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Stacey Pagorek

Column-editor : R. Barry Dale

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Robert T. Floyd, Kurt R. Behrhorst and Stacey D. Walters

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Darrin M. Smith

Column-editor : R. Barry Dale

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Kathleen A. Swanik, Kellie Huxel Bliven and Charles Buz Swanik

Context:

There are contradictory data on optimal muscle-activation strategies for restoring shoulder stability. Further investigation of neuromuscular-control strategies for glenohumeral-joint stability will guide clinicians in decisions regarding appropriate rehabilitation exercises.

Objectives:

To determine whether subscapularis, infraspinatus, and teres minor (anteroposterior force couple) muscle activation differ between 4 shoulder exercises and describe coactivation ratios and individual muscle-recruitment characteristics of rotator-cuff muscles throughout each shoulder exercise.

Design:

Crossover.

Setting:

Laboratory.

Participants:

healthy, physically active men, age 20.55 ± 2.0 y.

Interventions:

4 rehabilitation exercises: pitchback, PNF D2 pattern with tubing, push-up plus, and slide board.

Main Outcomes Measures:

Mean coactivation level, coactivation-ratio patterns, and level (area) of muscle-activation patterns of the subscapularis, infraspinatus, and teres minor throughout each exercise.

Results:

Coactivation levels varied throughout each exercise. Subscapularis activity was consistently higher than that of the infraspinatus and teres minor combined at the start of each exercise and in end ranges of motion. Individual muscle-recruitment levels in the subscapularis were also different between exercises.

Conclusion:

Results provide descriptive data for determining normative coactivation-ratio values for muscle recruitment for the functional exercises studied. Differences in subscapularis activation suggest a reliance to resist anteriorly directed forces.

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Joseph S. Parry, Rachel Straub and Daniel J. Cipriani

Context:

The Bodyblade Pro is used for shoulder rehabilitation after injury. Resistance is provided by blade oscillations—faster oscillations or higher speeds correspond to greater resistance. However, research supporting the Bodyblade Pro’s use is scarce, particularly in comparison with dumbbell training.

Objective:

To compare muscle activity, using electromyography (EMG), in the back and shoulder regions during shoulder exercises with the Bodyblade Pro vs dumbbells.

Design:

Randomized crossover study.

Setting:

San Diego State University biomechanics laboratory.

Participants:

11 healthy male subjects age 19–32 y.

Intervention:

Subjects performed shoulder-flexion and -abduction exercises using a Bodyblade Pro and dumbbells (5, 8, and 10 lb) while EMG recorded activity of the deltoid, pectoralis major, infraspinatus, serratus anterior, and erector spinae.

Main Outcome Measures:

Average peak muscle activity (% maximum voluntary isometric contraction) was separately measured for shoulder abduction and flexion in the range of 85° to 95°. Differences among exercise devices were separately analyzed for the flexed and abducted positions using 1-way repeated-measures ANOVA.

Results:

The Bodyblade Pro produced greater muscle activity than all the dumbbell trials. Differences were significant for all muscles measured (all P < .01) except for the erector spinae during shoulder flexion with a 10-lb dumbbell. EMG activity for the Bodyblade Pro exceeded 50% of the MVIC during both shoulder flexion and abduction. For the dumbbell conditions, only the 10-lb trials approached this effect.

Conclusions:

Using a Bodyblade during shoulder exercises results in greater shoulder- and back-muscle recruitment than dumbbells. The Bodyblade Pro can activate multiple muscles in a single exercise and thereby minimize the need for multiple dumbbell exercises. The Bodyblade Pro is an effective device for shoulder- and back-muscle activation that warrants further use by clinicians interested in its use for rehabilitation.

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Martha Walker, Donald Sussman, Michael Tamburello, Bonnie VanLunen, Elizabeth Dowling and Beth Ernst Jamali

Context:

A strength-endurance diagram predicts that a person should be able to perform 30 repetitions of an exercise if the resistance level is 60% of 1-repetition maximum (1RM).

Objective:

To compare the number of repetitions predicted by the diagram with recorded repetitions of a shoulder exercise.

Design:

Single-group comparison with a standard.

Setting:

University.

Participants:

34 healthy adults (20 women, 14 men) with a mean age of 29 years (range 20–49).

Main Outcome Measures:

The number of repetitions that subjects could perform in good form of a shoulder exercise with resistance of 60% 1RM.

Results:

The mean number of repetitions was 21 (± 3, range 15–28), which was significantly different than the 30 repetitions that the diagram predicted.

Conclusions:

The strength-endurance diagram did not accurately predict the number of repetitions of a shoulder exercise that subjects could perform.

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Gretchen Oliver, Lisa Henning and Hillary Plummer

The purpose of this study was to examine activations of selected scapular stabilizing musculature while performing an overhead throw with a hold (not releasing the ball) in two different throwing positions—standing with a crow hop and kneeling on the ipsilateral knee. Surface electromyography was used to examine activations of throwing side lower trapezius (LT), middle trapezius (MT), serratus anterior (SA), and upper trapezius (UT). Muscle activations were recorded while performing the overhead throw with holds while in two throwing positions. MANOVA results revealed no significant differences between the two throwing conditions and muscle activations of LT, MT, SA, and UT: F(8,124) = .804, p = .600; Wilks’s Λ = .904, partial η2 = .049. Although no significant differences were observed in the scapular stabilizers between the two conditions, moderate (21–50% MVIC) to high (> 50% MVIC) activations of each muscle were present, indicating that nonrelease throws may be beneficial for scapular stabilization in throwers.

