Article

Effects of a stretching protocol for the pectoralis minor on muscle length, function, and scapular kinematics in individuals with and without shoulder pain

October 2016
Journal of Hand Therapy 30(1)

DOI:10.1016/j.jht.2016.06.006

Authors:

Dayana Rosa

University of Malaga

John Borstad

College of St. Scholastica

Lívia Silveira Pogetti

Federal University of Minas Gerais

Paula Rezende Camargo

Universidade Federal de São Carlos

Study design: Parallel-group intervention with repeated measures. Introduction: Shortening of the pectoralis minor (PM) may contribute to alterations in scapular kinematics. Purpose of the study: To evaluate the effects of a stretching protocol on function, muscle length, and scapular kinematics in subjects with and without shoulder pain. Methods: A sample of 25 patients with shoulder pain and 25 healthy subjects with PM tightness performed a daily stretching protocol for 6 weeks. Outcome measures included Disabilities of the Arm, Shoulder, and Hand questionnaire, PM length, and scapular kinematics. Results: Disabilities of the Arm, Shoulder, and Hand scores decreased (P < .05) in the patient group at post-intervention. No differences (P > .05) were found for PM length in both groups. Scapular anterior tilt increased (P < .05) at 90° of flexion in the healthy group. Discussion: This study demonstrated that a daily home stretching protocol significantly decreases pain and improves function in subjects with shoulder pain. The mechanism responsible for these improvements does not appear directly related to PM muscle length or scapula kinematics, suggesting that other neuromuscular mechanisms are involved. Conclusion: The PM stretching protocol did not change the PM length or scapular kinematics in subjects with or without shoulder pain. However, pain and function of the upper limbs improved in patients with shoulder pain. Level of evidence: 2b.

Frequency of pectoralis minor muscle tightness among asymptomatic individuals

Article

Full-text available

Feb 2022

Objective: To determine the frequency of Pectoralis minor muscle tightness among individuals with asymptomatic shoulder. Methodology: This cross-sectional study was conducted among 190 individuals with asymptomatic shoulder in Dow university of Health Sciences. A self-administered questionnaire was used for demographical data. Pectoralis minor muscle length was measured and Pectoralis minor index was calculated to assess Pectoralis minor tightness. Data we`re analyzed using SPSS version 21. Results: Out of 190 participants, 157 (82.6%) were female and 33 (17.4%.) male. Mean age, height, weight and body mass index were 26.54 ± 7.17, 160.59 ± 12.43, 58.22 ± 1.231 and 22.18 ± 3.68, respectively. Frequency of pectoralis minor muscle tightness was 26.8%. Conclusion: There is low frequency of pectoralis minor muscle tightness among individuals with asymptomatic shoulder.

Comparison of specific and non-specific treatment approaches for individuals with posterior capsule tightness and shoulder impingement symptoms: A randomized controlled trial

Article

May 2021
REV BRAS FISIOTER

Background Posterior capsule tightness (PCT) is associated with shoulder pain and altered shoulder kinematics, range of motion (ROM), external rotation (ER) strength, and pain sensitization. Objective To assess the effects of two interventions on shoulder kinematics, Shoulder Pain and Disability Index (SPADI) scores, ROM, strength, and pressure pain threshold (PPT) in individuals with PCT and shoulder impingement symptoms. Methods In this prospectively registered randomized controlled trial 59 individuals were randomized to either an Experimental Intervention Group (EIG, n=31) or a Control Intervention Group (CIG, n=28). The low flexion (LF) test was used to determine the presence of PCT. Shoulder kinematics, SPADI scores, internal rotation (IR) and ER ROM, ER strength, and PPT were measured pre- and post-treatment. Those in the EIG received an intervention specific to pain and PCT and those in the CIG received a non-specific intervention, both 4 weeks in duration. Results Individuals in the EIG demonstrated more scapular upward rotation (P=.03; mean difference (MD)=3.3°; 95% Confidence Interval (CI)=1.3°, 4.9°) and improved value on the LF test (P=.02; MD=4.6°; 95%CI=0.7°, 8.6°) than those in the CIG after treatment. Both groups presented less anterior (P<.01; MD=-0.7mm; 95%CI=-1.3mm, -0.2mm) and superior (P<.01; MD=-0.5mm; 95%CI=-0.9mm, -0.2mm) humeral translations, decreased SPADI score (P<.01; MD=-23.6; 95%CI=-28.7, -18.4), increased IR ROM (P<.01; MD=4.6°; 95%CI=1.8°, 7.8°) and PPTs for upper trapezius (P<.01; MD=60.1kPa; 95%CI=29.3kPa, 90.9kPa), infraspinatus (P=.04; MD=47.3kPa; 95%CI=2.1kPa, 92.5kPa), supraspinatus (P<.01; MD=63.7kPa; 95%CI=29.6kPa, 97.9kPa), and deltoid (P<.01; MD=40.9kPa; 95%CI=12.3kPa, 69.4kPa) after treatment. Conclusion The experimental intervention was more effective at improving PCT as measured through changes in the LF test. No benefit of the specific approach over the non-specific intervention was noted for the remaining variables.

Pectoralis minor length measurements in three different scapula positions

Article

Full-text available

Nov 2020

Background: The pectoralis minor (PM) muscle is commonly regarded as a contributor to abnormal scapula positioning. Subsequently, the muscle length of the scapular stabilising muscles may be affected, as these muscles assume a lengthened position, which over time causes weakness. There are inconsistencies regarding PM muscle length values because of the different techniques and positions used when the length of the PM muscle is measured. Objective: To determine the PM muscle length in participants aged 18-24 using a Vernier® caliper and expressed as pectoralis minor index (PMI), with the scapula in three different positions. Method: The PM muscle length of 144 participants was measured with a Vernier® caliper (intraclass correlation coefficient 0.83-0.87). Measurements were made with the scapula in the resting position, in an active and a passive posterior tilt position. Results: Significant differences were observed in PMI between the resting scapula position - 10.04 (confidence interval, CI 9.93-10.14) and active posterior tilt - 10.19 (CI 10.09-10.30) (p < 0.001); the resting position - 10.04 (CI 9.93-10.14) and passive posterior tilt - 10.77 (10.66-10.87) (p < 0.001) and active - 10.19 (CI 10.09-10.30) and passive posterior tilt 10.77 (10.66-10.87) (p < 0.001). The dominant side had lower PMI values than the non-dominant side. Conclusion: The significant differences between the active and posterior tilt positions suggested that optimal muscle length of PM was affected by the inner range strength of the lower fibres of Trapezius. Clinical implications: It is important that in clinical practice not only the length of PM in scapular misalignment but also the strength of the antagonistic muscles is considered.

Does pectoralis minor stretching provide additional benefit over an exercise program in participants with subacromial pain syndrome? A randomized controlled trial

Article

Aug 2019

Background: Adaptive shortening of the pectoralis minor is one of the biomechanical mechanisms associated with subacromial pain syndrome (SPS). Objective: To compare the effects of an exercise program alone with an exercise program in combination with pectoralis minor stretching in participants with SPS. Design: Randomized controlled trial. Methods: Eighty adult participants with SPS were randomly allocated to two groups. The control group (n=40) received a 12-week specific exercise program and the intervention group (n=40) received the same program plus stretching exercises of the pectoralis minor muscle. The primary outcome measure was shoulder function assessed by a Constant−Murley questionnaire, and the secondary outcomes were the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, visual analog scale (VAS), and pectoralis minor resting length. Results: The present study shows no difference between the two interventions according to the Constant−Murley questionnaire (1.5 points; p=0.58), VAS at rest (0.2 cm; p=0.11), VAS at movement (0.5 cm; p=0.08), and pectoralis minor resting length (0.3 cm; p=0.06). The DASH questionnaire showed greater functional improvement in the control group (5.4 points; p=0.02). Finally, only pectoralis minor length index showed difference statistical significant in favor of intervention group (0.3%; p=0.04). Conclusion: In the short-term, the addition of a program of stretching exercises of the pectoralis minor does not provide significant clinical benefit with respect to functional improvement or pain reduction in participants with SPS.

Exercise therapy may affect scapular position and motion in individuals with scapular dyskinesis: a systematic review of clinical trials

Article

Aug 2019
J SHOULDER ELB SURG

Background: Therapeutic exercise for scapular muscles is suggested to be effective in reducing shoulder pain in patients with rotator cuff disorders, whereas its effectiveness on scapular position and motion has remained unclear. Therefore, the aim of this systematic review was to investigate whether exercise therapy improves scapular position and motion in individuals with scapular dyskinesis. Methods: This study is a wide systematic review including any type of clinical trial in which the effect of any type of therapeutic exercise, including scapular muscle strengthening, stretching, and scapular stabilization exercise, is investigated in adult participants. Results: Twenty studies were included in this systematic review. Studies were categorized on the basis of the techniques they used to measure scapular position and motion and the included participants. Methodologic quality of the studies was assessed by the Cochrane tool of assessing the risk of bias. Eight studies used 3-dimensional techniques for measuring scapular motions. Among them, 5 studies showed significant effects of exercise on scapular motion, of which 3 studies investigated individuals with subacromial impingement syndrome (SIS). The other 12 studies used 2-dimensional measurement techniques, of which 8 studies reported significant effects of exercise on scapular position and motion both in SIS patients and in asymptomatic individuals. However, their methodologic quality was debatable. Therefore, there was conflicting evidence for the effect of exercise on scapular dyskinesis. Conclusion: There is a lack of evidence for beneficial effects of exercise in improving scapular position and motion in individuals with scapular dyskinesis. However, exercise is beneficial in reducing pain and disability in individuals with SIS.

Effectiveness of stretching exercise versus kinesiotaping in improving length of the pectoralis minor: A systematic review and network meta-analysis

Article

Aug 2019

Objective: Shortness of the pectoralis minor (PM) is a potential mechanism underlying shoulder impingement syndrome. Few studies have examined the effects of kinesiotaping and stretching exercise on PM length or index. This systematic review and network meta-analysis investigated the effects of stretching exercise and kinesiotaping on PM length and index in adults. Methods: This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomised controlled trials including adults with or without symptomatic shoulders were included. Heterogeneity between studies was assessed using I2 statistics, and publication bias was evaluated by constructing a funnel plot. Results: We extracted data from six randomised controlled trials that included 263 participants (age range: 18-50 years). Compared with usual care, kinesiotaping resulted in greater improvement in PM length (mean difference, 1.15 cm; 95% confidence interval [CI]: 0.20-2.10 cm). Compared with usual care and kinesiotaping, proprioceptive neuromuscular facilitation (PNF) stretching increased PMI significantly, with a mean difference of 1.40 (95% CI: 1.17-1.63) and 1.08 (95% CI: 0.29-1.87) cm, respectively. Conclusion: Compared with no intervention, kinesiotaping is beneficial for lengthening the PM. Intervention with static stretching alone has no effect on PM length. Compared with kinesiotaping alone and no intervention, PNF stretching increases PMI.

Acute Effects of Pectoralis Minor Self Mobilization on Shoulder Motion and Posture: A Blinded and Randomized Placebo-Controlled Study in Asymptomatic Individuals

Article

Mar 2019

Kevin Laudner

Context: Tightness of the pectoralis minor is a common characteristic that has been associated with aberrant posture and shoulder pathology. Determining conservative treatment techniques for maintaining and lengthening this muscle is critical. Although some gross stretching techniques have been proven effective, there are currently no empirical data regarding the effectiveness of self-myofascial release for treating tightness of this muscle. Objective: To determine the acute effectiveness of a self-myofascial release with movement technique of the pectoralis minor for improving shoulder motion and posture among asymptomatic individuals. Design: Randomized controlled trial. Setting: Orthopedic rehabilitation clinic. Participants: A total of 21 physically active, college-aged individuals without shoulder pain volunteered to participate in this study. Main outcome measures: Glenohumeral internal rotation, external rotation, and flexion range of motion (ROM), pectoralis minor length, and forward scapular posture were measured in all participants. The intervention group received one application of a self-soft-tissue mobilization of the pectoralis minor with movement. The placebo group completed the same motions as the intervention group, but with minimal pressure applied to the xiphoid process. Separate analyses of covariance were used to determine differences between groups (P < .05). Results: Separate analyses of covariance showed that the self-mobilization group had significantly more flexion ROM, pectoralis minor length, and less forward scapular posture posttest than the placebo group. However, the difference in forward scapular posture may not be clinically significant. No differences were found between groups for external or internal rotation ROM. Conclusions: The results of this study indicate that an acute self-myofascial release with movement is effective for improving glenohumeral flexion ROM and pectoralis minor length, and may assist with forward scapular posture. Clinicians should consider this self-mobilization in the prevention and rehabilitation of pathologies associated with shortness of the pectoralis minor.

Is there Relationship between Pectoralis Minor Muscle Length and Shoulder Rotator Muscles Strength?

