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.

Assessment of pain, scapulothoracic muscle strength, endurance and scapular dyskinesis in individuals with and without nonspecific chronic neck pain: A cross-sectional study.

INTRODUCTION: This study is aimed to evaluate pain, muscle strength, scapular muscular endurance and scapular kinesis in individuals with Nonspecific Chronic Neck Pain and to compare them with asymptomatic individuals. In addition, to investigate the effect of mechanical changes in the scapular region on neck pain. METHOD: 40 individuals who applied to Kirikkale University Faculty of Medicine Hospital Physical Therapy and Rehabilitation Center and diagnosed with NSCNP and 40 asymptomatic individuals for the control group were included the study. Pain was evaluated with Visual Analogue Scale, pain threshold and pain tolerance with algometer, cervical deep flexor group muscle strength with Stabilizer Pressure Biofeedback device, and neck and scapulothoracic muscle strength with Hand Held Dynamometer. Scapular Dyskinesia Test, Scapular Depression Test and Lateral Scapular Slide Test were used to evaluate scapular kinesis. A timer was used to evaluate scapular muscular endurance. RESULT: Pain threshold and pain tolerance values of the NSCNP group were lower (p < 0.05). Muscle strength around neck and scapulothoracic region of the NSCNP group were lower than the asymptomatic individuals (p < 0.05). NSCNP group had more scapular dyskinesia (p < 0.05). Scapular muscular endurance values of the NSCNP group were lower (p < 0.05). CONCLUSION: As a result, pain threshold and pain tolerance decreased, muscle strength of the neck region and the scapular region decreased, scapular endurance values decreased and the incidence of scapular dyskinesia increased in the individuals with NSCNP compared to the asymptomatic individuals. It is thought that our study will provide a different perspective in the evaluation of neck pain and including the scapular region to the evaluations.

The effect of EMG biofeedback training on muscle activation in an impingement population.

Subacromial impingement syndrome (SAIS) is one of the most diagnosed causes of pain in the upper extremity. The purpose of this study was to investigate muscle activity between asymptomatic and SAIS shoulders on the same subject while understanding the effectiveness of EMG biofeedback training (EBFB) on bilateral overhead movements. Ten participants (7 male), that tested positive for 2/3 SAIS clinical tests, volunteered for the study. Bilateral muscle activity was measured via electrodes on the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and lumbar paraspinals (LP). Participants performed bilateral scapular plane overhead movements before and after EBFB. EBFB consisted of 10 bilateral repetitions of I, W, T, and Y exercises focused on reducing UT and increasing LT and SA activity. Prior to EBFB, no significant difference in muscle activity was present between sides. A significant main effect of time indicated that after EBFB both sides exhibited reduced UT activity at 60° (p = 0.003) and 90° (p = 0.036), LT activity was increased at all measured humeral angles (p < 0.0005), and SA muscle activity was increased at 110° (p = 0.001). EBFB in conjunction with scapular based exercise effectively alters muscle activity of asymptomatic and symptomatic scapular musculature.

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.

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.

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.

Single-Session Video and Electromyography Feedback in Overhead Athletes With Scapular Dyskinesis and Impingement Syndrome.

CONTEXT: Subacromial impingement syndrome (SIS) is associated with scapular dyskinesis, or imbalanced scapular muscle activity. Evidence has shown that feedback can improve scapular control in patients with SIS. However, it is unknown whether real-time video feedback or electromyography (EMG) biofeedback is optimal for improving scapular kinematics and muscle activity during a functional task. OBJECTIVE: To compare the effects of video and EMG feedback sessions on absolute muscle activity (upper trapezius [UT], lower trapezius [LT], serratus anterior), muscle balance ratios (UT/LT, UT/serratus anterior), and scapular kinematics (anterior-posterior tilt, external-internal rotation, upward rotation) in SIS participants during arm elevation and lowering. DESIGN: Randomized controlled clinical trial. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: Overhead athletes who were diagnosed with SIS and who also exhibited scapular dyskinesis (N = 41). MAIN OUTCOME MEASURE(S): Three-dimensional kinematics and EMG were recorded before and after feedback training. RESULTS: Lower trapezius muscle activity increased (4.2%-18%, P < .011) and UT/LT decreased (0.56-1.17, P < .013) in the EMG biofeedback training group as compared with those in the video feedback training group. Scapular upward rotation during arm elevation was higher in the video group than in the EMG group after feedback training (2.3°, P = .024). CONCLUSIONS: The EMG biofeedback improved muscle control and video feedback improved the correction of scapular upward rotation in patients with SIS. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT03252444.

