Effects of elastic kinesiology taping on shoulder proprioception: a systematic review.

BACKGROUND: Shoulder injuries are associated with proprioceptive deficits. Elastic kinesiology tape (KT) is used for treating musculoskeletal disorders, including shoulder injuries, as it arguably improves proprioception. OBJECTIVE: To synthesize the evidence on the effects of elastic KT on proprioception in healthy and pathological shoulders. METHODS: Four databases (PubMed, WoS, CINAHL, SPORTDiscus) were searched for studies that investigated the effects of elastic KT on shoulder proprioception. Outcome measures were active joint position sense (AJPS), passive joint position sense (PJPS), kinesthesia, sense of force (SoF), and sense of velocity (SoV). Risk of bias (RoB) was assessed using the Cochrane Collaboration RoB tool for randomized controlled trials (RCTs), and the ROBINS-1 for non-RCTs, while the certainty of evidence was determined using GRADE. RESULTS: Eight studies (5 RCTs, 3 non-RCTs) were included, yielding 187 shoulders (102 healthy and 85 pathological shoulders). RoB ranged from low (2 studies), moderate (5 studies), to high (1 study). Elastic KT has a mixed effect on AJPS of healthy shoulders (n=79) (low certainty). Elastic KT improves AJPS (subacromial pain syndrome and rotator cuff tendinopathy, n=52) and PJPS (chronic hemiparetic shoulders, n=13) among pathological shoulders (very low certainty). Elastic KT has no effect on kinesthesia among individuals with subacromial pain syndrome (n=30) (very low certainty). CONCLUSION: There is very low to low certainty of evidence that elastic KT enhances shoulder AJPS and PJPS. The aggregate of evidence is currently so low that any recommendation on the effectiveness of elastic KT on shoulder proprioception remains speculative.

Shoulder-specific rehabilitation combined with aerobic exercises versus solely shoulder-specific rehabilitation in patients with type 2 diabetes mellitus: study protocol for a randomized controlled superiority trial.

BACKGROUND: Musculoskeletal disorders are very common in patients with diabetes mellitus (DM). The upper limb is one of the regions that is most frequently affected generally presenting limited joint mobility, pain, and a decreased muscle strength. Most clinical trials with a focus on shoulder musculoskeletal rehabilitation are carried out in patients who do not present DM. Thus, the purpose of the present study is to compare the effects of two distinct treatment protocols (conventional shoulder musculoskeletal rehabilitation combined with aerobic exercises versus solely conventional shoulder musculoskeletal rehabilitation) on shoulder pain, function, strength, kinematics, and supraspinatus tendon thickness in patients with type 2 DM after 12 weeks of intervention and a subsequent follow-up at week 20. METHODS: A randomized controlled superiority trial will be conducted. Participants with a clinical diagnosis of type 2 DM of both sexes, age between 40 and 70 years, presenting shoulder pain will be randomly assigned to one of the following groups: (1) conventional shoulder musculoskeletal rehabilitation combined with aerobic exercises; (2) solely conventional shoulder musculoskeletal rehabilitation. All individuals will be evaluated before starting the treatment protocol (baseline) and at the end of treatment (post 12 weeks) and as a follow-up at 20 weeks. The shoulder function assessed by the SPADI (Shoulder Pain and Disability Index) questionnaire will be considered as primary outcome; the secondary outcome will be shoulder pain, measured with NPRS scales. Other outcomes will include range of motion, measured using a digital inclinometer; isometric shoulder muscle strength, measured using a manual muscle dynamometer; shoulder kinematics, measured using three-dimensional inertial units measurement; supraspinatus tendon thickness, measured using an ultrasound; AGE accumulation, using a skin autofluorescence measurement; and HbA1c (hemoglobin a1c), fasting glucose and lipid profile measured by a simple blood test. DISCUSSION: DM is a highly prevalent disease and a public health problem worldwide, and the upper extremity musculoskeletal disorders in DM are barely recognized and largely underestimated. In this way, it would be interesting to analyze if the combination of aerobic exercises with conventional musculoskeletal rehabilitation protocols could generate better results in the functionality, pain, mobility and an improvement in the biochemical aspects related to the hyperglycemia of these patients compared to solely the conventional musculoskeletal rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov NCT04817514. Registered on March 26, 2021.

Electromyographic analysis of the serratus anterior and upper trapezius in closed kinetic chain exercises performed on different unstable support surfaces: a systematic review and meta-analysis.

