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Comparison of Infraspinatus and Posterior Deltoid Muscle Activities According to Exercise Methods and Forearm Positions During Shoulder External Rotation Exercises

어깨 가쪽돌림 운동 시 운동방법과 아래팔의 자세에 따른 가시아래근과 뒤어깨세모근의 근활성도 비교

  • Son, Myeong-gi (Department of Physical Therapy, The Graduate School, Daejeon University) ;
  • Kim, Suhn-yeop (Department of Physical Therapy, College of Health and Medical Science, Daejeon University)
  • 손명기 (대전대학교 대학원 물리치료학과) ;
  • 김선엽 (대전대학교 보건의료과학대학 물리치료학과)
  • Received : 2022.04.19
  • Accepted : 2022.05.12
  • Published : 2022.05.20

Abstract

Background: Shoulder external rotation exercises are commonly used to improve the stabilizing ability of the infraspinatus. However, during exercise, excessive activation of the posterior deltoid compared to the infraspinatus causes the humeral head to move anteriorly in an abnormal position. Many researchers have emphasized selective activation of the infraspinatus during shoulder external rotation exercise. Objects: This study aims to delineate the optimal exercise method for selective activation of infraspinatus by investigating the muscle activities of the infraspinatus and posterior deltoid according to the four shoulder exercise methods and two forearm positions. Methods: Thirty healthy individuals participated in this study. The participants were instructed to perform shoulder external rotation exercises following four exercise methods: sitting external rotation (SIER); standing external rotation at 90° abduction (STER); prone external rotation at 90° abduction (PRER); side-lying external rotation (SLER), and two forearm positions (neutral, supinated). The electromyography (EMG) signal amplitude was measured during each exercise. Surface EMG signals were recorded from the posterior deltoid, infraspinatus, and biceps brachii. Results: EMG results of the infraspinatus and posterior deltoid in PRER, were significantly higher than that of the other exercises (p < 0.01). The EMG ratio (infraspinatus/posterior deltoid) in SIER was significantly higher than that of the other exercises. EMG activation of the posterior deltoid in SIER, PRER, and SLER was significantly higher in neutral than in supinated (p < 0.01). Furthermore, the EMG of the infraspinatus in SIER was significantly higher in neutral than in supinated (p < 0.01). The EMG ratio (infraspinatus/ posterior deltoid) in SIER was significantly higher in neutral than in supinated (p < 0.05.) Contrarily EMG ratios in PRER and SLER were significantly higher in supinated than in neutral (p < 0.05). Conclusion: The results show that clinicians should consider these exercise methods and forearm positions when planning shoulder external rotation exercises for optimal shoulder rehabilitation.