Scapular muscles' activity in female volleyball players with scapular asymmetry in the resting position.

BACKGROUND/AIM: Resting scapular asymmetry with a more protracted and depressed position of the scapula in the dominant throwing side relative to the scapula of the contralateral side is commonly detected in overhead athletes with both healthy and disabled shoulders. It has been proposed that possible alterations in the EMG activity of periscapular muscles due to asymmetric position of the scapula may alter its kinematics leading to shoulder pathology. The aim of the current study was to identify possible alterations in the activation of periscapular muscles of healthy female volleyball players with scapular asymmetry in the resting position. METHODS: Resting position of the scapula was determined in 37 healthy professional female volleyball players. Twenty-two players, with the scapula of the dominant side in a more protracted and depressed position compared to the non-dominant side, were classified as the asymmetry group. Fifteen players with almost symmetrical position of both scapulae comprised the control group. All participants performed an upper extremity closed chain exercise (knee push-ups) on a stable (floor) and an unstable surface (BOSU platform), while the EMG activity of serratus anterior (SA), upper trapezius (UT) and middle trapezius (MT) was recorded bilaterally. RESULTS: No significant group (asymmetry vs. control) by side (dominant vs. non-dominant) by surface condition (floor vs. BOSU platform) interaction was detected with regard to the EMG activity of SA, UT and MT. Although not statistically significant the asymmetry group demonstrated a tendency for reduced EMG activity of the SA on the dominant compared to the contra-lateral side and compared to the dominant side of the control group. CONCLUSIONS: The EMG activity of periscapular muscles (SA, UT and MT) was not affected during execution of a close chain exercise in healthy female volleyball players with the scapula of the dominant side in a more protracted and depressed resting position.

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.

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.

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.

Change of pectoralis minor length, and acromial distance, during scapular retraction at 60° shoulder elevation.

As the pectoralis minor muscle is inserted into the coracoid process, an improper length of this muscle would affect scapular and shoulder motions. Therefore, this study is proposed to assess the effects on pectoralis minor's length and acromial distance after active scapular retraction in scaption at 60° elevation. Sixty right-hand-dominant participants (11 males, 49 females) were randomized into an intervention group and a control group. The intervention group performed pectoralis minor muscle stretching by active scapular retraction, while the control group were asked to sit in an upright position. The result shows that, the mean lengths of pectoralis minor in the intervention group were significantly increased when compared with those of the control group (p = 0.004 and p = 0.014 respectively). Simultaneously, the reduction in acromial distance of this intervention group was substantially greater than the control group's (p < 0.001 and p = 0.001 respectively). However, it should be noted that the results reported only relate to the period immediately following muscle stretching.

Increased strength of the scapular stabilizer and lumbar muscles after twelve weeks of Pilates training using the Reformer machine: A pilot study.

OBJECTIVE: The aim of this work was to analyze muscle strength in Pilates novices who used the Reformer equipment during twelve training sessions. METHODS: Twenty-four healthy young female volunteers, who were non-smokers and did not exercise regularly, were split into a control group (mean age 28 ± 4 years and BMI 24.55 ± 3.21 kg/m2) and a training group (mean age 29 ± 4 years and BMI 22.69 ± 2.87 kgm2). The data were checked for normality using the Kolmogorov-Smirnov test, and were then analyzed using the t-test (p < 0.05). RESULTS: After the training sessions, there were statistically significant differences between the groups for the scapular stabilizer muscles (p = 0.0263) and the lumbar muscles (p = 0.0001). For the scapular stabilizers, the initial/final values were 14.69 ± 2.80/14.79 ± 2.89 (control group) and 15.99 ± 3.54/17.44 ± 2.88 (Pilates group). The corresponding values for the lumbar muscles were 53.83 ± 11.66/53.28 ± 11.14 (control group) and 54.75 ± 10.27/64.80 ± 10.20 (Pilates group). CONCLUSION: After twelve sessions of Pilates with the Reformer equipment, there were improvements in lumbar extensor and scapular stabilizer strength. Several benefits are reported by practitioners of Pilates, but until now, there has been limited scientific evidence of the improvement of strength in the trunk and limbs after application of the technique.