Background: Multiple investigations have compared the electromyographic (EMG) activity of the scapular muscles between stable and unstable support surfaces during the execution of closed kinetic chain exercises. However, these comparative analyses have grouped different unstable surfaces (wobble board, BOSU, therapeutic ball, and suspension equipment) into a single data pool, without considering the possible differences in neuromuscular demand induced by each unstable support surface. This study aimed to analyze the individual effect of different unstable support surfaces compared to a stable support surface on scapular muscles EMG activity during the execution of closed kinetic chain exercises. Methodology: A literature search was conducted of the Pubmed Central, ScienceDirect and SPORTDiscus databases. Studies which investigated scapular muscles EMG during push-ups and compared at least two support surfaces were included. The risk of bias of included articles was assessed using a standardized quality assessment form for descriptive, observational and EMG studies, and the certainty of the evidence was measured with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A random-effects model was used to calculate effect sizes (ES, Hedge's g). Results: Thirty studies were selected in the systematic review. Of these, twenty-three low-to-high quality studies (498 participants) were included in the meta-analysis. The main analyzes revealed, in decreasing order, greater UT EMG activity during push-ups performed on suspension equipment (ES = 2.92; p = 0.004), therapeutic ball (ES = 1.03; p < 0.001) and wobble board (ES = 0.33; p = 0.003); without effect on the BOSU ball. In addition, no effect was observed for SA on any unstable device. The certainty of the evidence ranged from low to very low due to the inclusion of descriptive studies, as well as high imprecision, inconsistency, and risk of publication bias. Conclusion: These findings could be applied in scapular muscles strengthening in healthy individuals. The use of suspension equipment achieves higher UT activation levels. Conversely, the use of any type of unstable devices to increase the activation levels of the SA in shoulder musculoskeletal dysfunctions is not recommended. These conclusions should be interpreted with caution as the available evidence showed a low to very low certainty of evidence, downgraded mostly by inconsistency and imprecision.

Effect of conscious abdominal contraction on the activation of periscapular muscles in individuals with subacromial pain syndrome.

BACKGROUND: Synergism between shoulder and trunk muscles seems to be effective to increase periscapular muscle activation in asymptomatic subjects. The influence of conscious contraction of the abdominal muscles has not yet been studied in non-athlete subjects with pain. The study aimed to investigate the effect of the instruction for conscious activation of the abdominal muscles on the activity of the scapulothoracic muscles during shoulder exercises in subjects with subacromial pain syndrome. METHOD: Thirty subjects with unilateral pain (mean age 52 ± 11 years) participated in this study. Three isometric and five dynamic exercises for the scapulothoracic muscles were assessed. The group without instruction just repeated the exercises, while the instruction group was evaluated before and after conscious abdominal training. The linear mixed model analysis was used to compare the muscle activation between groups. FINDINGS: Differences between groups after the conscious abdominal contraction for activation of middle and lower trapezius on the symptomatic side in the "Full can"(p = 0.03; effect size:0.92 middle trapezius); (p = 0.02; effect size:0.96 lower trapezius) and "Knee Push" (p = 0.01; effect size:0.75 lower trapezius). For asymptomatic side, the exercises "External Rotation Kneeling" (p = 0.04; effect size: 0.81 lower trapezius); (p = 0.00; effect size: 2.09 serratus anterior), "Knee Push" (p = 0.04; effect size:1.24 serratus anterior) and "Wall Slide" (p = 0.01; effect size: 1.03 serratus anterior). INTERPRETATION: Conscious contraction of the abdominal muscle immediately alter the activation of the serratus anterior muscle during closed kinetic chain exercises on the asymptomatic side and increased activation of trapezius on the symptomatic side during shoulder open kinetic chain exercise.

Reliability of the Modified CKCUEST and correlation with shoulder strength in adolescent basketball and volleyball players.

BACKGROUND: Physical performance tests provide a more complete picture of the functional status of the athlete's upper extremity. OBJECTIVES: The primary purpose was to evaluate the reliability of the Modified Closed Kinetic Chain Upper Extremity Stability Test (MCKCUEST) in adolescent volleyball and basketball players. The secondary objective was to evaluate the relationship between the MCKCUEST and shoulder rotation isometric strength in this population. METHODS: Seventy-three healthy basketball (n=39) and volleyball (n=34) players participated to establish the reliability and correlations of the MCKCUEST. We used a two-session measurement design to evaluate the reliability of the MCKCUEST. Shoulder rotation isometric strength was performed to determine relationships with the MCKCUEST. RESULTS: The intraclass correlation coefficients (ICC2,1) for intra-session reliability of the MCKCUEST ranged from 0.86 to 0.89, and the between days test-retest reliability (ICC3,1) was 0.93. The standard error of measurement (1 touch) and the minimal detectable change (3 touches) showed clinically acceptable absolute reliability values. A weak correlation was found between the MCKCUEST power score and shoulder rotation isometric strength (r values between 0.3 and 0.4). CONCLUSIONS: Results demonstrated good to excellent relative reliability and clinically acceptable absolute reliability values for the MCKCUEST on adolescent basketball and volleyball athletes. Performances on the MCKCUEST were weakly associated with shoulder rotation strength.

