Ann Cools

Ghent University | UGhent · Department of Rehabilitation Sciences and Physiotherapy

The aim of the present study was to analyze whether a compensatory training program including iso-inertial flywheel training could reduce shoulder imbalances in a group of asymptomatic young tennis players. After an initial evaluation, twenty-six young tennis players were assigned to either a supervised training group (FTG, n = 13) or a control gro...

An increased understanding of rotational strength as a potential prognostic factor for injury in contact and collision athletes may be important in planning return to sport. The aim of this study was to (1) determine the test–retest reliability of clinically relevant, angle-specific rotational and peak torque measurements in a cohort of uninjured c...

Purpose: To investigate the effectiveness of two home-based exercise programs for treating multidirectional shoulder instability (MDI) in patients diagnosed with Hypermobile Ehlers-Danlos syndrome (hEDS) or Hypermobility Spectrum Disorders (HSD). Methods: Twenty-one hEDS/HSD patients with MDI were recruited from the Center for Medical Genetics o...

Background Scapular rehabilitation exercises should target appropriate muscles. Recently, adding external rotation resistance to scapular exercises has gained interest. Moreover, clinical experts advise kinetic chain integration into shoulder rehabilitation exercises. Objective To investigate scapular muscle activity during kinetic chain variation...

Background Differences in shoulder-disability among common shoulder-disorders in orthopaedic specialist care is unknown. Furthermore, rating of shoulder-disability using patient-reported outcomes is time-consuming, and a faster approach is needed. Objectives First, compare shoulder-disability among common shoulder-disorders. Secondly, rate shoulde...

Objective This study aimed to identify targets of intervention for reducing shoulder pain in wheelchair users with spinal cord injury (SCI) by (1) examining changes in subacromial space [acromiohumeral distance (AHD) and occupation ratio (OccRatio)] with fatiguing wheelchair propulsion, and different loading conditions [unloaded position vs. weight...

Background: Proprioception, our sense of joint awareness, is a sub-category of somatosensation, known as our “sixth sense”. It is part of our neuromuscular system, responsible for maintaining joint stability and preventing injury, particularly amongst shoulders. Proprioception is affected by injury and a decreased sense of proprioception can cause...

To determine whether shoulder external (ER) and internal rotational (IR) exercises at five different shoulder abduction angles affect the acromiohumeral distance (AHD). Twenty recreational overhead ath- letes were included. AHD was measured using real-time ultrasound for each of the five shoulder conditions as follows: neutral shoulder rotation (ac...

Background: Performing a careful but effective mobilisation of the hemiplegic shoulder is essential for optimal muscle activation and to preserve the passive range of motion (PROM) needed to perform functional tasks. Studies concerning passive mobilisation of the post-stroke shoulder are scarce. Objectives: A randomised multiple treatment trial was...

The aim of this cross-sectional study was to investigate isometric internal rotation (IR), external rotation (ER), abduction (ABD), and eccentric external rotation (eccER) shoulder strength and rotational range of motion (ROM) in adolescent male and female competitive tennis players. Additional aims of the study were to provide a tennis-specific no...

Objectives To investigate if there is a difference in muscle activity for overhead athletes before and after an intervention with correction of both core and scapula compared to no intervention and is there a difference between overhead athletes with or without shoulder pain. Design Controlled laboratory EMG study including intervention. Setting...

Synopsis: There is an absence of high-quality evidence to support rehabilitation and return-to-sport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sp...

Background Shoulder problems are common in handball, but preventable. However, player compliance remains a challenge, as the existing prevention program is time consuming. Objective To assess the effect of the Oslo Sports Trauma Research Center shoulder injury prevention program on external rotation (ER) strength and internal rotation (IR) range o...

Background Yet published values outlining the differences of sport-specific adaptations at the shoulder joint between symptomatic (S) and non-symptomatic (nS) overhead athletes vary widely. Information defining the link between overuse injuries in relation to both shoulder joint and core endurance is also lacking. Objective To evaluate if sport-sp...

