Grade-IV inferior glenohumeral mobilization does not immediately alter shoulder and scapular muscle activity: a repeated-measures study in asymptomatic individuals

Dosage of joint mobilization for the management of patients with rotator cuff-related shoulder pain: A scoping review

BACKGROUND

Evidence supporting type and dosage of joint mobilizations and rationale for selecting joint mobilization dosage for patients with rotator cuff-related shoulder pain are limited.

OBJECTIVES

This scoping review aimed to systematically map the type and dosage of joint mobilizations used in previous trials for managing patients with rotator cuff-related shoulder pain; and summarize the rationale for adopting a specific joint mobilization dosage.

METHODS

We searched six databases. We included randomised controlled trials using joint mobilization for patients with rotator cuff-related shoulder pain. We extracted data regarding technique, treatment joint mobilization dosages and rationale for a specific dosage.

RESULTS

We included 32 studies. Most studies did not or partially report technique (67%) and within-session dosage (64%) of passive joint mobilization. Overall treatment was fully reported in 95% of studies. The dosage used for passive joint mobilization was heterogeneous (ranging from grade I to grade V). Most studies (85%) did not or partially report technique of mobilization with movement (MWM), whereas within-session and overall treatment dosages were fully reported in more than 85% of studies. Three sets of 10 repetitions were commonly used within-session dosage for MWM. We found very limited information on the rationale for selecting dosage of joint mobilization.

CONCLUSION

We found limited information about the dosage or the rationale for selecting joint mobilization, with a heterogeneous dosage being tested across trials. Our findings highlight the importance of detailed reporting for dosage and rationale for selecting a specific dosage of joint mobilization.

Application of statistical parametric mapping for comparison of scapular kinematics and EMG

Scapular kinematics and EMG are frequently measured as a functional assessment of the shoulder. Previous studies have compared interval averaging for these time series data, but it is not clear whether this method exactly captures the dynamics of scapular kinematics and muscle activity. Statistical parametric mapping (SPM) can be used to compare time series data. The purpose of this study was to investigate whether there is a difference between the results of SPM and interval averaging (every 10° or 30°) in comparing scapular kinematics, EMG, and EMG ratio. Scapular kinematics and EMG of the upper trapezius (UT), middle trapezius (MT), and lower trapezius (LT) and serratus anterior (SA) were measured in 21 healthy males. Tasks included arm raising and lowering with or without load, and we compared scapular kinematics, EMG, and EMG ratio in the loaded and unloaded conditions. Results suggest disagreement between SPM and interval averaging. Characteristic results are that for scapular kinematics during lowering SPM showed a decrease in upward rotation in only the regions 113-65° and 42-30°, while interval averaging showed a decrease in all range. For EMG during lowering, SPM results were not significantly different in SA over 50-48 and 45-30°, while interval averaging suggested increased activity in all ranges. For EMG ratio during raising, SPM showed no significant difference, while interval averaging showed a decrease in UT/LT during the latter period. These results indicate that SPM provides better resolution regarding effect regions than interval averaging, and suggest that SPM may improve shoulder function assessment accuracy.

Dosage of joint mobilisation for the management of rotator cuff-related shoulder pain: protocol for a scoping review

INTRODUCTION

Rotator cuff-related shoulder pain is the most common diagnosis of shoulder pain, which ranks as the third most common musculoskeletal disorder. The first-line treatment for patients with rotator cuff-related shoulder pain is physiotherapy, and joint mobilisation is widely used in conjunction with other modalities. The type and dosage of joint mobilisations could influence treatment outcomes for patients with rotator cuff-related shoulder pain, although research evidence is inconclusive.

OBJECTIVES

To (1) systematically search, identify and map the reported type and dosage of joint mobilisations used in previous studies for the management of patients with rotator cuff-related shoulder pain; and (2) summarise the rationale for adopting a specific joint mobilisation dosage.