Keywords

References

  1. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol 2004;33(2):73-81. https://doi.org/10.1080/03009740310004667
  2. Kinsella R, Pizzari T. Electromyographic activity of the shoulder muscles during rehabilitation exercises in subjects with and without subacromial pain syndrome: a systematic review. Shoulder Elbow 2017;9(2):112-26. https://doi.org/10.1177/1758573216660038
  3. Parsons S, Breen A, Foster NE, Letley L, Pincus T, Vogel S, et al. Prevalence and comparative troublesomeness by age of musculoskeletal pain in different body locations. Fam Pract 2007;24(4):308-16. https://doi.org/10.1093/fampra/cmm027
  4. Terry GC, Chopp TM. Functional anatomy of the shoulder. J Athl Train 2000;35(3):248-55.
  5. Reinold MM, Wilk KE, Fleisig GS, Zheng N, Barrentine SW, Chmielewski T, et al. Electromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises. J Orthop Sports Phys Ther 2004;34(7):385-94. https://doi.org/10.2519/jospt.2004.34.7.385
  6. McCluskey GM, Getz BA. Pathophysiology of anterior shoulder instability. J Athl Train 2000;35(3):268-72.
  7. Clisby EF, Bitter NL, Sandow MJ, Jones MA, Magarey ME, Jaberzadeh S. Relative contributions of the infraspinatus and deltoid during external rotation in patients with symptomatic subacromial impingement. J Shoulder Elbow Surg 2008;17(1 Suppl):87S-92S. https://doi.org/10.1016/j.jse.2007.05.019
  8. Bitter NL, Clisby EF, Jones MA, Magarey ME, Jaberzadeh S, Sandow MJ. Relative contributions of infraspinatus and deltoid during external rotation in healthy shoulders. J Shoulder Elbow Surg 2007;16(5):563-8. https://doi.org/10.1016/j.jse.2006.11.007
  9. Mayerhoefer ME, Breitenseher MJ, Wurnig C, Roposch A. Shoulder impingement: relationship of clinical symptoms and imaging criteria. Clin J Sport Med 2009;19(2):83-9. https://doi.org/10.1097/jsm.0b013e318198e2e3
  10. Jang JH, Oh JS. Changes in shoulder external rotator muscle activity during shoulder external rotation in various arm positions in the sagittal plane. J Phys Ther Sci 2014;26(1):135-7. https://doi.org/10.1589/jpts.26.135
  11. Ballantyne BT, O'Hare SJ, Paschall JL, Pavia-Smith MM, Pitz AM, Gillon JF, et al. Electromyographic activity of selected shoulder muscles in commonly used therapeutic exercises. Phys Ther 1993;73(10):668-77; discussion 677-82. https://doi.org/10.1093/ptj/73.10.668
  12. Kim H, Hwang U, Jung S, Ahn S, Kim J, Kwon O. Effect of horizontal adduction force on infraspinatus and deltoid activities during the side-lying wiper exercise using pressure biofeedback. Phys Ther Korea 2017;24(4):77-83. https://doi.org/10.12674/ptk.2017.24.4.077
  13. Jaggi A, Lambert S. Rehabilitation for shoulder instability. Br J Sports Med 2010;44(5):333-40. https://doi.org/10.1136/bjsm.2009.059311
  14. Myers JB, Hwang JH, Pasquale MR, Blackburn JT, Lephart SM. Rotator cuff coactivation ratios in participants with subacromial impingement syndrome. J Sci Med Sport 2009;12(6):603-8. https://doi.org/10.1016/j.jsams.2008.06.003
  15. McCreesh KM, Crotty JM, Lewis JS. Acromiohumeral distance measurement in rotator cuff tendinopathy: is there a reliable, clinically applicable method? A systematic review. Br J Sports Med 2015;49(5):298-305. https://doi.org/10.1136/bjsports-2012-092063
  16. Sakita K, Seeley MK, Myrer JW, Hopkins JT. Shoulder-muscle electromyography during shoulder external-rotation exercises with and without slight abduction. J Sport Rehabil 2015;24(2):109-15. https://doi.org/10.1123/jsr.2013-0116
  17. Kolber MJ, Beekhuizen KS, Santore T, Fiers H. Implications for specific shoulder positioning during external rotator strengthening. Strength Cond J 2008;30(4):12-6. https://doi.org/10.1519/SSC.0b013e31817764ae
  18. Kim JW, Yoon JY, Kang MH, Oh JS. Selective activation of the infraspinatus during various shoulder external rotation exercises. J Phys Ther Sci 2012;24(7):581-4. https://doi.org/10.1589/jpts.24.581
  19. Sahrmann S. Diagnosis and treatment of movement impairment syndromes. St. Louis (MO): Mosby; 2002;215-26.
  20. Lim OB, Kim JA, Song SJ, Cynn HS, Yi CH. Effect of selective muscle training using visual EMG biofeedback on infraspinatus and posterior deltoid. J Hum Kinet 2014;44:83-90. https://doi.org/10.2478/hukin-2014-0113
  21. Grimsby O, Rivard J. Science, theory and clinical application in orthopaedic manual physical therapy: scientific therapeutic exercise progressions (STEP): the neck and upper extremity. Taylorsville (UT): The Academy of Graduate Physical Therapy; 2009;71-8.
  22. Blackburn TA. EMG analysis of posterior rotator cuff exercises. J Athl Train 1990;25:40-5.
  23. Ha SM, Kwon OY, Cynn HS, Lee WH, Kim SJ, Park KN. Selective activation of the infraspinatus muscle. J Athl Train 2013;48(3):346-52. https://doi.org/10.4085/1062-6050-48.2.18
  24. Ryan G, Johnston H, Moreside J. Infraspinatus isolation during external rotation exercise at varying degrees of abduction. J Sport Rehabil 2018;27(4):334-9. https://doi.org/10.1123/jsr.2016-0217
  25. Kang KH. The study about muscle activities and ROM of shoulder joint according to supination during external rotation. Korean Soc Wellness 2017;12(4):553-63. https://doi.org/10.21097/ksw.2017.11.12.4.553
  26. Lee GB, Hwang JM, Lee DY, Yu JH, Kim JS, Kim SG, et al. The effect of forearm position on the activity of the upper-extremity muscles during shoulder external rotation exercise using a pulley. Neurotherapy 2021;25(2):9-15.
  27. Hedt C, Lambert BS, Daum J, Pearson JM, McCulloch PC. Forearm position matters during eccentric shoulder exercises: an EMG recruitment study with implications for rehabilitation. Int J Sports Phys Ther 2020;15(6):1110-8. https://doi.org/10.26603/ijspt20201110
  28. Yu IY, Lee DK, Kang MJ, Oh JS. Effects of 3 infraspinatus muscle strengthening exercises on isokinetic peak torque and muscle activity. J Sport Rehabil 2019;28(3):229-35. https://doi.org/10.1123/jsr.2017-0110
  29. SENIAM. Recommendations for sensor locations on individual muscles. European Union [Internet]. Enschede: 2005 [cited 2021 Nov 2]. Available from: http://seniam.org/sensor_location.htm.
  30. David G, Magarey ME, Jones MA, Dvir Z, Turker KS, Sharpe M. EMG and strength correlates of selected shoulder muscles during rotations of the glenohumeral joint. Clin Biomech (Bristol, Avon) 2000;15(2):95-102. https://doi.org/10.1016/S0268-0033(99)00052-2
  31. Reinold MM, Escamilla RF, Wilk KE. Current concepts in the scientific and clinical rationale behind exercises for glenohumeral and scapulothoracic musculature. J Orthop Sports Phys Ther 2009;39(2):105-17. https://doi.org/10.2519/jospt.2009.2835
  32. Alizadehkhaiyat O, Hawkes DH, Kemp GJ, Frostick SP. Electromyographic analysis of the shoulder girdle musculature during external rotation exercises. Orthop J Sports Med 2015;3(11):2325967115613988.
  33. Schoenfeld B, Sonmez RG, Kolber MJ, Contreras B, Harris R, Ozen S. Effect of hand position on EMG activity of the posterior shoulder musculature during a horizontal abduction exercise. J Strength Cond Res 2013;27(10):2644-9. https://doi.org/10.1519/jsc.0b013e318281e1e9
  34. Kim SH, Ha KI, Kim HS, Kim SW. Electromyographic activity of the biceps brachii muscle in shoulders with anterior instability. Arthroscopy 2001;17(8):864-8. https://doi.org/10.1016/S0749-8063(01)90011-8
  35. Kim SH, Ha KI, Ahn JH, Kim SH, Choi HJ. Biceps load test II: a clinical test for SLAP lesions of the shoulder. Arthroscopy 2001;17(2):160-4. https://doi.org/10.1053/jars.2001.20665