Background Few studies have examined the association between the acute:chronic workload ratio (ACWR) and complaints/injuries in young tennis players. Primary aims: to investigate if accumulated external workload ‘spikes’ in ACWR of tennis training, match-play and fitness training, and if high or low workload/age ratio, were associated with the rate...

Background: Few studies have examined the association between the acute:chronic workload ratio (ACWR) and complaints/injuries in young tennis players. Primary aims of this study were to investigate if accumulated external workload "spikes" in ACWR of tennis training, match play, and fitness training, and to see if high or low workload/age ratio wer...

Context: Knowing the possible association between the isometric force of the shoulder rotators, scapular muscles and the Y-balance test upper quarter (YBT-UQ) performance could help identify which indicators of shoulder stability should be considered in this field test. Objective: To determine whether the isometric strength of the shoulder rotators...

Background: Scapular muscle activity during shoulder exercises has been explored with surface electromyography (EMG). However, knowledge about the activity of deeper-layer scapular muscles is still limited. Purpose: To investigate EMG activation of the deeper-layer scapular stabilizers (levator scapulae [LS], rhomboid major [RM], pectoralis mino...

The aim of this study was threefold (1) to assess the reliability of three upper-extremity performance tests: a countermovement push up, press jump and drop box land, performed on a set of dual-force plates (2) to examine whether there was an association between isokinetic dynamometry and the performance tests in a non-injured cohort of collision/c...

Objective: To assess the effectiveness of a short (5-10 minutes) shoulder external rotation (ER) strength program, using elastic bands, in adolescent handball players. Design: Randomized controlled trial. Methods: The sample included 6 adolescent handball teams (3 female, 3 male) with a total of 92 players and a mean age of 16.6 years. Players...

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 acti...

Purpose: To examine acromio-humeral distance (AHD) and shoulder isometric strength for external rotation (ER) and internal rotation (IR) in national elite badminton players. Methods: Seven elite badminton players with asymptomatic shoulders aged 24 ± 4 (mean ± SD) from the Danish national badminton team were investigated. Shoulder AHD, isometric...

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 t...

OBJECTIVES The primary purpose was to examine the reliability of a new shoulder physical performance test -the Shoulder Endurance Test (SET)- in young healthy overhead athletes and sedentary adults and to provide preliminary reference values. The secondary objective was to determine whether there are differences on SET scores based on groups, sides...

Introduction Atraumatic and degenerative rotator cuff tears are common in individuals over 55 years of age. This condition can have a high impact on social life and is associated with chronic pain, weakness and dysfunction of the upper limb. There is evidence that conservative approaches should be the first treatment option. Conservative treatment...

Objective: To investigate differences in EMG muscle activity and scapular kinematics during elevation in the scapular plane between healthy controls, participants with multidirectional shoulder laxity (MDL), and patients with multidirectional shoulder instability (MDI) who are diagnosed with hypermobile Ehlers-Danlos syndrome (hEDS) or Hypermobilit...

Background: Several studies reported the importance of glenohumeral and scapular muscle activity and scapular kinematics in multidirectional shoulder instability (MDI), yet a systematic overview is currently lacking. Objective: This systematic review evaluates and summarizes the evidence regarding muscle activity and shoulder kinematics in individ...

Werin, MB, Maenhout, AG, Icket, J, Jacxsens, N, Kempkes, E, and Cools, AM. Does the activity in scapular muscles during plyometric exercises change when the kinetic chain is challenged?-An EMG study. J Strength Cond Res 36(7): 1793-1800, 2022-Plyometric exercises for the shoulder are used in rehabilitation and in workout regime when the sport deman...

Background: Athletic endeavor can require the "athletic shoulder" to tolerate significant load through supraphysiological range and often under considerable repetition. Outcome measures are valuable when determining an athlete's safe return to sport. Few data are available to guide a clinician's choice from the variety of measures available. Purp...

