Benefits and limitations of isokinetic force assessments in swimmer's shoulders: A systematic review.

OBJECTIVE: To indicate the benefits and limitations of the isokinetic test results for the performance of the main shoulder joint movements in swimmers, considering the different competitive levels, swimming techniques, race distances, and sex. METHODS: Search on the PubMed, CENTRAL, Medline, LILACS, and SCOPUS databases for the oldest records up to October 2022. Risk of bias, methodological quality, and level of evidence were evaluated based on the NHLBI checklist. RESULTS: 29 articles met the criteria and were included in this study. The quality analysis classified three as "good" and 26 as "regular", with a KAPPA index of 0.87. The main benefits found involved assessments of the clinical condition of the shoulder joint complex, relationships with performance, and reliability studies. The limitations found point to the participant's positioning in the instrument, use of angular velocity above 180°/s, and sample size. CONCLUSION: The use of the isokinetic dynamometer allows verifying the levels of strength, endurance, balance, and asymmetries among swimmers of different techniques, distances, competitive levels, and sex. Thus, it helps in the analysis and monitoring of the clinical conditions of swimmers' shoulder joints, contributing to the decision-making process of physiotherapists and coaches.

Supine counterstrain technique for rhomboid tender point.

Because poor posture is a common instigating factor in back, shoulder, and neck pain, the rhomboid muscles should be considered in a complete physical evaluation. Previous techniques for treating a rhomboid tender point have addressed only one of the two main actions of the muscle, specifically retraction of the scapula utilizing shoulder abduction. This modified supine counterstrain technique for the rhomboid tender point incorporates both scapular retraction as well as superior, medial rotation of the inferior border of the scapula without abduction, providing a comprehensive treatment to accommodate patients with shoulder movement restrictions. This article discusses indications, contraindications, treatment, and a list of problem-solving strategies for the rhomboid tender point.

Using biofeedback to optimize scapular muscle activation ratios during a seated resisted scaption exercise.

Impairments in muscle activation have been linked to increased risk of developing shoulder pathologies such as subacromial impingement syndrome (SIS) and associated rotator cuff injuries. Individuals with SIS have demonstrated increased upper trapezius (UT) muscle activation and reduced serratus anterior (SA) and lower trapezius (LT) muscle activation, which can be collectively represented as ratios (UT/SA and UT/LT). Targeted exercise is an important component of shoulder rehabilitation programs to re-establish optimal muscle activation and ratios. Electromyography (EMG) biofeedback during exercise has been shown to reduce UT activation and favorably alter scapular muscle activation ratios, however, a literature gap exists regarding the efficacy of other types of biofeedback. Therefore, we compared the effects of three types of biofeedback (visual EMG, auditory, verbal cues) on UT/SA and UT/LT ratios during a seated resisted scaption exercise in fifteen subjects without shoulder pain. Baseline muscle activation was recorded and compared to real-time muscle activation during each randomized biofeedback trial. All biofeedback types showed improvements in the UT/SA and UT/LT ratios, with visual EMG demonstrating a significant change in UT/LT ratio (p < 0.05). These results suggest that biofeedback could be utilized as a component of rehabilitation programs to prevent or treat shoulder pain.

Validity of judo-specific tests to assess neuromuscular performance of judo athletes.

Uchi-komi Fitness Test (UFT) is a specific judo test that evaluates physiological fitness of judo athletes in similar conditions to judo matches. Neuromuscular parameters obtained by generic and judo-specific tests would aid to get more information about its criterion validity. This study aimed to analyse the relationship between UFT and shoulder external (PTEX) and internal (PTINT) rotation torque, handgrip strength (HGS) and vertical jumps (VJs) performance. The relationship between UFT and Judogi grip strength test (JGST) was also investigated. Eighteen male judo athletes participated in this study. Athletes performed neuromuscular tests (VJ, PTEX, PTINT and HGS) and judo-specific tests (JGST and UFT). Pearson's correlation was used with the level set at p < 0.05. Significant correlation was found between UFT and all VJ variables (r = 0.50-0.72, p < 0.004), UFT a + b (two first series of UFT) and PTEX (r = 0.49, p = 0.033), UFT and PTINT (r = 0.47, p = 0.044). Also, UFT was correlated to JGST (r = 0.50-0.72, p < 0.044, respectively). We conclude that muscle power of lower limbs, PTEX and PTINT was related to UFT. Strength-endurance in the upper limbs (JGST) was also related to the UFT performance.

