A systematic review of 3D scapular kinematics and muscle activity during elevation in stroke subjects and controls

Through the onset of post-stroke motor disorders, the normal scapular function is compromised. As a result, shoulder pain and associated upper limb dysfunctions frequently arise after stroke.This review aimed to provide a systematic overview of available literature on scapular function, i.e. scapular three-dimensional (3D) kinematics and muscle activity during elevation, in healthy persons, persons with primary shoulder disorders and post-stroke patients. 3D scapular kinematics have been widely reported in healthy persons and persons with primary shoulder disorders, whereby a general pattern of upward rotation and posterior tilt during elevation has been agreed upon. Results on scapular internal/external rotation are inconsistent. In a post-stroke population, 3D scapular kinematics are less frequently reported. Scapular muscle activity has thus far been studied to very limited extend and firm conclusions could not be drawn.Although 3D scapular kinematics and muscle activity registrations are being increasingly used, some general methodological aspects should be considered. While the International Society of Biomechanics already proposed recommendations on the definition of upper limb joint coordinate systems and rotation sequences, proper result comparison necessitates further guidelines on other methodological aspects, i.e. data collection, processing, analyzing, and reporting.     

Glenohumeral joint cartilage contact in the healthy adult during scapular plane elevation depression with external humeral rotation

The shoulder (glenohumeral) joint has the greatest range of motion of all human joints; as a result, it is particularly vulnerable to dislocation and injury. The ability to non-invasively quantify in-vivo articular cartilage contact patterns of joints has been and remains a difficult biomechanics problem. As a result, little is known about normal in-vivo glenohumeral joint contact patterns or the consequences that surgery has on altering them. In addition, the effect of quantifying glenohumeral joint contact patterns by means of proximity mapping, both with and without cartilage data, is unknown. Therefore, the objectives of this study are to (1) describe a technique for quantifying in-vivo glenohumeral joint contact patterns during dynamic shoulder motion, (2) quantify normal glenohumeral joint contact patterns in the young healthy adult during scapular plane elevation depression with external humeral rotation, and (3) compare glenohumeral joint contact patterns determined both with and without articular cartilage data. Our results show that the inclusion of articular cartilage data when quantifying in-vivo glenohumeral joint contact patterns has significant effects on the anterior–posterior contact centroid location, the superior–inferior contact centroid range of travel, and the total contact path length. As a result, our technique offers an advantage over glenohumeral joint contact pattern measurement techniques that neglect articular cartilage data. Likewise, this technique may be more sensitive than traditional 6-Degree-of-Freedom (6-DOF) joint kinematics for the assessment of overall glenohumeral joint health. Lastly, for the shoulder motion tested, we found that glenohumeral joint contact was located on the anterior–inferior glenoid surface.     

Effects of a posture-sensing air seat device (PSASD) on kinematics and trunk muscle activity during continuous computer work

The prevalence and incidence of musculoskeletal disorders is high with computer workers, and poor sitting posture can be considered a factor contributing to low back discomfort. In the clinical literature, maintaining a neutral spinal curvature has been considered an optimal sitting posture. This study investigated the flexion and lateral flexion of trunk movements and trunk muscle activity during computer work with and without a posture-sensing air seat device (PSASD). By sensing a certain amount of increased pressure over the baseline, posture-related visual feedback was given to participants through the PSASD. Eleven regular computer workers participated in this study. PSASD had the function of alerting the subject to their poor posture by using visual feedback. Subjects performed 20 min of computer work with and without a PSASD. Surface electromyography was used to measure the activity of the erector spine and internal abdominal oblique. Kinematic data were obtained using an electrogoniometer. The results showed that the mean of trunk flexion and lateral flexion was significantly reduced with PSASD. The activity of the erector spine and internal oblique was significantly higher with the PSASD than without. Our findings indicated that the PSASD helps to prevent habitual poor posture by maintaining an erect sitting posture during prolonged computer work.     

Effects of Kinesio taping on scapular kinematics of overhead athletes following muscle fatigue

Scapular kinematics alterations have been found following muscle fatigue. Considering the importance of the lower trapezius in coordinated scapular movement, this study aimed to investigate the effects of elastic taping (Kinesio taping, KT) for muscle facilitation on scapular kinematics of healthy overhead athletes following muscle fatigue. Twenty-eight athletes were evaluated in a crossover, single-blind, randomized design, in three sessions: control (no taping), KT (KT with tension) and sham (KT without tension). Scapular tridimensional kinematics and EMG of clavicular and acromial portions of upper trapezius, lower trapezius and serratus anterior were evaluated during arm elevation and lowering, before and after a fatigue protocol involving repetitive throwing. Median power frequency decline of serratus anterior was significantly lower in KT session compared to sham, possibly indicating lower muscle fatigue. However, the effects of muscle fatigue on scapular kinematics were not altered by taping conditions. Although significant changes were found in scapular kinematics following muscle fatigue, they were small and not considered relevant. It was concluded that healthy overhead athletes seem to present an adaptive mechanism that avoids the disruption of scapular movement pattern following muscle fatigue. Therefore, these athletes do not benefit from the use of KT to assist scapular movement under the conditions tested.     