Effects of adding scapular stabilization exercises to a periscapular strengthening exercise program in patients with subacromial pain syndrome: A randomized controlled trial.

BACKGROUND: Interventions focused on the scapula should be considered in treating subacromial pain syndrome (SAPS). However, the effect of adding scapular stabilization exercises to protocols of progressive strengthening of the shoulder complex muscles on a non-multimodal approach remains unclear. OBJECTIVE: To investigate the effect of adding scapular stabilization exercises, emphasizing retraction, and depression of the scapula, to a progressive periscapular strengthening protocol on disability, pain, muscle strength, and ROM in patients with SAPS. DESIGN: Randomized, controlled, superiority trial, prospectively registered, two-arms, parallel, blind assessor, blind patient, and allocation concealment. METHODS: Sixty patients with SAPS were randomly allocated into two groups: Periscapular Strengthening (PSG) or Scapular Stabilization (SSG) exercises. The interventions were performed three times a week for eight weeks. The primary outcome function and secondary outcomes (Pain, kinesiophobia, global perceived effect, satisfaction with treatment, the range of motion, scapula position and muscle strength) were measured in the baseline, four weeks, eight weeks (end of intervention) and 16 weeks after baseline. Shoulder pain and function were assessed by the Brazilian version of the Shoulder Pain and Disability Index (SPADI-Br). RESULTS: A total of 60 patients were included and randomized to PSG (n = 30) or SSG (n = 30) from March 2016 to June 2017. There were no between group differences in primary and secondary outcomes at any time point. CONCLUSION: The inclusion of the isolated scapular stabilization exercises, emphasizing retraction and depression of the scapula, to a progressive general periscapular strengthening protocol did not add benefits to self-reported shoulder pain and disability, muscle strength, and ROM in patients with SAPS. TRIAL REGISTRATION: ClinicalTrials.gov.

Changes in shoulder girdle strength in 3 consecutive years in elite adolescent swimmers: a longitudinal cohort study.

BACKGROUND: The shoulder complex is highly loaded during swimming. No studies were found analyzing the changes in shoulder girdle strength in young swimmers, through the years. OBJECTIVE: To analyze the changes in strength of internal rotators and external rotators of the arm, lower trapezius and supraspinatus and in the external rotators/internal rotators ratio in young elite swimmers through 3 years. METHODS: 31 adolescent elite swimmers (14-18 years, of both sexes) participated in the study. Isometric strength of the shoulder girdle muscles was performed using a handheld dynamometer during 3 years. RESULTS: For boys absolute data, internal rotators increased from the first to the second (p=0.0001; mean difference 45.6N; 95%CI 26.7-65.0) and third years (p=0.01; mean difference: 32.4; 95%CI: 9.3-55.5). Considering the weight-normalized data, internal rotators increased from the first to the second year (p<0.0001; mean difference: 0.52; 95%CI: 0.26-0.78), external rotators decreased from the first to the third year (p=0.003; mean difference: -0.33; 95%CI: -0.53 to -0.13) and from the second to the third year (p=0.0004; mean difference: -0.29; 95%CI: -0.46 to -0.12) and supraspinatus decreased from the second to the third year (p=0.006; mean difference: -0.17; 95%CI: -0.28 to -0.06). For girls, there were no significant differences in the absolute strength. Considering the weight-normalized data, lower trapezius decreased from the first to the third year (p=0.02; mean difference: -0.15; 95%CI: -0.27 to 0.03). Considering both sexes, the external rotators/internal rotators ratio decreased from the first to the second (p<0.0001; mean difference -0.12N; 95%CI -0.13 to -0.11) and third years (p<0.0001; mean difference -0.15N; 95%CI -0.16 to -0.14). CONCLUSION: Muscle imbalance can occur in the shoulder girdle in young swimmers in 3 years, with increased internal rotators and decreased external rotators and supraspinatus strength in boys, and decreased strength of the lower trapezius in girls. Attention should be given in young swimmers' shoulder girdle muscle balance.

Swimming Practice and Scapular Kinematics, Scapulothoracic Muscle Activity, and the Pressure-Pain Threshold in Young Swimmers.

