PNF and Movement

Korea Proprioceptive Neuromuscular Facilitation Association (대한고유수용성신경근촉진법학회)
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The Effects of Trapezius and Serratus Anterior Strengthening Exercise on Pain and Muscle Activation in Spinal Cord Injury Patients with Functional Shoulder Impingement Syndrome

승모근과 전거근 강화운동이 기능적 어깨충돌증후군을 가진 척수손상 환자의 통증과 근 활성도에 미치는 영향

  • Kim, Sang-Chul (Dept. of Physical Therapy, Gidaechan Clinics) ;
  • Lee, Young-Min (Dept. of Physical Therapy, Hallym University Chuncheon Sacred Heart Hospital) ;
  • Shin, Kyu-Hyun (Dept. of Physical Therapy, Yeoju Raphael's House)
  • 김상철 (기대찬의원 물리치료실) ;
  • 이영민 (한림대학교춘천성심병원 물리치료실) ;
  • 신규현 (여주 라파엘의집 물리치료실)
  • Received : 2017.11.05
  • Accepted : 2017.11.30
  • Published : 2018.04.30
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Abstract

Purpose: The aim of this study was to investigate the effects of trapezius and serratus anterior strengthening exercise on the shoulder pain and muscle activation of patients with spinal cord injury and functional shoulder impingement syndrome. Methods: The study consisted of 10 patients with spinal cord injury who were hospitalized in Rehabilitation Hospital U, Uijeongbu, South Korea. The exercise was implemented three times a week for 10 weeks. In each session, the subjects performed one of a total of five types of exercise at mid-level intensity. The shoulder pain and disability index (SPADI) was used to evaluate the patients before and after the intervention. The muscle activation of the upper trapezius, middle trapezius, lower trapezius, and anterior serratus muscle was assessed by surface electromyography (EMG) at the beginning of the experiment and 10 weeks later. Wilcoxon's singed-rank test was conducted to determine differences in the pain index and muscle activation before and after the exercise. The level of statistical significance was set at ${\alpha}=0.05$. Results: SPADI scores significantly decreased after the exercise (p<0.05). In comparisons of muscle activation, there was a significant improvement in the upper trapezius at $60^{\circ}$ shoulder joint flexion (p<0.05). There was no significant improvement at $90^{\circ}$ shoulder joint flexion. The middle trapezius showed a significant improvement at $120^{\circ}$ shoulder joint flexion (p<0.05). Conclusion: Trapezius and serratus anterior strengthening exercise reduced pain in spinal cord injury patients with functional shoulder impingement syndrome. The decreased muscle activation of upper trapezius and increased muscle activation of the anterior serratus muscle at $60^{\circ}$ shoulder joint flexion point to positive effects of the exercise on supraduction of the scapula.