Article

Full-text available

May 2018

Problem Statement: In joint movement, agonist and antagonist muscle strength, as well as the length and the shortness of these muscles is an important parameter. Muscle shortness is one of the factor that responsible of sports injuries. Shoulder is one of the most injured joint in Judo. In this joint, determination of the relationship between muscle shortness and agonist-antagonist muscles strength will be effective to increase muscle strength, sportive performance and prevent sports injuries. Purpose of Study: This study was conducted to determine the relationship between pectoralis minor (PM) muscle length and shoulder internal(IR)/external(ER) rotation isokinetic muscle strength in Judo athletes. Methods: The study included 80 (56 males, 24 female) professional Judo athletes aged between 14-25 (mean 17,31±2,51). Isokinetic muscle strength was assessed by ISOMED 2000 ® device. Pectoralis minor length was evaluated using a flexible tape measure in resting position. The assessments were made bilaterally. Findings and Results: There was a strong and statistically significant correlation between the PM length and the shoulder IR and ER peak torque values at both angular velocities and both sides (p <0,01). Conclusions and Recommendations: It was determined that the relationship between the length of the PM muscle and the internal and external rotator muscle strength of Judo athletes. Therefore, we think that by increasing shoulder muscle strength to enhance sportive performance, stretching exercises for PM muscle shortening should be added to training programs.

Pectoralis minor muscle elongation and scapulothoracic motion do not differ in individuals with short versus typical resting pectoralis minor muscle length: a cross-sectional study

Article

Jun 2018

Background: Individuals with short resting pectoralis minor muscle length have been shown to have aberrant scapulothoracic motion when compared to individuals with long resting pectoralis minor muscle length. However, the degree to which the pectoralis minor muscle can be lengthened and whether or not scapulothoracic motion differs between individuals with short and typical resting pectoralis minor muscle length is unknown. Objectives: To determine if: (1) pectoralis minor muscle elongation (percent pectoralis minor muscle can be actively and passively lengthened beyond resting length), (2) pectoralis minor muscle percent length change during overhead reaching, and (3) scapulothoracic motion during overhead reaching differ between individuals with short and typical resting pectoralis minor muscle length. Design: Two group comparison. Methods: Thirty healthy individuals were placed into a short or typical resting pectoralis minor muscle length group. A caliper was used to measure resting pectoralis minor muscle length and pectoralis minor muscle length during active and passive muscle lengthening. An electromagnetic tracking system was used to measure pectoralis minor muscle length change as well as scapular, humeral, and trunk motion during several arm elevation tasks. Pectoralis minor muscle elongation and length change during arm elevation tasks were compared between groups using independent t-tests. Two-factor mixed-model analyses of variance were used to compare scapulothoracic motion at arm elevation angles of 30°, 60°, 90°, and 120°. Results: Pectoralis minor muscle elongation and pectoralis minor muscle length change during arm elevation did not differ between groups. Scapulothoracic motion did not differ between groups across arm elevation tasks. Conclusions: Although resting pectoralis minor muscle length differed between groups, pectoralis minor muscle lengthening and scapulothoracic motion were similar between participants with short and typical resting pectoralis minor muscle length. Additional studies are needed to better understand the role of pectoralis minor muscle elongation on scapulothoracic motion.

Prompt Impact of Muscle Energy Technique on Pectoralis Muscle Tightness in Computer Users: A Quasi-Experimental Study

Article

Full-text available

Aug 2023

Tightness of the pectoralis minor muscle has been a common characteristic of abnormal posture. Prolonged inappropriate posture while using computers/laptops results in musculoskeletal problems, mainly in the upper limb. This study aims to see how the muscular energy technique affected pectoralis minor tightness in computer users right away. This study included 65 individuals aged 20-40 years following the inclusion/exclusion criteria. Participants received muscle energy technique for the pectoralis minor muscle. Pre- and post-assessment included the evaluation of pectoralis minor length, round shoulder posture (RSP), and forward head posture (FHP). We used the Kolmogorov–Smirnov test to assess the normality of data, as this study included > 50 participants. Data analysis was conducted using a paired t-test for within-group analysis. The outcome measures demonstrated significant improvement (p < 0.001). In conclusion, the muscle energy technique is effective in reducing muscle tightness, improving RSP and reducing FHP.

Effects of a High-Volume 7-Week Pectoralis Muscle Stretching Training on Muscle Function and Muscle Stiffness

Article

Full-text available

Jun 2023

Background There is evidence that high-volume static stretching training of the lower limbs can increase the range of motion (ROM) while decreasing muscles stiffness. However, to date, there is no evidence on the effects of upper limb stretching training or its effect mechanism. Therefore, this study aimed to investigate the effects of a comprehensive 7-week static stretching training program of the pectoralis major muscle (PMa) on glenohumeral joint ROM, muscle force, and muscle stiffness. Methods Thirty-eight healthy, physically active participants (23 male, 15 female) were randomly assigned to either the PMa-static stretching intervention (PMa-SS) group or the control group. The PMa-SS group performed a 7-week intervention comprising three sessions a week for 15 min per session, including three static stretching exercises of the PMa for 5 min each. Before and after the intervention period, shoulder extension ROM, muscle stiffness of the PMa (pars clavicularis), and maximal voluntary isometric contraction (MVIC) peak torque (evaluated at both long (MVIClong) and short (MVICshort) muscle lengths) were investigated on a custom-made testing device at 45° shoulder abduction. Results In the PMa-SS group, the shoulder extension ROM (+ 6%; p < 0.01; d = 0.92) and the MVIClong (+ 11%; p = 0.01; d = 0.76) increased. However, there were no significant changes in MVICshort or in PMa muscle stiffness in the PMa-SS group. In the control group, no changes occurred in any parameter. Conclusion In addition to the increase in ROM, we also observed an improved MVIC at longer but not shorter muscle lengths. This potentially indicates an increase in fascicle length, and hence a likely increase in sarcomeres in series.

Current Views of Scapular Dyskinesis and its Possible Clinical Relevance

Article

Full-text available

Feb 2022
Int J Sports Phys Ther

Scapular dyskinesis is a condition that is frequently observed clinically but not often understood. Too often it is viewed as a diagnosis which is not accurate because it is a physical impairment. This misclassification of dyskinesis has resulted in literature that simultaneously supports and refutes scapular dyskinesis as a relevant clinical entity as it relates to arm function. These conflicting views have not provided clear recommendations for optimal evaluation and treatment methods. The authors' experience and scholarship related to scapular function and dysfunction support that scapular dyskinesis is an impairment that has causative factors, that a pathoanatomical approach should not be the primary focus but should be considered as part of a comprehensive examination, that a qualitative examination for determining the presence or absence of a scapular contribution to shoulder dysfunction is currently the best option widely available to clinicians, and that rehabilitation approaches should be reconsidered where enhancing motor control becomes the primary focus rather than increasing strength.

Is the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire Adequate to Assess Individuals With Subacromial Pain Syndrome? Rasch Model and International Classification of Functioning, Disability and Health

Article

Feb 2021

Objective The Disabilities of the Arm Shoulder and Hand (DASH) questionnaire is highly used to assess patients with symptoms of subacromial pain syndrome (SPS). No study has analyzed the DASH by using the Rasch model in these patients and related the level of difficulty of the items with the International Classification of Functioning Disability and Health (ICF) domains. The purpose of this study was to evaluate the measurement properties of the DASH in individuals with SPS and to describe which International Classification of Functioning, Disability and Health (ICF) components are influenced by SPS based on the DASH. Methods The full version of the DASH was used to assess upper limbs pain and function in individuals with SPS. Responses were assessed using the Rasch model. Items of the DASH were grouped according to the level of difficulty, and associated to the ICF domains in order to identify which is the most compromised aspect in these individuals. Results Reliability and internal consistency for the DASH were shown to be 0.93 and 0.95, respectively. Item 3 (“Turn a key”) was the easiest, and 25 (“Pain during specific activity”) the most difficult. Only item 30 (“Less capable/confident/useful”) resulted as an erratic item. Item 15 (“Put on a sweater”) showed differential functioning by age, and item 11 (“Carry a heavy object”) by sex. Seven items showed differential functioning related to the angular onset of pain during arm elevation. Sixty percent of the most difficult items belonged to the “Body function” domain of the ICF. Conclusion Although some psychometric properties of the DASH are adequate according to the Rasch model, adjustments to some items are necessary for individuals with SPS. Clinicians should be cautious when interpreting the DASH, especially in patients with the angular onset of pain above 120° of arm elevation. Impact The information contained in this study should be used by clinicians to interpret the results of the DASH when assessing individuals with SPS. The DASH may not be adequate to assess those with shoulder pain above 120 degrees of arm elevation. These results are not generalizable to other shoulder pathologies.

Pain and its impact on functioning and disability in manual wheelchair users with spinal cord injury: a protocol for a mixed-methods study

Article

Full-text available

Jan 2021

Introduction Approximately 80% of people with spinal cord injury experience clinically significant chronic pain. Pain (whether musculoskeletal or neuropathic) is consistently rated as one of the most difficult problems to manage and negatively affects the individual’s physical, psychological and social functioning and increases the risk of pain medication misuse and poor mental health. The aim of this study is to therefore determine the presence of pain and its impact on functioning and disability as well as to develop a framework for self-management of pain for South African manual wheelchair users with spinal cord injury. Methods and analysis Community-dwelling participants with spinal cord injury will be invited to participate in this three-phase study. Phase 1 will use a quantitative, correlational design to determine factors related to pain such as pectoralis minor length, scapular dyskinesis, wheelchair functioning, physical quality of life, community reintegration and pain medication misuse. Demographic determinants of pain such as age, gender, type of occupation, completeness of injury and neurological level of injury will also be investigated. Participants with pain identified in phase 1 will be invited to partake in a qualitative descriptive and contextually designed phase 2 to explore their lived experience of pain through in-depth interviews. The results of phases 1 and 2 will then be used with the assistance from experts to develop a framework for self-management of pain using a modified Delphi study. Data analysis will include descriptive and inferential statistics (quantitative data) and thematic content analysis (qualitative data). Ethics and dissemination Approval for this study is granted by the Faculty of Health Sciences Research Ethics Committee of the University of the Pretoria (approval number 125/2018). This study is registered with the South African National Health Research Database (reference GP201806005). This study’s findings will be shared in academic conferences and published in scientific peer-reviewed journals.

Predictors of throwing performance in amateur male cricketers: A musculoskeletal approach

Article

Sep 2020

Optimal throwing speed and accuracy is built on a complex interaction of multiple variables. Although strength and power has been associated with throwing speed in cricketers, the individual muscles that contribute to optimal function of the shoulder-complex has not been adequately explored in connection with throwing performance. Consequently, this study aimed to investigate the correlation between musculoskeletal variables and overhead throwing performance in cricketers. Thirty-two amateur male cricketers were tested using a battery of 16 tests (strength, flexibility, scapula positioning) as well as a throwing speed (TS) and a novel accuracy test (TA). Only two of the sixteen tests were correlated with throwing performance in the multiple regression analysis. Non-dominant hip abduction strength correlated positively with TS (p < 0.05): on average, a strength increase of 10 newtons (N) was associated with an increase in TS of 0.60 km/h (95% CI: 0.12-1.08). Non-dominant pectoralis minor length correlated positively with TA (p < 0.01): on average, a one-centimetre increase in the length correlated to an increase, of 0.633 points (95% CI: 0.225-1.041). This cross-sectional study demonstrated that from an array of musculoskeletal variables, only non-dominant hip abduction strength correlated with TS, while only non-dominant pectoralis minor length correlated with TA in amateur cricketers.

Effects of the Muscle Energy Technique and the Self-Stretching Exercise of the Pectoralis Minor on the Pulmonary Function of Young Adults with Thoracic Kyphosis

Article

Full-text available

Jun 2020

The Influence of Glenohumeral Joint Posterior Capsule Tightness and Impingement Symptoms on Shoulder Impairments and Kinematics

Article

Jul 2019
PHYS THER

Background: Posterior capsule tightness (PCT) and shoulder impingement syndrome (SIS) symptoms are both associated with altered shoulder biomechanics and impairments. However, their combined effect on kinematics, pain, range of motion (ROM), strength, and function remain unknown. Objective: The purpose of this study was to determine if the combination of PCT and SIS affects scapular and humeral kinematics, glenohumeral joint ROM, glenohumeral joint external rotation strength, pain, and function differently than does either factor (PCT or SIS) alone. Design: The design was a cross-sectional group comparison. Methods: Participants were placed into 1 of 4 groups based on the presence or absence of SIS and PCT: control group (n = 28), PCT group (n = 27), SIS group (n = 25), and SIS + PCT group (n = 25). Scapular kinematics and humeral translations were quantified with an electromagnetic motion capture system. Shoulder internal rotation and external rotation ROM, external rotation strength, and pain and Shoulder Pain and Disabilities Index scores were compared between groups with ANOVA. Results: The SIS group had greater scapular internal rotation (mean difference = 5.13°; 95% confidence interval [CI] = 1.53°-8.9°) and less humeral anterior translation (1.71 mm; 95% CI = 0.53-2.9 mm) than the other groups. Groups without PCT had greater internal rotation ROM (16.05°; 95% CI = 5.09°-28.28°). The SIS + PCT group had lower pain thresholds at the levator scapulae muscle (108.02 kPa; 95% CI = 30.15-185.88 kPa) and the highest Shoulder Pain and Disabilities Index score (∼ 44.52; 95% CI = 33.41-55.63). Limitations: These results may be limited to individuals with impingement symptoms and cannot be generalized to other shoulder conditions. Conclusions: Decreased ROM and lower pain thresholds were found in individuals with both impingement symptoms and PCT. However, the combination of factors did not influence scapular and humeral kinematics.