CONTEXT: Whereas alterations in scapular kinematics, scapulothoracic muscle activity, and pain sensitivity have been described in adult swimmers, no researchers have examined these outcomes in young swimmers. OBJECTIVES: To compare scapular kinematics, scapulothoracic muscle activation, and the pressure-pain threshold (PPT) of the shoulder muscles among young nonpractitioners (those who were not involved in sports involving the upper limbs), amateur swimmers, and competitive swimmers. DESIGN: Cross-sectional study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 90 individuals (age = 11.63 ± 0.61 years) in 3 groups: nonpractitioners, amateur swimmers, and competitive swimmers. INTERVENTION(S): Scapular kinematics and activity of the upper trapezius, lower trapezius, and serratus anterior (SA) were measured during upper extremity elevation in the scapular plane. The PPT was assessed in the upper trapezius, infraspinatus, supraspinatus, middle deltoid, and tibialis anterior. MAIN OUTCOME MEASURE(S): Scapular kinematics, scapulothoracic muscle activation, and PPT. We conducted a 2-way mixed-model analysis of variance and a 1-way analysis of variance for scapular rotation and PPT, respectively. A Kruskal-Wallis test was used to assess muscle activity. The α level was set at .05. RESULTS: Competitive swimmers presented more internal rotation at 90° ( P = .03) and 120° ( P = .047) and more anterior tilt at 90° ( P = .03) than nonpractitioners. Amateur swimmers demonstrated more anterior tilt at 90° ( P = .004) and 120° ( P = .005) than nonpractitioners. Competitive swimmers had greater SA activation in the intervals from 60° to 90° ( P = .02) and 90° to 120° ( P = .01) than amateur swimmers. They also displayed more SA activation in the interval from 90° to 120° than nonpractitioners ( P = .04). No differences were found in any of the muscles for the PPT ( P > .05). CONCLUSIONS: Young competitive swimmers presented alterations in scapular kinematics and scapulothoracic muscle activation during upper extremity elevation that may be due to sport practice. Mechanical pain sensitivity was not altered in young swimmers.

Instruction and feedback for conscious contraction of the abdominal muscles increases the scapular muscles activation during shoulder exercises.

PURPOSE: The study aimed to investigate the effect of the instruction for conscious contraction of the abdominal muscles on the scapulothoracic muscles activation during shoulder exercises. DESIGN: Repeated measures design in a single group, pre-post instruction. METHODS: Sixty healthy male and female subjects (mean age 23.5 ± 3 years) volunteered for this study. Two isometric and three dynamic exercises for the scapulothoracic muscles, focusing on the serratus anterior muscle were assessed before and after familiarization training, standardized verbal, and tactile feedback applied to encourage abdominal muscle contraction. Repeated measures ANOVA and Bonferroni post-hoc test were used to compare normalized EMG amplitudes. RESULTS: Instruction increased EMG amplitude only for serratus anterior muscle during isometric exercises (Inferior Glide and Isometric Low Row). Conscious contraction of the abdominal muscles resulted in significant increase (p < 0.05) in the serratus anterior, upper, middle and lower trapezius EMG amplitude, during dynamic exercises (Wall Slide, Wall Press, and Knee Push-Up). CONCLUSION: Conscious contraction of the abdominal muscle increased the activation of the serratus anterior e the three parts of the trapezius during dynamic shoulder exercises with moderate to minimal levels of EMG activation. In the other hand, abdominal muscles contraction was effective to increase the activation of the serratus anterior during isometric exercises but did not increase the trapezius activation. So, Inferior Glide and Isometric Low Row performed along with encouraged abdominal muscle contraction are compatible to initial phases of the serratus anterior strengthening with low levels of upper trapezius muscle activation.

Prevention of shoulder injuries in overhead athletes: a science-based approach.

The shoulder is at high risk for injury during overhead sports, in particular in throwing or hitting activities, such as baseball, tennis, handball, and volleyball. In order to create a scientific basis for the prevention of recurrent injuries in overhead athletes, four steps need to be undertaken: (1) risk factors for injury and re-injury need to be defined; (2) established risk factors may be used as return-to-play criteria, with cut-off values based on normative databases; (3) these variables need to be measured using reliable, valid assessment tools and procedures; and (4) preventative training programs need to be designed and implemented into the training program of the athlete in order to prevent re-injury. In general, three risk factors have been defined that may form the basis for recommendations for the prevention of recurrent injury and return to play after injury: glenohumeral internal-rotation deficit (GIRD); rotator cuff strength, in particular the strength of the external rotators; and scapular dyskinesis, in particular scapular position and strength.

Prevention of shoulder injuries in overhead athletes: a science-based approach

The shoulder is at high risk for injury during overhead sports, in particular in throwing or hitting activities, such as baseball, tennis, handball, and volleyball. In order to create a scientific basis for the prevention of recurrent injuries in overhead athletes, four steps need to be undertaken: (1) risk factors for injury and re-injury need to be defined; (2) established risk factors may be used as return-to-play criteria, with cut-off values based on normative databases; (3) these variables need to be measured using reliable, valid assessment tools and procedures; and (4) preventative training programs need to be designed and implemented into the training program of the athlete in order to prevent re-injury. In general, three risk factors have been defined that may form the basis for recommendations for the prevention of recurrent injury and return to play after injury: glenohumeral internal-rotation deficit (GIRD); rotator cuff strength, in particular the strength of the external rotators; and scapular dyskinesis, in particular scapular position and strength.