Role of the kinetic chain in shoulder rehabilitation: does incorporating the trunk and lower limb into shoulder exercise regimes influence shoulder muscle recruitment patterns? Systematic review of electromyography studies

Richardson, Eleanor; Lewis, Jeremy; Gibson, Jo; Morgan, Christopher L.; Halaki, Mark; Ginn, Karen A.; Yeowell, Gillian

doi:10.1136/bmjsem-2019-000683

Cited by 22 publications

(18 citation statements)

References 60 publications

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“…Consider the scapula as part of a holistic approach to rehabilitating the shoulder complex, for example, strengthening the kinetic chain to improve scapular mechanics. 75…”

Section: Consensus Pointmentioning

confidence: 99%

2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels

Schwank¹,

Blazey²,

Asker³

et al. 2022

Journal of Orthopaedic & Sports Physical Therapy

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Professional and amateur athletes alike are burdened by shoulder injuries. 7,44,48,49,78,88 Shoulder pain affects athlete performance, training, and daily life. 61,64 More than half of elite collegiate American football players sustain at least 1 shoulder injury during their career. 48 Shoulder injuries are a problem for athletes in sports as diverse as rugby, 54 baseball, 34 handball, 20 diving, 73 water polo, 73 and kayaking. 41 Yet, there is a lack of quality evidence to guide clinicians, athletes, and coaches in managing shoulder injury risk or return to sport (RTS) post injury. The absence of quality evidence hinders those who wish to produce clinical practice guidelines. Previous consensus statements have targeted specific shoulder pathologies 4,31,60,89 and the scapula. 50 However, questions remain: • Which exercises are most appropriate for supporting primary prevention of shoulder injury in athletes? • Does screening for muscle weakness, such as a loss of rotational strength in the shoulder, hold value for athletes? • Which load management measures are relevant for the athlete with shoulder injury?U SYNOPSIS: There is an absence of high-quality evidence to support rehabilitation and return-tosport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sport. We developed the consensus via a 2-round Delphi process (involving more than 40 content and methods experts) and an in-person meeting. This consensus statement provides guidance with respect to load and risk management, supporting athlete shoulder rehabilitation, and decision making during the return-to-sport process. This statement is designed to offer clinicians the flexibility to apply principle-based approaches to managing the return-to-sport process within a variety of sporting backgrounds. The principles and consensus of experts working across multiple sports may provide a template for developing additional sport-specific guidance in the future.

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“…Consider the scapula as part of a holistic approach to rehabilitating the shoulder complex, for example, strengthening the kinetic chain to improve scapular mechanics. 75…”

Section: Consensus Pointmentioning

confidence: 99%

2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels

Schwank¹,

Blazey²,

Asker³

et al. 2022

Journal of Orthopaedic & Sports Physical Therapy

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“…For instance, it is not recommended to prescribe all SSE to the same individual, as treatment compliance is favored when fewer exercises are prescribed, rather than many [ 45 , 46 ]. Conversely, clinicians should not minimize other exercises or interventions that have been shown to be effective in the management of RCRSP, such as education and exercises targeting GH and core muscles [ 47 – 49 ]. Finally, when prescribed to an individual as part of a home-exercises program, SSE should be demonstrated by the rehabilitation professional and should come with clear instructions and specific exercises parameters (e.g., position, tempo, repetitions, sets, load) at an adequate level.…”

Section: Discussionmentioning

confidence: 99%

Co-creation of an exercise inventory to improve scapular stabilization and control among individuals with rotator cuff-related shoulder pain: a survey-based study amongst physiotherapists