Patterns of enhancement in paretic shoulder kinematics after stroke with musical cueing.

Musical cueing has been widely utilised in post-stroke motor rehabilitation; however, the kinematic evidence on the effects of musical cueing is sparse. Further, the element-specific effects of musical cueing on upper-limb movements have rarely been investigated. This study aimed to kinematically quantify the effects of no auditory, rhythmic auditory, and melodic auditory cueing on shoulder abduction, holding, and adduction in patients who had experienced hemiparetic stroke. Kinematic data were obtained using inertial measurement units embedded in wearable bands. During the holding phase, melodic auditory cueing significantly increased the minimum Euler angle and decreased the range of motion compared with the other types of cueing. Further, the root mean square error in the angle measurements was significantly smaller and the duration of movement execution was significantly shorter during the holding phase when melodic auditory cueing was provided than when the other types of cueing were used. These findings indicated the important role of melodic auditory cueing for enhancing movement positioning, variability, and endurance. This study provides the first kinematic evidence on the effects of melodic auditory cueing on kinematic enhancement, thus suggesting the potential use of pitch-related elements in psychomotor rehabilitation.

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.

Acute Effects of Pectoralis Minor Self-Mobilization on Shoulder Motion and Posture: A Blinded and Randomized Placebo-Controlled Study in Asymptomatic Individuals.

CONTEXT: Tightness of the pectoralis minor is a common characteristic that has been associated with aberrant posture and shoulder pathology. Determining conservative treatment techniques for maintaining and lengthening this muscle is critical. Although some gross stretching techniques have been proven effective, there are currently no empirical data regarding the effectiveness of self-myofascial release for treating tightness of this muscle. OBJECTIVE: To determine the acute effectiveness of a self-myofascial release with movement technique of the pectoralis minor for improving shoulder motion and posture among asymptomatic individuals. DESIGN: Randomized controlled trial. SETTING: Orthopedic rehabilitation clinic. PARTICIPANTS: A total of 21 physically active, college-aged individuals without shoulder pain volunteered to participate in this study. MAIN OUTCOME MEASURES: Glenohumeral internal rotation, external rotation, and flexion range of motion (ROM), pectoralis minor length, and forward scapular posture were measured in all participants. The intervention group received one application of a self-soft-tissue mobilization of the pectoralis minor with movement. The placebo group completed the same motions as the intervention group, but with minimal pressure applied to the xiphoid process. Separate analyses of covariance were used to determine differences between groups (P < .05). RESULTS: Separate analyses of covariance showed that the self-mobilization group had significantly more flexion ROM, pectoralis minor length, and less forward scapular posture posttest than the placebo group. However, the difference in forward scapular posture may not be clinically significant. No differences were found between groups for external or internal rotation ROM. CONCLUSIONS: The results of this study indicate that an acute self-myofascial release with movement is effective for improving glenohumeral flexion ROM and pectoralis minor length, and may assist with forward scapular posture. Clinicians should consider this self-mobilization in the prevention and rehabilitation of pathologies associated with shortness of the pectoralis minor.

Clinical Measures Related to Forward Shoulder Posture: A Reliability and Correlational Study.