Short Term Effects of a Pectoralis Minor Positional Release in Collegiate Swimmers

Article

Oct 2018

Johnathan Roman

Shoulder external rotation range of motion and pectoralis minor length in individuals with and without shoulder pain

Article

Apr 2018

Background: There is evidence that pectoralis minor (PM) length influences scapula position and that scapula position relates to glenohumeral joint (GHJ) external rotation (ER) range of motion (ROM). Objectives: To explore the association between PM resting length and GHJ ER ROM in individuals with and without shoulder pain. The influence of GHJ ER ROM measurement position on this association was also evaluated. Design: Cross-Sectional. Methods: Fifty individuals (25 asymptomatic and 25 with shoulder pain) participated. PM resting length was measured using a tape measure with subjects standing, while GHJ ER ROM was quantified using a digital inclinometer with participants in both supine and seated positions. The same blinded investigator took all measurements. Results/findings: A significant negative correlation between PM resting length and GHJ ER ROM in the seated position was noted in the asymptomatic group (r = -0.41; p = 0.04), but not in the symptomatic group (r = -0.33; p = 0.11). A nonsignificant negative correlation was also demonstrated in the supine position for both groups (r ranged from -0.35 to -0.17; p > 0.05). There was a significant group x position interaction (F = 4.06; p = 0.04) with more GHJ ER ROM (6.80°) for asymptomatic group in the seated position. Conclusions: PM length is not strongly correlated with GHJ ER ROM in individuals with or without shoulder pain. However, the position in which GHJ ER ROM is measured influenced the motion in asymptomatic individuals.

Association of Pectoralis Minor Muscle Length and Shoulder Range of Motion Among Individuals with and without Shoulder Pain

Article

Full-text available

Jan 2023

Background and Aim: To evaluate the association of pectoralis minor muscle length and the shoulder range of motion with and without shoulder pain. Methodology: A sample of 214 participants with and without shoulder pain were enrolled in an analytical cross sectional study at Institute of physical medicine and rehabilitation, Dow University of health sciences, Karachi. Questionnaire was provided to all participants after taking consent. Individuals were categorized into two equal groups i.e. one with and the other without pain). Shoulder active ranges were measured with universal goniometer and pectoralis minor length with measuring tape. Statistical Package of Social Sciences version 21 was used for data analysis. The descriptive variables were assessed for frequencies and percentages. Continuous variables were shown with mean and standard deviations and were correlated with bivariate correlation test. Considered significant was 0.05 p value. Results: Females were 176(82.2%) and males were 38 (17.8%). Mean ± SD of age, weight, height, and BMI were 26.82 ±7.50, 58.45 ±12.11, 160.59 ± 12.43, and 22.18 ±3.78 respectively. The pain intensity negatively correlated with shoulder range of motions (rs = -0.307 to - 0.775, p< 0.05) except medial rotation. Significant difference (p< 0.05) is found for length of pectoralis minor and range of motion between groups. There was also weak positive correlation between pectoralis minor index and shoulder lateral rotation (rs =0.215; p = 0.003). Conclusion: The shoulder pain affects shoulder joint range of motion and pectoralis minor length. Decreased pectoralis minor muscle length accompanies limited shoulder range of motion except, medial rotation.

Effectiveness of the Fascial Manipulation Approach Associated with a Physiotherapy Program in Recurrent Shoulder Disease

Article

Full-text available

Jun 2023

Shoulder pain is a serious clinical disease frequently related to absence from work. It is characterized by pain and stiffness, probably connected to the presence of an inflammatory substrate involving gleno-humeral capsule and collagen tissues. A physiotherapy program has shown to be effective for the conservative treatment of this disorder. Our aim is to assess if a manual treatment directed to fascial tissues could obtain better improvement regarding pain, strength, mobility, and function. A total of 94 healthcare workers with recurrent shoulder pain were recruited and then randomized in two groups: the control group (CG) underwent a five-session physiotherapy program; the study group (SG) underwent three sessions of physiotherapy and two sessions of fascial manipulation (FM) technique. At the end of the treatment phase, both groups improved every outcome. Despite few statistical differences between groups, at the follow-up visit, a greater percentage of subjects in SG overcame the minimal clinical important difference (MCID) in every outcome. We conclude that FM is effective for treatment of shoulder pain and further studies should better assess how to manage this treatment to obtain better results.

Effectiveness of the Fascial Manipulation Approach Associated with a Physiotherapy Programme in Recurrent Shoulder Disease

Preprint

Full-text available

May 2023

Shoulder pain is a serious clinical disease frequently related to absence from work. It’s characterized by pain and stiffness probably connected to the presence of an inflammatory substrate involving gleno-humeral capsule and collagen tissues. A physioterapy programme has shown to be effective for the conservative treatment of this disorder. Our aim is to assess if a manual treatment directed to fascial tissues could get better improvement regarding pain, strength, mobility and function. 94 healthcare workers with recurrent shoulder pain were recruited and then randomized in two groups: the control group (CG) underwent a physiotherapy programme; the study group (SG) underwent to 3 sessions of physiotherapy and to 2 session of Fascial Manipulation (FM) technique. At the end of the treatment phase, both groups improved every outcome. Despite few statistical differences between groups, at the follow up visit a greater percentage of subjects in SG overcame the minimal clinical important difference (MCID) in every outcome. We conclude that FM is effective for treatment of shoulder pain and further studies should better assess how to manage this treatment to get better results.

Exercise for Rotator Cuff Tendinopathy: Proposed Mechanisms for Recovery

Article

May 2023

Rotator cuff (RC) tendinopathy is a common recurrent cause of shoulder pain, and resistance exercise is the first-line recommended intervention. Proposed causal mechanisms of resistance exercise for patients with RC tendinopathy consist of four domains: tendon structure, neuromuscular factors, pain and sensorimotor processing, and psychosocial factors. Tendon structure plays a role in RC tendinopathy, with decreased stiffness, increased thickness, and collagen disorganization. Neuromuscular performance deficits of altered kinematics, muscle activation, and force are present in RC tendinopathy, but advanced methods of assessing muscle performance are needed to fully assess these factors. Psychological factors of depression, anxiety, pain catastrophizing, treatment expectations, and self-efficacy are present and predict patient-reported outcomes. Central nervous system dysfunctions also exist, specifically altered pain and sensorimotor processing. Resisted exercise may normalize these factors, but limited evidence exists to explain the relationship of the four proposed domains to trajectory of recovery and defining persistent deficits limiting outcomes. Clinicians and researchers can use this model to understand how exercise mediates change in patient outcomes, develop subgroups to deliver patient-specific approach for treatment and define metrics to track recovery over time. Supporting evidence is limited, indicating the need for future studies characterizing mechanisms of recovery with exercise for RC tendinopathy.

The Combined Effect of the Trapezius Muscle Strengthening and Pectoralis Minor Muscle Stretching on Correcting the Rounded Shoulder Posture and Shoulder Flexion Range of Motion among Young Saudi Females. A Randomized Comparative Study

Article

Full-text available

Feb 2023

Background: The shortening of the pectoralis minor muscle (PMi-M) and weakening of the lower trapezius muscle (LTr-M) affect scapular movement, resulting in the development of a rounded shoulder posture and reduction in the shoulder flexion range of motion (SFROM). Objective: This study evaluated the combined effect of LTr-M strengthening and PMi-M stretching on correcting the rounded shoulder postures and SFROM among young Saudi females. Methods: This study was based on a two-arm parallel-group repeated measures randomized comparative design. A total of sixty female participants with rounded shoulder postures were recruited and randomly allocated into groups 1 and 2 (n = 30/group). Each group performed supervised PMi-M stretching; however, group 2 performed a combination of LTr-M strengthening and PMi-M stretching. The outcomes, including rounded shoulder posture and SFROM, were assessed using the pectoralis minor length test (PMLT) and universal goniometer. A repeated measure ANOVA was used to compare the differences within-group and between-group for the outcomes measures at one-week (baseline) pre-intervention, two weeks, and three -weeks post-intervention. The significance level was set at q > 2.00 and p < 0.05 for all respective statistical analyses. Results: The within-group comparison revealed significant improvements (q > 2.00) in the outcomes of PMLT and SFROM when comparing their post-intervention scores to the baseline scores. The between-group comparison revealed a significant and an insignificant (q < 2.00) difference in the outcomes of PMLT and SFROM, respectively when comparing their scores at the second- and third-week post-intervention. Furthermore, the effect size of the intervention suggests an advantage of group 2 over group 1 in increasing the resting length of the PMi-M only among young Saudi females. Conclusions: The combined effect of LTr-M strengthening and PMi-M stretching was more beneficial than PMi-M stretching alone in correcting the rounded shoulder posture among young Saudi females by increasing PMi-M resting length. However, it could not yield a differential improvement in the SFROM outcome among them.

Pectoralis minor syndrome

Article

Full-text available

Nov 2022

Ilknur Aktaş

Pectoralis minor syndrome (PMS) is defined as compression of the brachial plexus (BP) nerves, axillary artery, and axillary vein under the pectoralis minor muscle. The symptoms of PMS resemble supraclavicular compression of the neurovascular bundle, with shoulder, neck, chest, and arm pain, and paresthesia and weakness in the arm and hand. The diagnosis of PMS can be confused with other upper extremity pain syndromes. A detailed history, including occupation, daily activities, sports, and trauma, is critical in the diagnosis, together with physical examination findings. Radiological examinations, including direct radiography, computed tomography, magnetic resonance imaging, and electrophysiological tests, are also helpful for the differential diagnosis. Arterial and venous Doppler ultrasound, including dynamic investigation, can display arterial and venous compression. Injection tests are used to confirm the definitive diagnosis. Conservative treatment is successful in most patients, and surgical treatment is considered in unresponsive cases.

“You have (rotator cuff related) shoulder pain, and to treat it, I recommend exercise.” A scoping review of the possible mechanisms clinicians use to underpin exercise therapy

Article

Aug 2022

Background Exercise is considered to be both essential and at the forefront of the management of rotator cuff-related shoulder pain (RCRSP). Despite this, many fail to substantially improve with exercise-based treatment. Hence, expanding the current knowledge about the possible mechanisms of exercise for RCRSP is critical. Objective To synthesise the range of mechanisms proposed for exercise in people with RCRSP. Design Scoping review Methods A systematic search of the Physiotherapy Evidence Database (PEDro) was conducted from inception to July 3, 2022. Two reviewers conducted the search and screening process and one reviewer extracted the data from each study. Randomised clinical trials using exercise for the management of RCRSP of any duration were included. The PEDro search terms used were “fitness training”, “strength training”, “stretching, mobilisation, manipulation, massage”, “upper arm, shoulder, or shoulder girdle”, “pain”, and “musculoskeletal”. Data were analysed using quantitative and qualitative approaches. Results 626 studies were identified and 110 were included in the review. Thirty-two unique mechanisms of exercise were suggested by clinical trialists, from which 4 themes emerged: 1) neuromuscular 2) tissue factors 3) neuro-endocrine-immune 4) psychological. Neuromuscular mechanisms were proposed most often (n = 156, 77%). Overall, biomedical mechanisms of exercise were proposed in 95% of cases. Conclusions The causal explanation for the beneficial effect of exercise for RCRSP in clinical research is dominated by biomedical mechanisms, despite a lack of supporting evidence. Future research should consider testing the mechanisms identified in this review using mediation analysis to progress knowledge on how exercise might work for RCRSP.

