Effect of scapular upward rotation exercises on scapular neuromuscular tenderness in subjects with depressed scapular alignment

https://doi.org/10.53730/ijhs.v6nS1.4831

Authors

  • Doha H. Al-Afify Assistant Lecturer, Basic Sciences Department, Faculty of Physical Therapy, Badr University in Cairo, Egypt
  • Ragia Kamel Professor, Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Egypt
  • Amr S. Shalaby Lecturer, Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Egypt

Keywords:

scapular downward rotation, pressure pain threshold, scapular upward rotation exercises

Abstract

Among the numerous scapular mal-alignments, scapular downward rotation (SDR) presents with depression, abduction and scapular tilt, attributed to upper trapezius elongation and levator scapulae stiffness, which consequently impacts scapular upward rotation. Scapular upward rotation exercise (SURE) that increase scapular upward rotators’ strength and stretch scapular downward rotator, provide the SDR patient with optimum muscle conditions in terms length and strength. This study was carried out to investigate the impact of upward rotation exercises on scapular muscles tenderness in subjects with scapular downward rotation alignment. Setting the p value at p < 0.001, the six weeks of intervention significantly improved pressure pain threshold (PPT) post-treatment of median, ulnar, radial nerves, upper trapezius, and upper and lower cervical facet joints (C2/C3 and C5/C6 zygapophyseal joints) compared to those of pre-treatment, with a percent of increase  of 81.85%, 93.38%, 92.68%, 87.54%, 76.32% and 69.66 % respectively. These results suggest that scapular upward rotation exercises regain optimal scapular function and posture that reduces neuromuscular tenderness in subjects with SDR.

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References

Aboodarda, S. J., Spence, A. J., & Button, D. C. (2015). Pain pressure threshold of a muscle tender spot increases following local and non-local rolling massage. BMC musculoskeletal disorders, 16(1), 1-10.

Andrade, G. T., Azevedo, D. C., De Assis Lorentz, I., Neto, R. S. G., Sadala Do Pinho, V., Gonçalves, R. T. F., ... & Van Dillen, L. R. (2008). Influence of scapular position on cervical rotation range of motion. Journal of orthopaedic & sports physical therapy 38(11), 668-673.

Azevedo, D.C., de Lima Pires, T., de Souza Andrade, F., McDonnell, M.K. (2008). Influence of scapular position on the pressure pain threshold of the upper trapezius muscle region. Eur J Pain, 12(2),226e32.

Azevedo, S., Kaschny, J. R., de Castilho, C. M., & de Brito Mota, F. (2007). A theoretical investigation of defects in a boron nitride monolayer. Nanotechnology, 18(49), 495707.

Byl, C., Puttlitz, C., Byl, N., Lotz, J., & Topp, K. (2002). Strain in the median and ulnar nerves during upper-extremity positioning. The Journal of hand surgery, 27(6), 1032-1040. https://doi.org/10.1053/jhsu.2002.35886

Caldwell, C., Sahrmann, S., Van DillenL. (2007). Use of a movement system impairment diagnosis for physical therapy in the management of a patient with shoulder pain. J Orthop Sports Phys Ther, 37, 551–563.

Chesterton, L.S., Barlas, P., Foster, N.E., Baxter, G.D., Wright, C.C. (2003). Gender differences in pressure pain threshold in healthy humans. Pain, 101(3), 259e66.

Choi, W. J., Cynn, H. S., Lee, C. H., Jeon, H. S., Lee, J. H., Jeong, H. J., & Yoon, T. L. (2015). Shrug exercises combined with shoulder abduction improve scapular upward rotator activity and scapular alignment in subjects with scapular downward rotation impairment. Journal of electromyography and kinesiology, 25(2), 363-370.

Cools, A.M., Struyf, F., De Mey, K., Maenhout, A., Castelein, B., Cagnie, B. (2014). Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med, 48(8), 692-7.

DiVeta, J., Walker, M.L., Skibinski, B. (1990). Relationship between performance of selected scapular muscles and scapular abduction in standing subjects. Phys Ther, 70, 470-476.