Context: Plyometric training has been shown to be beneficial in adolescent overhead athletes. However, existing research on the effects of plyometrics on sport performance has been limited. Objective: To systematically review the current literature to investigate whether plyometric training intervention improves upper- and lower-body sport perfo...

Objective: To develop a feasible protocol for testing maximum shoulder rotation strength in tetraplegic wheelchair athletes, and investigate concurrent validity of maximum isometric handheld dynamometer (HHD) towards maximum isokinetic dynamometer (ID) strength measurements; secondly, to study shoulder muscle activation during maximum shoulder rota...

Background Shoulder problems are common in handball, but injury risk reduction is possible by implementing a prevention program. However, player compliance to the program remains a challenge, with feedback from players that the program is too time consuming. Aim To develop a more efficient program, we aimed to assess the effect of the Oslo Sports...

Context: Proprioception deficits contribute to persistent and recurring physical disability, particularly with shoulder disorders. Proprioceptive training is thus prescribed in clinical practice. It is unclear whether nonsurgical rehabilitation can optimize shoulder proprioception. Objectives: To summarize the available evidence of conservative...

Objectives: To examine whether patients, diagnosed with the hypermobility type of the Ehlers-Danlos syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD), with multidirectional shoulder instability (MDI) have increased humeral head translations compared to healthy controls and to describe the direction of the humeral translations during five ex...

Background In the non-operative treatment of degenerative rotator cuff (RC) tears, exercise therapy is advocated. Exercises focusing on strengthening the anterior deltoid (AD) and the scapular muscles are proposed to compensate for RC dysfunction. However, the amount of electromyographic (EMG) activity in these muscles during these exercises remain...

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 scapu...

Studies that analyse the epidemiology of acute injuries in basketball players in European countries are limited. The purpose is to present an overview of the incidence of injuries and injury patterns in Flanders and to correlate them to possible intrinsic and extrinsic risk factors. All acute injuries that occurred in Flanders during 2009-2013, col...

Background Weakness of the shoulder external rotators (ER) is one of the main risk factors for shoulder pain in handball. Short, effective shoulder ER strength programs the players will adhere to are lacking. Objectives to develop a short and effective shoulder ER strength program, handball players will adhere to. Methods We conducted a modified...

Because of its superficial location, surface electrodes are commonly used to record lower trapezius activity. Recent evidence, however, would suggest that surface electromyography is not a valid to record activity from other superficially placed shoulder muscles. Therefore, the aim of this study was to determine the validity of using surface electr...

Shoulder injuries and sports-related shoulder pain are substantial burdens for athletes performing a shoulder loading sport. The burden of shoulder problems in the athletic population highlights the need for prevention strategies, effective rehabilitation programs, and a individually based return-to-play (RTP) decision. The purpose of this clinical...

Background Screening tests must be reliable, sensitive, specific, inexpensive, easy to perform and widely available. Physical performance tests (PPTs) meet these criteria and are routinely used for injury prediction, performance enhancement or post-rehabilitation outcome measures. Objectives The primary purpose was to evaluate the reliability of...

During nonoperative or postoperative rehabilitation after sports injuries, exercise selection is often based on minimal load on the injured/repaired glenohumeral structures, while optimally activating scapulothoracic muscles. Previous research explored scapular muscle activity during rehabilitation exercises using surface electromyography (EMG). Ho...

Context Scapular rehabilitation exercises should focus on selective activation of weaker muscles and minimal activation of hyperactive muscles. For rehabilitation of overhead athletes, single-plane open chain exercises below 90° of shoulder elevation are often recommended. Moreover, incorporating the kinetic chain in shoulder rehabilitation exercis...

Context Rotator cuff weakness and rotation ratio imbalances are possible risk factors for shoulder injury among overhead athletes. In consensus statements, organizations have highlighted the importance of a screening examination to identify athletes at risk of injury. The screening should be portable and designed to be feasible in many different en...

Objectives: To investigate if there is a difference in muscle activity patterns during high load plyometric shoulder exercises between overhead athletes with and without shoulder pain. Design: Controlled laboratory EMG study. Setting: University EMG Laboratory. Participants: Sixty overhead athletes, 30 with shoulder pain and 30 healthy contr...