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W. Steven Tucker, Charles W. Armstrong, Erik E. Swartz, Brian M. Campbell and James M. Rankin

Context:

Closed kinetic chain exercises are reported to provide a more functional rehabilitation outcome.

Objective:

To determine the amount of muscle activity in 4 shoulder muscles during exercise on the Cuff Link.

Design:

Repeated measures.

Setting:

Laboratory.

Subjects:

10 men and 10 women, age 18–50.

Intervention:

Subjects performed 3 sets of 5 revolutions on the Cuff Link in non-weight-bearing, partial-weight-bearing, and full-weight-bearing positions.

Main Outcome Measures:

Electromyography data were collected from the upper trapezius, anterior deltoid, serratus anterior, and pectoralis major and were expressed as percentage of maximal isometric contractions.

Results:

Significant differences were found across the weight-bearing conditions for all 4 muscles. Exercise on the Cuff Link required minimal to significant amounts of muscle recruitment.

Conclusions:

Muscle recruitment increases as weight bearing increases during use of the Cuff Link, suggesting an increase in dynamic stabilization of the glenohumeral joint.

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İlker Eren, Nazan Canbulat, Ata Can Atalar, Şule Meral Eren, Ayla Uçak, Önder Çerezci and Mehmet Demirhan

Context: Ideal rehabilitation method following arthroscopic capsulolabral repair surgery for anterior shoulder instability has not been proven yet. Although rapid or slow protocols were compared previously, home- or hospital-based protocols were not questioned before. Objective: The aim of this prospective unrandomized controlled clinical trial is to compare the clinical outcomes of home-based and hospital-based rehabilitation programs following arthroscopic Bankart repair. Design: Nonrandomized controlled trial. Setting: Orthopedics and physical therapy units of a single institution. Patients: Fifty-four patients (49 males and 5 females) with an average age of 30.5 (9.1) years, who underwent arthroscopic capsulolabral repair and met the inclusion criteria, with at least 1-year follow-up were allocated into 2 groups: home-based (n = 33) and hospital-based (n = 21) groups. Interventions: Both groups received identical rehabilitation programs. Patients in the home-based group were called for follow-up every 3 weeks. Patients in the hospital-based group admitted for therapy every other day for a total of 6 to 8 weeks. Both groups were followed identically after the eighth week and the rehabilitation program continued for 6 months. Main Outcome Measures: Clinical outcomes were assessed using Disabilities of Arm Shoulder Hand, Constant, and Rowe scores. Mann–Whitney U test was used to compare the results in both groups. Wilcoxon test was used for determining the progress in each group. Results: Groups were age and gender matched (P = .61, P = .69). Average number of treatment sessions was 13.8 (7.3) for patients in the hospital-based group. Preoperative Disabilities of Arm Shoulder Hand (27.46 [11.81] vs 32.53 [16.42], P = .22), Constant (58.23 [14.23] vs 54.17 [10.46], P = .13), and Rowe (51.72 [15.36] vs 43.81 [19.16], P = .12) scores were similar between groups. Postoperative scores at sixth month were significantly improved in each group (P = .001, P = .001, and P = .001). No significant difference was observed between 2 groups regarding clinical scores in any time point. Conclusions: We have, therefore, concluded that a controlled home-based exercise program is as effective as hospital-based rehabilitation following arthroscopic capsulolabral repair for anterior shoulder instability.

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Aimee L. Thornton, Cailee W. McCarty and Mollie-Jean Burgess

Clinical Scenario:

Shoulder pain is a common musculoskeletal condition that affects up to 25% of the general population. Shoulder pain can be caused by any number of underlying conditions including subacromial impingement syndrome, rotator-cuff tendinitis, and biceps tendinitis. Regardless of the specific pathology, pain is generally the number 1 symptom associated with shoulder injuries and can severely affect daily activities and quality of life of patients with these conditions. Two of the primary goals in the treatment of these conditions are reducing pain and increasing shoulder range of motion (ROM).3 Conservative treatment has traditionally included a therapeutic exercise program targeted at increasing ROM, strengthening the muscles around the joint, proprioceptive training, or some combination of those activities. In addition, these exercise programs have been supplemented with other interventions including nonsteroidal anti-inflammatory drugs, corticosteroid injections, manual therapy, activity modification, and a wide array of therapeutic modalities (eg, cryotherapy, EMS, ultrasound). Recently, low-level laser therapy (LLLT) has been used as an additional modality in the conservative management of patients with shoulder pain. However, the true effectiveness of LLLT in decreasing pain and increasing function in patients with shoulder pain is unclear.

Focused Clinical Question:

Is low-level laser therapy combined with an exercise program more effective than an exercise program alone in the treatment of adults with shoulder pain?