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.

Reproducibility of subscapularis muscle thickness measurement using ultrasound imaging. -Relationship between subscapularis muscle thickness and internal rotation torque of the shoulder joint.

BACKGROUND: Few studies have reported on the morphometry of the subscapularis muscle using ultrasound imaging (USI); and their reproducibility has not been verified. OBJECTIVES: This study aimed to clarify the relative and absolute reproducibility of USI measurements of subscapularis muscle thickness at rest and during isometric contraction as well as the degree of change in muscle thickness caused by the amount of internal rotational torque in the shoulder joint. DESIGN: Two-group repeated-measures study. METHODS: The subjects were the inferior fibers of the subscapularis muscle of 40 healthy adult males. Muscle thickness was measured at rest and at 10%-30% of the maximum isometric internal rotation torque. Intraclass correlation coefficients (ICC) and Brand Altman analysis were used for reproducibility measurement. The degree of change in muscle thickness at each torque was also calculated. RESULTS: Intra- and inter-rater ICCs (ranged from 0.69 to 0.91) were good. A proportional error was observed in intra-rater measurements. Both minimal detectable change 95 (ranged from 2.33 to 6.47) were high. The subscapularis muscle thickness was significantly increased at 10% torque (25.49 ± 3.80 mm), 20% torque (26.07 ± 3.90 mm), and 30% torque (25.96 ± 3.82 mm) as compared to that in resting conditions (24.53 ± 4.46 mm) (p < 0.05). CONCLUSION: The reproducibility and error of the subscapularis muscle thickness measurement using USI used in this study were clarified when repeated measurements were made in the same limb position and under the same probe installation conditions, suggesting that the contraction of the subscapularis muscle can be estimated by muscle thickness measurement.

Unilateral seated shot-put test, muscle strength, and range of motion on recreational athletes with chronic shoulder pain: Cross-sectional study.

OBJECTIVE: To correlate the functional performance assessed by means of the Unilateral Seated Shot-Put Test (SSPT) with shoulder muscle strength, range of motion (ROM), and handgrip strength in recreational athletes with chronic shoulder pain. METHODS AND MATERIALS: The sample was composed of recreational athletes with nonspecific pain in the dominant shoulder ≥3 months, both sexes, aged between 18 and 45 years. We diagnosed shoulder pain by reporting pain intensity ≥3 points on the Numerical Rating Pain Scale and used the Shoulder Pain and Disability Index, Pain-Related Catastrophizing Thoughts Scale, and Baecke Questionnaire. Moreover, shoulder muscle strength, handgrip strength, ROM, and functional performance using the SSPT were evaluated. We used the Spearman correlation coefficient to investigate the correlation between the variables. RESULTS: Nineteen participants were included. Most of the sample consisted of adult women with adequate body mass and pain predominantly in the right shoulder. We observed higher correlation magnitudes of the SSPT with handgrip strength (rho = 0.818 to 0.833, p < 0.05). Correlations of the SPPT with shoulder musculature strength were of low to moderate magnitude (rho = 0.461 to 0.672, p < 0.05). The only significant correlation (p < 0.05) found was between the SSPT and ROM (horizontal adduction), however, with a weak magnitude (rho <0.50). CONCLUSION: SSPT correlates strongly with handgrip strength and moderately with shoulder muscle strength in recreational athletes with chronic shoulder pain.

Inclinometer Reliability for Shoulder Ranges of Motion in Individuals With Subacromial Impingement Syndrome.