Context The shoulder joint and girdle are highly loaded during field hockey play. To optimize performance and to better substantiate preventive programs, it is important to gain insight into shoulder-girdle muscle function and balance in this athlete population. Objective To evaluate relative scapular muscle activity ratios through surface electro...

Objectives: The primary purpose was to evaluate the reliability of the Upper Limb Rotation Test (ULRT). The secondary objective was to evaluate the relationship between the ULRT and two PPTs (SMBT and CKCUEST), trunk rotation range of motion (SRT) and shoulder rotational isometric strength. Design: Reliability study and correlation study. Setti...

A quasi-experimental, pretest–posttest design. To identify acute changes in the supraspinatus and biceps tendon following fatiguing wheelchair propulsion and to associate tendon changes with risk factors associated with shoulder pain in persons with spinal cord injury (SCI). Biomechanical laboratory Swiss Paraplegic Research. A population-based sam...

Objective: The objective of the study was to compare the acromiohumeral distance (AHD) between patients diagnosed with hypermobility type of the Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD) and healthy controls by evaluating the relative amount the tendon occupies in the subacromial area. Furthermore, the aim was to evalu...

Introduction: Proprioception encompasses the submodalities of joint position sense (JPS), kinesthesia, sense of force, and velocity. Owing to the vast mobility of the shoulder, it heavily relies on an intact sense of proprioception. Moreover, shoulder injuries are associated with a decreased sense of proprioception. What remains unclear is how sho...

Objective: To examine if fatigue-inducing wheelchair propulsion changes neuromuscular activation and propulsion biomechanics and to determine predictor variables of susceptibility to fatigue. Design: This study with a quasi-experimental, one-group, pretest posttest design investigates a population-based sample of wheelchair users with a spinal c...

Background: Shoulders of elite field hockey players are loaded continuously during play. Frequent high shoulder loading is known to influence certain shoulder variables, such as acromiohumeral distance. However, the influence of elite field hockey play on acromiohumeral distance is not examined yet. Objective: To examine the acromiohumeral dista...

Study design: This is a systematic review. Introduction: Scapular taping is widely used in the management of scapular dysfunction. However, its effects on the scapular kinematics and the electromyography (EMG) activity of the periscapular muscles are not clear. Purpose of the study: The purpose of the study was to systematically review the cur...

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 muscl...

Shoulders of elite field hockey players are loaded continuously during play. However, shoulder girdle muscle performance in this population has never been examined yet. This study aimed to compare isokinetic shoulder girdle performance in elite male field hockey players to matched controls, with respect to strength, endurance and muscle balance. Th...

As in every body region, a structural and methodical assessment consisting of clinically relevant and valid tests, after an appropriate history, is essential. The combination of the anatomic complexity of the shoulder and the great and varied demands placed on it during handball mean that a deep knowledge of the functional anatomy of the area is cr...

This study aimed to provide an age, gender and sport-based normative database for three functional shoulder tests: Y Balance Test – Upper Quarter (YBT-UQ), Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), and Seated Medicine Ball Throw (SMBT). A second aim was to discuss gender, age and sports differences. Finally, correlation between...

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/intern...

Handball is one of the Olympic sports with the highest risk of injury, according to results from the IOC injury and illness surveillance system [1]. The game is characterized by a high playing tempo, rapid changes of movement, jumps with hard landings, frequent contact and collisions between players, as well as repetitive knee and shoulder joint st...

In epidemiologic studies of elite tennis players, the shoulder is frequently cited as one of the most often injured regions from high-level repetitive tennis play [1]. Ellenbecker et al. [2] reviewed many epidemiologic studies and reported high incidences (4–24%) of shoulder pain among elite players. Additionally, Kovacs et al. [3] surveyed 861 eli...

http://www.wcpt.org/wcpt2017/FS-16

Muscle fatigue is considered to be one cause of shoulder pain, and subjects with generalized joint hypermobility (GJH) are affected more by shoulder pain. The purpose of this study was to examine the effects of muscle fatigue on acromiohumeral distance (AHD) and scapular dyskinesis in women with GJH. Thirty-six asymptomatic participants were assign...