The effects of scapular mobilization in patients with subacromial impingement syndrome: a randomized, double-blind, placebo-controlled clinical trial.

OBJECTIVE: To determine the effects of scapular mobilization on function, pain, range of motion, and satisfaction in patients with subacromial impingement syndrome (SAIS). DESIGN: Randomized, double-blind, placebo-controlled clinical trial. SETTING: University hospital clinics in Turkey. PARTICIPANTS: 66 participants (mean ± SD age 52.06 ± 3.71 y) with SAIS. INTERVENTIONS: Participants were randomized into 3 groups: scapular mobilization, sham scapular mobilization, and supervised exercise. Before the interventions transcutaneous electrical stimulation and hot pack were applied to all groups. Total intervention duration for all groups was 3 wk with a total of 9 treatment sessions. MAIN OUTCOME MEASURES: Shoulder function and pain intensity were primary outcome measures; range of motion and participant satisfaction were secondary outcome measures. Shoulder function was assessed with the short form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH). A visual analog scale was used to evaluate pain severity. Active range of motion was measured with a universal goniometer. A 7-point Likert scale was used to evaluate satisfaction. Outcome measurements were performed at baseline, before visits 5 and 10, 4 wk after visit 9, and 8 wk after visit 9. RESULTS: There was no group difference for DASH score (P = .75), pain at rest (P = .41), pain with activity (P = .45), pain at night (P = .74), and shoulder flexion (P = .65), external rotation (P = .63), and internal rotation (P = .19). There was a significant increase in shoulder motion and function and a significant decrease in pain across time when all groups were combined (P < .001). The level of satisfaction was not significantly different for any of the questions about participant satisfaction between all groups (P > .05). CONCLUSION: There was not a significant advantage of scapular mobilization for shoulder function, pain, range of motion, and satisfaction compared with sham or supervised-exercise groups in patients with SAIS.

Effect of seated thoracic manipulation on changes in scapular kinematics and scapulohumeral rhythm in young asymptomatic participants: a randomized study.

OBJECTIVE: The purpose of this study was to evaluate the immediate effects of seated thoracic manipulation on scapulothoracic kinematics and scapulohumeral rhythm during arm flexion in young asymptomatic participants. METHODS: A convenience sample of 42 young asymptomatic participants was randomly divided in 2 groups: manipulation and sham group. Measurements were taken before and after the intervention. All participants completed the Disabilities of the Arm, Shoulder, and Hand questionnaire to assess pain and physical function. The manipulation group received the manipulation (high velocity, low amplitude), which was performed by a physical therapist with the patient in the seated position and with the arms crossed over the chest and hands passed over the shoulders. For the sham group, the same procedure was performed, with the exception that the high-velocity thrust was not applied. Three-dimensional (3D) kinematic data were collected with the participants in a relaxed standing position using a 3D electromagnetic tracking system. All participants performed 3 repetitions of arm flexion before and after manipulation. RESULTS: There were no differences (P = .79) in Disabilities of the Arm, Shoulder, and Hand scores when the manipulation (3.37 ± 3.72) was compared with the sham group (3.68 ± 4.27). The 3-way analysis of variance showed no significant interaction among group, angle, and time differences for the outcomes (scapulothoracic internal/external rotation [F = 0.43; P = .82], upward/downward rotation [F = 0.08; P = .99], tilt [F = 0.23; P = .94], and scapulohumeral rhythm [F = 4; P = .86]). The intragroup effect was small for the outcomes measured in both groups. CONCLUSIONS: Thoracic manipulation in the seated position did not affect scapulohumeral rhythm and 3D scapular kinematics during arm flexion in young asymptomatic participants.

Real-time visual feedback can be used to activate scapular upward rotators in people with scapular winging: an experimental study.