OBJECTIVES: The purpose of this study was to examine the reliability of clinical measures related to forward shoulder posture (pectoralis minor index [PMI], scapular index [SI], abduction index [AI], acromion to the wall index [AWI] acromion to the treatment table index [ATI], and thoracic curvature [TC]), and to investigate the association (redundancy) among these measures. METHODS: Twenty-one asymptomatic participants participated in this study. Two physiotherapists were trained to perform the clinical measurements. Intraclass correlation coefficients (ICC2,k) were calculated to assess intra- and interrater reliabilities. Pearson product moment correlation was used to investigate the existence of possible redundancy between the measures that showed high intra- and interrater reliabilities. RESULTS: The measures showed ICCs between 0.30 and 0.97. Five measures, PMI, SI, AWI, ATI, and TC, showed appropriate values for intrarater reliability (ICCs 0.77-0.94), and 3 measures, AWI, ATI, and TC, for interrater reliability (ICCs 0.82-0.85). Among measures that showed acceptable intra- and interrater reliability values, 2 measures were redundant, showing high association (AWI vs ATI) (r = 0.80, P < .001). CONCLUSION: For PMI, SI, AWI, ATI, and TC measures, adequate values of intrarater reliability were observed. For AWI, ATI, and TC, adequate values of interrater reliability were found. Two pairs of measures were highly associated (PMI with SI; AWI with ATI), which indicates redundancy among them. Our results suggest that, when the same examiner performs the assessment, the combined use of the PMI, AWI, and TC measures allows a quick but comprehensive evaluation of the presence of forward shoulder posture.

The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study.

BACKGROUND: The purpose of this study is to evaluate the effect of a six-week combined manual therapy (MT) and stabilizing exercises (SEs), with a one-month follow-up on neck pain and improving function and posture in patients with forward head and rounded shoulder postures (FHRSP). METHODS: Sixty women with neck pain and FHRSP were randomized into three groups: Group 1 performed SE and received MT (n = 20), Group 2 performed SE (n = 20) and Group 3 performed home exercises (n = 20) for six weeks. The follow-up time was one month after the post test. The pain, function, and head and shoulder angles were measured before and after the six-week interventions, and during a one-month follow-up. RESULTS: There were significant within-group improvements in pain, function, and head and shoulder posture in groups 1 and 2. There were significant between-group differences in groups 1 and 2 in head posture, pain, and function favoring group 1 with effect size 0.432(p = 0.041), 0.533 (P = 0.038), and 0.565(P = 0.018) respectively. There were significant between-group differences in both intervention groups versus the control group favoring the intervention groups. CONCLUSION: These findings suggest that both interventions were significantly effective in reducing neck pain and improving function and posture in patients. However, the improvement in function and pain were more effective in Group 1 as compared to Group 2, suggesting that MT can be used as a supplementary method to the stabilizing intervention in the treatment of neck pain. More researches are needed to confirm the result of this study. TRIAL REGISTRATION: UMIN000030141 modified on 2018.03.08. This study is a randomized control trial registered at UMIN-CTR website, the trial was retrospectively registered and the unique trial number is UMIN000030141 .

Isokinetic assessment of shoulder complex strength in adolescent elite synchronized swimmers.

Children and adolescent participation in sport has increased in recent years. Synchronized swimming requires correct muscle balance in the shoulder complex. The purpose of this study was to establish isokinetic strength profiles and peak torque ratios of shoulder internal and external rotator muscles in a female high-level synchronized swimming team. Twenty-six adolescent female high-level synchronized swimmers, aged 12-14, participated in this study. Maximal bilateral shoulder concentric external and internal rotation force was measured at 60°/s (5 repetitions) and 180°/s (15 repetitions). The isokinetic concentric strength generated by the internal rotator muscles was significantly higher (p < 0.05) than by the external rotators in both limbs and at both velocities. Significant bilateral differences in the external rotation (ER):internal rotation (IR) strength ratio were noted at 60°/s. Isokinetic assessment is essential in sports medicine, since it is the only test capable of diagnosing any shoulder strength deficit.

Immediate effect of scapula-focused exercises performed with kinematic biofeedback on scapular kinematics in individuals with subacromial pain syndrome.