OBJECTIVE: This study aimed to determine the intra- and interrater reliability of active and passive range of motion in the shoulders of individuals with subacromial impingement syndrome using a digital inclinometer. METHODS: The raters evaluated active and passive range of motion in the shoulder of 50 individuals with unilateral subacromial impingement syndrome in movements including flexion, abduction, extension, external rotation in a neutral position, external rotation with the arm at 90° of abduction, and internal rotation with the arm at 90° of abduction. The tests were performed by 2 examiners on the same day, with a 10-minute interval, and were repeated by 1 examiner after a 2- to 4-day interval. Reliability was analyzed using the intraclass correlation coefficient (ICC2,3). RESULTS: There was moderate to excellent interrater (ICC2,3 = 0.50-0.95) and intrarater (ICC2,3 = 0.74-0.94) reliability. In the interrater analysis, the standard error of measurement (SEM) ranged from 4.1° to 10°, the percentage SEM (%SEM) ranged from 2% to 17%, and the minimum detectable change ranged from 9.5° to 23.4°. In the intrarater analysis, the SEM ranged from 4° to 9.2°, %SEM ranged from 3% to 14%, and the minimum detectable change ranged from 9.3° to 21.4°. CONCLUSION: The digital inclinometer showed moderate to excellent reliability for measuring active and passive range of motion in shoulders with unilateral subacromial impingement syndrome.

Normative reference values for handgrip strength, shoulder and ankle range of motion and upper-limb and lower limb stability for 137 youth judokas of both sexes.

OBJECTIVES: To provide reference values for handgrip strength, shoulder and ankle range of motion (ROM) and upper-limb and lower limb stability for youth judokas of both sexes and investigate the effects of sex and side dominance. DESIGN: Cross-sectional. METHODS: A total of 137 youth judokas from under-18 (n=60) and under-21 (n=77) categories of both sexes were assessed. Handgrip strength was assessed using a Jamar dynamometer, ankle ROM was measured by lunge test, shoulder ROM was assessed by an inclinometer and upper-limb and lower limb stability were assessed by the Closed Kinetic Chain Upper Extremity Stability Test and by the Modified Star Excursion Balance Test (mSEBT). RESULTS: In both categories, males had greater handgrip strength. In the under-18 category, the dominant side had greater handgrip strength, the non-dominant side of females had smaller shoulder external rotation ROM than the dominant side and also than both sides of males, and females had greater shoulder IR ROM. In the under-21 category, the dominant side of females had greater ankle dorsiflexion ROM than the dominant side of males, the dominant sides and females had greater shoulder ER ROM, and males had better performance in the mSEBT. CONCLUSIONS: This study provided reference values for handgrip strength, shoulder and ankle ROM, upper and lower limb stability for youth judokas, which can be used to guide assessment during preseason. Sex influenced on shoulder ER and IR ROM, handgrip strength and lower limb stability. In addition, side dominance influenced on shoulder ER ROM and on handgrip strength.

Between-Day Reliability of Scapular Locator for Measuring Scapular Position During Arm Elevation in Asymptomatic Participants.

OBJECTIVE: The aim of this study was to assess the between-day reliability of the scapular locator for measuring scapular rotations during arm elevation in patients without shoulder pain/conditions/disorders. METHODS: Twenty-three asymptomatic individuals were measured during 2 sessions separated by 24 hours. One observer measured scapular position with a scapular locator while participants held their arms at 30°, 60°, 90°, and 120° elevation in the scapular plane. Three trials were performed for each arm position. RESULTS: At 30°, between-day intraclass correlation coefficients (ICCs) for all scapular rotations were poor (ICC 0.10-0.40). At higher arm elevations (60°, 90°, and 120°), ICCs ranged from 0.73 to 0.93 for scapular upward rotation, 0.80 to 0.87 for posterior tilt, and 0.37 to 0.62 for scapular internal rotation. For all scapular rotations, the standard error of measurement was less than 6°, and the smallest detectable difference ranged from 11° to 18°. CONCLUSION: The findings indicate good to excellent reliability for measuring scapular upward/downward rotation and anterior/posterior tilt between 60° and 120° of shoulder elevation in the scapular plane. However, low reliability was found for all scapular rotations at 30° elevation, and for scapular internal rotation at higher arm elevation.

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.

