Borms D1, Cools A1
1Ghent University, Rehabilitation Sciences, Ghent, Belgium
Background: Overhead athletes are at high risk for shoulder injuries with prevalence rates up to 41%, depending on the specific sports performance. Many of these shoulder injuries are presented as non-specific shoulder pain when the throwing arm is in an overhead position. These shoulder impingement symptoms cause great discomfort, often resulting in decreased sports performance. Conservative treatment focusing on exercise therapy, including rotator cuff (RC) and scapular muscle training, is proven to be efficient for decreasing pain and improving function. Nevertheless, clinical experts advise integrating the kinetic into shoulder rehabilitation exercises for overhead athletes. However, the added value of kinetic chain training in the rehabilitation of overhead athletes with shoulder pain has not yet been investigated.
Purpose: To examine the influence of kinetic chain training versus isolated shoulder and/or lower limb training on shoulder pain and function in overhead athletes with shoulder impingement symptoms.
Methods: Fifty overhead athletes with shoulder impingement symptoms (34 male, 16 female) were randomly allocated to three treatment groups: (1) The control group only performed isolated shoulder exercises (rotator cuff and scapular muscle training). The experimental groups (2) performed the same exercises as the control group combined with isolated lower limb training or (3) performed the shoulder exercises with activation of the lower limbs in the kinetic chain. Before and after the six-week home exercise program, the Shoulder Pain and Disability Index (SPADI), Western Ontario Shoulder Instability Index (WOSI), Y balance test - Upper Quarter (YBT-UQ) and isokinetic shoulder and scapular strength were evaluated. Patients also rated subjective perception of improvement after treatment.
Results: No significant group differences could be determined for any of the outcome measures. After treatment, SPADI and WOSI scores had significantly decreased, and YBT-UQ performance had significantly increased. Little improvement was seen over time for shoulder or scapular isokinetic strength. Patients' self-rated perception of improvement was similar in all groups with 83.8% being “improved” (very little up to very large), 11.6% had “no change” and 4.7% being “worse” (very little).
Conclusion(s): Adding isolated lower limb training or kinetic chain training into shoulder exercises did not result in superior outcome for shoulder pain or function compared to isolated shoulder exercises. This study showed that home exercise programs are effective for improving shoulder pain, disability and functional performance in overhead athletes with shoulder impingement symptoms. Nevertheless, a six-week training program did not result in increased isokinetic shoulder or scapular strength. Future studies are needed to determine long-term treatment effects.
Implications: Integrating the kinetic chain into shoulder rehabilitation should be based on the athletes' individual preferences and needs since an isolated shoulder exercise approach shows similar short-term improvement of shoulder pain and function.
Keywords: Exercise therapy, functional training, shoulder impingement syndrome
Funding acknowledgements: The work was unfunded.
Purpose: To examine the influence of kinetic chain training versus isolated shoulder and/or lower limb training on shoulder pain and function in overhead athletes with shoulder impingement symptoms.
Methods: Fifty overhead athletes with shoulder impingement symptoms (34 male, 16 female) were randomly allocated to three treatment groups: (1) The control group only performed isolated shoulder exercises (rotator cuff and scapular muscle training). The experimental groups (2) performed the same exercises as the control group combined with isolated lower limb training or (3) performed the shoulder exercises with activation of the lower limbs in the kinetic chain. Before and after the six-week home exercise program, the Shoulder Pain and Disability Index (SPADI), Western Ontario Shoulder Instability Index (WOSI), Y balance test - Upper Quarter (YBT-UQ) and isokinetic shoulder and scapular strength were evaluated. Patients also rated subjective perception of improvement after treatment.
Results: No significant group differences could be determined for any of the outcome measures. After treatment, SPADI and WOSI scores had significantly decreased, and YBT-UQ performance had significantly increased. Little improvement was seen over time for shoulder or scapular isokinetic strength. Patients' self-rated perception of improvement was similar in all groups with 83.8% being “improved” (very little up to very large), 11.6% had “no change” and 4.7% being “worse” (very little).
Conclusion(s): Adding isolated lower limb training or kinetic chain training into shoulder exercises did not result in superior outcome for shoulder pain or function compared to isolated shoulder exercises. This study showed that home exercise programs are effective for improving shoulder pain, disability and functional performance in overhead athletes with shoulder impingement symptoms. Nevertheless, a six-week training program did not result in increased isokinetic shoulder or scapular strength. Future studies are needed to determine long-term treatment effects.
Implications: Integrating the kinetic chain into shoulder rehabilitation should be based on the athletes' individual preferences and needs since an isolated shoulder exercise approach shows similar short-term improvement of shoulder pain and function.
Keywords: Exercise therapy, functional training, shoulder impingement syndrome
Funding acknowledgements: The work was unfunded.
Topic: Musculoskeletal: upper limb; Sport & sports injuries
Ethics approval required: Yes
Institution: Ghent University
Ethics committee: Ethical Committee of Ghent University Hospital
Ethics number: B670201525329
All authors, affiliations and abstracts have been published as submitted.