Greenfield, B., Catlin, P.A., Coats, P.W., Green, E., McDonald, J.J., North, C. (1995). Posture in patients with shoulder overuse injuries and healthy individuals. J Orthop Sports Phys Ther, 21, 287-295.

Ha, S. M., Kwon, O. Y., Yi, C. H., Cynn, H. S., Weon, J. H., & Kim, T. H. (2016). Effects of scapular upward rotation exercises on alignment of scapula and clavicle and strength of scapular upward rotators in subjects with scapular downward rotation syndrome. Journal of Electromyography and Kinesiology, 26, 130-136.

Ha, S. M., Kwon, O. Y., Yi, C. H., Jeon, H. S., & Lee, W. H. (2011). Effects of passive correction of scapular position on pain, proprioception, and range of motion in neck-pain patients with bilateral scapular downward-rotation syndrome. Manual therapy, 16(6), 585-589.

Helgadottir, H., Kristjansson, E., Mottram, S., Karduna, A., & Jonsson Jr, H. (2011). Altered alignment of the shoulder girdle and cervical spine in patients with insidious onset neck pain and whiplash-associated disorder. Journal of applied biomechanics, 27(3).

Kang, M.H., Choi, J.Y., Oh, J.S. (2015). Effects of crossed brassiere straps on pain, range of motion, and electromyographic activity of scapular upward rotators inwomen with scapular downward rotation syndrome. PM&R, 7(12), 1261e1268.

Kiernan, M. C., & Lin, C. S. Y. (2012). Nerve excitability: a clinical translation. Aminoff’s electrodiagnosis in clinical neurology. Elsevier, Saunders, 345-65.

Kim, B. J., & Lee, J. H. (2015). Effects of scapula-upward taping using kinesiology tape in a patient with shoulder pain caused by scapular downward rotation. Journal of physical therapy science, 27(2), 547-548.

Kim, T. H., & Lim, J. Y. (2016). The effects of wall slide and sling slide exercises on scapular alignment and pain in subjects with scapular downward rotation. Journal of physical therapy science, 28(9), 2666-2669.

Lee JH, Yoo WG. (2012). Effect of scapular elevation taping on scapular depression syndrome: a case report. J Back Musculoskelet Rehabil, 25(3),187-91.

Lee, J. H., Cynn, H. S., Choi, W. J., Jeong, H. J., & Yoon, T. L. (2016). Various shrug exercises can change scapular kinematics and scapular rotator muscle activities in subjects with scapular downward rotation syndrome. Human movement science, 45, 119-129. https://doi.org/10.1016/j.humov.2015.11.016

Lee, K. T., Chuang, C. C., Lai, C. H., Ye, J. J., & Wu, C. L. (2015). Study of the trapezius muscle region pressure pain threshold and latency time in young people with and without depressed scapula. Manual Therapy, 20(1), 124-129. https://doi.org/10.1016/j.math.2014.07.014

Lee, K. T., Chuang, C. C., Lai, C. H., Ye, J. J., & Wu, C. L. (2015). Study of the trapezius muscle region pressure pain threshold and latency time in young people with and without depressed scapula. Manual Therapy, 20(1), 124-129. https://doi.org/10.1016/j.math.2014.07.014

Lewis, J.S., Wright, C., Green, A. (2005). Subacromial impingement syndrome: the effect of changing posture on shoulder range of movement. J Orthop Sports Phys Ther, 35, 72–87.

Lim, J.Y., Kim, T.H., Lee, J.S. (2015). Reliability of measuring the passive range of shoulder horizontal adduction using a smartphone in the supine versus the side-lying position. J Phys Ther Sci, 27, 3119–3122.

Lluch, E., Arguisuelas, M.D., Calvente Quesada, O., Martínez Noguera, E., PeiróPuchades, M., Pérez Rodríguez, J.A., Falla, D. (2014). Immediate effects of active versus passive scapular correction on pain and pressure pain threshold in patients with chronic neck pain. J Manipulative PhysiolTher, 37(9), 660-6.

