Mirror Cross-Exercise on a Kinetic Chain Approach Improves Throwing Performance in Professional Volleyball Athletes With Scapular Dyskinesis

in Journal of Sport Rehabilitation

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Eleftherios Paraskevopoulos
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Theocharis Simeonidis
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Charilaos Tsolakis
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Panagiotis Koulouvaris
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Maria Papandreou
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Context: Volleyball players have shown to be at an increased risk of developing scapular dyskinesis. The kinetic chain exercise approach has gained a lot of attention because of its claims to provide an improved motor control and scapular kinematics. A form of cross exercise, known as mirror therapy, may enhance the effects of a kinetic chain exercise approach in throwing performance. Objective: To examine the effects of mirror cross exercise (MCE), based on a kinetic chain exercise approach in the throwing performance of volleyball athletes with scapular dyskinesis. Design: Randomized controlled trial. Setting: Biomechanics laboratory. Methods: 39 volleyball players with scapular dyskinesis were randomly allocated into 3 groups. The first group completed a 6-week kinetic chain approach (KCA group), the second group completed a kinetic chain exercise approach program in addition to MCE group, and the control group followed only their regular training program. Before and after delivering both interventions, throwing accuracy, speed, and force were determined while measuring the ground reaction forces of the drive leg during throwing. Two-way mixed analysis of variance investigated the effects of intervention and time and their interaction. Results: The results showed intervention × time statistically significant interactions for throwing accuracy, speed, and force for the MCE and the KCA groups. Over the 6-week training period, the MCE and the KCA groups showed significant improvements in throwing accuracy (P < .01) and speed (P < .01), while the ground reaction forces did not change (P > .05). Throwing force increased significantly in the MCE group (P = .01). Between-group comparison showed statistically significant improvements in the throwing accuracy for the MCE and KCA groups against the control group (P < .01) at posttesting. The MCE demonstrated superior results over the KCA in the aforementioned measures. Conclusions: This study suggests that the addition of MCE in a KCA program enhances energy transfer throughout the distal and proximal segments, thus improving kinetic chain recruitment and potentially preventing shoulder pathology.

Paraskevopoulos and Papandreou are with the Department of Physiotherapy, University of West Attica, Athens, Greece. Simeonidis and Tsolakis are with the Orthopaedic Center of Research and Education PN Soukakos, Attikon Hospital, Athens, Greece. Tsolakis is also with the School of Physical Education and Sports Science, National and Kapodistrian University of Athens, Athens, Greece. Koulouvaris is with the Department of Orthopedics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

Paraskevopoulos (lefteris.15@hotmail.com) is corresponding author.

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  • 1.

    Burn MB, McCulloch PC, Lintner DM, Liberman SR, Harris JD. Prevalence of scapular dyskinesis in overhead and nonoverhead athletes: a systematic review. Orthop J Sports Med. 2016;4(2):18. doi:10.1177/2325967115627608

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Pires ED, Camargo PR. Analysis of the kinetic chain in asymptomatic individuals with and without scapular dyskinesis. Clin Biomech. 2018;54:815. doi:10.1016/j.clinbiomech.2018.02.017

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    van der Graaff E, Kom B, van Dis F, Gasparutto X, Hoozemans M, Veeger D. Asymmetry and evolution over a one-year period of the upward rotation of the scapula in youth baseball pitchers. Int Biomech. 2018;5(1):5762. doi:10.1080/23335432.2018.1499441

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    McMullen J, Uhl TL. A kinetic chain approach for shoulder rehabilitation. J Athl Train. 2000;35(3):329337.

  • 5.

    Maenhout A, Van Praet K, Pizzi L, Van Herzeele M, Cools A. Electromyographic analysis of knee push up plus variations: what is the influence of the kinetic chain on scapular muscle activity? Br J Sports Med. 2010;44(14):10101015. doi:10.1136/bjsm.2009.062810

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Saini SS, Shah SS, Curtis AS. Scapular dyskinesis and the kinetic chain: recognizing dysfunction and treating injury in the tennis athlete. Curr Rev Musculoskelet Med. 2020;13(6):748756. doi:10.1007/s12178-020-09672-6

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Paraskevopoulos E, Simeonidis T, Tsolakis C, Koulouvaris P, Papandreou M. The adjunctive benefits of mirror cross education on kinetic chain exercise approach in volleyball athletes with scapular dyskinesis. J Sports Med Phys Fitness. Publishined online February 22, 2021. doi:10.23736/s0022-4707.21.12174-7

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Howatson G, Zult T, Farthing JP, Zijdewind I, Hortobágyi T. Mirror training to augment cross-education during resistance training: a hypothesis. Front Hum Neurosci. 2013;7:396. doi:10.3389/fnhum.2013.00396

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Perugini M, Gallucci M, Costantini G. A practical primer to power analysis for simple experimental designs. Int Rev Soc Psychol. 2018;31:123. doi:10.5334/irsp.181