BACKGROUND: Given the changes in the patterns of muscular activation and scapular movement in individuals with subacromial pain syndrome, the use of neuromuscular training has been considered in rehabilitation protocols. There is currently no evidence of the effects of the use of three-dimensional (3D) kinematic biofeedback on individuals with subacromial pain syndrome. This study aimed to determine the immediate effect of scapular motor control exercises using 3D kinematic biofeedback on the scapular kinematics, inter-segment coordination and pain of individuals with subacromial pain syndrome. METHOD: The kinematics of the scapulothoracic joint of 26 subjects with subacromial pain syndrome were assessed in the movement arm elevation and lowering in the sagittal plane before and after performance of three scapula-focused exercises using kinematic biofeedback. The individuals were familiarized with the selected exercises to acquire a greater scapular posterior tilt, while kinematic biofeedback, with visual and auditory stimuli, was used in real time. Scapular kinematics, pain, and subjective perception of exertion were the pre- and post-test measures. FINDINGS: In the movement of arm elevation and lowering, no differences were found in scapular tilt and on coordination between the segments pre- and post-test and the effect size was considered small. INTERPRETATION: Our results demonstrate that the performance of scapula-focused exercises using kinematic biofeedback does not cause immediate changes in the magnitude of scapular movement. However, inter-segmental coordination showed evidence of changes for scapular tilt in the lowering of the arm and internal rotation in the elevation and the lowering of the arm in individuals with subacromial pain syndrome.

Scapular Muscle Activity During Static Yoga Postures.

Study Design Controlled, cross-sectional laboratory study. Background Despite the growing popularity of yoga, little is known about the muscle activity of the scapular stabilizers during isometric yoga postures and their potential utility in shoulder rehabilitation. Objectives To examine scapular stabilizer muscle activation during various yoga postures. Methods Twenty women with yoga experience and no shoulder pain or injury participated. Electromyography was used to record the muscle activity of the upper, middle, and lower trapezius, as well as of the serratus anterior, during 15 yoga postures. Results Muscle activity varied between yoga postures (3%-57% maximum voluntary isometric contraction [MVIC]). Overall, the "locust arms forward" posture elicited the highest activity from the upper (22.4% MVIC), middle (41.8% MVIC), and lower (56.8% MVIC) trapezius, while several postures elicited moderate activity (greater than 20% MVIC) from the serratus anterior. Conversely, the "dancer's pose right," "reverse tabletop," and "warrior II" postures demonstrated low activity (less than or equal to 15.7% MVIC) of the scapular stabilizers. Conclusion Strengthening the scapular stabilizer muscles is an important component of shoulder rehabilitation. Yoga postures have been identified that activate the scapular stabilizer muscles at varying levels of activity. J Orthop Sports Phys Ther 2018;48(6):504-509. Epub 6 Apr 2018. doi:10.2519/jospt.2018.7311.

Shoulder mechanical demands of slow underwater exercises in the scapular plane.

BACKGROUND: The mechanical demands of underwater shoulder exercises have only been assessed indirectly via electromyographical measurements. Yet, this is insufficient to understand all the clinical implications. The purpose of this study was to evaluate musculoskeletal system loading during slow (30°/s) scapular plane arm elevation and lowering performed in two media (air vs water) and body positions (sitting vs supine). METHODS: Eighteen participants' upper bodies were scanned and virtually animated within unsteady numerical fluid flow simulations to compute hydrodynamic forces. Together with weight, buoyancy and segment inertial parameters, these were fed into an inverse dynamics model to obtain net shoulder moments, power and work. FINDINGS: Positive mechanical work done at the shoulder was 32.4% (95% CI [29.2, 35.6]) and 25.0% [22.8, 27.2] that when performing the same movement on land, supine and sitting respectively. Arm elevation was ~2.5× less demanding sitting than supine (mean 0.012 (SD 0.018) vs mean 0.027 (SD 0.012) J·kg-1, P = 0.034). Instantaneous power was consistently positive when sitting albeit very low during elevation (0.003 W·kg-1) whereas, when supine, it was alternately negative for short period (~1.2 s) and positive (~4.8 s), peaking at levels 3× higher (0.01 W·kg-1). INTERPRETATION: Performing sitting elicited concentric muscle contractions at very low effort, which is advantageous during early rehabilitation to restore joint mobility. Exercising supine, by contrast, required rapid pre-stretch followed by concentric force production at an overall higher mechanical cost, and is therefore better suited to more advanced rehabilitation stages.