Effect of antioxidants, mitochondrial cofactors and omega-3 fatty acids on telomere length and kinematic joint mobility in young and old shepherd dogs - A randomized, blinded and placebo-controlled study.

In dogs, decreasing telomere length is a biomarker for cellular aging. On a systemic level, aging affects the locomotor system in particular, leading to restricted joint mobility. As aging is thought to be related to oxidative stress, it may be counteracted by a diet enriched with antioxidants, mitochondrial cofactors and omega-3 fatty acids. This randomized, blinded and placebo-controlled study examined the influence of an accordingly enriched diet compared to a control diet on 36 young and 38 old shepherd dogs. At the outset, after 3 and after 6 months, mean and minimum telomere lengths were measured. Furthermore, minimum and maximum joint angles and range of motion of the shoulder, elbow, carpal, hip, stifle and tarsal joints were measured by computer-assisted gait analysis. A positive influence of the enriched diet on old dogs could be verified for minimum telomere length and all three parameters of the shoulder joint on the side with the higher vertical ground reaction force after 6 months. In the other joints there were less significant differences; in some cases they indicated a contrary influence of the enriched diet on young dogs, probably due to its reduced protein content. The greater effect of the enriched diet on minimum than on mean telomere length may be due to the higher preference of telomerase for short telomeres. The greater effect on shoulder joint mobility is explained by the greater influence of musculature and connective tissue in this joint. For elderly dogs it is advisable to feed these nutritional supplements.

Comparison of Myofascial Release Techniques on Pectoralis Minor Length, Glenohumeral Total Arc of Motion, and Skin Temperature: A Pilot Study.

CONTEXT: The pectoralis minor (PM) is an important postural muscle that may benefit from myofascial techniques, such as Graston Technique® (GT) and self-myofascial release (SMR). OBJECTIVE: To examine the effects of GT and SMR on PM length, glenohumeral total arc of motion (TAM), and skin temperature. DESIGN: Cohort. SETTING: Laboratory. PARTICIPANTS: Twenty-six healthy participants (19 females and 7 males; age = 20.9 [2.24] y, height = 170.52 [8.66] cm, and weight = 72.45 [12.32] kg) with PM length restriction participated. INTERVENTIONS: Participants were randomized to the intervention groups (GT = 12 and SMR = 14). GT and SMR interventions were both applied for a total of 5 minutes during each of the 3 treatment sessions. MAIN OUTCOME MEASURES: PM length, TAM, and skin temperature were collected before and after each intervention session (Pre1, Post1, Pre2, Post2, Pre3, and Post3) and at 1-week follow-up (follow-up). Separate intervention by time analyses of variance examined differences for each outcomes measure. Bonferroni post hoc analyses were completed when indicated. Significance was set a priori at P ≤ .05. RESULTS: No significant intervention by time interactions were identified for PM length, TAM, or temperature (P > .05). No significant intervention main effects were identified for PM length (P > .05), TAM (P > .05), or temperature (P > .05) between the GT or SMR technique groups. Overall, time main effects were found for PM length (P = .02) and temperature (P < .001). Post hoc analysis showed a significant increase in PM length for both intervention groups at follow-up (P = .03) compared with Post2. Furthermore, there were significant increases in temperature at Post1 (P < .001), Post2 (P = .01), and Post3 (P < .001) compared with Pre1; Post2 was increased compared with Pre2 (P = .003), Pre3 (P < .001), and follow-up (P = .01); Post3 increased compared with Pre3 (P = .01) and follow-up (P = .01). CONCLUSION: Serial application of GT and SMR to the PM did not result in increases in PM length or TAM. Regardless of intervention, skin temperature increased following each intervention.

Posterior Thigh Foam Rolling Increases Knee Extension Fatigue and Passive Shoulder Range-of-Motion.

