Kristof De Mey

Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete

The scapula functions as a bridge between the shoulder complex and the cervical spine and plays a very important role in providing both mobility and stability of the neck/shoulder region. The association between abnormal scapular positions and motions and glenohumeral joint pathology has been well established in the literature, whereas studies investigating the relationship between neck pain and scapular dysfunction have only recently begun to emerge. Although several authors have emphasised the relevance of restoring normal scapular kinematics through exercise and manual therapy techniques, overall scapular rehabilitation guidelines decent for both patients with shoulder pain as well as patients with neck problems are lacking. The purpose of this paper is to provide a science-based clinical reasoning algorithm with practical guidelines for the rehabilitation of scapular dyskinesis in patients with chronic complaints in the upper quadrant.

Scapular Muscle Rehabilitation Exercises in Overhead Athletes With Impingement Symptoms Effect of a 6-Week Training Program on Muscle Recruitment and Functional Outcome

Background: Previous research has identified some specific exercises to correct scapular muscle balance and onset timing in healthy subjects. However, evidence for their effectiveness in overhead athletes with impingement symptoms has been lacking until now. Hypothesis: A 6-week exercise program consisting of previously selected exercises is able to improve muscle activation and onset timing during shoulder elevation. This program may also change pain and functionality levels in overhead athletes with mild impingement symptoms. Study Design: Case series; Level of evidence, 4. Methods: Forty-seven overhead athletes with mild impingement symptoms (25 men and 22 women) were enrolled in this study. Before and after the 6-week training program, the Shoulder Pain and Disability Index (SPADI) score was individually obtained and maximum voluntary isometric contraction (MVIC) values were determined by surface electromyography. Mean muscle activation levels, muscle ratio data, and muscle onset timing were assessed for the upper (UT), middle (MT), and lower (LT) trapezius and serratus anterior (SA) muscle during arm elevation in the scapular plane. Results: Forty participants completed the exercise program. The SPADI scores significantly decreased from 29.86 ± 17.03 during initial assessment to 11.7 ± 13.78 during postmeasurements (P < .001). The 3 trapezius muscle parts showed increased MVIC values and decreased activation levels during arm elevation, whereas this was not the case for the SA muscle. After the training program, UT/SA significantly decreased, whereas UT/MT and UT/LT did not change (P < .05). No differences in muscle timing between pre- and postmeasurements could be identified. The LT showed significant earlier activation compared with UT (−0.47; P < .001) and MT (−0.49; P < .001). The serratus anterior showed significant earlier activation compared with the UT (−0.74; P < .001), MT (−0.76; P < .001), and LT muscles (F = 0.27; P = .046). Conclusion: This is the first longitudinal study to demonstrate that previously selected exercises (1) improve pain and function based on SPADI scores, (2) reduce relative trapezius muscle activation, and (3) alter UT/SA ratios. However, they were unable to change the timing of the scapular muscles during arm elevation when compared before and after a 6-week training program in overhead athletes with mild impingement symptoms.