Bilateral Comparison of Anterior Shoulder Position in Elite Tennis Players

Article

Full-text available

Aug 2022
Int J Sports Phys Ther

Background In elite tennis players, musculoskeletal adaptations in the dominant upper extremity have been reported for range of motion, strength, and scapular biomechanics. In addition to scapular dysfunction, tightness and inflexibility of the pectoral musculature have been identified as risk factors for the development of overuse shoulder injury in overhead athletes. Hypothesis Differences in anterior shoulder position will be identified between the dominant and non-dominant extremity in elite tennis players. The purpose of this study was to examine bilateral differences in anterior shoulder posture measured using a double square in elite tennis players without shoulder injury. Study Design Descriptive Laboratory Study Methods Three hundred and six uninjured elite tennis players were measured in the supine position using a double square method to measure anterior shoulder position. The distance from the surface of the table to the anterior most position of the shoulder (in millimeters) was measured bilaterally and compared. A dependent t-test was used to test for significant differences in anterior shoulder position between the dominant and non-dominant extremity. Results One hundred thirty-three males and 173 females were included in this study with a mean age of 16.58 years. The mean difference between extremities indicates increased anterior shoulder positioning on the dominant shoulder of 7.65 mm in females, and 8.72 in males. Significantly greater (p<.001) anterior shoulder position measures were documented on the dominant shoulder as compared to the non-dominant shoulder. Conclusions The results of this study showed significantly (p<.001) greater anterior shoulder position on the dominant extremity of elite male and female tennis players. The differences of 7-8mm between extremities has clinical application for interpreting anterior shoulder position test results in this population. Level of Evidence 3

Arthroscopic release of the pectoralis minor tendon from the coracoid for pectoralis minor syndrome

Article

Full-text available

Dec 2022

Purpose The term “ pectoralis minor syndrome ” refers to this constellation of symptoms that can occur when the pectoralis minor (Pm) is shortened and contracted. Release of the tendon of the Pm from the coracoid has been reported to provide substantial clinical improvement to patients presenting with pectoralis minor syndrome. The purpose of this study was (1) to describe the technique for endoscopic release of pectoralis minor tendon at the subdeltoid space, (2) to classify the pectoralis minor syndrome according to its severity and (3) and to report the short-term outcomes of this procedure in a consecutive series of patients diagnosed with pectoralis minor syndrome. Methods Endoscopic release of the pectoralis minor tendon was performed in a series of 10 patients presenting with pectoralis minor syndrome. There were six females and four males with a median age at the time of surgery of 42 (range from 20 to 58) years. Four shoulders were categorized as grade I (scapular dyskinesis), and six as grade II (intermittent brachial plexopathy). Shoulders were evaluated for pain, motion, satisfaction, subjective shoulder value (SSV), quick-DASH, ASES score, and complications. The mean follow-up time was 19 (range, 6 to 49) months. Results Arthroscopic release of the tendon of the Pm led to substantial resolution of pectoralis minor syndrome symptoms in all but one shoulder, which was considered a failure. Preoperatively, the median VAS for pain was 8.5 (range, 7–10) and the mean SSV was 20% (range, 10% - 50%). At most recent follow-up the mean VAS for pain was 1 (range, 0–6) and the mean SSV 80% (range, 50% - 90%). Before surgery, mean ASES and quick-DASH scores were 19.1 (range, 10–41.6) and 83.1 (range, 71 and 95.5) points respectively. At most recent follow-up, mean ASES and quick-DASH scores were 80.1 (range, 40–100) and 19.3 (range, 2.3–68) points respectively. No surgical complications occurred in any of the shoulder included in this study. Conclusions Endoscopic release of the tendon of the pectoralis minor from the coracoid improves pain, function and patient reported outcomes in the majority of patients presenting with the diagnosis of isolated pectoralis minor syndrome.

Comprehensive supervised heavy training program versus home training regimen in patients with subacromial impingement syndrome: a randomized trial

Article

Full-text available

Jan 2022
BMC MUSCULOSKEL DIS

Background There is no consensus on the best training regimen for subacromial impingement syndrome (SIS). Several have been suggested, but never tested. The purpose of the study is to compare a comprehensive supervised training regimen (STR) based on latest evidence including heavy slow resistance training with a validated home-based regimen (HTR). We hypothesized that the STR would be superior to the HTR. Methods Randomised control trial with blinded assessor. 126 consecutive patients with SIS were recruited and equally randomised to 12 weeks of either supervised training regimen (STR), or home-based training regimen (HTR). Primary outcomes were Constant Score (CS) and Shoulder Rating Questionnaire (SRQ) from baseline and 6 months after completed training. Results were analyzed according to intention-to treat principles. The study was retrospectively registered in ClinicalTrials.gov. Date of registration: 07/06/2021. Identification number: NCT04915430. Results CS improved by 22.7 points for the STR group and by 23,7 points for the HTR ( p = 0.0001). The SRQ improved by 17.7 and 18.1 points for the STR and the HTR groups respectively (p = 0.0001). The inter-group changes were non-significant. All secondary outcomes (passive and active range of motion, pain on impingement test, and resisted muscle tests) improved in both groups, without significant inter-group difference. Conclusion We found no significant difference between a comprehensive supervised training regimen including heavy training principles, and a home-based training program in patients with SIS.

Additional effects of Thoracic manipulation on pain, shoulder disability and range of motion in Adhesive Capsulitis

Article

Full-text available

Dec 2021

Aim: To determine the additional effects of thoracic manipulation on shoulder pain, shoulder range of motion (ROM) and disability in combination with conventional physical therapy exercises for individuals with adhesive capsulitis. Materials: A parallel, randomized controlled clinical trial was conducted. 32 patients (16 in each group), aged between 40‑60 years from both genders having shoulder pain, clinically diagnosed with adhesive capsulitis (Stage II and III), along with thoracic spine hypo mobility were included. Patients were randomized into conventional physiotherapy group (A) and thoracic manipulation group (B). Clinical trial was continued for two weeks with three sessions per week and a follow up was done at the end of 3rd week. Visual analogue scale (VAS), shoulder range of motion (ROM) and Disabilities of Arm Shoulder and Hand (DASH) score were used for outcomes measurement. Results: Intragroup comparison for shoulder ROM, DASH and VAS scores shows a significant (p value=≤0.001) for both groups. Intergroup comparison for shoulder ROM was improved significantly on post-intervention (p value=≤0.001). While intergroup comparison of baseline to end value for VAS showed insignificant result (p value=0.373). Conclusion: Additional effects of thoracic manipulation to conventional physical therapy underwent a greater improvement regarding shoulder range of motions and disability. Conventional physical therapy exercises and a combination of thoracic manipulation to conventional physical therapy exercises are equally effective for decreasing shoulder pain. Keywords: Adhesive Capsulitis, Pain, Frozen shoulder, Physical Therapy, Rehabilitation

Low Risk of Fracture With End-Range Movements of the Hip in People With Low Bone Mineral Density: A Narrative Review

Article

Full-text available

Nov 2021

Background: The risks of end-range movements for people with osteoporosis, specifically at the hips and shoulder, are not well understood. Objectives: To synthesize literature on the safety of stretching for people with osteoporosis by searching: 1) biomechanical literature to determine how much force results from an end-range maneuverer and is required to fracture joint components (focusing on the hip joint) and 2) clinical literature to describe techniques used, populations studied, effects, and reported adverse events. Methods: We conducted two separate search strategies in PubMed, EMBASE, and Scopus (1955–2020). Results: 16 articles described either biomechanical or clinical effects of passive and active end ranges of the hip joint. The largest load in the hip, described in the literature was in a crescent lunge during yoga. The moment produced in a crescent lunge is much smaller than that of the tensile strength of osteoporotic bone, suggesting the crescent lunge movement could be considered safe. Clinically, no adverse events were reported in exercise, stretching or yoga interventions. Conclusion: This review found no evidence that end range movements of the hip are unsafe, but there is little evidence. No studies were identified that explored the risk of humeral fracture during end range stretches.

Investigation of the Effects of Video Games-Based Exercise Training on Subacromial Impingement Syndrome

Article

Full-text available

Aug 2021
J Harran Unv Med F

Amaç: Bu çalışmanın amacı, subakromiyal sıkışma sendromu (SSS) tanılı hastalarda konservatif fizyoterapi (KF) ile birlikte uygulanan video oyunları tabanlı egzersiz eğitiminin (VOTEE) ağrı, fonksiyonellik ve eklem pozisyon hissi üzerine etkilerini araştırmaktır. Materyal ve Metod: Çalışmamıza SSS tanılı 40-65 yaş arasındaki Neer evrelemesine göre Evre II ve Evre III sınıflamasına dahil olan olgular alındı. Çalışmamıza dahil edilen 50 hasta randomize olarak iki gruba ayrıldı. İlk gruba (n=25) KF ve VOTEE, ikinci gruba (n=25) sadece KF uygulandı. Her iki grup da 20 seans tedaviye alındı. Olgular tedavi öncesi ve tedavi sonrası ağrı (Vizüel Analog Skala), eklem hareket açıklığı (EHA) ve ağrılı ark (gonyometre), kas kuvveti (dinamometre), eklem pozisyon hissi (lazer imleç yardımlı açı tekrarlama testi), fonksiyonellik (DASH ve SPADI) açısından değerlendirildi. Bulgular: Her iki grupta da ağrı şiddetinde ve ağrılı ark değerlerinde azalma, eklem hareket açıklığı ve kas kuvveti değerlerinde artış, eklem pozisyon hissi deviasyonlarında azalma ve fonksiyonellik düzeyinde artış görüldü (p<0.05). EHA değerleri, kas kuvveti (fleksiyon, ekstansiyon, abduksiyon, internal rotasyon, eksternal rotasyon), ağrılı ark değeri, DASH puanı, SPADI ağrı parametresi açısından gruplararası fark bulunmadı (p>0.05). Ağrı, horizontal adduksiyon kas kuvveti, eklem pozisyon hissi, SPADI disabilite ve SPADI toplam parametresinde fark bulundu (p<0.05). Sonuç: Çalışmamızın sonucunda KF ile birlikte uygulanan VOTEE’nin, sadece KF uygulamasına göre ağrının azalması, eklem pozisyon hissinde artış ve fonksiyonellik düzeyinde artış sağladığı belirlendi. Bu nedenle, SSS’li hastalarda uygulanan KF’nin VOTEE ile desteklenebileceği düşünmekteyiz.

EFFECT OF LOW LEVEL LASER THERAPY ON HEMIPLEGIC SHOULDER PAIN IN POST STROKE SUBJECTS

Article

Jul 2021

Shoulder pain is a common complication of a stroke which can impede participation in rehabilitation and has been associated with poor outcomes. Low Level LASER Therapy (LLLT) is one of the adjunct treatments of choice with exercise therapy for shoulder rehabilitation in Physiotherapy. The objective of this study was to investigate the effect of LLLT on Hemiplegic Shoulder Pain (HSP) in reducing shoulder pain and improving upper limb function in post Stroke subjects. Prospective study design. 68 subjects with mean age of 53 years having a clinical diagnosis of Stroke with HSP were randomly allocated into two groups. In Group-A (n=34) subjects were treated with LLLT and standardized Rehabilitation Programme, where as in Group-B (n=34) subjects were treated with standardized Rehabilitation Programme. Participants were given interventions twice a week for 8 weeks. The outcomes of this intervention were measured by SPADI for pain, disability and FMA-UE for function. Statistical analysis of the data revealed that within group comparison both groups showed signicant improvement in all parameters, where as in between groups comparison Group-A showed better improvement compared to the Group-B. After 8 weeks of interventions both Group-A and Group-B showed signicant improvement in reducing pain and improving upper limb function. However LLLT along with Standardized Rehabilitation Programme showed more improvement when compared to the Standardised Rehabilitation Programme alone. Thus this study concludes that LLLT is a useful adjunct in HSPalong with rehabilitation

Acute and Prolonged Effects of Stretching on Shear Modulus of the Pectoralis Minor Muscle

Article

Full-text available

Mar 2021
J SPORT SCI MED

Increased muscle stiffness of the pectoralis minor (PMi) could deteriorate shoulder function. Stretching is useful for maintaining and improving muscle stiffness in rehabilitation and sport practice. However, the acute and prolonged effect of stretching on the PMi muscle stiffness is unclear due to limited methodology for assessing individual muscle stiffness. Using shear wave elastography, we explored the responses of shear modulus to stretching in the PMi over time. The first experiment (n = 20) aimed to clarify the acute change in the shear modulus during stretching. The shear modulus was measured at intervals of 30 s × 10 sets. The second experiment (n = 16) aimed to observe and compare the prolonged effect of different durations of stretching on the shear modulus. Short and long stretching duration groups underwent 30s × 1 set and 30s × 10 sets, respectively. The assessments of shear modulus were conducted before, immediately after, and at 5, 10, and 15 min post-stretching. In experiment I, the shear modulus decreased immediately after a bout (30 s) of stretching (p < 0.001, change: -2.3 kPa, effect size: r = 0.72) and further decreased after 3 repetitions (i.e., 90 s) of stretching (p = 0.03, change: -1.0 kPa, effect size: r = 0.53). In experiment II, the change in the shear modulus after stretching was greater in the long duration group than in the short duration group (p = 0.013, group mean difference: -2.5 kPa, partial η2 = 0.36). The shear modulus of PMi decreased immediately after stretching, and stretching for a long duration was promising to maintain the decreased shear modulus. The acute and prolonged effects on the PMi shear modulus provide information relevant to minimum and persistent stretching time in rehabilitation and sport practice.