The Effects of Thai Yoga on Physical Fitness: A Meta-Analysis of Randomized Control Trials.

OBJECTIVES: Thai yoga is a traditional Thai exercise used for improving health-related physical fitness. Many studies have evaluated these effects, but their results remain inconclusive. This meta-analysis aimed to examine the effectiveness of Thai yoga on physical fitness. DESIGN/METHODS: PubMed, EMBASE, CINAHL, Cochrane library, Thai Library Integrated System (ThaiLis), Physiotherapy Evidence Database (PEDro), National Rehabilitation Information Center (Rehabdata), Scopus, Web of Science, Thai University library databases/journals, and Thai Physical Therapy database up to March 2016 were searched for randomized controlled trials (RCTs) examining the effect of Thai yoga exercise compared with normal daily activities as controls, in any language. The weighted mean difference (WMD) and 95% confidence intervals (95% CI) were performed using the random-effects model. RESULTS: Seven RCTs met the inclusion criteria. Thai yoga training significantly improved body flexibility by 3.9 cm after 4 weeks [95% CI = 3.9-4.0; p < 0.001: no heterogeneity χ2 = 0.66, d.f.2, p = 0.7; I2 0.00%] and 8.9 cm after 8 weeks [95% CI = 7.4-10.5; p < 0.001: no heterogeneity χ2 = 0.16, d.f.2, p = 0.9; I2 0.00%] compared to controls. It also significantly increased range of motion (ROM) of right shoulder extension by 1.5 degrees at week 8, compared to controls [95% CI = 0.12-2.81; p = 0.03; low heterogeneity χ2 = 1.61, d.f.1, p = 0.2; I2 37.9%]. Greater ROM for right shoulder abduction was observed after 12 weeks compared to controls [22.2 degrees (95% CI = 20-24; p < 0.001): no heterogeneity χ2 = 0.29, d.f.1, p = 0.6; I2 0.00%]. CONCLUSIONS: Thai yoga exercises appeared useful, in particular, on body and right shoulder joint flexibility. Regular stretching exercise of Thai yoga and/or in combination with exercises could promote health-related physical fitness.

The effects of pressure biofeedback training on infraspinatus muscle activity and muscle thickness.

The aim of this study was to investigate muscle activity in the infraspinatus and posterior deltoid and infraspinatus muscle thickness during a prone external rotation (PER) exercise using pressure biofeedback. Fifteen healthy men participated in this study, performing PER exercise with pressure biofeedback under four conditions (comfortable, 2 mm Hg, 4 mm Hg, and 8 mm Hg). Surface electromyography (EMG) was used to monitor infraspinatus and posterior deltoid muscle activity, and ultrasonography was used to collect infraspinatus muscle thickness data. Infraspinatus activity and muscle thickness were greatest at 2 mm Hg pressure feedback, and both measures were significantly different from those under other pressure feedback conditions (p < 0.05). In contrast, posterior deltoid activity was lower at 2 mm Hg. However, there was no significant difference between any of the four pressure feedback conditions. These findings suggest that PER exercise with pressure biofeedback, particularly at 2 mm Hg, is effective in selectively activating the infraspinatus muscle.

Effects of Kinesiology Taping on Scapular Reposition Accuracy, Kinematics, and Muscle Activity in Athletes With Shoulder Impingement Syndrome: A Randomized Controlled Study.

