Impact of Physiotherapy Rehabilitation Program on Post-Operative Stiffness of Supraspinatus Tendinitis.

In the general population, shoulder pain is a common musculoskeletal problem. Older people are frequently affected, and the most common causes of shoulder pain are the problems with rotator cuffs which are seen in primary care practice. The incidence of rotator cuff tear increases with advanced age and it has been estimated that the prevalence of shoulder pain in older patients ranges from 21% to 27%.(1)Tendons are thick, fibrous tissues that transmits muscle-generated force to the bones and thus generates joint movement. Repeated activities and complex muscle-tendon overuse can damage tendons that lead to pain and decrease function.(2)The supraspinatus muscle is a part of the rotator cuff of shoulder.(3) The inflammation of a muscle tendon causes tendinitis and it has varying levels of pain. Supraspinatus tendonitis is an inflammation of supraspinatus tendon often associated with shoulder impingement syndrome.(4) The Supraspinatus tear that causes the supraspinatus tendon to affect the acromion leading to pain is the cause of Supraspinatus Tendinitis. The main cause of the Supraspinatus tear is constant pressure, increased workload and wear and tear associated with age.(5)Total loss of active abduction at the glenohumeral joint is due to a complete tear of supraspinatus.(6) Supraspinatus tendonitis complications include leading to a rotator cuff tear. Initially, rotator cuff tears were almost identified as secondary to tendon haemorrhage and tendonitis products of untreated impingement.(7)The primary purpose of rehabilitation to achieve short-term and long-term goal, patient education and consistent plan of care. The patient's awareness on the need to take non-operative steps, improvement, and the availability of choices will assist them in being active participants in their treatment.(7)

Contribuição da natação para a reabilitação da bursite de ombro pós-fase aguda / Contribution of swimming for the rehabilitation of the shoulder bursitis post-acute phase

A reabilitação da bursite subacromial associada à instabilidade multidirecional dá-se através de um programa de fortalecimento progressivo de todo o complexo do ombro. Sendo o nado crawl um aliado para promoção do fortalecimento do complexo do ombro objetivou-se investigar o potencial efeito que a natação exerce sobre a bursite subacromial. Foi realizada uma pesquisa bibliográfica baseada em cinesiologia aplicada, biomecânica da natação, conceitos de bursite subacromial, estabilidade e instabilidade do ombro e natação. A partir da base teórica de causas, conceitos e fases da bursite foram analisados os possíveis efeitos da natação sobre a patologia, apontando vantagem do meio aquático no processo de reabilitação, bem como pontuais benefícios do nado crawl para a restauração e estabilização da mobilidade articular, juntamente com a reestruturação do engrama proprioceptivo do sujeito patológico.

The rehabilitation of subacromial bursitis associated with multidirectional instability takes place through a program of gradual strengthening of the entire complex of shoulder. As the crawl swimming an ally to promote the strengthening of shoulder complex the objective was to investigate the potential effect that swimming has on subacromial bursitis. A literature search based on applied kinesiology, biomechanics of swimming, concepts of subacromial bursitis, stability and instability of the shoulder and swimming. From the theoretical basis of causes, concepts and stages of bursitis analyzed the possible effects of swimming on the pathology, pointing advantage of the aquatic environment in the rehabilitation process, and crawl off benefits for the restoration and stabilization of joint mobility along with the restructuring of the engram proprioceptive subject's pathological.

Razão eletromiográfica de músculos estabilizadores do ombro durante a execução de exercícios com haste oscilatória / Electromyographic ratio of shoulder stabilizer muscles during performance of exercises with oscillatory poles

Os processos de dor e disfunção do ombro são muito comuns e demandam grande atenção por parte dos profissionais que treinam e reabilitam esta articulação. O excesso de ativação do músculo trapézio superior (TS) combinado com a diminuição da ativação do trapézio inferior (TI) têm sido proposto como fator contribuinte para lesões no ombro. Diversos equipamentos são usados no treinamento e reabilitação destes músculos como faixas elásticas, cargas livres e, recentemente, hastes oscilatórias. Apesar de muito utilizada no contexto clínico e desportivo, pouco se sabe acerca dos efeitos destas hastes sobre o recrutamento dos músculos estabilizadores de ombro. Assim, o objetivo do presente estudo foi determinar a razão de ativação entre os músculos TS e TI em diferentes exercícios realizados com haste oscilatória. Participaram do estudo 12 indivíduos do sexo feminino, jovens (20,4 ± 2,0 anos), fisicamente ativas. O sinal eletromiográfico dos músculos TS e TI foi coletado durante a execução de três diferentes exercícios realizados com a haste oscilatória. A análise dos dados eletromiográficos foi feita a partir dos valores de root mean square (RMS) pelo cálculo da razão entre os músculos TS e TI para cada exercício. Para análise estatística foram utilizados os testes ANOVA para medidas repetidas e post hoc de Bonferroni, considerando como nível de significância p < 0,05. O exercício III apresentou menor razão entre os músculos TS e TI (0,722), seguido pelos exercícios I e II, respectivamente (0,876 e 0,995). CONCLUSÃO: O uso da haste oscilatória em exercícios executados unimanualmente no plano sagital e com a haste perpendicular ao solo são recomendados para o treinamento e reabilitação dos músculos estabilizadores da escápula por promoverem menor ativação do TS em relação o TI.

Shoulder pain and dysfunction processes are very common and demand great attention from the professionals who work with training and rehabilitation of this joint. Excessive activation of the upper trapezius muscle (UT) combined with decreased activation of the lower trapezius (LT) have been proposed as a contributing factor to shoulder injuries. Several equipments are used in training and rehabilitation of these muscles like elastic bands, free weights and recently, oscillatory poles. Despite having been used in clinical and sports context, little is known about their effects on the recruitment of shoulder stabilizers. Thus, the objective of the present study was to determine the activation ratio between UT and LT in different exercises performed with an oscillatory pole. 12 young (20.4 ±2.0 years) and physically fit females participated in this study. EMG signal of UT and LT was collected during 3 different exercises performed with oscillatory pole. The EMG signal analysis was done with Root Mean Square (RMS) values by the calculation of the ratio between the muscles UT and LT for each exercise. Statistical analysis was carried out with ANOVA for repeated measures and post hoc of Bonferroni tests, considering significant p<0.05. Exercise III showed lower ratio between UT and LT (0.722), followed by exercises I and II, respectively (0.876 and 0.995). CONCLUSION: The use of oscillatory pole in exercises performed with single hand grip, sagittal plane and with the pole perpendicularly to floor are recommended for training and rehabilitation of scapular stabilizer muscles since these promote lower activation of UT than LT.