Scapular movement training versus standardized exercises for individuals with chronic shoulder pain: protocol for a randomized controlled trial

Article

Aug 2020
REV BRAS FISIOTER

Background Scapular focused exercise interventions are frequently used to treat individuals with shoulder pain. However, evidence for changes in scapular motion after intervention is limited. Objective To compare the effects of scapular movement training versus standardized exercises for individuals with shoulder pain. Methods This will be a single-blinded randomized controlled trial. Sixty-four individuals with shoulder pain for at least 3 months, scapular dyskinesis, and a positive scapular assistance test will be randomly allocated to one of two groups: Scapular Movement Training (group 1) and Standardized Exercises (group 2). Group 1 will receive education about scapular position and movement, and be trained to modify the scapular movement pattern. Group 2 will perform stretching and strengthening exercises. Both groups will be treated twice a week for eight weeks. Three-dimensional scapular kinematics and muscle activity of the serratus anterior and upper, middle, and lower trapezius during elevation and lowering of the arm will be assessed at baseline and after 8 weeks of treatment. Pain intensity, function, fear avoidance beliefs, and kinesiophobia will be assessed at baseline and after 4 and 8 weeks of treatment, and 4 weeks after the end of treatment. Conclusions The results of this study may contribute to a better understanding of the efficacy of scapular focused treatments for individuals with shoulder pain. Clinical trial registration: NCT03528499

Comparison of scapular kinematics and muscle strength between those with a positive and a negative Scapular Assistance Test

Article

Jan 2020
CLIN BIOMECH

Background: The Scapular Assistance Test was suggested to directly assess the influence of scapular motion on pain and indirectly measure the function of the scapular rotators. However, it is still not clear if individuals with a positive Scapular Assistance Test actually present changes in scapular motion and muscle strength. This study compared scapular kinematics and muscle strength between those with a positive Scapular Assistance Test and those with a negative Scapular Assistance Test. Methods: Fifty individuals with shoulder pain were randomly allocated to: positive (n = 25) or negative Scapular Assistance Test (n = 25) group. Scapular kinematics was measured during elevation and lowering of the arm. Strength of the serratus anterior and lower trapezius was also measured. Two-way analysis of variance was used to compare kinematics between groups. Unpaired Student's t-test and Mann-Whitney test were used to compare strength of serratus anterior and lower trapezius, respectively. Findings: There were no differences (P > 0.05) in scapular internal rotation and upward rotation between both groups. For scapular tilt, there was group main effect (P < 0.05) during elevation and lowering of the arm, whereas the positive Scapular Assistance Test group presented greater scapular anterior tilt. There was no difference (P > 0.05) in strength between groups. Interpretation: Individuals with a positive Scapular Assistance Test are more likely to present decreased scapular posterior tilt in those with shoulder pain. Strength of the scapular muscles seems to be same in those with a positive and a negative Scapular Assistance Test.

Rehabilitation and Prehabilitation for Upper Extremity in Throwing Sports: Emphasis on Lacrosse

Article

Full-text available

Jul 2019

Lacrosse imposes multiple simultaneous physical demands during play including throwing and catching a ball while holding a crosse, running, cutting, and jumping. Often, these skills are completed while experiencing contact from another player leading to both on-and-off platform movements. Other motions include defensive blocking and pushing past defenders. Repetitive motions over sustained durations in practice or competition impart mechanical stresses to the shoulder or elbow joints, supportive muscles, and connective tissue. Preparation for lacrosse participation involves bilateral optimization of strength and durability of stabilizer muscles. Passing and shooting skills are encouraged to be equally effective on both sides; therefore, symmetric strength and flexibility are vital for prehabilitation and rehabilitation efforts. This article will: 1) provide insights on the upper-extremity musculoskeletal demands of lacrosse and related sports with similar throwing motion and 2) describe prehabilitation and rehabilitation methods that improve athlete durability and reduce likelihood of upper-extremity injury. Introduction Despite the rapid growth of lacrosse participation in developing players, appropriate prerehabilitation and rehabilitation training strategies to prepare these players are still in development. Lacrosse is a unique throwing sport, because it involves continuous upper-extremity use through carriage and play with a handheld crosse, physical contact (1), and high-speed lower-body motion. In this fast-paced game, athletes (10 for men, 12 for women) run distances up and down a field while carrying a ball, passing, shooting, or defending a goal or other defending other players with the crosse. Regulation game times range from 40 to 50 min, depending on the age and sex of the competitors.

Differences in scapular upward rotation, pectoralis minor and levator scapulae muscle length between the symptomatic, the contralateral asymptomatic shoulder and control subjects: A cross-sectional study in a Spanish primary care setting

Article

Full-text available

Jun 2019

Objective To determine the potential differences in both scapular positioning and scapular movement between the symptomatic and asymptomatic contralateral shoulder, in patients with unilateral subacromial pain syndrome (SAPS), and when compared with participants free of shoulder pain. Setting Three different primary care centres. Participants A sample of 73 patients with SAPS in their dominant arm was recruited, with a final sample size of 54 participants. Primary outcome measures The scapular upward rotation (SUR), the pectoralis minor and the levator scapulae muscles length tests were carried out. Results When symptomatic shoulders and controls were compared, an increased SUR at all positions (45°, 90° and 135°) was obtained in symptomatic shoulders (2/3,98/8,96°, respectively). These differences in SUR surpassed the minimal detectable change (MDC95) (0,91/1,55/2,83° at 45/90/135° of shoulder elevation). No differences were found in SUR between symptomatic and contralateral shoulders. No differences were found in either pectoralis minor or levator scapulae muscle length in all groups. Conclusions SUR was greater in patients with chronic SAPS compared with controls at different angles of shoulder elevation.

Influence of reducing anterior pelvic tilt on shoulder posture and the electromyographic activity of scapular upward rotators

Article

Feb 2019

Background: Modifications of posture in a segment may influence the posture of adjacent and nonadjacent segments and muscular activity. The spine-shoulder and spine-pelvis relationships suggest that the pelvis may influence shoulder posture. Objective: To investigate the effect of the active reduction of the anterior pelvic tilt on shoulder and trunk posture during static standing posture and on the electromyographic activity of the scapular upward rotators during elevation and lowering of the arm. Methods: Thirty-one young adults were assessed in a relaxed standing position and a standing position with 30% active reduction of the anterior pelvic tilt. The pelvic tilt, trunk posture, and forward shoulder posture during the static standing posture and the electromyographic activity during elevation and lowering of the arm were assessed. Results: Paired t-tests indicated that the active reduction of the anterior pelvic tilt reduced the trunk extension (MD=1.09; 95%CI=-2.79 to -1.03). There were no effects on the forward shoulder posture (MD=0.09; 95%CI=-0.92 to 1.09). Repeated measures of analyses of variance indicated an increase in lower trapezius electromyographic activity (MD=3.6; 95%CI=1.28 to 5.92). There was a greater reduction in upper trapezius activity after pelvic tilt reduction during arm elevation (MD=1.52%; 95%CI=-2.79 to -0.25) compared to that during the lowering phase. There were no effects of pelvic tilt reduction on the electromyographic activity of the serratus anterior (MD=3.26; 95%CI=-3.36 to 9.87). Conclusion: The influence of pelvic posture on the trunk posture and lower trapezius activation should be considered when assessing or planning exercise for individuals with shoulder or trunk conditions.

Scapular kinematic alterations during arm elevation with decrease in pectoralis minor stiffness after stretching in healthy individuals

Article

Mar 2018
J SHOULDER ELB SURG

Background: Pectoralis minor tightness may be seen in individuals with scapular dyskinesis, and stretching is used for the treatment of altered scapular motion in sports and clinical fields. However, few researchers have reported on the effects of pectoralis minor stiffness on scapular motion during arm elevation. This study investigated whether an acute decrease of pectoralis minor stiffness after stretching changes the scapular motion during arm elevation. Methods: The study allocated 15 dominant and 15 nondominant upper limbs in healthy men as control and interventional limbs, respectively. In the intervention limb group, the shoulder was passively and horizontally abducted at 150° of elevation for 5 minutes to stretch the pectoralis minor muscle. Before and after stretching, an electromagnetic sensor was used to examine 3-dimensional scapular motion during abduction and scaption. Ultrasonic shear wave elastography was used to measure pectoralis minor stiffness before and immediately after stretching and after arm elevation. Results: In the interventional limb, pectoralis minor stiffness decreased by 3.2 kPa immediately after stretching and by 2.5 kPa after arm elevation. The maximal changes in scapular kinematics after stretching were 4.8° of external rotation and 3.3° of posterior tilt in abduction, and 4.5° of external rotation and 3.7° of posterior tilt in scaption. Upward rotation in abduction or scaption did not change. Conclusions: Stretching for the pectoralis minor muscle increases external rotation and posterior tilt of the scapula during arm elevation.

Correlation between Aberrant Upper Body Posture and Shoulder Function in Subacromial Impingement Syndrome

Article

Apr 2023

Managing Scapular Dyskinesis

Article

Mar 2023
Phys Med Rehabil Clin

Scapular dyskinesis, the impairment of optimal scapular position and motion, is common in association with shoulder injury. A comprehensive evaluation process can show the causative factors and lead to effective treatment protocols. The complexity of scapular motion and the integrated relationship between the scapula, humerus, trunk, and legs suggest a need to develop rehabilitation programs that involve all segments working as a unit rather than isolated components. This is best accomplished with an integrated rehabilitation approach that includes rectifying deficits in mobility, strength, and motor control but not overtly focusing on any one area.

Effect of passive pectoralis minor stretching on scapular kinematics in scapular dyskinesia

Article

Full-text available

Apr 2022

passive stretch technique in conjunction with strengthening was found to be a better approach in bringing about effective pectoralis minor lengthening and thereby, reducing the overall dyskinetic movements of the scapula.

Arthroscopic Pectoralis Minor Release

Chapter

Jan 2023

Gia Rodriguez-Vaquero

Hyperactivation of the pectoralis minor (PM) can originate shoulder pain and dysfunction. PM hyperactivation results in secondary protraction and medial tilt of the scapula with scapula-thoracic abnormal motion, causing secondary impingement of the subacromial space.PM insertion release has been proposed to restore scapular balance and shoulder function. Open and arthroscopic release in lateral decubitus has been described. In this chapter, we describe the arthroscopic technique in beach chair position.Hyperactivation PM syndrome is a rare disease and the reports on this procedure are anecdotical. We evaluate ten patients diagnosed with hyperactivation PM syndrome who underwent isolated arthroscopic PM release at mean 18 month follow-up and good outcomes were reported in terms of pain, Constant score, subjective satisfaction with the surgery, improved shoulder function and numbness to the hand. Scapulothoracic motion got normalized.This technique seems to be safe, reproducible and present good outcomes at midterm follow-up, but arthroscopic skills and knowledge of the neurovascular anatomy are required. Hyperactivation of the pectoralis minor (PM) can originate shoulder pain and dysfunction. PM hyperactivation results in secondary protraction and medial tilt of the scapula with scapula-thoracic abnormal motion, causing secondary impingement of the subacromial space. PM insertion release has been proposed to restore scapular balance and shoulder function. Open and arthroscopic release in lateral decubitus has been described. In this chapter, we describe the arthroscopic technique in beach chair position. Hyperactivation PM syndrome is a rare disease and the reports on this procedure are anecdotical. We evaluate ten patients diagnosed with hyperactivation PM syndrome who underwent isolated arthroscopic PM release at mean 18 month follow-up and good outcomes were reported in terms of pain, Constant score, subjective satisfaction with the surgery, improved shoulder function and numbness to the hand. Scapulothoracic motion got normalized. This technique seems to be safe, reproducible and present good outcomes at midterm follow-up, but arthroscopic skills and knowledge of the neurovascular anatomy are required.

