Context Deviations in scapular motions and subsequent alterations in associated soft tissues are thought to contribute to overuse shoulder injuries in overhead athletes. Whereas rigid and Kinesio taping are recommended for preventing these injuries, high-level evidence from clinical trials is still needed. Objective To determine and compare the short-term effects of rigid and Kinesio taping on scapular dyskinesis, scapular upward rotation, and pectoralis minor length in asymptomatic overhead athletes. Design Randomized controlled trial. Setting Athletic training rooms. Patients or Other Participants Seventy-two elite asymptomatic overhead athletes (age = 17.00 ± 4.09 years, height = 1.75 ± 0.11 m, mass = 67.26 ± 15.25 kg, body mass index = 21.80 ± 3.00). Intervention(s) We randomly assigned participants to 1 of 4 groups: rigid taping, Kinesio taping, placebo, or control (no taping). For the first 3 groups, we applied tape to the shoulder and scapular region. Main Outcome Measure(s) We evaluated all groups for observable scapular dyskinesis using the scapular dyskinesis test, scapular upward rotation using a digital inclinometer, and pectoralis minor length using the pectoralis minor index at baseline, immediately after taping, and at 60 to 72 hours after taping. Results The scapular dyskinesis percentage (P < .05) decreased and the pectoralis minor index (P < .001) increased immediately and at 60 to 72 hours after taping in the rigid-taping and Kinesio-taping groups. We observed no differences among groups for the change in the pectoralis minor index (P > .05). Scapular upward rotation did not change after taping in any group (P > .05). Conclusions Rigid or Kinesio taping of the shoulder and scapular region improved scapular dyskinesis and pectoralis minor length but did not alter scapular upward rotation. Short-term rigid and Kinesio taping may help improve scapular dyskinesis and pectoralis minor length in overhead athletes.
Context: Selective strengthening of scapular stabilizers is one of the emphases of the recent literature. Closed kinetic chain (CKC) exercises are used extensively in shoulder rehabilitation. However, a limited number of studies have reported scapular muscle ratios during CKC exercises. Objectives: To determine the CKC exercises producing the optimal ratios of the scapular stabilizer muscles in healthy shoulders. Evidence Acquisition: A systematic search within PubMed, Embase, CINAHL Plus, and SPORTDiscus with Full Text and ULAKBIM National Medical Database was performed up to January 2018. Studies were selected according to the predetermined criteria. If the pooled mean ratios (upper trapezius [UT]/middle trapezius [MT], UT/lower trapezius [LT], and UT/serratus anterior [SA]), which were calculated from the percentage of maximum voluntary contractions of muscles, were <0.60, these exercises were considered as ideal for higher activation of the MT, LT, and SA than the UT. Evidence Synthesis: The search identified 1284 studies, and 29 observational studies were included for review. Seventy-nine CKC exercises were determined. Four exercises for the MT, 9 for the LT, and 59 for the SA were identified from the articles as being optimal exercises to activate the specified muscle more than the UT. Conclusions: This review identified optimal CKC exercises that provide good ratios between the MT, LT, and SA with the UT. Most exercises have optimal UT/SA ratios, but some exercises performed on unstable surfaces may lead to excessive activation of the UT relative to the SA. For the UT/MT, the isometric low row, inferior glide, and half supine pull-up with slings are the ideal exercises. Isometric one-hand knee push-up variations seem to be the best choice for the UT/LT. The results suggest that many CKC exercises may be utilized to enhance scapular muscle balance when rehabilitating shoulder pathology.
Shoulder injuries are common in competitive youth swimmers because of sport-specific changes in upper extremity physical characteristics and acromio-humeral distance (AHD). These physical alterations could cause abnormal scapular kinematics and positioning. Subacromial pain syndrome (SPS), scapular dyskinesis, and SLAP lesions require a multiphase approach. A 14years-old female athlete who has been swimming for 7 years had SPS symptoms for 14 months. She also had scapular dyskinesis and suspected SLAP lesion. She received 15 treatment sessions. We conducted a progressive and comprehensive rehabilitation program consisting of electrotherapy, thermal agent, mobilization techniques, posterior shoulder stretching exercises, upper and lower extremity strengthening, proprioception, scapular stabilization, and core stabilization exercises, rhythmic stabilization exercises, plyometric exercises, and the advanced thrower's 10 program. Internal rotation range of motion (IRROM) with bubble inclinometer, pain with Visual Analog Scale, and AHD with ultrasonographic imaging were assessed before treatment and at the end of the 9th and 15th treatment sessions. Before treatment, IRROM was 52°, AHD was 10.67 mm, and pain intensity at rest and during swimming was 0 and 3.1 cm, respectively. After 9 treatment sessions, IRROM was 55.6°, AHD was 11.62 mm, pain intensity at rest and during swimming was 3.7 cm and 5.1 cm, respectively. At the end of the treatment, IRROM was 58.33°, AHD was 12.02 mm, pain intensity at rest and during swimming was 0 cm. A progressive and challenging rehabilitation program may positively change the scapular and glenohumeral kinematic patterns leading to an increase in AHD and IRROM, therefore a decrease in pain.
We aimed to investigate the relationships of isometric and eccentric shoulder abduction strength with acromiohumeral distance and supraspinatus tendon thickness based on the disease stage in patients with subacromial impingement syndrome. Eighty-two patients with subacromial impingement syndrome were assessed. Acromiohumeral distance and supraspinatus tendon thickness were measured using ultrasonography. Isometric and eccentric shoulder abduction strength were measured with a hand-held dynamometer. Spearman’s correlation coefficients were calculated. Isometric (rho = 0.428, p=.021) and eccentric (rho = 0.487, p=.007) shoulder abduction strength showed moderate correlations with acromiohumeral distance in patients with acute symptoms (n = 29). There was no relationship between acromiohumeral distance and abduction strength in patients with chronic symptoms (n = 53) (p>.050). Supraspinatus tendon thickness showed no significant correlation with abduction strength (p>.050). These findings suggest that the relationship between acromiohumeral distance and abduction strength differs according to disease stage. However, supraspinatus tendon thickness was not correlated with abduction strength regardless of disease stage. In patients with acute subacromial impingement syndrome symptoms increasing shoulder abduction strength may be a potential strategy to improve acromiohumeral distance.
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