Optimal activation ratio of the scapular muscles in closed kinetic chain shoulder exercises: A systematic review.

BACKGROUND: Muscle synergies contribute to scapular position during arm movement. The trapezius and serratus anterior (SA) muscles are the main stabilizers and are therefore the main target muscles of therapeutic exercises. OBJECTIVE: To systematically review the current literature investigating the optimal activation ratio of the scapular muscles during a range of closed kinetic chain exercises. METHODS: A systematic review search was conducted to identify studies reporting shoulder electromyography (EMG) activity during rehabilitation exercises in healthy participants. The search was conducted in PubMed, Cochrane Library, MEDLINE, CINAHL, Scopus, SPORTDiscus, and ScienceDirect. The included studies reported closed kinetic chain exercises and the muscle activity as a percentage of maximum voluntary isometric contraction (%MVIC) or muscle ratios of the lower trapezius (LT), middle trapezius (MT), and SA with respect to the upper trapezius (UT). Muscle ratios were classified as optimal if they were equal to or lower than 0.6, and the adapted Newcastle-Ottawa Scale (NOS) was used to evaluate the methodological quality of the selected studies. RESULTS: Twenty-nine studies were included in this review; 7 main exercises and 30 variations of these were reported. The average electromyographic activity of the concentric and eccentric phase was considered. Half Push Up, Push Up Plus, and Scap Protraction exercises showed optimal SA activity (UT/SA < 0.6), while Press Up, Half Push Up, and One Hand Plank exercises showed optimal LT activity (UT/LT < 0.6). According to the NOS, 15 studies were classified as moderate methodological quality. CONCLUSIONS: The exercises in higher positions (e.g. exercises with the trunk closest to the vertical line) or unstable surfaces tend to favor UT activity over the MT, LT and SA. The exercises including scapular retraction showed optimal UT/MT and UT/LT ratios, while those including scapular protraction showed optimal UT/SA ratios. This will assist therapists in the correct selection of exercises for shoulder rehabilitation.

Glenohumeral internal rotation deficit in table tennis players.

Table tennis requires rapid and extreme movements that may result in shoulder adaptations, such as glenohumeral internal rotation deficit, which is a risk factor for several injuries. This study compared range of motion of internal and external rotation and total rotation motion of glenohumeral joint between dominant and non-dominant shoulders of table tennis players. This is a cross-sectional observational study. Twenty healthy male table tennis players that were enrolled in an official table tennis league took part in this study (mean age: 22.9 ± 12.9 years, time of sports practice: 6.2 ± 7.12 years). Measurements of passive glenohumeral external rotation and internal rotation were taken with the individuals in the supine and sidelying positions. Total rotation motion was calculated by summing external and internal rotations. The dominant side showed decreased internal rotation when compared to non-dominant side in both supine (mean difference: 14.9°, p = 0.02) and sidelying positions (mean difference: 16.3°, p = 0.01). No significant difference (p > 0.05) was found for external rotation and total rotation motion between dominant and non-dominant shoulders. The findings indicate that table tennis players exhibit glenohumeral internal rotation deficit of dominant shoulder.

Sex-Related Differences in Scapular Kinematics During Elevation of the Arm in Asymptomatic Children and Adults.

Recently, it has been suggested that sex may influence scapular kinematics. A more comprehensive analysis of the scapular kinematics in children and adults, including sex as a factor, will help to understand if differences between sexes are present since childhood. The purpose of this study was to compare scapular kinematics between sex in children and adults during elevation of the arm. One-hundred and sixteen asymptomatic adults (58 men and 58 women) and 53 children (28 boys and 25 girls) participated in the study. Three-dimensional scapular kinematics during elevation of the arm were obtained using an electromagnetic tracking device. Women had a more upwardly rotated scapula in the nondominant side (P < .05), with large effects and a more anteriorly tilted position at 60°, 90°, and 120° of arm elevation in the dominant side, and at 90° and 120° in the nondominant side (P < .05) with moderate effects when compared with men. Differences between sexes were not found in the children (P > .05). In conclusion, sex seems to influence scapular kinematics in adulthood, but not in childhood.