Monteiro, ER, Costa, PB, Corrêa Neto, VG, Hoogenboom, BJ, Steele, J, and da Silva Novaes, J. Posterior thigh foam rolling increases knee extension fatigue and passive shoulder range-of-motion. J Strength Cond Res 33(4): 987-994, 2019-The purpose of this study was to analyze the acute effects of different foam rolling (FR) volumes on knee extensors fatigue and shoulder passive range-of-motion (PROM). Twelve recreationally active women were recruited for participation in 2 experiments separated by 3 weeks, and the same subjects performed all procedures in each experiment. In experiment 1, subjects performed 3 sets of knee extensions using a predetermined 10 repetition maximum load to momentary concentric failure: control condition (CG) with passive rest and 2 FR conditions for the hamstrings using 2 volumes (60 and 120 seconds; FR60 and FR120, respectively). Experiment 2 consisted of 2 shoulder flexion and extension baseline PROM tests. Following baseline measures, subjects performed a single 60-second bout of FR on the hamstrings. Outcome PROM measures were measured through manual goniometry immediately (post-0), 10 minutes (post-10), 20 minutes (post-20), 30 minutes (post-30), 24 hours (post-24), and 48 hours (post-48) after the intervention to assess the effects on PROM over an extended period. Fatigue index indicated significantly greater fatigue resistance for CG when compared with FR60 (p = 0.035; [INCREMENT]% = 6.49) and FR120 (p = 0.002; [INCREMENT]% = 9.27), and there were no significant differences between FR60 and FR120 (p = 0.513; [INCREMENT]% = 2.78). Shoulder flexion PROM increased in post-0 as compared to baseline 1 (p = 0.002; d = 1.58), baseline 2 (p < 0.001; d = 1.92), and baseline higher measurement (p < 0.001; d = 1.59) and remained increased for post-10 as compared to baseline 2 (p = 0.017; d = 1.55). Shoulder extension PROM increased in post-0 as compared to baseline 1 (p < 0.001; d = 2.61), baseline 2 (p < 0.001; d = 2.83), and baseline higher measurement (p < 0.001; d = 2.59) and remained increased for post-10 as compared to baseline 1 (p < 0.001; d = 1.93), baseline 2 (p < 0.001; d = 2.16), and baseline higher measurement (p < 0.001; d = 1.91) and post-20 as compared to baseline 1 (p = 0.008; d = 1.58), baseline 2 (p = 0.001; d = 1.85), and baseline higher measurement (p = 0.011; d = 1.55). Foam rolling volumes equal to or greater than 60 seconds are detrimental to the ability to continually produce force in the lower extremity and should not be applied to the hamstrings muscle group between sets of knee extensions. PROM results indicate that FR applied to the hamstrings demonstrates an increase in both shoulder flexion and extension PROM. This work may have important clinical (rehabilitation) implications, as it demonstrates global effects of FR on functional outcomes.

A descriptive analysis of shoulder muscle activities during individual stages of the Turkish Get-Up exercise.

The Turkish Get-Up (TGU) is a complex and multi-planar exercise; the performer begins in a supine lying position, progresses toward upright standing through a series of 7 stages while holding a mass overhead in one hand, and returns to the original supine lying position through a reversal of the same 7 stages. A descriptive analysis of shoulder muscle activity during the TGU may provide insight toward its use in training and rehabilitation contexts. Our objectives were to: (1) describe the activity patterns from a subset of muscles that span the glenohumeral joint during individual stages of the TGU, and (2) interpret these patterns through comparisons between left- and right-side muscles, and between the up and down phases of the TGU. Twelve individuals with at least one-year experience performing the TGU were included in this study. Surface electromyographic (EMG) recordings were bilaterally obtained from 8 glenohumeral muscle groups while participants performed ten trials of the TGU with a kettlebell in their right hand. Instants representing the start and end of each TGU stage were identified from a synchronized video for each trial, and EMG activities for each muscle were integrated over the duration of each stage. Average integrated EMG and within-participant coefficients of variation were calculated. Overall, the greatest muscular demand occurred during the second (press to elbow support) and fifth (leg sweep) stages. Activities from muscles on the ipsilateral side to the kettlebell (right-side) were greater during stages when the contralateral upper limb did not contribute to supporting the body; however, contralateral (left-side) muscles were invoked during stages when the non-kettlebell-bearing forearm or hand contributed to supporting the body. The results suggest the importance of training both phases of the TGU to gain the most benefit from the exercise and highlights the asymmetric nature of the exercise, which may be particularly relevant for athletes engaged in activities with rotational demands.