Scapular dyskinesis presenting in patients with shoulder pain may have multiple causes related to shoulder impairments or may simply be an incidental finding. The physical examination should assess the impairments related to scapular dyskinesis in order to develop an appropriate rehabilitation program. The key impairments to examine are soft tissue...

Objectives The purpose of the study was to evaluate performance quality of shoulder plyometric exercises, and examine the relation to scapular muscle activation during an intense exercise bout. Design Observational study. Setting University laboratory. Participants 32 healthy university students (male/female: 14/18) volunteers. Main outcome mea...

Study Design Narrative Review. Introduction One of the shoulder pain disorders in which the function of the scapula is comprised is the subacromial pain syndrome. Several rehabilitation guidelines and exercises have been proposed to improve scapulothoracic muscle dysfunction. Consideration of muscle activation patterns may help to select the most...

Volleyball-specific skills such as spiking and serving place a tremendous load on the shoulder girdle. These overhead skills subject the dominant shoulder girdle to repetitive stress, which may cause breakdown and injury to the soft tissues. To better understand the mechanism of overuse shoulder injuries in volleyball athletes, the volleyball medic...

Introduction De nombreuses etudes ont evalue les facteurs de risque chez les athletes pratiquant des sports de lancers. La faiblesse des rotateurs externes de la coiffe des rotateurs de l’epaule est associee a une augmentation de la probabilite d’apparition de probleme au sein de l’epaule ainsi que des lesions entrainant une intervention chirurgica...

Study Design Systematic review. Introduction Constituents of proprioception include our awareness of the position (joint position sense [JPS]) and motion (kinesthesia) of our limbs in space. Proprioceptive deficits are associated with musculoskeletal disorders but remain a challenge to quantify, particularly at the shoulder. Purpose of the Study...

Objective: Muscle strength imbalance in the shoulder region can be considered as a predisposing factor in the development of movement dysfunctions, possibly leading to overuse injuries. Repetitive overhead throwing, performed in sports, may result in muscle imbalance between the external (ER) and internal (IR) rotators. Muscle strength measured wi...

Background The cartilage of the epiphyseal plate might be 2–5 times weaker than surrounding fibrous tissue; therefore epiphyseal (growth) plates are very sensitive to their surrounding mechanical environment. Objective The specific aim of the study was to investigate and compare epiphyseal length and extension in the proximal humerus, closure in t...

Background Risk factors among overhead athletes have been investigated in many studies. The rotator cuff external rotator weakness is associated with an increased probability of substantial shoulder problems and throwing related injury requiring surgical intervention. Objective To evaluate the relative and absolute reliability and the validity of...

Objective: The aim of this study was to investigate short-term and long-term treatment effects of dry needling (DN) and manual pressure (MP) technique with the primary goal of determining if DN has better effects on disability, pain, and muscle characteristics in treating myofascial neck/shoulder pain in women. Methods: In this randomized clinic...

Background: Progressive biceps loading is recommended in the nonoperative and operative rehabilitation of biceps-related disorders. Previous researchers have proposed a continuum of exercises with low to moderate biceps loads to be used in the early and intermediate phases of rehabilitation. A progression of exercises with moderate to high biceps...

Context: Isokinetic testing is used to determine possible deficits in upper extremity strength in overhead athletes. Given that isokinetic testing is restricted to a laboratory setting, field tests, such as the Seated Medicine Ball Throw (SMBT) and were developed to assess upper body performance. The relationship between these field tests and isok...

The labelling of non-traumatic shoulder pain related to the structures of the subacromial space has been debated for many years. Historically, labelling of shoulder diagnoses and exploring theories about the underlying causes of shoulder pain are interrelated. Many authors use the phrase ‘syndrome’ describing a combination of findings, often occurr...