Pectoralis Minor Syndrome – Review of Pathoanatomy, Diagnosis, and Management of the Primary Cause of Neurogenic Thoracic Outlet Syndrome

Article

Jun 2022
J SHOULDER ELB SURG

Thoracic outlet syndrome is an umbrella term for compressive pathologies in the supra and infraclavicular fossae, with the vast majority being neurogenic in nature. These compressive neuropathies, such as pectoralis minor syndrome, can be challenging problems for both patients and physicians. Robust understanding of thoracic outlet anatomy and scapulothoracic biomechanics are necessary to distinguish neurogenic versus vascular disorders, and properly diagnose affected patients. Repetitive overhead activity, particularly when combined with scapular dyskinesia, leads to pectoralis minor shortening, decreased volume of the retropectoralis minor space, and subsequent brachial plexus compression causing neurogenic thoracic outlet syndrome. Combining a thorough history, physical exam, and diagnostic modalities including ultrasound-guided injections are necessary to arrive at the correct diagnosis. Rigorous attention must be paid to rule out alternate etiologies such as peripheral neuropathies, vascular disorders, cervical radiculopathy, and space-occupying lesions. Initial nonoperative treatment with pectoralis minor stretching, as well as periscapular and postural retraining, is successful in the majority of patients. For patients that fail nonoperative management, surgical release of the pectoralis minor may be performed through a variety of approaches. Both open and arthroscopic pectoralis minor release may be performed safely with effective resolution of neurogenic symptoms. When further indicated by the preoperative work-up, this can be combined with suprascapular nerve release and brachial plexus neurolysis for complete infraclavicular thoracic outlet decompression.

Association of Both Scapular Upward Rotation and Scapulothoracic Muscle Lengths With Shoulder Pain, Function, and Range of Movement

Article

Sep 2020
J MANIP PHYSIOL THER

Objective Our aim was to analyze whether shoulder pain is related to scapular upward rotation (SUR) or to the lengths of the pectoralis minor and levator scapulae muscles. Methods This cross-sectional, observational study was carried out in 3 primary-care centers; 54 individuals with chronic shoulder pain participated. Scapular upward rotation and the lengths of the pectoralis minor and levator scapulae muscles were assessed. Results The level of association was small between shoulder pain and function and (1) the lengths of the pectoralis minor ( r = 0.08, P = .93) and levator scapulae ( r = −0.01, P = .57) muscles and (2) SUR at 45° ( r = 0.17, P = .21), 90° ( r = 0.08, P = .57), and 135° ( r = 0.10, P = 0.45) of shoulder elevation. Conclusion The relationship was small between shoulder pain and function and (1) SUR (45°, 90°, and 135° of shoulder elevation) and (2) the lengths of the pectoralis minor and levator scapulae muscles. Thus, the use of SUR and pectoralis minor and levator scapulae lengths in shoulder assessment should be undertaken with caution. Other factors such as psychological factors, central/peripheral sensitization, and intrinsic properties of the tissue have to be taken into account.

Consensus Definition of Muscle Tightness From Multidisciplinary Perspectives

Article

Nov 2019

Background: Muscle tightness is a complex ailment that affects quality of life in people who experience it. Muscle tightness is not clearly defined by National Library of Medicine, which creates confusion in clinical practice. Objectives: The purpose of this study was to identify the attributes of muscle tightness from expert clinicians' perception and develop a consensus definition from multidisciplinary perspectives. Methods: This non-intervention study employed semi-structured interviews using qualitative design. Twelve multidisciplinary expert clinicians participated in the study. Results: The results indicate that limited range of motion is a key feature of muscle tightness; however, there are six other attributes: loss of function, changes in muscle texture, change in sensation, asymmetry, pain, and contracted muscle state. These attributes are largely subjective and are inter-related. Discussion: The new definition captures the multiple domains of muscle tightness. Lack of a standardized tool is a challenge, particularly when subjective assessments require patients' input. Development of such a tool to measure muscle tightness is advocated.

Physical Fitness and Exercise Strategy According to General Characteristics of Spinal Cord Injured Person

Article

Full-text available

May 2019

PURPOSE Spinal cord injuries cause a decrease in overall body function after spinal cord injury. The physical fitness of the spinal cord injured person varies greatly depending on the level of injury, physical activity, and the use of a wheelchair. Therefore, exercise prescription programs that take into account the type of disability of the spinal cord injuries will help improve physical fitness. The purpose of this study was to identify the physical characteristics of spinal cord injured people by examining previous studies and to suggest strategies for applying effective exercise programs. METHODS This study was conducted to investigate previous studies and to present the physical characteristics of spinal cord injuries according to spinal cord injury level, physical activity level and wheelchair use, and to determine the appropriate exercise test method and effective exercise prescription strategy. RESULTS This study suggested the exercise test method considering the physical characteristics of the spinal cord injured people and the NMES exercise program for the cardiorespiratory capacity enhancement exercise program and the NMES exercise program for the prevention of the lower extremity muscle activity. CONCLUSIONS The application of a customized exercise prescription program for spinal cord injuries would have a positive effect on the prevention of secondary complications due to spinal cord injury and improvement of the quality of life of people with spinal cord injury. Based on the results of this study, we expect that the scientific exercise prescription program will be applied to people with spinal cord injuries.

Comparison of Myofascial Release Techniques on Pectoralis Minor Length, Glenohumeral Total Arc of Motion, and Skin Temperature: A Pilot Study

Article

Dec 2018

Context: The pectoralis minor (PM) is an important postural muscle that may benefit from myofascial techniques, such as Graston Technique® (GT) and self-myofascial release (SMR). Objective: To examine the effects of GT and SMR on PM length, glenohumeral total arc of motion (TAM), and skin temperature. Design: Cohort. Setting: Laboratory. Participants: Twenty-six healthy participants (19 females and 7 males; age = 20.9 [2.24] y, height = 170.52 [8.66] cm, and weight = 72.45 [12.32] kg) with PM length restriction participated. Interventions: Participants were randomized to the intervention groups (GT = 12 and SMR = 14). GT and SMR interventions were both applied for a total of 5 minutes during each of the 3 treatment sessions. Main outcome measures: PM length, TAM, and skin temperature were collected before and after each intervention session (Pre1, Post1, Pre2, Post2, Pre3, and Post3) and at 1-week follow-up (follow-up). Separate intervention by time analyses of variance examined differences for each outcomes measure. Bonferroni post hoc analyses were completed when indicated. Significance was set a priori at P ≤ .05. Results: No significant intervention by time interactions were identified for PM length, TAM, or temperature (P > .05). No significant intervention main effects were identified for PM length (P > .05), TAM (P > .05), or temperature (P > .05) between the GT or SMR technique groups. Overall, time main effects were found for PM length (P = .02) and temperature (P < .001). Post hoc analysis showed a significant increase in PM length for both intervention groups at follow-up (P = .03) compared with Post2. Furthermore, there were significant increases in temperature at Post1 (P < .001), Post2 (P = .01), and Post3 (P < .001) compared with Pre1; Post2 was increased compared with Pre2 (P = .003), Pre3 (P < .001), and follow-up (P = .01); Post3 increased compared with Pre3 (P = .01) and follow-up (P = .01). Conclusion: Serial application of GT and SMR to the PM did not result in increases in PM length or TAM. Regardless of intervention, skin temperature increased following each intervention.

The interaction between pain and movement

Article

Jul 2018
J HAND THER

Study design: Clinical commentary. Introduction/purpose: Pain and movement are universally relevant phenomena that influence human experiences in readily observable ways. Improved understanding of pain-movement relationships can guide medical and rehabilitative approaches to recovery and decrease risk of dysfunctional long-term consequences of otherwise normal neuromuscular responses. Therefore, the overall intent of this article is to elucidate the relationships between pain and movement as they relate to clinical decision making. Conclusions: Motor output is highly adaptable, can be influenced by multiple mechanisms at various levels along the nervous system, and may vary between individuals despite similar diagnoses. Therefore, interventions need to be individualized and consider both the types of motor response observed (ie, whether the response is protective or maladaptive), and the patient's acute physical activity tolerance when prescribing exercise/movement.

Reliability of measuring pectoralis minor muscle resting length in subjects with and without signs of shoulder impingement

Article

Full-text available

Mar 2016

Background: Pectoralis minor adaptive shortening may change scapula resting position and scapular kinematics during arm elevation. A reliable and clinically feasible method for measuring pectoralis minor length will be useful for clinical decision making when evaluating and treating individuals with shoulder pain and dysfunction. Objectives: To evaluate intrarater, interrater, and between-day reliability of a pectoralis minor (PM) muscle length measurement in subjects with and without signs of shoulder impingement. Method: A convenience sample of 100 individuals (50 asymptomatic and 50 symptomatic) participated in this study. Intra- and interrater reliability of the measurement was estimated in 50 individuals (25 asymptomatic and 25 symptomatic), and between-day reliability of the measurement repeated over an interval of 7 days was estimated in an independent sample of 50 additional participants. Pectoralis minor length was measured using a flexible tape measure with subjects standing. Results: Intraclass correlation coefficients (ICC3,k) for intrarater and interrater reliability ranged from 0.86-0.97 and 0.95 for between-day reliability in both groups. Standard error of measurements (SEM) ranged from 0.30-0.42 cm, 0.70-0.84 cm, and 0.40-0.41 cm for intrarater, interrater, and between-day reliability, respectively, across the sample. The minimal detectable change (MDC) for between-day measurements ranged from 1.13-1.14 cm for both groups. Conclusions: In asymptomatic individuals and in those with signs of shoulder impingement, a single rater or pair of raters can measure pectoralis minor muscle length using a tape measure with very good reliability. This measurement can also be reliably used by the same rater over a seven day interval.

Effects of Stretching and Strengthening Exercises With and Without Manual Therapy on Scapular Kinematics, Function, and Pain in Individuals With Shoulder Impingement: A Randomized Controlled Trial

Article

Full-text available

Oct 2015
J ORTHOP SPORT PHYS

Study design: Randomized controlled trial. Objective: To evaluate the effects of an exercise protocol, with and without manual therapy, on scapular kinematics, function, pain, and mechanical sensitivity in individuals with shoulder impingement syndrome. Background: Stretching and strengthening exercises have been shown to effectively decrease pain and disability in individuals with shoulder impingement syndrome. There is still conflicting evidence regarding the efficacy of adding manual therapy to an exercise therapy regimen. Methods: Forty-six patients were assigned to 1 of 2 groups, one of which received a 4-week intervention of stretching and strengthening exercises (exercise alone) and the other the same intervention, supplemented by manual therapy targeting the shoulder and cervical spine (exercise plus manual therapy). All outcomes were measured preintervention and postintervention at 4 weeks. Outcome measures were scapular kinematics in the scapular and sagittal planes during arm elevation, function as determined through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, pain as assessed with a visual analog scale, and mechanical sensitivity as assessed with pressure pain threshold. Results: Independent of the intervention group, small, clinically irrelevant changes in scapular kinematics were observed postintervention. A significant group-by-time interaction effect (P = .001) was found for scapular anterior tilt during elevation in the sagittal plane, with a 3.0° increase (95% confidence interval [CI]: -1.5°, 7.5°) relative to baseline in the exercise-plus-manual therapy group compared to a decrease of 0.3° (95% CI: -4.2°, 4.8°) in the exercise-alone group. Pain, mechanical sensitivity, and the DASH score improved similarly for both groups by the end of the intervention period. Conclusion: Adding manual therapy to an exercise protocol did not enhance improvements in scapular kinematics, function, and pain in individuals with shoulder impingement syndrome. The noted improvements in pain and function are not likely explained by changes in scapular kinematics.

Comparison of scapular posterior tilting exercise alone and scapular posterior tilting exercise after pectoralis minor stretching on scapular alignment and scapular upward rotators activity in subjects with short pectoralis minor

Article

Full-text available

Jan 2015

To compare scapular posterior tilting exercise alone and scapular posterior tilting exercise after pectoralis minor (PM) stretching on the PM index (PMI), scapular anterior tilting index, scapular upward rotation angle, and scapular upward rotators' activity in subjects with a short PM. Fifteen subjects with a short PM participated in this study. The PMI, scapular anterior tilting index, and scapular upward rotation angle were measured after scapular posterior tilting exercise alone and scapular posterior tilting exercise after PM stretches. Scapular upward rotators' activities were collected during scapular posterior tilting exercise alone and scapular posterior tilting exercise after PM stretches. The PMI and scapular upward rotation angle, as well as the activity of the upper trapezius, lower trapezius, and serratus anterior muscles, were significantly greater for scapular posterior tilting exercise after PM stretching and the scapular anterior tilting index was significantly lower for scapular posterior tilting exercise after PM stretching than the scapular posterior tilting exercise alone. Scapular posterior tilting exercise after PM stretching in subjects with a short PM could be an effective method of modifying scapular alignment and scapular upward rotator activity. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Effects of Scapular Mobilization in Patients With Subacromial Impingement Syndrome: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Article

Full-text available

Jul 2014

To determine the effects of scapular mobilization on function, pain, range of motion, and satisfaction in patients with subacromial impingement syndrome (SAIS). Randomized, double-blind, placebo-controlled clinical trial. University hospital clinics in Turkey. 66 participants (mean ± SD age 52.06 ± 3.71 y) with SAIS. Participants were randomized into 3 groups: scapular mobilization, sham scapular mobilization, and supervised exercise. Before the interventions transcutaneous electrical stimulation and hot pack were applied to all groups. Total intervention duration for all groups was 3 wk with a total of 9 treatment sessions. Shoulder function and pain intensity were primary outcome measures; range of motion and participant satisfaction were secondary outcome measures. Shoulder function was assessed with the short form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH). A visual analog scale was used to evaluate pain severity. Active range of motion was measured with a universal goniometer. A 7-point Likert scale was used to evaluate satisfaction. Outcome measurements were performed at baseline, before visits 5 and 10, 4 wk after visit 9, and 8 wk after visit 9. There was no group difference for DASH score (P = .75), pain at rest (P = .41), pain with activity (P = .45), pain at night (P = .74), and shoulder flexion (P = .65), external rotation (P = .63), and internal rotation (P = .19). There was a significant increase in shoulder motion and function and a significant decrease in pain across time when all groups were combined (P  .001). The level of satisfaction was not significantly different for any of the questions about participant satisfaction between all groups (P > .05). There was not a significant advantage of scapular mobilization for shoulder function, pain, range of motion, and satisfaction compared with sham or supervised-exercise groups in patients with SAIS.