Comparison of muscular activities between subjects with and without scapular downward rotation impairment during diagonal pattern of exercises.

BACKGROUNDS: One form of abnormal scapular alignment is scapular downward rotation (SDR). Changes in muscle function in SDR have not been clearly identified, and SDR exercises also require investigation. Although a diagonal pattern of exercise is commonly used as part of the exercise protocol, a direct comparison of shoulder and scapular diagonal exercises has not yet been conducted. The objectives of this study were to determine the altered activation of the scapular musculature in the SDR group and to investigate which diagonal pattern of exercise effectively activates the scapular musculature. METHODS: Thirty-two participants (18 in the control group and 14 in the SDR group) volunteered to participate in this study. Electromyographic signals were collected from four muscles, the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and anterior deltoid (AD), during standing performance of diagonal shoulder and scapular exercises. RESULTS: The control group showed significantly lower UT activity, UT/LT ratio, and UT/SA values than the SDR group (p < .05). Activation of the AD was significantly higher in the SDR than in the control group (p < .05). SA and AD activation were significantly higher in shoulder diagonal pattern exercises than in scapular diagonal pattern exercises (p < .05). The scapular posterior elevation pattern exercise showed significantly higher UT and LT activities than anterior elevation and shoulder diagonal pattern exercises (p < .05). CONCLUSION: Our findings suggest that reduced activation of the UT could lead to greater activation in the AD in SDR. Scapular posterior elevation exercise is advantageous as selectively activates the trapezius musculature, and shoulder diagonal pattern exercise is advantageous in activating the SA and AD.

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.

Shoulder joint kinetics and dynamics during underwater forward arm elevation.

Aquatic exercises are widely implemented into rehabilitation programs. However, both evaluating their mechanical demands on the musculoskeletal system and designing protocols to provide progressive loading are difficult tasks. This study reports for the first time shoulder joint kinetics and dynamics during underwater forward arm elevation performed at speeds ranging from 22.5 to 90°/s. Net joint moments projected onto anatomical axes of rotation, joint power, and joint work were calculated in 18 participants through a novel approach coupling numerical fluid flow simulations and inverse dynamics. Joint dynamics was revealed from the 3D angle between the joint moment and angular velocity vectors, identifying three main functions-propulsion, stabilization, and resistance. Speeds <30°/s necessitated little to no power at all, whereas peaks about 0.20 W⋅kg-1 were seen at 90°/s. As speed increased, peak moments were up to 61 × higher at 90 than at 22.5°/s, (1.82 ±â€¯0.12%BW⋅AL vs 0.03 ±â€¯0.01%BW⋅AL, P < 0.038). This was done at the expense of a substantial decrease in the joint moment contribution to joint stability though, which goes against the intuition that greater stabilization is required to protect the shoulder from increasing loads. Slow arm elevations (<30°/s) are advantageous for joint mobility gain at low mechanical solicitation, whereas the intensity at 90°/s is high enough to stimulate muscular endurance improvements. Simple predictive equations of shoulder mechanical loading are provided. They allow for easy design of progressive protocols, either for the postoperative shoulder or the conditioning of athlete targeting very specific intensity regions.

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 Self-Myofascial Release on Shoulder Function and Perception in Adolescent Tennis Players.

