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de Sire A, Demeco A, Frizziero A, Marotta N, Spanò R, Carozzo S, Costantino C, Ammendolia A. Risk of injury and kinematic assessment of the shoulder biomechanics during strokes in padel players: a cross-sectional study. J Sports Med Phys Fitness 2024; 64:383-391. [PMID: 37955931 DOI: 10.23736/s0022-4707.23.15418-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Padel players commonly suffer from shoulder pain and the particularly high incidence is probably linked to the high frequency of strokes. In addition, due to the repetitive technical gesture, an adequate technique is essential in terms of performance and injury risk prevention. Aim of this study was to objectively evaluate shoulder kinematic during the athletic gesture to analyze the risk factors linked to padel strokes. METHODS Professional and amateur padel players underwent a three-dimensional motion analysis of the padel strokes utilizing optoelectronic and surface electromyography systems (BTS Bioengineering, Garbagnate Milanese, Milan, Italy). RESULTS Twelve padel players were included in this study (10 professional players in Group A and 10 amateurs in Group B). Experience influences the execution of padel strokes with a significant difference between group A and B in terms of gleno-humeral rotation and scapular tilt. Moreover, a subgroup analysis revealed that male players execute voleè with a higher external rotation (P=0.043), and forehand with a higher scapular tilt (P=0.044). CONCLUSIONS The results confirm that the high ranges of motion of the overhead strokes could rise the risk of slap lesion, impingement, and glenohumeral internal rotation deficit. However, a correct execution of the athletic gesture is linked with a dynamic stabilization of the humeral head. In conclusion, the kinematic analysis could help in the early identification of the kinematic alteration to build a tailored rehabilitation plan based on the athlete's needs.
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Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, The Magna Græcia University of Catanzaro, Catanzaro, Italy
- Research Center on Musculoskeletal Health, The Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Andrea Demeco
- Department of Medicine and Surgery, University of Parma, Parma, Italy -
| | - Antonio Frizziero
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Nicola Marotta
- Research Center on Musculoskeletal Health, The Magna Græcia University of Catanzaro, Catanzaro, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Riccardo Spanò
- Department of Medical and Surgical Sciences, The Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Simone Carozzo
- Department of Experimental and Clinical Medicine, The Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, The Magna Græcia University of Catanzaro, Catanzaro, Italy
- Research Center on Musculoskeletal Health, The Magna Græcia University of Catanzaro, Catanzaro, Italy
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Mackay EJ, Robey NJ, Suprak DN, Buddhadev HH, San Juan JG. The effect of EMG biofeedback training on muscle activation in an impingement population. J Electromyogr Kinesiol 2023; 70:102772. [PMID: 37043978 DOI: 10.1016/j.jelekin.2023.102772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
Subacromial impingement syndrome (SAIS) is one of the most diagnosed causes of pain in the upper extremity. The purpose of this study was to investigate muscle activity between asymptomatic and SAIS shoulders on the same subject while understanding the effectiveness of EMG biofeedback training (EBFB) on bilateral overhead movements. Ten participants (7 male), that tested positive for 2/3 SAIS clinical tests, volunteered for the study. Bilateral muscle activity was measured via electrodes on the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and lumbar paraspinals (LP). Participants performed bilateral scapular plane overhead movements before and after EBFB. EBFB consisted of 10 bilateral repetitions of I, W, T, and Y exercises focused on reducing UT and increasing LT and SA activity. Prior to EBFB, no significant difference in muscle activity was present between sides. A significant main effect of time indicated that after EBFB both sides exhibited reduced UT activity at 60° (p = 0.003) and 90° (p = 0.036), LT activity was increased at all measured humeral angles (p < 0.0005), and SA muscle activity was increased at 110° (p = 0.001). EBFB in conjunction with scapular based exercise effectively alters muscle activity of asymptomatic and symptomatic scapular musculature.
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Affiliation(s)
- Eliot J Mackay
- Department of Health and Human Development, Western Washington University, Bellingham, WA, United States.
| | - Nathan J Robey
- Department of Health and Human Development, Western Washington University, Bellingham, WA, United States
| | - David N Suprak
- Department of Health and Human Development, Western Washington University, Bellingham, WA, United States
| | - Harsh H Buddhadev
- Department of Health and Human Development, Western Washington University, Bellingham, WA, United States
| | - Jun G San Juan
- Department of Health and Human Development, Western Washington University, Bellingham, WA, United States.