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References

  1. Bayley JC, Cochran TP, Sledge CB. The weight-bearing shoulder. The impingement syndrome in paraplegics. The Journal of Bone and Joint Surgery American. 1987;69 (5):676-678. https://doi.org/10.2106/00004623-198769050-00006
  2. Belling Sorensen AK, Jorgensen U. Secondary impingement in the shoulder. An improved terminology in impingement. Scandinavian Journal of Medicine & Science in Sports. 2000;10(5):266-278. https://doi.org/10.1034/j.1600-0838.2000.010005266.x
  3. Brindle TJ, Nyland JA, Nitz AJ, et al. Scapulothoracic latent muscle reaction timing comparison between trained overhead throwers and untrained control subjects. Scandinavian Journal of Medicine & Science in Sports. 2007;17(3):252-259. https://doi.org/10.1111/j.1600-0838.2006.00574.x
  4. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. The Journal of Arthroscopy and Related Surgery. 2003;19(4):404-420. https://doi.org/10.1053/jars.2003.50128
  5. Chen HY, Chen SS, Chiu WT, et al. A nationwide epidemiological study of spinal cord injury in geriatric patients in Taiwan. Neuroepidemiology. 1997;16(5):241-247. https://doi.org/10.1159/000109693
  6. Choi JD. Effect of 7-week serratus anterior strengthening exercises on shoulder pain with serratus anterior weakness. Yonsei University. Dissertation of Doctorate Degree. 2008
  7. Cools AM, Declercq GA, Cambier DC, et al. Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms. Scandinavian Journal of Medicine & Science in Sports. 2007;17(1):25-33. https://doi.org/10.1111/j.1600-0838.2006.00570.x
  8. Cools AM, Witvrouw EE, Declercq GA, et al. Evaluation of isokinetic force production and associated muscle activity in the scapular rotators during a protraction-retraction movement in overhead athletes with impingement symptoms. British Journal of Sports Medicine. 2004;38(1):64-68. https://doi.org/10.1136/bjsm.2003.004952
  9. Cools AM, Witvrouw EE, Mahieu NN, et al. Isokinetic scapular muscle performance in overhead athletes with and without impingement symptoms. Journal of Athletic Training. 2005;40(2):104-110.
  10. Curtis KA, Tyner TM, Zachary L, et al. Effect of a standard exercise protocol on shoulder pain in long-term wheelchair users. Spinal Cord. 1999;37(6):421-429. https://doi.org/10.1038/sj.sc.3100860
  11. Decker MJ, Hintermeister RA, Faber KJ, et al. Serratus anterior muscle activity during selected rehabilitation exercises. The American Journal of Sports Medicine. 1999;27(6):784- 791. https://doi.org/10.1177/03635465990270061601
  12. Dyson-Hudson TA, Shiflett SC, Kirshblum SC, et al. Acupuncture and trager psychophysical integration in the treatment of wheelchair user's shoulder pain in individuals with spinal cord injury. Archives of Physical Medicine and Rehabilitation. 2001;82(8):1038-1046. https://doi.org/10.1053/apmr.2001.24888
  13. Ekstrom RA, Bifulco KM, Lopau CJ, et al. Comparing the function of the upper and lower parts of the serratus anterior muscle using surface electromyography. Journal of Orthopaedic & Sports Physical Therapy. 2004;34(5):235-243. https://doi.org/10.2519/jospt.2004.34.5.235
  14. Eriks-Hoogland IE, de Groot S, Post MW, et al. Correlation of shoulder range of motion limitations at discharge with limitations in activities and participation one year later in persons with spinal cord injury. Journal of Rehabilitation Medicine. 2011;43(3):210-215. https://doi.org/10.2340/16501977-0655
  15. Finley MA, McQuade KJ, Rodgers MM. Scapular kinematics during transfers in manual wheelchair users with and without shoulder impingement. Clinical Biomechanics (Bristol, Avon). 2005;20(1):32-40. https://doi.org/10.1016/j.clinbiomech.2004.06.011
  16. Finley MA, Rasch EK, Keyser RE, et al. The biomechanics of wheelchair propulsion in individuals with and without upper-limb impairment. Journal of Rehabilitation Research and Development. 2004;41(3B):385-395. https://doi.org/10.1682/JRRD.2004.03.0385
  17. Finley MA, Rodgers MM. Effect of 2-speed geared manual wheelchair propulsion on shoulder pain and function. Archives of Physical Medicine and Rehabilitation. 2007;88(12): 1622-1627. https://doi.org/10.1016/j.apmr.2007.07.045
  18. Goldstein B, Young J, Escobedo EM. Rotator cuff repairs in individuals with paraplegia. American Journal of Physical Medicine & Rehabilitation. 1997;76(4):316-322. https://doi.org/10.1097/00002060-199707000-00011
  19. Hobson DA, Tooms RE. Seated lumbar/pelvic alignment. A comparison between spinal cord-injured and noninjured groups. Spine(PhilaPa1976). 1992;17(3):293-298. https://doi.org/10.1097/00007632-199203000-00009