Scapular Kinematics Pre- and Post-Thoracic Thrust Manipulation in Individuals With and Without Shoulder Impingement Symptoms: A Randomized Controlled Study

Article

Full-text available

May 2014

Study design: Randomized controlled trial with immediate follow-up. Objectives: To evaluate the immediate effects of a low-amplitude, high-velocity thrust thoracic spine manipulation (TSM) on pain and scapular kinematics during elevation and lowering of the arm in individuals with shoulder impingement syndrome (SIS). The secondary objective was to evaluate the immediate effects of TSM on scapular kinematics during elevation and lowering of the arm in individuals without symptoms. Background: Considering the regional interdependence among the shoulder and the thoracic and cervical spines, TSM may improve pain and function in individuals with SIS. Comparing individuals with SIS to those without shoulder pathology may provide information on the effects of TSM specifically in those with SIS. Methods: Fifty subjects (mean ± SD age, 31.8 ± 10.9 years) with SIS and 47 subjects (age, 25.8 ± 5.0 years) asymptomatic for shoulder dysfunction were randomly assigned to 1 of 2 interventions: TSM or a sham intervention. Scapular kinematics were analyzed during elevation and lowering of the arm in the sagittal plane, and a numeric pain rating scale was used to assess shoulder pain during arm movement at preintervention and postintervention. Results: For those in the SIS group, shoulder pain was reduced immediately after TSM and the sham intervention (mean ± SD preintervention, 2.9 ± 2.5; postintervention, 2.3 ± 2.5; P<.01; moderate effect size [Cohen d = 0.2]). Scapular internal rotation increased 0.5° ± 0.02° (P = .04; small effect size [Cohen d<0.1]) during elevation of the arm after TSM and sham intervention in the SIS group only. Subjects with and without SIS who received TSM and asymptomatic subjects who received the sham intervention had a significant increase (1.6° ± 2.7°) in scapular upward rotation postintervention (P<.05; small effect size [Cohen d<0.2]), which was not considered clinically significant. Scapular anterior tilt increased 1.0° ± 4.8° during elevation and lowering of the arm postmanipulation (P<.05; small effect size [Cohen d<0.2]) in the asymptomatic subjects who received TSM. Conclusion: Shoulder pain in individuals with SIS immediately decreased after a TSM. The observed changes in scapular kinematics following TSM were not considered clinically important. Level of evidence: Therapy, level 4. J Orthop Sports Phys Ther 2014;44(7):475-487. Epub 22 May 2014. doi:10.2519/jospt.2014.4760.

Interrater and intrarater reliability of the pectoralis minor muscle length measurement in subjects with and without shoulder impingement symptoms

Article

Full-text available

Apr 2014

Measuring the pectoralis minor muscle length (PML) is of clinical interest, as a short PML has been associated with a decrease of scapular posterior tilting and shoulder pain. However, as no reliability data are available at present, the objective of this study was to examine the inter- and intrarater reliability of the PML measurement in both subjects with and without shoulder impingement symptoms (SIS). Therefore, two assessors performed the PML measurement (3 times/shoulder) in 25 patients with SIS and 25 pain-free controls. Both assessors were blinded for each other's findings. For reliability testing, intra-class coefficients (ICCs; model 2,1) and standard errors of measurements were calculated. Intrarater reliability analysis resulted with ICCs ranging from 0.87 (Standard error of measurement (SEM) 0.21-0.27%) (symptomatic) to 0.93 (SEM 0.19-0.30%) (asymptomatic) in patients with SIS, representing excellent test-retest agreement. Healthy subjects presented with ICCs ranging from 0.76 (SEM 0.29-0.32%) (dominant side) to 0.87 (SEM 0.21-0.32%) (non-dominant side), representing good test-retest agreement. ICCs and SEMs on the symptomatic and asymptomatic side (0.48 and 0.46%; 0.56 and 0.61%) in SIS patients, and on the two sides (non-dominant; 0.47 and 0.45%, dominant; 0.53 and 0.38% respectively) in healthy subjects showed moderate interrater reliability and low dispersion of the measurement errors. We concluded that the PML measurement has good to excellent intrarater reliability and poor to moderate interrater reliability.

Reliability and Minimal Detectable Change of 3D Scapular Orientation in Subjects With and Without Shoulder Impingement.

Article

Full-text available

Mar 2014
J ORTHOP SPORT PHYS

Study design: Clinical measurement. Objective: To establish trial-to-trial within-day and between-day reliability, standard error of measurement, and minimal detectable change of scapular orientation during elevation and lowering of the arm, and with the arm relaxed at the side, in individuals with and without shoulder impingement. Background: Electromagnetic devices are commonly used to measure 3-D scapular kinematics during arm elevation in different conditions and for intervention studies. However, there is a lack of studies that evaluate within- and between-day reliability of these measurements. Methods: The subjects were allocated to either a control group or an impingement group. Kinematic data were collected using the Flock of Birds electromagnetic device during elevation and lowering of the arm in the sagittal plane on 2 different occasions, separated by 3 to 5 days. Forty-nine subjects were tested for within-day reliability. Forty-three subjects were reassessed for between-day reliability. Results: Intraclass correlation coefficients for within- and between-day assessment of scapular orientation during elevation and lowering of the arm in both groups ranged from 0.92 to 0.99 and from 0.54 to 0.88, respectively. Intraclass correlation coefficients for assessment of scapular orientation with the arms relaxed at the side in both groups ranged from 0.66 to 0.95. The standard error of measurement for between-day measurements ranged from 3.37° to 7.44° for both groups. The minimal detectable change for between-day measurements increased from 7.81° at the lower to 17.27° at the higher humerothoracic elevation angles. Conclusion: These results support the use of Flock of Birds to measure scapular orientations in subjects with and without impingement symptoms. The measurements showed excellent within-day reliability but were not highly reliable over time.

Minimal Clinically Important Difference of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH) and Its Shortened Version (QuickDASH)

Article

Full-text available

Oct 2013
J ORTHOP SPORT PHYS

Study design: Prospective, single-group observational design. Objectives: To determine the minimal clinically important difference (MCID) for the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure and its shortened version (QuickDASH) in patients with upper-limb musculoskeletal disorders, using a triangulation of distribution- and anchor-based approaches. Background: Meaningful threshold change values of outcome tools are crucial for the clinical decision-making process. Methods: The DASH and QuickDASH were administered to 255 patients (mean ± SD age, 49 ± 15 years; 156 women) before and after a physical therapy program. The external anchor administered after the program was a 7-point global rating of change scale. Results: The test-retest reliability of the DASH and QuickDASH was high (intraclass correlation coefficient model 2,1 = 0.93 and 0.91, respectively; n = 30). The minimum detectable change at the 90% confidence level was 10.81 points for the DASH and 12.85 points for the QuickDASH. After triangulation of these results with those of the mean-change approach and receiver-operating-characteristic-curve analysis, the following MCID values were selected: 10.83 points for the DASH (sensitivity, 82%; specificity, 74%) and 15.91 points for the QuickDASH (sensitivity, 79%; specificity, 75%). After treatment, the MCID threshold was reached/surpassed by 61% of subjects using the DASH and 57% using the QuickDASH. Conclusion: The MCID values from this study for the DASH (10.83 points) and the QuickDASH (15.91 points) could represent the lower boundary for a range of MCID values (reasonably useful for different populations and contextual characteristics). The upper boundary may be represented by the 15 points for the DASH and 20 points for the QuickDASH proposed by the DASH website.

Non-traumatic arm, neck and shoulder complaints: Prevalence, course and prognosis in a Dutch university population

Article

Full-text available

Jan 2013
BMC MUSCULOSKEL DIS

Background Complaints of arm, neck and shoulder are a major health problem in Western societies and a huge economic burden due to sickness absence and health-care costs. In 2003 the 12-month prevalence’s in the Netherlands were estimated at 31.4% for neck pain, 30.3% for shoulder pain, and 17.5% for wrist and hand pain. Research data suggest that these complaints are increasingly common among university students. The aims of the present study are to provide insight into the prevalence of complaints of arm, neck or shoulder in a university population, to evaluate the clinical course of these complaints and to identify prognostic factors which influence this course. Methods The present study is designed as a prospective cohort study, in which a cross-sectional survey is embedded. A self-administered cross-sectional survey will be conducted to gain insight into the prevalence of complaints of arm, neck or shoulder among university students and staff, and to identify persons who are eligible for follow up in the prognostic cohort study. Patients with a new complaint of pain and discomfort in neck and upper extremities between 18–65 years will be asked to participate in the prognostic cohort study. At baseline, after 6, 12, 26 and 52 weeks individual patient data will be collected by means of digitized self-administered questionnaires. The following putative prognostic determinants will be investigated: socio-demographic factors, work-related factors, complaint characteristics, physical activity and psychosocial factors. The primary outcome is subjective recovery. Secondary outcomes are functional limitations of the arm, neck, shoulder and hand, and complaint severity during the previous week. Discussion To our knowledge, this is the first prognostic study on the course of complaints of arm, neck or shoulder that is conducted within a university population. Moreover, there are hardly any studies that have estimated the prevalence of these complaints among university students. The results of this study can be used for patient education and management decisions, as well as for the development of interventions. Moreover, identification of high risk groups in the population is needed to generate hypotheses or explanations of health differences and for the design of prevention programs.

Scapular-focused treatment in patients with shoulder impingement syndrome: A randomized clinical trial

Article

Full-text available

Oct 2012
CLIN RHEUMATOL

The purpose of this clinical trial is to compare the effectiveness of a scapular-focused treatment with a control therapy in patients with shoulder impingement syndrome. Therefore, a randomized clinical trial with a blinded assessor was used in 22 patients with shoulder impingement syndrome. The primary outcome measures included self-reported shoulder disability and pain. Next, patients were evaluated regarding scapular positioning and shoulder muscle strength. The scapular-focused treatment included stretching and scapular motor control training. The control therapy included stretching, muscle friction, and eccentric rotator cuff training. Main outcome measures were the shoulder disability questionnaire, diagnostic tests for shoulder impingement syndrome, clinical tests for scapular positioning, shoulder pain (visual analog scale; VAS), and muscle strength. A large clinically important treatment effect in favor of scapular motor control training was found in self-reported disability (Cohen's d = 0.93, p = 0.025), and a moderate to large clinically important improvement in pain during the Neer test, Hawkins test, and empty can test (Cohen's d 0.76, 1.04, and 0.92, respectively). In addition, the experimental group demonstrated a moderate (Cohen's d = 0.67) improvement in self-experienced pain at rest (VAS), whereas the control group did not change. The effects were maintained at three months follow-up.

Motor control retraining exercises for shoulder impingement: Effects on function, muscle activation, and biomechanics in young adults

Article

Full-text available

Sep 2012

Objective: Evidence for effective management of shoulder impingement is limited. The present study aimed to quantify the clinical, neurophysiological, and biomechanical effects of a scapular motor control retraining for young individuals with shoulder impingement signs. Method: Sixteen adults with shoulder impingement signs (mean age 22 ± 1.6 years) underwent the intervention and 16 healthy participants (24.8 ± 3.1years) provided reference data. Shoulder function and pain were assessed using the Shoulder Pain and Disability Index (SPADI) and other questionnaires. Electromyography (EMG) and 3-dimensional motion analysis was used to record muscle activation and kinematic data during arm elevation to 90° and lowering in 3 planes. Patients were assessed pre and post a 10-week motor control based intervention, utilizing scapular orientation retraining. Results: Pre-intervention, patients reported pain and reduced function compared to the healthy participants (SPADI in patients 20 ± 9.2; healthy 0 ± 0). Post-intervention, the SPADI scores reduced significantly (P < .001) by a mean of 10 points (±4). EMG showed delayed onset and early termination of serratus anterior and lower trapezius muscle activity pre-intervention, which improved significantly post-intervention (P < .05). Pre-intervention, patients exhibited on average 4.6-7.4° less posterior tilt, which was significantly lower in 2 arm elevation planes (P < .05) than healthy participants. Post-intervention, upward rotation and posterior tilt increased significantly (P < .05) during 2 arm movements, approaching the healthy values. Conclusion: A 10-week motor control intervention for shoulder impingement increased function and reduced pain. Recovery mechanisms were indicated by changes in muscle recruitment and scapular kinematics. The efficacy of the intervention requires further examined in a randomized control trial.

Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests

Article

Full-text available

Jul 2012
BRIT J SPORT MED

To update our previously published systematic review and meta-analysis by subjecting the literature on shoulder physical examination (ShPE) to careful analysis in order to determine each tests clinical utility. This review is an update of previous work, therefore the terms in the Medline and CINAHL search strategies remained the same with the exception that the search was confined to the dates November, 2006 through to February, 2012. The previous study dates were 1966 - October, 2006. Further, the original search was expanded, without date restrictions, to include two new databases: EMBASE and the Cochrane Library. The Quality Assessment of Diagnostic Accuracy Studies, version 2 (QUADAS 2) tool was used to critique the quality of each new paper. Where appropriate, data from the prior review and this review were combined to perform meta-analysis using the updated hierarchical summary receiver operating characteristic and bivariate models. Since the publication of the 2008 review, 32 additional studies were identified and critiqued. For subacromial impingement, the meta-analysis revealed that the pooled sensitivity and specificity for the Neer test was 72% and 60%, respectively, for the Hawkins-Kennedy test was 79% and 59%, respectively, and for the painful arc was 53% and 76%, respectively. Also from the meta-analysis, regarding superior labral anterior to posterior (SLAP) tears, the test with the best sensitivity (52%) was the relocation test; the test with the best specificity (95%) was Yergason's test; and the test with the best positive likelihood ratio (2.81) was the compression-rotation test. Regarding new (to this series of reviews) ShPE tests, where meta-analysis was not possible because of lack of sufficient studies or heterogeneity between studies, there are some individual tests that warrant further investigation. A highly specific test (specificity >80%, LR+ ≥ 5.0) from a low bias study is the passive distraction test for a SLAP lesion. This test may rule in a SLAP lesion when positive. A sensitive test (sensitivity >80%, LR- ≤ 0.20) of note is the shoulder shrug sign, for stiffness-related disorders (osteoarthritis and adhesive capsulitis) as well as rotator cuff tendinopathy. There are six additional tests with higher sensitivities, specificities, or both but caution is urged since all of these tests have been studied only once and more than one ShPE test (ie, active compression, biceps load II) has been introduced with great diagnostic statistics only to have further research fail to replicate the results of the original authors. The belly-off and modified belly press tests for subscapularis tendinopathy, bony apprehension test for bony instability, olecranon-manubrium percussion test for bony abnormality, passive compression for a SLAP lesion, and the lateral Jobe test for rotator cuff tear give reason for optimism since they demonstrated both high sensitivities and specificities reported in low bias studies. Finally, one additional test was studied in two separate papers. The dynamic labral shear may be sensitive for SLAP lesions but, when modified, be diagnostic of labral tears generally. Based on data from the original 2008 review and this update, the use of any single ShPE test to make a pathognomonic diagnosis cannot be unequivocally recommended. There exist some promising tests but their properties must be confirmed in more than one study. Combinations of ShPE tests provide better accuracy, but marginally so. These findings seem to provide support for stressing a comprehensive clinical examination including history and physical examination. However, there is a great need for large, prospective, well-designed studies that examine the diagnostic accuracy of the many aspects of the clinical examination and what combinations of these aspects are useful in differentially diagnosing pathologies of the shoulder.

Development of an upper extremity outcome measure: The DASH (Disabilities of the Arm, Shoulder, and Hand)

Article

Full-text available

Jun 1996
AM J IND MED

This paper describes the development of an evaluative outcome measure for patients with upper extremity musculoskeletal conditions. The goal is to produce a brief, self-administered measure of symptoms and functional status, with a focus on physical function, to be used by clinicians in daily practice and as a research tool. This is a joint initiative of the American Academy of Orthopedic Surgeons (AAOS), the Council of Musculoskeletal Specialty Societies (COMSS), and the Institute for Work and Health (Toronto, Ontario).Our approach is consistent with previously described strategies for scale development. In Stage 1, Item Generation, a group of methodologists and clinical experts reviewed 13 outcome measurement scales currently in use and generated a list of 821 items. In Stage 2a, Initial Item Reduction, these 821 items were reduced to 78 items using various strategies including removal of items which were generic, repetitive, not reflective of disability, or not relevant to the upper extremity or to one of the targeted concepts of symptoms and functional status. Items not highly endorsed in a survey of content experts were also eliminated. Stage 2b, Further Item Reduction, will be based on results of field testing in which patients complete the 78-item questionnaire. This field testing, which is currently underway in 20 centers in the United States, Canada, and Australia, will generate the final format and content of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Future work includes plants for validity and reliability testing. © 1996 Wiley-Liss, Inc.

Eccentric training for shoulder abductors improves pain, function and isokinetic performance in subjects with shoulder impingement syndrome-a case series

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Full-text available

Feb 2012

Conservative treatments have been proposed for people with shoulder impingement syndrome (SIS), such as strengthening of the rotator cuff and scapular muscles and stretching of the soft tissues of the shoulder. However, there is a lack of studies analyzing the effectiveness of eccentric training in the treatment of SIS. To evaluate the effects of eccentric training for shoulder abductors on pain, function, and isokinetic performance during concentric and eccentric abduction of the shoulder in subjects with SIS. Twenty subjects (7 females, 34.2 SD 10.2 years, 1.7 SD 0.1 m, 78.0 SD 16.3 kg) with unilateral SIS completed the study protocol. Bilateral isokinetic eccentric training at 60º/s for shoulder abductors was performed for six consecutive weeks, twice a week, on alternate days. For each training day, three sets of 10 repetitions were performed with a 3-minute rest period between the sets for each side. The range of motion trained was 60° (ranging from 80° to 20°). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate functional status and symptoms of the upper limbs. Peak torque, total work and acceleration time were measured during concentric and eccentric abduction of the arm at 60º/s and 180º/s using an isokinetic dynamometer. DASH scores, peak torque, total work and acceleration time improved (p<0.05) after the period of intervention. This study suggests that isokinetic eccentric training for shoulder abductors improves physical function of the upper limbs in subjects with SIS.

Current concepts in muscle stretching for exercise and rehabilitation

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Full-text available

Feb 2012
Int J Sports Phys Ther

Phil Page

Stretching is a common activity used by athletes, older adults, rehabilitation patients, and anyone participating in a fitness program. While the benefits of stretching are known, controversy remains about the best type of stretching for a particular goal or outcome. The purpose of this clinical commentary is to discuss the current concepts of muscle stretching interventions and summarize the evidence related to stretching as used in both exercise and rehabilitation.

Comprehensive Impairment-Based Exercise and Manual Therapy Intervention for Patients With Subacromial Impingement Syndrome: A Case Series

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Full-text available

Aug 2010

Case series. Few studies have defined the dosage and specific techniques of manual therapy and exercise for rehabilitation for patients with subacromial impingement syndrome. This case series describes a standardized treatment program for subacromial impingement syndrome and the time course and outcomes over a 12-week period. Ten patients (age range, 19-70 years) with subacromial impingement syndrome defined by inclusion and exclusion criteria were treated with a standardized protocol for 10 visits over 6 to 8 weeks. The protocol included a 3-phase progressive strengthening program, manual stretching, thrust and nonthrust manipulation to the shoulder and spine, patient education, activity modification, and a daily home exercise program of stretching and strengthening. Patients completed a history and measures of impairments and functional disability at 2, 4, 6, and 12 weeks. Treatment success was defined as both a 50% improvement on the Disabilities of the Arm, Shoulder, and Hand (DASH) score and a global rating of change of at least "moderately better." At 6 weeks, 6 of 10 patients had a successful (mean +/- SD) DASH outcome score (initial, 33.9 +/- 16.2; 6 weeks, 8.1 +/- 9.2). At 12 weeks, 8 of 10 patients had a successful DASH outcome score (initial, 33.1 +/- 14; 12 weeks, 8.3 +/- 6.4). As a group, the largest improvement was in the first 2 weeks. The most common impairments for all 10 patients were rotator cuff and trapezius muscle weakness (10 of 10 patients), limited shoulder internal rotation motion (8 of 10 patients), and reduced kyphosis of the midthoracic area (7 of 10 patients). A program aimed at strengthening rotator cuff and scapular muscles, with stretching and manual therapy aimed at thoracic spine and the posterior and inferior soft-tissue structures of the glenohumeral joint appeared to be successful in the majority of patients. This case series describes a comprehensive impairment-based treatment which resulted in symptomatic and functional improvement in 8 of 10 patients in 6 to 12 weeks. Therapy, level 4.

Descriptive profile of scapulothoracic position, strength and flexibility variables in adolescent elite tennis players

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Full-text available

Jul 2010
BRIT J SPORT MED

Descriptive study, cross-sectional design. Tennis requires repetitive overhead movement patterns that can lead to upper extremity injury. The scapula plays a vital role in injury-free playing. Scapular dysfunction has been associated with shoulder injury in the overhead athlete. The purpose of this study was to describe variables regarding scapular position, muscle strength and flexibility in young elite tennis players. Thirty-five adolescent Swedish elite tennis players (19 boys, aged 13.6 (+/-1.4) years, 16 girls, aged 12.6 (+/-1.3) years), selected on the basis of their national ranking, underwent a clinical screening protocol consisting of: scapular upward rotation at several angles of arm elevation; isometric scapular muscle strength; and anthropometric measurement of pectoralis minor (PM) length. The players showed significantly more scapular upward rotation on their dominant side (p<0.001). For both genders, upper trapezius (p=0.003) and serratus anterior (p=0.01) strength was significantly greater on the dominant side, whereas middle and lower trapezius strength showed no side differences. PM was shorter on the dominant side (p<0.001), and in the female players (p=0.006) compared with the boys. These results indicate some sports-related adaptations of young tennis players on their dominant side at the scapulothoracic level to exposure to their sport. These data may assist the clinician in the prevention and rehabilitation of sport-specific injuries in adolescent tennis players.

Scapular and rotator cuff muscle activity during arm elevation: A review of normal function and alterations with shoulder impingement

Article

Full-text available

Feb 2009

OBJECTIVE: The purpose of this manuscript is to review current knowledge of how muscle activation and force production contribute to shoulder kinematics in healthy subjects and persons with shoulder impingement. RESULTS: The middle and lower serratus anterior muscles produce scapular upward rotation, posterior tilting, and external rotation. Upper trapezius produces clavicular elevation and retraction. The middle trapezius is primarily a medial stabilizer of the scapula. The lower trapezius assists in medial stabilization and upward rotation of the scapula. The pectoralis minor is aligned to resist normal rotations of the scapula during arm elevation. The rotator cuff is critical to stabilization and prevention of excess superior translation of the humeral head, as well as production of glenohumeral external rotation during arm elevation. Alterations in activation amplitude or timing have been identified across various investigations of subjects with shoulder impingement as compared to healthy controls. These include decreased activation of the middle or lower serratus anterior and rotator cuff, delayed activation of middle and lower trapezius, and increased activation of the upper trapezius and middle deltoid in impingement subjects. In addition, subjects with a short resting length of the pectoralis minor exhibit altered scapular kinematic patterns similar to those found in persons with shoulder impingement. CONCLUSION: These normal muscle functional capabilities and alterations in patient populations should be considered when planning exercise approaches for the rehabilitation of these patients.

To stretch or not to stretch: The role of stretching in injury prevention and performance

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Full-text available

Apr 2010
SCAND J MED SCI SPOR

Stretching is commonly practiced before sports participation; however, effects on subsequent performance and injury prevention are not well understood. There is an abundance of literature demonstrating that a single bout of stretching acutely impairs muscle strength, with a lesser effect on power. The extent to which these effects are apparent when stretching is combined with other aspects of a pre-participation warm-up, such as practice drills and low intensity dynamic exercises, is not known. With respect to the effect of pre-participation stretching on injury prevention a limited number of studies of varying quality have shown mixed results. A general consensus is that stretching in addition to warm-up does not affect the incidence of overuse injuries. There is evidence that pre-participation stretching reduces the incidence of muscle strains but there is clearly a need for further work. Future prospective randomized studies should use stretching interventions that are effective at decreasing passive resistance to stretch and assess effects on subsequent injury incidence in sports with a high prevalence of muscle strains.

Effects of strengthening and stretching exercises applied during working hours on pain and physical impairment in workers with subacromial impingement syndrome

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Full-text available

Oct 2009

Effects of a stretching protocol for the pectoralis minor on muscle length, function, and scapular kinematics in individuals with and without shoulder pain

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