Document Type : Original Articles

Authors

1 Department of Sports Injuries and Corrective Exercises, Faculty of Physical Education, University of Guilan, Rasht, Iran.

2 Department of sport injures and Corrective Exercises, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran

3 School of Sport Science, Shahrood University of Technology, Shahrood, Semnan, Iran

Abstract

Background: This study aimed to investigate the extent to which an 8-week scapular stabilizer strengthening and stretching exercise can reduce shoulder pain and improve wheelchair basketball sport skills.
Methods: This is a parallel-group randomized controlled trial involving twenty-five elite wheelchair basketball players aged 25 to 54 who experienced shoulder pain. They were randomly assigned to either the exercise group (n=13) or the control group (n=12). The 8-week exercise program consisted of strengthening exercises targeting the serratus anterior, scapular retractor, and shoulder external rotator muscles, as well as stretching exercises for the upper trapezius, pectoralis major and minor muscles, and the posterior glenohumeral capsule and underlying soft tissues. Shoulder pain intensity was assessed using the wheelchair user's shoulder pain index, and basketball performance was evaluated using wheelchairs’ basketball skill tests. In addition, measurements of shoulder internal and external rotation range of motion, scapular upward rotation, maximal isometric muscle strength of middle and lower trapezius muscles, and pectoralis minor muscle length were taken at baseline and after the 8-week exercise intervention.
Top of Form
Results: Participants in the exercise group experienced a significantly lower level of shoulder pain (p=0.001) and demonstrated a higher level of sports performance in all tests (p<0.05) compared to the control group. Moreover, the exercise group showed significant improvements in shoulder internal and external rotation range of motion (ROM) (p>0.001), external rotators muscle strength (p<0.001), and middle and lower trapezius muscle strength (p=0.003 and p=0.004, respectively) in comparison to the control group. Additionally, scapular upward rotation (p<0.001) and pectoralis minor length (p<0.001) were significantly increased in the exercise group compared to the control group (p<0.05).
Conclusions: Indeed, the results suggest that an eight-week exercise program focused on scapular stabilizers and rotator cuff muscles can improve glenohumeral internal rotation, pectoralis minor length, and lower trapezius muscle strength. As a result, this exercise program could be considered a viable option for alleviating shoulder pain and enhancing sports performance in wheelchair basketball players.
 
 
 