Trapezius Muscle Timing During Selected Shoulder Rehabilitation Exercises

STUDY DESIGN Controlled laboratory study. OBJECTIVES To examine the timing of the 3 portions of the trapezius muscle in relation to the posterior deltoid (PD) muscle and in relation to one another during 4 selected shoulder exercises: (1) prone extension, (2) forward flexion in side lying, (3) external rotation in side lying, and (4) prone horizontal abduction with external rotation. BACKGROUND Deficiencies in trapezius muscle recruitment have been identified in patients with shoulder pain. Alterations in the trapezius muscle activation level and timing have been identified in previous research. Scapular muscle exercises in which the middle trapezius (MT) and lower trapezius (LT) muscle showed optimal activity with minimal upper trapezius (UT) muscle participation have been recently identified. However, it is currently unknown if these exercises also promote early activation of the scapular stabilizing musculature. METHODS The intermuscular and intramuscular timing of muscle activation (based on an activation level of greater than 10% maximum voluntary contraction beyond basic activity) of the 3 portions of the trapezius muscle during 4 exercises were examined by surface EMG in 30 healthy subjects on the dominant side (14 males, 16 females). A 1-sample t test was used to determine which portions of the trapezius muscle were activated significantly earlier or later than the PD (intermuscular timing). An analysis of variance for repeated measures (3 levels) was used for each exercise to determine possible timing differences among the 3 portions of the trapezius muscle (intramuscular timing). RESULTS Intermuscular and intramuscular differences in timing of the portions of the trapezius muscle were found. The UT was activated significantly later than the PD (P<.01), and the MT was activated significantly earlier than the PD (P<.01), during the prone extension exercise. During the horizontal abduction with external rotation exercise, the MT (P<.01) and the LT (P = .01) were activated significantly earlier than the PD. During prone extension, side-lying external rotation, and prone horizontal abduction with external rotation, significant differences were found between the UT and MT, between the UT and LT, but not between the MT and LT. In these exercises the MT and LT were activated significantly earlier than the UT. During forward flexion in side lying, no significant timing differences were found between the activation of the portions of the trapezius. CONCLUSIONS With the exception of the LT during prone extension, the prone extension exercise and the prone horizontal abduction with external rotation exercise promote early activation of the MT and LT in relation to the scapular and glenohumeral prime mover. Taking into account the limited generalizability of the results due to a narrow age range, these exercises are potentially promising for the treatment of intermuscular and intramuscular timing disorders of the trapezius muscle.

Conscious Correction of Scapular Orientation in Overhead Athletes Performing Selected Shoulder Rehabilitation Exercises: The Effect on Trapezius Muscle Activation Measured by Surface Electromyography

STUDY DESIGN Controlled laboratory study. OBJECTIVES To assess the effect of conscious correction of scapular orientation on the activation of the 3 sections of the trapezius muscle during shoulder exercises in overhead athletes with scapular dyskinesis. BACKGROUND Previous research has led to the recommendation of 4 exercises for training of the trapezius muscle: prone extension, sidelying external rotation, sidelying forward flexion, and prone horizontal abduction with external rotation. However, the extent to which conscious correction of scapular orientation impacts trapezius muscle activation levels during these exercises is unknown. METHODS Absolute (upper trapezius [UT], middle trapezius [MT], lower trapezius [LT]) and relative (UT/MT and UT/LT) muscle activation levels were determined with surface electromyography in 30 asymptomatic overhead athletes with scapular dyskinesis, during 4 selected exercises performed with and without conscious correction of scapular orientation. Repeated-measures analyses of variance were used to determine if a voluntary scapular orientation correction strategy influenced the activation levels of the different sections of the trapezius during each exercise. RESULTS With conscious correction of scapular orientation, activation levels of the 3 sections of the trapezius muscle significantly increased during prone extension (mean ± SD difference: UT, 5.9% ± 8.6% maximal voluntary isometric contraction [MVIC]; MT, 13.8% ± 11.0% MVIC; LT, 9.8% ± 10.8% MVIC; P<.05) and sidelying external rotation (UT, 2.2% ± 4.4% MVIC; MT, 6.7% ± 10.6% MVIC; LT, 13.3% ± 24.4% MVIC; P<.05). There was no difference between conditions for sidelying forward flexion and prone horizontal abduction with external rotation. The UT/MT and UT/LT ratios were similar between conditions for all 4 exercises. CONCLUSION Conscious correction of scapular orientation during the prone extension and sidelying external rotation exercises can be used to increase the activation level in the 3 sections of the trapezius in overhead athletes with scapular dyskinesis. Although lack of kinematic data limits the interpretation of the results, this study suggests that conscious correction of scapular orientation can be performed without altering the favorable UT/MT and UT/LT ratios that have been previously reported for these exercises.

Sonographic evaluation of the acromiohumeral distance in elite and recreational female overhead athletes.