QUESTION: Can real-time visual feedback facilitate the activity of serratus anterior in individuals with scapular winging during shoulder flexion? DESIGN: Comparative, repeated-measures experimental study. PARTICIPANTS: Nineteen subjects with scapular winging. INTERVENTION: Participants performed isometric shoulder flexion at 60° and 90° with and without real-time visual feedback using a video camera to monitor scapular winging. OUTCOME MEASURES: Activity in the upper trapezius, lower trapezius, and serratus anterior muscles was measured using surface electromyography. A video motion analysis system measured the displacement of a marker attached to the acromion in the frontal and sagittal planes. RESULTS: Visual feedback significantly increased activity in the upper trapezius at 60° of shoulder flexion by 2.3% of maximum voluntary isometric contraction (95% CI 0.7 to 4.0). Visual feedback also significantly increased activity in the serratus anterior at 60° and 90° of shoulder flexion, by 3.0% (95% CI 2.3 to 3.6) and 5.9% (95% CI 3.3 to 8.5) of maximum voluntary isometric contraction respectively. These effects equated to effect sizes from 0.29 to 0.46. Visual feedback also significantly improved movement of the acromion superiorly at 60° of shoulder flexion and anteriorly at 60° and 90° of shoulder flexion. CONCLUSION: Real-time visual feedback can be used to activate the upper trapezius and serratus anterior muscles and to improve movement of the scapula during shoulder flexion in people with scapular winging.

The use of EMG biofeedback for learning of selective activation of intra-muscular parts within the serratus anterior muscle: a novel approach for rehabilitation of scapular muscle imbalance.

Motor control and learning possibilities of scapular muscles are of clinical interest for restoring scapular muscle balance in patients with neck and shoulder disorders. The aim of the study was to investigate whether selective voluntary activation of intra-muscular parts within the serratus anterior can be learned with electromyographical (EMG) biofeedback, and whether the lower serratus anterior and the lower trapezius muscle comprise the lower scapula rotation force couple by synergistic activation. Nine healthy males practiced selective activation of intra-muscular parts within the serratus anterior with visual EMG biofeedback, while the activity of four parts of the serratus anterior and four parts of the trapezius muscle was recorded. One subject was able to selectively activate both the upper and the lower serratus anterior respectively. Moreover, three subjects managed to selectively activate the lower serratus anterior, and two subjects learned to selectively activate the upper serratus anterior. During selective activation of the lower serratus anterior, the activity of this muscle part was 14.4+/-10.3 times higher than the upper serratus anterior activity (P<0.05). The corresponding ratio for selective upper serratus vs. lower serratus anterior activity was 6.4+/-1.7 (P<0.05). Moreover, selective activation of the lower parts of the serratus anterior evoked 7.7+/-8.5 times higher synergistic activity of the lower trapezius compared with the upper trapezius (P<0.05). The learning of complete selective activation of both the lower and the upper serratus anterior of one subject, and selective activation of either the upper or lower serratus anterior by five subjects designates the promising clinical application of EMG biofeedback for restoring scapular muscle balance. The synergistic activation between the lower serratus anterior and the lower trapezius muscle was observed in only a few subjects, and future studies including more subjects are required before conclusions of a lower scapula rotation couple can be drawn.

Acute effects of scapular mobilization in shoulder dysfunction: a double-blind randomized placebo-controlled trial.

OBJECTIVE: The aim of this study was to evaluate the initial effects of scapular mobilization (SM) on shoulder range of motion (ROM), scapular upward rotation, pain, and function. DESIGN: Pretest-posttest for 3 groups (SM, sham, and control). SETTING: A double-blinded, randomized, placebo-controlled trial was conducted to evaluate the initial effect of the SM at a sports physiotherapy clinic. PARTICIPANTS: 39 subjects (22 women, 17 men; mean age 54.30 +/- 14.16 y, age range 20-77 y). INTERVENTIONS: A visual analog scale, ROM, scapular upward rotation, and function were assessed before and just after SM. SM (n = 13) consisted of the application of superoinferior gliding, rotations, and distraction to the scapula. The sham (n = 13) condition replicated the treatment condition except for the hand positioning. The control group (n = 13) did not undergo any physiotherapy and rehabilitation program. MAIN OUTCOME MEASURES: Pain severity was assessed with a visual analog scale. Scapular upward rotation was measured with a baseline digital inclinometer. Constant Shoulder Score (CSS) was used to measure shoulder function. RESULTS: After SM, we found significant improvements for shoulder ROM, scapular upward rotation, and CSS between pretreatment and posttreatment compared with the sham and control groups. In the sham group, shoulder-ROM values increased or decreased for the shoulder and scapular upward rotation was not changed. Pain, ROM, and physical function of the shoulder were not significantly different in the sham group than in controls (P > .05). CONCLUSIONS: SM may be a useful manual therapy technique to apply to participants with a painful limitation of the shoulder. SM increases ROM and decreases pain intensity.