  20. Huxham FE, Goldie PA, Patla AE. Theoretical considerations in balance assessment. The Australian Journal of Physiotherapy. 2001;47(2):89-100. https://doi.org/10.1016/S0004-9514(14)60300-7
  21. Hwang BY. The bobath concept in adult neurology. Seoul. Seoul Med-Media. 2008.
  22. Janssen-Potten YJ, Seelen HA, Drukker J, et al. The effect of seat tilting on pelvic position, balance control, and compensatory postural muscle use in paraplegic subjects. Archives of Physical Medicine and Rehabilitation. 2001;82(10):1393-1402. https://doi.org/10.1053/apmr.2001.25989
  23. Jobe CM. Superior glenoid impingement. Current concepts. Clinical Orthopaedics and Related Research. 1996;(330):98-107.
  24. Kamkar A, Irrgang JJ, Whitney SL. Nonoperative management of secondary shoulder impingement syndrome. Journal of Orthopaedic & Sports Physical Therapy. 1993;17(5): 212-224. https://doi.org/10.2519/jospt.1993.17.5.212
  25. Ludewig PM, Hoff MS, Osowski EE, et al. Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises. The American Journal of Sports Medicine. 2004;32(2):484-493. https://doi.org/10.1177/0363546503258911
  26. McClure PW, Michener LA, Karduna AR. Shoulder function and 3-dimensional scapular kinematics in people with and without shoulder impingement syndrome. Physical Therapy. 2006;86(8):1075-1090.
  27. Meister K. Injuries to the shoulder in the throwing athlete. Part one: Biomechanics/ pathophysiology/classification of injury. The American Journal of Sports Medicine. 2000;28(2):265-275. https://doi.org/10.1177/03635465000280022301
  28. Mulroy SJ, Thompson L, Kemp B, et al. Strengthening and optimal movements for painful shoulders (STOMPS) in chronic spinal cord injury: a randomized controlled trial. Physical Therapy. 2011;91(3):305-324. https://doi.org/10.2522/ptj.20100182
  29. Nash MS, Koppens D, van Haaren M, et al. Power- assisted wheels ease energy costs and perceptual responses to wheelchair propulsion in persons with shoulder pain and spinal cord injury. Archives of Physical Medicine and Rehabilitation. 2008;89(11): 2080-2085. https://doi.org/10.1016/j.apmr.2008.05.018
  30. Nash MS, van de Ven I, van Elk N, et al. Effects of circuit resistance training on fitness attributes and upper-extremity pain in middle-aged men with paraplegia. Archives of Physical Medicine and Rehabilitation. 2007;88(1):70-75. https://doi.org/10.1016/j.apmr.2006.10.003
  31. National Spinal Cord Injury Statistical Center. Annual statistical report-complete public version. 2010.
  32. Nawoczenski DA, Ritter-Soronen JM, Wilson CM, et al. Clinical trial of exercise for shoulder pain in chronic spinal injury. Physical Therapy. 2006;86(12):1604-1618. https://doi.org/10.2522/ptj.20060001
  33. Neer CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. The Journal of Bone and Joint Surgery American. 1972;54(1):41-50. https://doi.org/10.2106/00004623-197254010-00003
  34. Otom AS, Doughan AM, Kawar JS, et al. Traumatic spinal cord injuries in Jordan-an epidemiological study. Spinal Cord. 1997;35(4):253-255. https://doi.org/10.1038/sj.sc.3100402
  35. Page, P. Shoulder muscle imbalance and subacromial impingement syndrome in overhea athletes. International Journal of Sports Physical Therapy. 2011;6(1):51-58.
  36. Paine RM, Voight M. The role of the scapula. Journal of Orthopaedic & Sports Physical Therapy. 1993;18(1):386-391. https://doi.org/10.2519/jospt.1993.18.1.386
  37. Samuelsson KA, Tropp H, Gerdle B. Shoulder pain and its consequences in paraplegic spinal cord-injured, wheelchair users. Spinal Cord. 2004;42(1):41-46. https://doi.org/10.1038/sj.sc.3101490
  38. Seelen HA, Potten YJ, Huson A, et al. Impaired balance control in paraplegic subjects. Journal of Electromyography and Kinesiology. 1997;7(2):149-160. https://doi.org/10.1016/S1050-6411(97)88884-0
  39. Shirado O, Kawase M, Minami A, et al. Quantitative evaluation of long sitting in paraplegic patients with spinal cord injury. Archives of Physical Medicine and Rehabilitation. 2004;85(8):1251-1256. https://doi.org/10.1016/j.apmr.2003.09.014
  40. Sie IH, Waters RL, Adkins RH, et al. Upper extremity pain in the postrehabilitation spinal cord injured patient. Archives of Physical Medicine and Rehabilitation. 1992;73(1): 44-48.
  41. Sprigle S, Wootten M, Sawacha Z, et al. Relationships among cushion type, backrest height, seated posture, and reach of wheelchair users with spinal cord injury. The Journal of Spinal Cord Medicine. 2003;26(3):236-243. https://doi.org/10.1080/10790268.2003.11753690
  42. Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord. 2006;44(9):523-529. https://doi.org/10.1038/sj.sc.3101893