Objective:To compare the acromiohumeral distance (AHD) and the change of this distance during abduction between the dominant and nondominant shoulders of female overhead athletes and to compare AHD between elite and recreational female athletes. Design:Case–control study. Setting:Laboratory, institutional. Independent Variables:“Side” (dominant and nondominant), “group” (elite and recreational athletes), and “degree of abduction” (0, 45, and 60 degrees). Participants:Sixty-two female overhead athletes participated in this study: 29 elite handball players and 33 recreational overhead athletes of different sports disciplines (volleyball, water polo, squash, and badminton). Main Outcome Measures:Acromiohumeral distance was measured at 3 positions of abduction using ultrasound: at 0, 45, and 60 degrees of abduction. Results:Acromiohumeral distance measurements showed good test–retest reliability (intraclass correlation coefficients between 0.88 and 0.92). In all overhead athletes, the AHD was significantly larger on the dominant side compared with the nondominant side, at all positions of abduction (mean difference = 0.94 ± 0.18 mm). Significant reduction of the AHD during abduction occurred relative to the initial size at 0 degree of abduction, at both sides. When comparing elite and recreational athletes, the AHD was significantly larger in elite athletes (mean difference = 0.92 ± 0.47 mm). Moreover, significantly less reduction occurred during the first degrees of abduction (0-45 degrees) in elite athletes (9.37% ± 2.17% reduction) compared with the recreational athletes (17.68% ± 2.03% reduction). Conclusions:The AHD is larger on the dominant side compared with the nondominant side and in elite female athletes compared with recreational female athletes. Moreover, less reduction of the AHD occurs in the elite athlete group during the first 45 degrees of abduction.

Analysing Team Formations in Football with the Static Qualitative Trajectory Calculus

In this paper, we introduce the Static Qualitative Trajectory Calculus (QTCS), a qualitative spatiotemporal method based on the Qualitative Trajectory Calculus (QTC), for team formation analysis in football. While methods for team formation analysis are mostly quantitative, QTCS enables the comparison of team formations by describing the relative positions between players in a qualitative manner, which is much more related to the way players position themselves on the field. To illustrate the method, we present a series of examples based on real football matches of a 2016-2017 European football competition. With QTCS, team formations of both an entire team as well as a smaller group of players can be described. Analysis of these formations can be done for multiple matches, thereby defining the playing style of a team, or at critical moments during a game, such as set pieces.

De revalidatie van scapulaire dyskinesie bij patiënten met schouderklachten

Scapulaire dyskinesie wordt vaak gezien bij patienten met schouderklachten, ongeacht de diagnose, waaraan zowel bij een conservatieve als een postoperatieve kinesitherapeutische behandeling aandacht besteed dient te worden. De eerste taak van de kinesitherapeut is vaststellen of de dyskinesie te relateren is aan de actuele klachten. Indien de therapeut van oordeel is dat er scapulaire betrokkenheid is in de schouderklachten, is dit een indicatie voor een progressief, evidence-based en functioneel behandelprogramma. In dit hoofdstuk wordt de scapulaire dyskinesie in het kader van schouderpathologie kort geschetst, wordt een algoritme voor de therapeutische aanpak voorgesteld en worden enkele concrete behandeltechnieken beschreven die onmiddellijk in de praktijk toe te passen zijn.

Revalidatie van scapulaire spieren bij bovenhandse sporters met impingement

Op basis van onderzoek uitgevoerd op gezonde individuen zijn vier oefeningen geselecteerd om de scapulaire spierbalans en de timing van de scapulaire spieractivatie te verbeteren. Er bestaat echter nog geen evidentie voor de effectiviteit van deze oefeningen bij bovenhandse sporters met impingementklachten. In dit prospectief onderzoek werden 47 bovenhandse atleten met milde impingementklachten geincludeerd. Door middel van oppervlakte-elektromyografie werd de activiteit van de verschillende bundels van de m. trapezius en van de m. serratus anterior bestudeerd tijdens het heffen van de arm in het scapulaire vlak. Daarnaast werd bij iedereen de Shoulder Pain and Disability Index afgenomen om de pijn en het functionele resultaat te beoordelen. Veertig atleten beeindigden het programma. De drie trapeziusbundels vertoonden hogere maximale contractiewaarden en gedaalde activatieniveaus tijdens het heffen van de arm, terwijl dit niet het geval was voor de m. serratus anterior. De timing van de spieractivatie was niet gewijzigd na zes weken oefenen. Dit is de eerste longitudinale studie die aantoont dat een eenvoudig oefenprogramma bestaande uit slechts vier oefeningen de relatieve trapeziusactiviteit kan verlagen, de pijn kan verminderen en de functionele mogelijkheden kan verbeteren. Deze resultaten zijn hoopgevend omdat op deze manier mogelijk voorkomen wordt dat vage schouderklachten en functionele beperkingen een chronisch karakter krijgen.