METHODS AND ANALYSIS

We will follow the methodological framework outlined by Arksey and O'Malley and report the results as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline. Two authors will independently screen and extract data from the six databases: PubMed, Scopus, Web of Science, CINAHL, Cochrane Library and SPORTDiscus, with publication date from their inceptions to 25 August 2021. A third author will be consulted if the two authors disagree about the inclusion of any study in the review. We will summarise the results using descriptive statistics and qualitative thematic analysis.

ETHICS AND DISSEMINATION

Ethical approval is not required for this protocol. Mapping and summarising the reported type and dosage of joint mobilisations for patients with rotator cuff-related shoulder pain from previous studies will provide a foundation for further optimal selection of type and dosage of joint mobilisations for treating patients with rotator cuff-related shoulder pain. The review is part of an ongoing research that focuses on joint mobilisation for patients with rotator cuff-related shoulder pain. The results will be disseminated through presentations at academic conferences and a peer-reviewed publication.

The Effect of Shoulder Mobilization on Scapular and Shoulder Muscle Activity During Resisted Shoulder Abduction: A Crossover Study of Asymptomatic Individuals

OBJECTIVE

The primary aim was to investigate the effect of inferior shoulder mobilization on scapular and shoulder muscle activity during resisted shoulder abduction in asymptomatic individuals.

METHODS

This was a lab-based, repeated-measures, crossover, randomized controlled study. Twenty-two participants were recruited. The order of experimental conditions was randomized. Each participant performed 5 repetitions of resisted shoulder abduction before and after the control and mobilization (grade +IV inferior shoulder mobilization, 3 sets, 60 seconds) conditions. Surface electromyography recorded the muscle activity of anterior, middle, and posterior deltoid; supraspinatus; infraspinatus; upper and lower trapezius; serratus anterior; and latissimus dorsi muscles.

RESULTS

Muscle activity levels reduced for infraspinatus (11.3% MVIC, 95% CI: 1.7-20.8), middle (22.4% MVIC, 95% CI: 15.9-28.8) and posterior deltoid (8.7 % MVIC, 95% CI: 4.6-12.9), and serratus anterior (-28.1% MVIC, 95% CI: 15.6-40.8) muscles after the mobilization condition during the eccentric phase of shoulder abduction. No carryover effects were observed, and within-session reliability was excellent (intraclass correlation coefficient scores ranging from 0.94 to 0.99).

CONCLUSION

Our findings suggest that inferior glenohumeral mobilization reduces activity levels of some scapular and shoulder muscles. Given the exploratory nature of our study, changes in muscle activity levels may have been found by chance. Confirmatory studies are required.

The immediate effects of passive joint mobilisation on local muscle function. A systematic review of the literature

BACKGROUND

Passive joint mobilisation is popular among healthcare providers and their patients; however, its effectiveness for improving muscle function is not well researched and the mechanisms of action involved are unclear.

OBJECTIVES

To assess the effect of passive joint mobilisations on the function of muscles surrounding the targeted joints in symptomatic as well as asymptomatic individuals.

SELECTION CRITERIA

Controlled experimental trials assessing the immediate effect of passive joint mobilisation on outcomes associated with local muscle function.

DATA COLLECTION

Two authors independently assessed trial quality and extracted data.

MAIN RESULTS

A total of seventeen studies were included, of which ten studies reported data on asymptomatic individuals and seven studies reported data on symptomatic individuals with various conditions. There is a moderate level of evidence that joint mobilisation immediately decreases the activation of superficial muscles during low load conditions in symptomatic individuals. For asymptomatic individuals, there is a low level of evidence that passive joint mobilisation improves maximum muscle strength when compared to sham mobilisation, opposed to a very low level of evidence suggesting no effect in symptomatic individuals. The five studies reporting data on both, changes in muscle function as well as changes in pain, suggest that other, not pain-related mechanisms may play an important role regarding the reported improvement in muscle function.

CONCLUSION

Current best evidence suggests that passive joint mobilisation has the ability to immediately alter muscle function. The specific mechanisms of action involved require further basic science investigations. Registration number (PROSPERO): CRD42018117033.