CONTEXT: Tennis induces a decreased internal rotation range of motion at the dominant glenohumeral joint. The effects of self-myofascial release have not yet been investigated to restore glenohumeral range of motion. OBJECTIVE: This study aimed at investigating the effects of self-myofascial release on shoulder function and perception in adolescent tennis players. DESIGN: Test-retest design. SETTING: Tennis training sport facilities. PARTICIPANTS: Eleven male players participated in this study (age: 15 [3] y; height: 173.1 [11.1] cm; mass: 56.0 [15.1] kg; International Tennis Number: 3). INTERVENTION: During 5 weeks, the players performed their regular tennis training. During 5 additional weeks, self-myofascial release of the infraspinatus and pectoralis muscles was implemented 3 times per week after the warm-up of the regular training session. MAIN OUTCOME MEASURES: The primary outcome was glenohumeral internal rotation range of motion. The secondary outcomes were perceived shoulder instability and tennis serve accuracy and velocity. RESULTS: Adding self-myofascial release allowed an increase of 11° (2°) of internal rotation range of motion at the dominant glenohumeral joint (P < .001) and a decreased perception of shoulder instability (P = .03), while maintaining tennis serve velocity and accuracy. CONCLUSIONS: Implementing self-myofascial release on infraspinatus and pectoralis muscles 3 times per week during 5 weeks improved dominant glenohumeral internal rotation range of motion in tennis players. It can be used as a strategy to preserve the mobility of this joint.

Effects of 3 Different Elastic Therapeutic Taping Methods on the Subacromial Joint Space.

OBJECTIVE: The purpose of this study was to examine the effects of 3 different elastic therapeutic taping methods on the subacromial joint space in healthy adults. METHODS: Pre-/post-test laboratory study method was used in this study. Forty-eight healthy adults with no prior history of shoulder injury or surgery and no history of dominant shoulder pain in the past 6 months were enrolled in the study. Participants were placed into 3 groups (8 males and 8 females per group) on the basis of a consecutively assigned allocation design. A baseline measurement of the acromiohumeral distance (AHD) was taken by using diagnostic ultrasonography for every participant. On the basis of group assignment, participants were then taped according to the Kinesio Tape (Kinesio Tex Classic Tape) guidelines in one of 3 conditions: (1) taping of the supraspinatus from insertion to origin; (2) taping of the anterior and posterior deltoids from insertion to origin; and (3) a combination of both techniques. After a 5-minute wait period, the AHD was remeasured with the tape intervention in place, with each participant serving as his or her own control. RESULTS: Data analysis showed a statistically significant increase in AHD when using the taping technique over the anterior and posterior deltoids (Condition 2). The subacromial space increased in both males and females when the supraspinatus was taped from insertion to origin (Condition 1), but not at a statistically significant level. Condition 3, in which both taping techniques were used simultaneously, did not show an increase at a statistically significant level. CONCLUSIONS: The application of the Kinesio Tape from insertion to muscle origin of the supraspinatus or the anterior and posterior deltoid increased the subacromial joint space.

The effects of preventive rubber band training on shoulder joint imbalance and throwing performance in handball players: A randomized and prospective study.