Martínez-Merinero, P., Lluch, E., Gallezo-Izquierdo, T., Pecos-Martín, D., Plaza-Manzano, G., Nuñez-Nagy, S., Falla, D. (2017). The influence of a depressed scapular alignment on upper limb neural tissue mechanosensitivity and local pressure pain sensitivity, Musculoskeletal Scienceand Practice.

Park SY, Yoo WG. (2013). Effect of sustained typing work on changes in scapular position, pressure pain sensitivity and upper trapezius activity. J Occup Health, 55(3), 167

Park, S. Y., & Park, D. J. (2019). Comparison of muscular activities between subjects with and without scapular downward rotation impairment during diagonal pattern of exercises. Journal of bodywork and movement therapies, 23(1), 59-64.

Pizzari T, Wickham J, Balster S, Ganderton C, Watson L. (2014). Modifying a shrug exercise can facilitate the upward rotator muscles of the scapula. Clinical biomechanics, 29, 201-5.

Polianskis, R., Graven-Nielsen, T., & Arendt-Nielsen, L. (2001). Computer-controlled pneumatic pressure algometry—a new technique for quantitative sensory testing. European Journal of Pain, 5(3), 267-277.

Reinold, M.M., Escamilla, R.F., Wilk, K.E. (2009). Current concepts in the scientific and clinical rationale behind exercises for glenohumeral and scapulothoracic musculature. The Journal of orthopaedic and sports physical therapy, 39,105-17.

Sahrmann, S.A. (2002). Diagnosis and treatment of movement impairment syndromes. St Louis, MO: Mosby Inc.

Sahrmann, S.A. (2011). Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines. St.Louis.

Salian, S. C., & Tulsankar, G. N. (2017). Strength-duration curve: A measure for assessing pain in trapezius spasm. Indian Journal of Pain, 31(1), 41.

Schmid, A.B., Brunner, F., Luomajoki, H., Held, U., Bachmann, L.M., Künzer, S., Coppieters, M.W. (2009). Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system. BMC MusculoskeletDisord, 10:11.

Seok, J. H., & Kim, T. H. (2020). The effects of scapular alignment exercise and nerve mobilization on pain and muscle activity in subjects with scapular depression alignment. Journal of Musculoskeletal Science and Technology, 4(2), 58-65.

Sterling, M,, Treleaven, J,, Edwards, S,, Jull, G. (2000). Pressure pain thresholds of upper limb peripheral nerve trunks in asymptomatic subjects. Physiother Res Int, 5(4), 220-9.

Van Dillen, L.R., McDonnell, M.K., Susco,T.M., Sahrmann, S.A. (2007). The Immediate Effect of Passive Scapular Elevation on Symptoms With Active Neck Rotation in Patients With Neck Pain. Clin J Pain, 23, 641–47.

Vanderweeen L, Oostendorp RB, Vaes P, DuquetW.Pressure algometry in manual therapy. ManTher 1996; 1(5):258–65.

Wagemakers, S. H., van der Velden, J. M., Gerlich, A. S., Hindriks-Keegstra, A. W., van Dijk, J. F., &Verhoeff, J. J.A. (2019). systematic review of devices and techniques that objectively measure patients' pain. Pain Physician, 22(1), 1-13.

Watson, L.A., Pizzari, T., Balster, S. (2009). Thoracic outlet syndrome part 1clinical manifestations, differentiation and treatment pathways. Man Ther, 14(6), 586-95.

Yoo, W. G. (2016). The effect of shoulder supporting banding and shoulder pulling banding using elastic bands on shoulder pain and scapular position of a scapular dyskinesis patient with shoulder depression and scapular downward rotation. Journal of physical therapy science, 28(2), 705-707.

Published

18-03-2022

How to Cite

Al-Afify, D. H., Kamel, R., & Shalaby, A. S. (2022). Effect of scapular upward rotation exercises on scapular neuromuscular tenderness in subjects with depressed scapular alignment. International Journal of Health Sciences, 6(S1), 728–744. https://doi.org/10.53730/ijhs.v6nS1.4831

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Section

Peer Review Articles