CONTEXT: Scapular proprioception is a key concern in managing shoulder impingement syndrome (SIS). However, no study has examined the effect of elastic taping on scapular proprioception performance. OBJECTIVE: To investigate the immediate effect of kinesiology taping (KT) on scapular reposition accuracy, kinematics, and muscle activation in individuals with SIS. DESIGN: Randomized controlled study. SETTING: Musculoskeletal laboratory, National Yang-Ming University, Taiwan. PARTICIPANTS: Thirty overhead athletes with SIS. INTERVENTIONS: KT or placebo taping over the upper and lower trapezius muscles. MAIN OUTCOME MEASURES: The primary outcome measures were scapular joint position sense, measured as the reposition errors, in the direction of scapular elevation and protraction. The secondary outcomes were scapular kinematics and muscle activity of the upper trapezius, lower trapezius, and serratus anterior during arm elevation in the scapular plane (scaption). RESULTS: Compared with placebo taping, KT significantly decreased the reposition errors of upward/downward rotation (P = .04) and anterior/posterior tilt (P = .04) during scapular protraction. KT also improved scapular kinematics (significant group by taping effect for posterior tilt, P = .03) during scaption. Kinesiology and placebo tapings had a similar effect on upper trapezius muscle activation (significant taping effect, P = .003) during scaption. CONCLUSIONS: Our study identified the positive effects of KT on scapular joint position sense and movement control. Future studies with a longer period of follow-up and clinical measurement might help to clarify the clinical effect and mechanisms of elastic taping in individuals with SIS.

Kinematic analysis of proximal-to-distal and simultaneous motion sequencing of straight punches.

Consecutive proximal-to-distal sequencing of motion is considered to be integral for generating high velocity of distal segments in many sports. Simultaneous usage of proximal and distal segments as seen in martial arts is by far less well investigated. Therefore, the aim of the study was to characterise and differentiate the concepts of consecutive (CSM) and simultaneous (SSM) sequence of motion in straight reverse punches as practised in Practical Wing Chun. Four experienced martial artists succeeded an eligibility test for technical proficiency in both concepts and performed a total number of 20 straight punches per concept. Eight MX13 Vicon cameras (250 fps) and Visual3D were used for motion capture and analyses. Both motion concepts showed proximal-to-distal sequencing of maximal joint velocities but, in SSM, this was coupled with simultaneous initiation. Key characteristics were: high pelvis momentum and backswing of shoulder and elbow (CSM); and importance of shoulder involvement (SSM). Different ranges of motion, timing aspects and achieved maximal angular velocities distinguished both concepts, which led to differences (p < 0.05) in fist velocity at contact, execution time, distance and horizontal shift of the centre of mass. Proper application of both concepts depends on the environmental setting, situational requirements and individual fighting style.

Kinematic comparison of the seoi-nage judo technique between elite and college athletes.

This study sought to identify biomechanical factors that determine fast and skilful execution of the seoi-nage (shoulder throw) technique by comparing kinematics between elite and college judo athletes. Three-dimensional motion data were captured using a VICON-MX system with 18 cameras operating at 250 Hz as three male elite and seven male college judo athletes performed seoi-nage. No significant difference was found in motion phase time of the turning phase between the two groups, indicating that motion phase time is not necessarily a factor contributing quickness in seoi-nage. The maximum relative velocity of the whole body centre of mass along the anterior-posterior direction was significantly greater in the elite athletes (2.74 ± 0.33 m/s) than in the college athletes (1.62 ± 0.47 m/s) during the turning phase (p = 0.023). The overall angular velocity of the body part lines, particularly the arm line, tended to be greater in the elite athletes (p = 0.068). The results imply that the velocity of the thrower relative to the opponent in the forward drive and turning motion reflects high skill seoi-nage. Coaches should recognise the relative forward velocity as a factor that may contribute to a successful seoi-nage when teaching the judo throw technique.

Ipsilateral EEG mu rhythm reflects the excitability of uncrossed pathways projecting to shoulder muscles.