OBJECTIVES: To investigate the effects of a strength training program (STP) using rubber band exercises. METHODS: Twenty-five athletes were divided into two groups: muscular imbalance in the dominant (D) and in the non-dominant (ND) upper limbs. Each group was subdivided into experimental and control groups. Experimental groups performed eighteen sessions of STP. Athletes were submitted to ball throwing and isokinetic strength tests to assess the muscular strength of the shoulder rotator muscles and conventional and functional balance ratios. RESULTS: STP improved external rotator peak torque (18.0 ± 0.8 to 21.3 ± 1.0 Nm, p < 0.01) and total work (29.3 ± 0.9 to 34.5 ± 1.5 J, p < 0.01) in the D experimental group, while only total work (34.8 ± 2.5 to 37.6 ± 3.1 J, p < 0.03) improved in the D control group. The ND experimental group also presented significant improvement in external rotator peak torque (18.8 ± 0.8 to 21.1 ± 1.3 Nm, p < 0.01) and total work values (29.0 ± 1.4 to 34.6 to 1.6 J, p < 0.01) while there was no strength improvement in the ND control group. The ND experimental group showed an improvement in conventional (61.5 ± 3.5 to 72.7 ± 3.0%, p = 0.03) and functional (1.0 ± 0.1 to 1.6 ± 0.08, p < 0.01) ratios. STP did not improve the conventional ratio in the D experimental group. However, STP produced a large effect size. The D experimental group presented an improvement in ball velocity (49.0 ± 2.4 to 52.5 ± 2.2 km/h, p = 0.04) in standing position throwing. CONCLUSIONS: STP improves muscular strength of external rotator muscles and muscular balance.

Differences between clinician- and self-administered shoulder sustained mobilization on scapular and shoulder muscle activity during shoulder abduction: A repeated-measures study on asymptomatic individuals.

BACKGROUND: Sustained glenohumeral postero-lateral glide administered by a clinician is commonly used in the management of patients with shoulder pain. This technique reduced shoulder muscle activity in asymptomatic individuals, but it is unknown whether a self-administered version of the mobilization leads to similar neuromuscular response. This study compared the effect of sustained shoulder mobilizations (performed by a physiotherapist) with self-administered mobilization (with a belt) on activity levels of scapular and glenohumeral shoulder muscles. METHODS: Twenty-two individuals participated in this study, which had a cross-over, repeated measures design. Seven shoulder muscles (upper and lower trapezius, supraspinatus, infraspinatus, posterior deltoid, middle deltoid, and serratus anterior) were monitored using surface electromyography (SEMG) during shoulder abduction performed with a clinician-administered sustained mobilization, and with self-administered sustained mobilization. Muscle activity levels were measured prior, during and after the sustained glide was applied to the shoulder. Mixed-effect models for repeated measures were used for within- and between-condition comparisons. RESULTS: There was no carry-over effect. Within-condition comparisons suggest that both interventions lead to changes in scapular and shoulder muscle activity levels. No differences between clinician-administered and self-administered mobilizations at intervention and follow-up were found for the monitored muscles, with the exception of upper trapezius. CONCLUSIONS: In young, asymptomatic individuals, self- or clinician-administered sustained mobilizations reduced activity levels of most scapular and shoulder muscles during shoulder abduction. This effect was observed only while the sustained glides were applied to the shoulder. At the immediate follow-up, muscle activity levels were similar to baseline measurements.

Immediate effects of cervical unilateral anterior-posterior mobilisation on shoulder pain and impairment in post-operative arthroscopy patients.

BACKGROUND: Lateral gliding cervical spine mobilisation is shown to improve shoulder pain, disability and function. However, despite common clinical-use, no study reports the effect of unilateral anterior-posterior (A-P) cervical mobilisation on shoulder pain and function, and particularly in patients after arthroscopic shoulder surgery. OBJECTIVE: Examine the immediate effect of single-level Grade III cervical unilateral A-P mobilisation on shoulder pain, flexion and abduction range of motion (ROM) and external rotator strength compared to placebo cervical unilateral A-P light touch pressure. METHODS: Single session intervention with a crossover design in 32 (15 women) postoperative arthroscopic shoulder patients. RESULTS: Immediate and superior treatment effects were shown for A-P cervical mobilisation in improving flexion ROM, isometric strength of external rotation, and pain intensity during flexion (all p< 0.05) when compared to the placebo. However, effects may not be considered clinically meaningful. CONCLUSION: Unilateral A-P mobilisation applied to the cervical spine shows a tendency toward positively influencing post-arthroscopy shoulder pain and function. Further study examining cervical mobilisations directed in different planes to influence shoulder motion appear warranted.