Keywords

  1. De Groot S, Balvers IJ, Kouwenhoven SM, Janssen TW. Validity and reliability of tests determining performance-related components of wheelchair basketball. Journal of Sports Sciences. 2012;30(9):879-87.
  2. Ferrara M, Davis R. Injuries to elite wheelchair athletes. Spinal cord. 1990;28(5):335.
  3. Webborn N, Emery C. Descriptive epidemiology of Paralympic sports injuries. PM&R. 2014;6(8):S18-S22.
  4. Akbar M, Brunner M, Ewerbeck V, Wiedenhöfer B, Grieser T, Bruckner T, et al. Do overhead sports increase risk for rotator cuff tears in wheelchair users? Archives of physical medicine and rehabilitation. 2015;96(3):484-8.
  5. Yildirim NU, Comert E, Ozengin N. Shoulder pain: a comparison of wheelchair basketball players with trunk control and without trunk control. Journal of back and musculoskeletal rehabilitation. 2010;23(2):55-61.
  6. Heyward OW, Vegter RJ, De Groot S, Van Der Woude LH. Shoulder complaints in wheelchair athletes: A systematic review. PloS one. 2017;12(11):e0188410.
  7. Curtis K, Tyner T, Zachary L, Lentell G, Brink D, Didyk T, et al. Effect of a standard exercise protocol on shoulder pain in long-term wheelchair users. Spinal cord. 1999;37(6):421.
  8. Morrow MM, Hurd WJ, Kaufman KR, An K-N. Shoulder demands in manual wheelchair users across a spectrum of activities. Journal of Electromyography and Kinesiology. 2010;20(1):61-7.
  9. Stirane D, Kiukucane E, Vetra A, Nulle A, editors. The consequences of shoulder pain intensity on quality of life and community participation in paraplegic wheelchair users. SHS Web of Conferences; 2012: EDP Sciences.
  10. Wang J-C, Chan R-C, Tsai Y-A, Huang W-C, Cheng H, Wu H-L, et al. The influence of shoulder pain on functional limitation, perceived health, and depressive mood in patients with traumatic paraplegia. The journal of spinal cord medicine. 2015;38(5):587-92.
  11. Nickel R, Lange M, Stoffel DP, Navarro EJ, Zetola VF. Upper limb function and functional independence in patients with shoulder pain after stroke. Arquivos de neuro-psiquiatria. 2017;75(2):103-6.
  12. Ballinger DA, Rintala DH, Hart KA. The relation of shoulder pain and range-of-motion problems to functional limitations, disability, and perceived health of men with spinal cord injury: a multifaceted longitudinal study. Archives of physical medicine and rehabilitation. 2000;81(12):1575-81.
  13. Dorrestijn O, Stevens M, Winters JC, van der Meer K, Diercks RL. Conservative or surgical treatment for subacromial impingement syndrome? A systematic review. Journal of shoulder and elbow surgery. 2009;18(4):652-60.
  14. Mulroy SJ, Thompson L, Kemp B, Hatchett PP, Newsam CJ, Lupold DG, et al. Strengthening and optimal movements for painful shoulders (STOMPS) in chronic spinal cord injury: a randomized controlled trial. Physical therapy. 2011;91(3):305-24.
  15. Van Straaten MG, Cloud BA, Morrow MM, Ludewig PM, Zhao KD. Effectiveness of home exercise on pain, function, and strength of manual wheelchair users with spinal cord injury: a high-dose shoulder program with telerehabilitation. Archives of physical medicine and rehabilitation. 2014;95(10):1810-7. e2.
  16. Cratsenberg KA, Deitrick CE, Harrington TK, Kopecky NR, Matthews BD, Ott LM, et al. Effectiveness of exercise programs for management of shoulder pain in manual wheelchair users with spinal cord injury. Journal of Neurologic Physical Therapy. 2015;39(4):197-203.
  17. Wilroy J, Hibberd E. Evaluation of a shoulder injury prevention program in wheelchair basketball. Journal of sport rehabilitation. 2018;27(6):554-9.
  18. Curtis KA, Roach KE, Brooks Applegate E, Amar T, Benbow CS, Genecco TD, Gualano J. Development of the wheelchair user's shoulder pain index (WUSPI). Spinal Cord. 1995 May;33(5):290-3.
  19. Norris ES, Wright E, Sims S, Fuller M, Neelly K. The reliability of smartphone and goniometric measurements of hip range of motion. Journal of Rehabilitation Sciences & Research. 2016;3(4):77-84.
  20. Johnson MP, McClure PW, Karduna AR. New method to assess scapular upward rotation in subjects with shoulder pathology. Journal of Orthopaedic & Sports Physical Therapy. 2001;31(2):81-9.
  21. Visser J, Mans E, De Visser M, Van den Berg-Vos R, Franssen H, De Jong J, et al. Comparison of maximal voluntary isometric contraction and hand-held dynamometry in measuring muscle strength of patients with progressive lower motor neuron syndrome. Neuromuscular disorders. 2003;13(9):744-50.
  22. Michener LA, Boardman ND, Pidcoe PE, Frith AM. Scapular muscle tests in subjects with shoulder pain and functional loss: reliability and construct validity. Physical therapy. 2005;85(11):1128-38.
  23. Finley M, Goodstadt N, Soler D, Somerville K, Friedman Z, Ebaugh D. Reliability and validity of active and passive pectoralis minor muscle length measures. Brazilian journal of physical therapy. 2017;21(3):212-8.
  24. Gorostiaga EM, Llodio I, Ibáñez J, Granados C, Navarro I, Ruesta M, et al. Differences in physical fitness among indoor and outdoor elite male soccer players. European journal of applied physiology. 2009;106(4):483-91.
  25. Brasile FM. Wheelchair basketball skills proficiencies versus disability classification. Adapted Physical Activity Quarterly. 1986;3(1):6-13.
  26. Vanlandewijck Y, Daly D, Theisen D. Field test evaluation of aerobic, anaerobic, and wheelchair basketball skill performances. International journal of sports medicine. 1999;20(08):548-54.
  27. Nawoczenski DA, Ritter-Soronen JM, Wilson CM, Howe BA, Ludewig PM. Clinical trial of exercise for shoulder pain in chronic spinal injury. Physical therapy. 2006;86(12):1604-18.
  28. Muyor JM. Exercise intensity and validity of the ratings of perceived exertion (Borg and OMNI Scales) in an indoor cycling session. Journal of human kinetics. 2013;39(1):93-101.
  29. Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. Journal of Shoulder and Elbow Surgery. 2009;18(6):927-32.
  30. Morrow MM, Kaufman KR, An K-N. Scapula kinematics and associated impingement risk in manual wheelchair users during propulsion and a weight relief lift. Clinical biomechanics. 2011;26(4):352-7.
  31. Page P. Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes. International journal of sports physical therapy. 2011;6(1):51-8.
  32. Finley MA, Ebaugh D. Association of Pectoralis Minor Muscle Extensibility, Shoulder Mobility, and Duration of Manual Wheelchair Use. Archives of physical medicine and rehabilitation. 2017;98(10):2028-33.
  33. Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. Journal of orthopaedic & sports physical therapy. 2005;35(4):227-38.
  34. Burnham RS, May L, Nelson E, Steadward R, Reid DC. Shoulder pain in wheelchair athletes: the role of muscle imbalance. The American journal of sports medicine. 1993;21(2):238-42.
  35. Gutierrez DD, Thompson L, Kemp B, Mulroy SJ. The relationship of shoulder pain intensity to quality of life, physical activity, and community participation in persons with paraplegia. The journal of spinal cord medicine. 2007;30(3):251-5.
  36. Gómez SG, Pérez-Tejero J. Wheelchair basketball: influence of shoulder pain in sport skills. Revista de psicología del deporte. 2017;26(1):45-9.
  37. Brewer BW, Van Raalte JL, Linder DE. Effects of pain on motor performance. Journal of Sport and Exercise Psychology. 1990;12(4):353-65.
  38. Graven-Nielsen T, Arendt-Nielsen L. Impact of clinical and experimental pain on muscle strength and activity. Current rheumatology reports. 2008;10(6):475.