et al. 2022

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Background Scapular stabilization exercises (SSE) are often included in the treatment of individuals with rotator cuff-related shoulder pain (RCRSP) to decrease pain and improve function. These SSE typically aim to strengthen the scapular muscles and optimize dynamic neuromuscular control of the scapula, which may improve overall shoulder stability and movement quality. No consensus of the recommended SSE for the management of RCRSP is available. Hence, this study aimed to consult physiotherapists to co-create an inventory of recommended SSE based on the exercise’s relevance and frequency of prescriptions for the rehabilitation of individuals with RCRSP. Methods A group of 16 physiotherapists with experience in treating shoulder pain participated in a sequential consultation incorporating two distinct rounds of consultation focusing on SSE (modified Delphi design). In round 1, physiotherapists identified and demonstrated up to 10 SSE that they commonly recommend or use among individuals with RCRSP. The description and performance of all SSE were audio and video recorded. All SSE suggested by more than one participant in round 1 advanced to round 2. In round 2, physiotherapists rated these SSE on a 4-point Likert scale according to their perceived relevance and frequency of prescription for this population. Results In round 1, out of the 25 SSE recommended by participants, 19 SSE (76.0%) were recommended by more than one physiotherapist and advanced to round 2. In round 2, 13 SSE were consensually classified (agreement ≥75%) as being relevant for the rehabilitation of individuals with RCRSP. SSE targeting the recruitment of the serratus anterior and lower trapezius muscles were considered the most relevant for the management of RCRSP, whereas SSE targeting neuromuscular scapular control were the most prescribed SSE for the management of RCRSP. Conclusions An inventory composed of 13 SSE was co-created by physiotherapists based on their relevance and frequency of prescription for the rehabilitation of individuals with RCRSP. When designing an exercise program, physiotherapists can use this SSE inventory to inform their exercise selection, in combination with their current knowledge on shoulder rehabilitation, as well as patients’ preferences.

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“…13,45,56 Too much external rotation can also increase the risk of elbow injury, due to increased elbow varus torque. 43 Pitchers with bilateral differences in total shoulder rotation or shoulder flexion have high probabilities for elbow injury. 56 However, insufficient shoulder external rotation flexibility can also increase the risk of shoulder injury and elbow injury.…”

Section: Arm Cocking Phasementioning

confidence: 99%

The Clinician’s Guide to Baseball Pitching Biomechanics

Diffendaffer

Bagwell

Fleisig

et al. 2022

Sports Health: A Multidisciplinary Approach

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Context: Improper baseball pitching biomechanics are associated with increased stresses on the throwing elbow and shoulder as well as an increased risk of injury. Evidence Acquisition: Previous studies quantifying pitching kinematics and kinetics were reviewed. Study Design: Clinical review. Level of Evidence: Level 5. Results: At the instant of lead foot contact, the elbow should be flexed approximately 90° with the shoulder at about 90° abduction, 20° horizontal abduction, and 45° external rotation. The stride length should be about 85% of the pitcher’s height with the lead foot in a slightly closed position. The pelvis should be rotated slightly open toward home plate with the upper torso in line with the pitching direction. Improper shoulder external rotation at foot contact is associated with increased elbow and shoulder torques and forces and may be corrected by changing the stride length and/or arm path. From foot contact to maximum shoulder external rotation to ball release, the pitcher should demonstrate a kinematic chain of lead knee extension, pelvis rotation, upper trunk rotation, elbow extension, and shoulder internal rotation. The lead knee should be flexed about 45° at foot contact and 30° at ball release. Corrective strategies for insufficient knee extension may involve technical issues (stride length, lead foot position, lead foot orientation) and/or strength and conditioning of the lower body. Improper pelvis and upper trunk rotation often indicate the need for core strength and flexibility. Maximum shoulder external rotation should be about 170°. Insufficient external rotation leads to low shoulder internal rotation velocity and low ball velocity. Deviation from 90° abduction decreases the ability to achieve maximum external rotation, increases elbow torque, and decreases the dynamic stability in the glenohumeral joint. Conclusion: Improved pitching biomechanics can increase performance and reduce risk of injury. SORT: Level C.

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Role of the kinetic chain in shoulder rehabilitation: does incorporating the trunk and lower limb into shoulder exercise regimes influence shoulder muscle recruitment patterns? Systematic review of electromyography studies

Cited by 22 publications

References 60 publications

2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels

2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels

Co-creation of an exercise inventory to improve scapular stabilization and control among individuals with rotator cuff-related shoulder pain: a survey-based study amongst physiotherapists

The Clinician’s Guide to Baseball Pitching Biomechanics

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