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Parel I, Candoli V, Filippi MV, Padolino A, Merolla G, Sanniti S, Galassi R, Paladini P, Cutti AG. Shoulder Rehabilitation Exercises With Kinematic Biofeedback After Arthroscopic Rotator Cuff Repair: Protocol for a New Integrated Rehabilitation Program. JMIR Res Protoc 2023; 12:e35757. [PMID: 36947146 PMCID: PMC10131889 DOI: 10.2196/35757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 07/28/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The recovery of scapular and humeral physiological kinematic parameters, as well as the sensorimotor control of movement, plays a primary role in the rehabilitation process after arthroscopic rotator cuff repair. A highly customized rehabilitation approach is required to achieve this aim. Biofeedback can be a useful tool, but there is poor evidence of its application in the rehabilitation after arthroscopic rotator cuff tear repair. OBJECTIVE The aim of this paper is to outline an innovative exercise-based rehabilitation program exploiting visual biofeedback for the recovery of patients arthroscopically treated for rotator cuff repair. METHODS For establishment of the innovative program, a multidisciplinary team involving experts in shoulder surgery, rehabilitation medicine, physical therapy, and biomedical and clinical engineering was formed. Starting from a conventional rehabilitation program, the team selected a set of exercises to be integrated with a biofeedback tool, named the INAIL (National Institute for Insurance against Accidents at Work) Shoulder and Elbow Outpatient program (ISEO program). ISEO is a motion analysis system based on inertial wearable sensors positioned over the thorax, scapula, humerus, and forearm. ISEO can return a visual biofeedback of humerus and scapula angles over time or of the scapula-humeral coordination, with possible overlap of patient-specific or asymptomatic reference values. A set of 12 progressive exercises was defined, divided into four groups based on humerus and scapula movements. Each group comprises 2-4 of the 12 exercises with an increasing level of complexity. Exercises can require the use of a ball, stick, rubber band, and/or towel. For each exercise, we present the starting position of the patient, the modality of execution, and the target position, together with notes about the critical factors to observe. The type of visual biofeedback to adopt is specified, such as the coordination between angles or the variation of a single angle over time. To guide the therapist in customizing the patient's rehabilitation program, a list of operative guidelines is provided. RESULTS We describe various applications of the ISEO exercise program in terms of frequency and intensity. CONCLUSIONS An innovative rehabilitation program to restore scapular and humeral kinematics after rotator cuff repair based on kinematic biofeedback is presented. Biofeedback is expected to increase patient awareness and self-correction under therapist supervision. Randomized controlled trials are needed to investigate the potential effect of the exercise-based biofeedback in comparison with conventional rehabilitation programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/35757.
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Affiliation(s)
- Ilaria Parel
- Laboratory of Biomechanics, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
- Department of Clinical Engineering, Azienda Unità Sanitaria Locale della Romagna, Cesena, Italy
| | - Valeria Candoli
- Department of Rehabilitation Medicine, Azienda Unità Sanitaria Locale della Romagna, Riccione, Italy
| | - Maria Vittoria Filippi
- Department of Rehabilitation Medicine, Azienda Unità Sanitaria Locale della Romagna, Riccione, Italy
| | - Antonio Padolino
- Laboratory of Biomechanics, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
- Shoulder and Elbow Surgical Unit, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
| | - Giovanni Merolla
- Laboratory of Biomechanics, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
- Shoulder and Elbow Surgical Unit, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
| | - Stefano Sanniti
- Department of Clinical Engineering, Azienda Unità Sanitaria Locale della Romagna, Cesena, Italy
| | - Riccardo Galassi
- Department of Rehabilitation Medicine, Azienda Unità Sanitaria Locale della Romagna, Riccione, Italy
| | - Paolo Paladini
- Laboratory of Biomechanics, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
- Shoulder and Elbow Surgical Unit, Azienda Unità Sanitaria Locale della Romagna, Cattolica, Italy
| | - Andrea Giovanni Cutti
- Laboratory of Motion Analysis, National Institute for Insurance against Accidents at Work Prosthetic Center, Vigorso di Budrio, Italy
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Ben Kibler W, Lockhart JW, Cromwell R, Sciascia A. Managing Scapular Dyskinesis. Phys Med Rehabil Clin N Am 2023; 34:427-451. [PMID: 37003662 DOI: 10.1016/j.pmr.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
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.
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Yu IY, Kang MH. Influence of scapular motion cues on trapezius muscle activity during Y exercise. J Back Musculoskelet Rehabil 2023; 36:1171-1178. [PMID: 37458020 DOI: 10.3233/bmr-220366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND The Y exercise is a therapeutic exercise facilitating lower trapezius muscle activity. OBJECTIVE To identify the effects of scapular movement cues (posterior tilt vs. posterior tilt with adduction/depression) on trapezius muscle activity during Y exercise. METHODS Fifteen healthy men without current shoulder pain performed general Y exercise; Y exercise with cues for scapular posterior tilt; and Y exercise with cues for scapular posterior tilt, adduction, and depression. Electromyography (EMG) data for the trapezius muscles were collected during Y exercise. The posterior tilt angle of the scapula was measured in the prone position with and without cues for scapular posterior tilt using an inclinometer application. RESULTS The greatest lower trapezius muscle activity was observed during Y exercise with cues for scapular posterior tilt, while the greatest EMG activity of the upper trapezius was observed during Y exercise with cues for scapular posterior tilt, adduction, and depression (p< 0.05). Middle trapezius muscle activity did not significantly differ among the three Y exercise conditions (p= 0.175). Cues for scapular posterior tilt significantly increased the scapular posterior tilt angle in the prone shoulder abduction position (p= 0.007). CONCLUSION Cues for scapular posterior tilt were most effective in facilitating lower trapezius muscle activity during Y exercise.
