and biceps [BB] and triceps [TB] brachii) was measured in 32 healthy participants performing 16 commonly described shoulder rehabilitation exercises. Results: Of the 16 exercises, 13 (side-lying shoulder forward flexion, prone extension, seated rowing, serratus punch, knee push-up plus, internal and external rotation both in 20 degrees and 90 degrees of abduction, forearm supination, uppercut, and internal and external rotation diagonal) showed low (<20% maximal voluntary isometric contraction [MVIC]) EMG activity in the BB, and 3 (forward flexion in supination, full can, and elbow flexion in forearm supination) showed moderate (20%-50% MVIC) activity. None of the exercises elicited high (>50% MVIC) EMG activity. Based on the results, a ranking was calculated of the exercises, with mean EMG levels between 2.2% +/- 1.24% (during internal rotation against resistance in 90 degrees of shoulder abduction) and 35.9% +/- 18.82% (during forward flexion in external rotation and supination) of MVIC. Conclusion: This study describes a continuum of exercises with an increasing level of EMG activity in the BB. Exercises targeting the trapezius resulted in less loads on the biceps compared with exercises for the SA. In addition, exercises with an internal rotation component showed low activity in the BB. In general, the exercises meant to target the BB showed the highest levels of activity in the BB.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
biceps pathological disorders, LONG HEAD, PART II, POSTERIOR LESIONS, SERRATUS ANTERIOR, IMPINGEMENT SYMPTOMS, PROGRAM, MUSCLE-ACTIVITY, ELECTROMYOGRAPHIC ANALYSIS, SUPERIOR LABRUM ANTERIOR, DISABLED THROWING SHOULDER, SLAP lesions, electromyography, rehabilitation
journal title
AMERICAN JOURNAL OF SPORTS MEDICINE
Am. J. Sports Med.
volume
42
issue
6
pages
1315 - 1322
Web of Science type
Article
Web of Science id
000340721400014
JCR category
ORTHOPEDICS
JCR impact factor
4.362 (2014)
JCR rank
2/72 (2014)
JCR quartile
1 (2014)
ISSN
0363-5465
DOI
10.1177/0363546514526692
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
4388688
handle
http://hdl.handle.net/1854/LU-4388688
date created
2014-05-19 22:50:59
date last changed
2017-01-30 08:48:05
@article{4388688,
  abstract     = {Background: Although rehabilitation exercises are recommended in the nonoperative and postoperative treatment of biceps-related disorders and superior labrum anterior-posterior (SLAP) lesions in overhead athletes, a progressive exercise protocol with controlled low to moderate loads on the biceps has not yet been described. 
Purpose: To describe a continuum of exercises with progressive low to moderate loads on the biceps based on electromyographic (EMG) analysis. 
Study Design: Descriptive laboratory study. 
Methods: Using surface electromyography, the EMG activity of 8 muscles (upper [UT], middle [MT], and lower [LT] trapezius; serratus anterior [SA]; anterior [AD] and posterior [PD] portions of the deltoid; and biceps [BB] and triceps [TB] brachii) was measured in 32 healthy participants performing 16 commonly described shoulder rehabilitation exercises. 
Results: Of the 16 exercises, 13 (side-lying shoulder forward flexion, prone extension, seated rowing, serratus punch, knee push-up plus, internal and external rotation both in 20 degrees and 90 degrees of abduction, forearm supination, uppercut, and internal and external rotation diagonal) showed low ({\textlangle}20\% maximal voluntary isometric contraction [MVIC]) EMG activity in the BB, and 3 (forward flexion in supination, full can, and elbow flexion in forearm supination) showed moderate (20\%-50\% MVIC) activity. None of the exercises elicited high ({\textrangle}50\% MVIC) EMG activity. Based on the results, a ranking was calculated of the exercises, with mean EMG levels between 2.2\% +/- 1.24\% (during internal rotation against resistance in 90 degrees of shoulder abduction) and 35.9\% +/- 18.82\% (during forward flexion in external rotation and supination) of MVIC. 
Conclusion: This study describes a continuum of exercises with an increasing level of EMG activity in the BB. Exercises targeting the trapezius resulted in less loads on the biceps compared with exercises for the SA. In addition, exercises with an internal rotation component showed low activity in the BB. In general, the exercises meant to target the BB showed the highest levels of activity in the BB.},
  author       = {Cools, Ann and Borms, Dorien and Cottens, Simon and Himpe, Marcia and Meersdom, Stijn and Cagnie, Barbara},
  issn         = {0363-5465},
  journal      = {AMERICAN JOURNAL OF SPORTS MEDICINE},
  keyword      = {biceps pathological disorders,LONG HEAD,PART II,POSTERIOR LESIONS,SERRATUS ANTERIOR,IMPINGEMENT SYMPTOMS,PROGRAM,MUSCLE-ACTIVITY,ELECTROMYOGRAPHIC ANALYSIS,SUPERIOR LABRUM ANTERIOR,DISABLED THROWING SHOULDER,SLAP lesions,electromyography,rehabilitation},
  language     = {eng},
  number       = {6},
  pages        = {1315--1322},
  title        = {Rehabilitation exercises for athletes with biceps disorders and SLAP lesions: a continuum of exercises with increasing loads on the biceps},
  url          = {http://dx.doi.org/10.1177/0363546514526692},
  volume       = {42},
  year         = {2014},
}

Chicago
Cools, Ann, Dorien Borms, Simon Cottens, Marcia Himpe, Stijn Meersdom, and Barbara Cagnie. 2014. “Rehabilitation Exercises for Athletes with Biceps Disorders and SLAP Lesions: a Continuum of Exercises with Increasing Loads on the Biceps.” American Journal of Sports Medicine 42 (6): 1315–1322.
APA
Cools, Ann, Borms, D., Cottens, S., Himpe, M., Meersdom, S., & Cagnie, B. (2014). Rehabilitation exercises for athletes with biceps disorders and SLAP lesions: a continuum of exercises with increasing loads on the biceps. AMERICAN JOURNAL OF SPORTS MEDICINE, 42(6), 1315–1322.
Vancouver
1.
Cools A, Borms D, Cottens S, Himpe M, Meersdom S, Cagnie B. Rehabilitation exercises for athletes with biceps disorders and SLAP lesions: a continuum of exercises with increasing loads on the biceps. AMERICAN JOURNAL OF SPORTS MEDICINE. 2014;42(6):1315–22.
MLA
Cools, Ann, Dorien Borms, Simon Cottens, et al. “Rehabilitation Exercises for Athletes with Biceps Disorders and SLAP Lesions: a Continuum of Exercises with Increasing Loads on the Biceps.” AMERICAN JOURNAL OF SPORTS MEDICINE 42.6 (2014): 1315–1322. Print.