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    McClure P, Tate AR, Kareha S, Irwin D, Zlupko E. A clinical method for identifying scapular dyskinesis, part 1: reliability. J Athl Train. 2009;44(2):160164. doi:10.4085/1062-6050-44.2.160

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Rossi DM, Pedroni CR, Martins J, de Oliveira AS. Intrarater and interrater reliability of three classifications for scapular dyskinesis in athletes. PLoS One. 2017;12(7):e0181518. doi:10.1371/journal.pone.0181518

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Wassinger CA, Sole G, Osborne H. The role of experimentally-induced subacromial pain on shoulder strength and throwing accuracy. Manual Therapy. 2012;17(5):411415. doi:10.1016/j.math.2012.03.008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Whinton AK, Thompson KMA, Power GA, Burr JF. Testing a novel isokinetic dynamometer constructed using a 1080 Quantum. PLoS One. 2018;13(7):e0201179. doi:10.1371/journal.pone.0201179

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Howenstein J, Kipp K, Sabick M. Peak horizontal ground reaction forces and impulse correlate with segmental energy flow in youth baseball pitchers. J Biomech. 2020;108:109909. doi:10.1016/j.jbiomech.2020.109909

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    MacWilliams BA, Choi T, Perezous MK, Chao EY, McFarland EG. Characteristic ground-reaction forces in baseball pitching. Am J Sports Med. 1998;26(1):6671. doi:10.1177/03635465980260012801

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Ramsey D, Crotin R. Stride length: the impact on propulsion and bracing ground reaction force in overhand throwing. Sports Biomech. 2018;18:553570. doi:10.1080/14763141.2018.1442872

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Bell Z, Wong V, Spitz R, et al. The contraction history of the muscle and strength change: lessons learned from unilateral training models. Physiol Meas. 2019;41:16. doi:10.1088/1361-6579/ab516c

    • Search Google Scholar
    • Export Citation
  • 18.

    Turgut E, Duzgun I, Baltaci G. Effects of scapular stabilization exercise training on scapular kinematics, disability, and pain in subacromial impingement: a randomized controlled trial. Arch Phys Med Rehabil. 2017;98(10):19151923.e3. doi:10.1016/j.apmr.2017.05.023

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Cohen J. Statistical Power Analysis for the Behavioral Sciences. New York, NY: L. Erlbaum Associates; 1988.

  • 20.

    Abbas SA, Harikesavan K, Venkatesan P. Effect of neuromuscular training on functional throwing performance and speed in asymptomatic cricket players. J Bodywork Movement Ther. 2018;23:502507. doi:10.1016/j.jbmt.2018.02.014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Lust K, Sandrey M, Bulger S, Wilder N. The effects of 6-week training programs on throwing accuracy, proprioception, and core endurance in baseball. J Sport Rehabil. 2009;18:407426. doi:10.1123/jsr.18.3.407

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Dragert K, Zehr EP. High-intensity unilateral dorsiflexor resistance training results in bilateral neuromuscular plasticity after stroke. Exp Brain Res. 2013;225(1):93104. doi:10.1007/s00221-012-3351-x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Ausenda C, Carnovali M. Transfer of motor skill learning from the healthy hand to the paretic hand in stroke patients: a randomized controlled trial. Eur J Phys Rehabil Med. 2011;47(3):41725.

    • Search Google Scholar
    • Export Citation
  • 24.

    Yavuzer G, Selles R, Sezer N, et al. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89(3):393398. doi:10.1016/j.apmr.2007.08.162

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Weon JH, Kwon OY, Cynn HS, Lee WH, Kim TH, Yi CH. Real-time visual feedback can be used to activate scapular upward rotators in people with scapular winging: an experimental study. J Physiother. 2011;57(2):101107. doi:10.1016/s1836-9553(11)70020-0

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Sterling M, Jull G, Wright A. The effect of musculoskeletal pain on motor activity and control. J Pain. 2001;2(3):135145. doi:10.1054/jpai.2001.19951

  • 27.

    Kibler WB, Sciascia A. Evaluation and management of scapular dyskinesis in overhead athletes. Curr Rev Musculoskelet Med. 2019;12(4):515526. doi:10.1007/s12178-019-09591-1

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Reinold MM, Gill TJ. Current concepts in the evaluation and treatment of the shoulder in overhead-throwing athletes, part 1: physical characteristics and clinical examination. Sports Health. 2010;2(1):3950. doi:10.1177/1941738109338548

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Schmidt RA. Motor schema theory after 27 years: reflections and implications for a new theory. Res Q Exerc Sport. 2003;74(4):366375. doi:10.1080/02701367.2003.10609106

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Forthomme B, Crielaard JM, Croisier JL. Scapular positioning in athlete’s shoulder: particularities, clinical measurements and implications. Sports Med. 2008;38(5):369386. doi:10.2165/00007256-200838050-00002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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