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Affiliation(s)
- Il-Young Yu
- Rehabilitation Center, Dang Dang Korean Medicine Hospital, Changwon, Korea
| | - Min-Hyeok Kang
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Busan, Korea
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Briel S, Olivier B, Mudzi W. Scapular force: Couple ratios in healthy shoulders - An observational study reflecting typical values. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2022; 78:1619. [PMID: 35937095 PMCID: PMC9350558 DOI: 10.4102/sajp.v78i1.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 05/09/2022] [Indexed: 11/01/2022] Open
Abstract
Background Scapular stability is primarily maintained through the action of the scapular stabilisers and not through bony stability. The values of the force couple ratios of the scapular stabilisers remain largely unknown. Objectives To determine typical scapular force couple strength ratios in the pain-free shoulders of healthy female and male participants. Methods This was a quantitative cross-sectional study. The muscle strength of the serratus anterior upper and lower fibres, the upper, middle and lower trapezius and the rhomboids (in both shoulders) were determined in kilogram force (kgf) using a handheld dynamometer. The ratios of the force couples of the scapulae of both shoulders of the participants were calculated. Participants (both female and male) with healthy shoulders were recruited from the general public (a local university, schools, church groups and sport clubs). We mainly utilised descriptive analysis. Statistical significance was set at 5%. Results Force couple ratios were as follows (means, with SD). Dominant arm in women: upper trapezius:lower trapezius 3.63 (0.97); serratus anterior lower fibres:lower trapezius = 1.97 (0.27); middle trapezius:serratus anterior upper fibres = 0.40 (0.10); serratus anterior lower fibres:rhomboids = 1.41 (0.21); lower trapezius:rhomboids = 0.74 (0.17). Dominant arm in men: upper trapezius:lower trapezius = 2.70 (0.72); serratus anterior lower fibres:lower trapezius = 2.15 (0.45); middle trapezius:serratus anterior upper fibres = 0.47 (0.12); serratus anterior lower fibres:rhomboids = 1.40 (0.31) and lower trapezius:rhomboids = 0.17 (0.6). Conclusion Specific force couple strength ratios were determined, between and within the nondominant and the dominant arms of the shoulders of healthy women and men. Clinical implications Scapular stability is mainly maintained through the optimal force couple balance of the scapular stabilisers.
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Affiliation(s)
- Sonia Briel
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Benita Olivier
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Witness Mudzi
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Riek LM, Pfohl K, Zajac J. Using biofeedback to optimize scapular muscle activation ratios during a seated resisted scaption exercise. J Electromyogr Kinesiol 2022; 63:102647. [DOI: 10.1016/j.jelekin.2022.102647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/13/2022] [Accepted: 02/18/2022] [Indexed: 10/19/2022] Open
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Weng YH, Huang TS, Huang CY, Chen HY, Tsai YS, Lin JJ. Glenohumeral internal rotation deficit on pitching biomechanics and muscle activity. Int J Sports Med 2021; 43:538-544. [PMID: 34638156 DOI: 10.1055/a-1667-6080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To characterize the scapular pitching biomechanics in symptomatic GIRD pitchers (SG) compared to asymptomatic GIRD (ASG) and healthy pitchers. The scapular kinematics and associated muscle activities during pitching were recorded in 33 high school pitchers. Compared to healthy, GIRD pitchers had less scapular posterior tilt in each pitching event (average difference, AD = 14.4°, p < 0.01) and ASG demonstrated less scapular upward rotation at ball release (AD = 12.8°, p < 0.01) and greater muscle activity in the triceps brachii in the early-cocking phase (AD = 9.9%, p = 0.015) and in the serratus anterior in the late-cocking phase (AD = 30.8%, p < 0.01). Additionally, SG had less muscular activity on triceps brachii in the acceleration phase and serratus anterior in the cocking phase (AD = 37.8%, p = 0.016; AD = 15.5%, p < 0.01, respectively) compared to ASG. GIRD pitchers exhibited less scapular posterior tilt during pitching, which may cause impingement. Since tightness of the anterior shoulder is a common cause of inadequacy of posterior tilt during arm elevation, stretching exercise of the anterior shoulder is recommended. Given the inadequate recruitment during pitching in the GIRD pitchers, symptoms may develop following potential impingement.
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Affiliation(s)
- Yi-Hsuan Weng
- School and Graduate Institute of Physical Therapy, National Taiwan University College of Medicine Department of Physical therapy, Taipei, Taiwan
| | - Tsun-Shun Huang
- School and Graduate Institute of Physical Therapy, National Taiwan University College of Medicine Department of Physical therapy, Taipei, Taiwan
| | - Cheng-Ya Huang
- School and Graduate Institute of Physical Therapy, National Taiwan University College of Medicine Department of Physical therapy, Taipei, Taiwan
| | - Hsing-Yu Chen
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Shen Tsai
- Graduate Institute of Sports Sciences, University of Taipei, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School & Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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