BACKGROUND: Motor planning, imagery or execution is associated with event-related desynchronization (ERD) of mu rhythm oscillations (8-13 Hz) recordable over sensorimotor areas using electroencephalography (EEG). It was shown that motor imagery involving distal muscles, e.g. finger movements, results in contralateral ERD correlating with increased excitability of the contralateral corticospinal tract (c-CST). Following the rationale that purposefully increasing c-CST excitability might facilitate motor recovery after stroke, ERD recently became an attractive target for brain-computer interface (BCI)-based neurorehabilitation training. It was unclear, however, whether ERD would also reflect excitability of the ipsilateral corticospinal tract (i-CST) that mainly innervates proximal muscles involved in e.g. shoulder movements. Such knowledge would be important to optimize and extend ERD-based BCI neurorehabilitation protocols, e.g. to restore shoulder movements after stroke. Here we used single-pulse transcranial magnetic stimulation (TMS) targeting the ipsilateral primary motor cortex to elicit motor evoked potentials (MEPs) of the trapezius muscle. To assess whether ERD reflects excitability of the i-CST, a correlation analysis between between MEP amplitudes and ipsilateral ERD was performed. METHODS: Experiment 1 consisted of a motor execution task during which 10 healthy volunteers performed elevations of the shoulder girdle or finger pinching while a 128-channel EEG was recorded. Experiment 2 consisted of a motor imagery task during which 16 healthy volunteers imagined shoulder girdle elevations or finger pinching while an EEG was recorded; the participants simultaneously received randomly timed, single-pulse TMS to the ipsilateral primary motor cortex. The spatial pattern and amplitude of ERD and the amplitude of the agonist muscle's TMS-induced MEPs were analyzed. RESULTS: ERDs occurred bilaterally during both execution and imagery of shoulder girdle elevations, but were lateralized to the contralateral hemisphere during finger pinching. We found that trapezius MEPs increased during motor imagery of shoulder elevations and correlated with ipsilateral ERD amplitudes. CONCLUSIONS: Ipsilateral ERD during execution and imagery of shoulder girdle elevations appears to reflect the excitability of uncrossed pathways projecting to the shoulder muscles. As such, ipsilateral ERD could be used for neurofeedback training of shoulder movement, aiming at reanimation of the i-CST.

Referred Pain Patterns of the Infraspinatus Muscle Elicited by Deep Dry Needling and Manual Palpation.

OBJECTIVES: To identify the most common referred pain (ReP) pattern of the infraspinatus myofascial trigger point (MTrP) and compare its coincidence with the original ReP pattern, to verify whether there are any significant differences by sex and types of technique and to determine the observed signs and symptoms evoked by deep dry needling (DDN) and manual palpation (MPal). DESIGN: A cohort study of patients randomized to two different examination methods (July and August 2016). SETTINGS: Students and staff recruited from Miguel Hernandez University (Southeast Spain). PATIENTS: One hundred thirty-three participants (70.7% women) with shoulder complaints were randomly assigned to either an MPal (n = 67) or DDN group (n = 66). INTERVENTIONS: The same physiotherapist carried out the techniques on all participants, and the same protocol was followed for both the DDN and MPal groups. The physiotherapist did not ask participants about their pain features or other relevant issues. OUTCOME MEASURES: Local twitch response (LTR) and ReP assessed through a visual analogue scale and features of ReP of the infraspinatus muscle. RESULTS: The areas with the highest percentage of ReP were the front (area 3; 27.1%) and back (area 11; 21.1%) of the arm, anterior (area 4; 36.1%) and posterior (area 12; 42.1%) shoulder, and infraspinatus muscle area. DDN proved to be significantly easier than MPal in evoking an LTR (p ≤ 0.001). There were significant differences between sexes in zone 2 (p = 0.041) and no statistically significant differences were found by technique. CONCLUSIONS: The ReP pattern of the infraspinatus muscle coincides with the original pattern described by Travell and Simons, although the neck area should be questioned. The study found no significant differences in the ReP pattern by sex and when comparing MPal with DDN of MTrP of the infraspinatus muscle. DDN proved to be significantly easier than MPal in evoking an LTR.