Exercises With Optimal Scapulothoracic Muscle Activation for Individuals With Paraplegia.

IF 2.4 Q1 REHABILITATION
Topics in Spinal Cord Injury Rehabilitation Pub Date : 2023-01-01 Epub Date: 2023-12-30 DOI:10.46292/sci21-00059
Linda M Riek, Amy Aronson, Kacie Giust, Samantha Putnam, Hannah Froese, Sean Rutherford, Mary Kathryn White
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Abstract

Background: Individuals with paraplegia and coexisting trunk and postural control deficits rely on their upper extremities for function, which increases the risk of shoulder pain. A multifactorial etiology of shoulder pain includes "impingement" of the supraspinatus, infraspinatus, long head of the biceps tendons, and/or subacromial bursa resulting from anatomic abnormalities, intratendinous degeneration, and altered scapulothoracic kinematics and muscle activation. Targeting serratus anterior (SA) and lower trapezius (LT) activation during exercise, as part of a comprehensive plan, minimizes impingement risk by maintaining optimal shoulder alignment and kinematics during functional activities. To prevent excessive scapular upward translation, minimizing upper trapezius (UT) to SA and LT activation is also important.

Objectives: To determine which exercises (1) maximally activate SA and minimize UT:SA ratio and (2) maximally activate LT and minimize UT:LT ratio.

Methods: Kinematic and muscle activation data were captured from 10 individuals with paraplegia during four exercises: "T," scaption (sitting), dynamic hug, and SA punch (supine). Means and ratios were normalized by percent maximum voluntary isometric contraction (MVIC) for each muscle. One-way repeated measures analysis of variance determined significant differences in muscle activation between exercises.

Results: Exercises were rank ordered: (1) maximum SA activation: SA punch, scaption, dynamic hug, "T"; (2) maximum LT activation: "T," scaption, dynamic hug, SA punch; 3) minimum UT:SA ratio: SA punch, dynamic hug, scaption, "T"; and (4) minimum UT:LT ratio: SA punch, dynamic hug, "T," scaption. Exercise elicited statistically significant changes in percent MVIC and ratios. Post hoc analyses revealed multiple significant differences between exercises (p < .05).

Conclusion: SA punch produced the greatest SA activation and lowest ratios. Dynamic hug also produced optimal ratios, suggesting supine exercises minimize UT activation more effectively. To isolate SA activation, individuals with impaired trunk control may want to initiate strengthening exercises in supine. Participants maximally activated the LT, but they were not able to minimize UT while upright.

针对截瘫患者的肩胛胸肌最佳激活运动。
背景:截瘫患者同时伴有躯干和姿势控制障碍,其功能依赖于上肢,这增加了肩部疼痛的风险。肩部疼痛的多因素病因包括冈上肌腱、冈下肌腱、肱二头肌长头肌腱和/或肩峰下滑囊的 "撞击",这些 "撞击 "是由解剖异常、肌腱内变性以及肩胛胸运动学和肌肉激活的改变造成的。作为综合计划的一部分,在锻炼过程中针对前锯肌和斜方肌下部进行激活,可在功能活动中保持最佳的肩关节排列和运动学,从而将撞击风险降至最低。为了防止肩胛骨过度上移,最大限度地减少斜方肌上部(UT)对斜方肌上部和斜方肌下部的激活也很重要:目的:确定哪些练习(1)能最大限度地激活 SA 并最大限度地降低 UT:SA 比率;(2)能最大限度地激活 LT 并最大限度地降低 UT:LT 比率:方法:采集 10 名截瘫患者在四种练习中的运动学和肌肉激活数据:方法:采集了 10 名截瘫患者在四种运动中的运动学和肌肉激活数据:"T"、肩胛(坐位)、动态拥抱和 SA 冲拳(仰卧位)。平均值和比率按每块肌肉的最大自主等长收缩百分比(MVIC)进行归一化。单向重复测量方差分析确定了不同练习之间肌肉激活的显著差异:结果:练习按以下顺序排列:(1) 最大 SA 激活:T"、肩胛、动态拥抱、SA 冲拳;(3) 最小 UT:SA 比值:3) 最小 UT:SA 比率:SA 冲拳、动态拥抱、猛击、"T";以及 (4) 最小 UT:LT 比率:SA 冲拳、动态拥抱、"T":SA冲拳、动态拥抱、"T"、肩胛。运动引起了 MVIC 百分比和比率的显著统计学变化。事后分析显示,不同运动之间存在多个显著差异(P < .05):结论:SA 冲拳产生最大的 SA 激活和最低的比率。动态拥抱也产生了最佳比率,这表明仰卧练习能更有效地减少UT激活。为了隔离SA激活,躯干控制能力受损的人可能需要在仰卧状态下开始加强练习。参与者最大限度地激活了LT,但他们无法在直立时最大限度地减少UT。
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来源期刊
CiteScore
3.20
自引率
3.40%
发文量
33
期刊介绍: Now in our 22nd year as the leading interdisciplinary journal of SCI rehabilitation techniques and care. TSCIR is peer-reviewed, practical, and features one key topic per issue. Published topics include: mobility, sexuality, genitourinary, functional assessment, skin care, psychosocial, high tetraplegia, physical activity, pediatric, FES, sci/tbi, electronic medicine, orthotics, secondary conditions, research, aging, legal issues, women & sci, pain, environmental effects, life care planning
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