Kinesiotaping for scapular dyskinesis: The influence on scapular kinematics and on the activity of scapular stabilizing muscles

Scapular dyskinesis is observed in 61% of overhead athletes (Burn et al., 2016). For most of them, it remains asymptomatic. However, scapular dyskinesis is considered a risk factor for shoulder injury by some authors (Clarsen et al., 2014). The aim of this study is to explore the effectiveness of kinesiotaping in modifying scapular kinematics and peri-scapular muscle activity in dyskinetic athletes. The 3-dimensional position and orientation of the scapula as well as the activation of upper trapezius, lower trapezius and serratus anterior were recorded in twenty asymptomatic athletes during shoulder movements (flexion and abduction), in loaded and unloaded conditions and in three circumstances (standard, kinesiotaping 1, kinesiotaping 2). A significant decrease between 9 and 12% in upper trapezius activity was observed with kinesiotaping 1 and 2. Lower trapezius activity was slightly increased with kinesiotaping 1 while it was significantly decreased about 15–20% with kinesiotaping 2. No change was observed in serratus anterior activity, for either kinesiotaping 1 or 2. Considering scapular kinematics, both kinesiotaping 1 and 2 significantly increased posterior tilt and upward rotation. External rotation was decreased with kinesiotaping 2, in comparison to standard condition. Kinesiotaping, and especially taping 1, seems to be an effective method for changing periscapular muscle activity and scapular kinematics.     

Comparing non-invasive scapular tracking methods across elevation angles,planes of elevation and humeral axial rotations

Altered scapular motions premeditate shoulder impingement and other musculoskeletal disorders. Divergent experimental conditions in previous research precludes rigorous comparisons of non-invasive scapular tracking techniques. This study evaluated scapular orientation measurement methods across an expanded range of humeral postures. Scapular medial/lateral rotation, anterior/posterior tilt and protraction/retraction was measured using an acromion marker cluster (AMC), a scapular locator, and a reference stylus. Motion was captured using reflective markers on the upper body, as well as on the AMC, locator and stylus. A combination of 5 arm elevation angles, 3 arm elevation planes and 3 arm axial rotations was examined. Measurement method interacted with elevation angle and plane of elevation for all three scapular orientation directions (p < 0.01). Method of measurement interacted with axial rotation in anterior/posterior tilt and protraction/retraction (p < 0.01). The AMC had strong agreement with the reference stylus than the locator for the majority of humeral elevations, planes and axial rotations. The AMC underestimated lateral rotation, with the largest difference of ∼2° at 0° elevation. Both the locator and AMC overestimated posterior tilt at high arm elevation by up to 7.4°. Misestimations from using the locator could be enough to potentially obscure meaningful differences in scapular rotations.     

Effects of scapular upward rotation exercises on alignment of scapula and clavicle and strength of scapular upward rotators in subjects with scapular downward rotation syndrome

The purpose of this study was to investigate the effects of a 6-week scapular upward rotation exercise (SURE) on scapular and clavicular alignment and scapular upward rotators strength in subjects with scapular downward rotation syndrome (SDRS). Seventeen volunteer subjects with SDRS were recruited from university populations. The alignment of the scapula and clavicle was measured using radiographic analysis and compared in subjects before and after a 6-week self-SURE program. A hand-held dynamometer was used to measure the strength of the scapular upward rotators. The subjects were instructed how to perform the self-SURE program at home. The 6-week self-SURE program was divided into two sections (the first section with non-resistive SURE during weeks 1–3, and the second section with resistive SURE using thera-band during weeks 4–6). The significance of the difference between pre- and post-program was assessed using a paired t-test, with the level of statistical significance set at p < 0.05. Significant differences between pre- and post-program were found for scapular and clavicular alignment (p < 0.05). Additionally, the comparison between pre- and post-program measurements of the strength of the scapular upward rotators showed significant differences (p < 0.05). The results of this study showed that a 6-week self-SURE program is effective for improving scapular and clavicular alignment and increasing the strength of scapular upward rotator muscles in subjects with SDRS.     

Effect of abducting and adducting muscle activity on glenohumeral translation, scapular kinematics and subacromial space width in vivo

It is currently unknown in which ways activity of the ab- and adductor shoulder muscles affects shoulder biomechanics (scapular kinematics and glenohumeral translation), and whether these changes are relevant for alterations of the subacromial space width. The objective of this experimental in vivo study was thus to test the hypotheses that potential changes of the subacromial space width (during antagonistic muscle activity) are caused by alterations of scapular kinematics and/or glenohumeral translation. The shoulders of 12 healthy subjects were investigated with an open MRI-system at 30 degrees, 60 degrees, 90 degrees, 120 degrees and 150 degrees of arm elevation. A force of 15N was applied to the distal humerus, once causing isometric contraction of the abductors and once contraction of the adductors. The scapulo-humeral rhythm, scapular tilting and glenohumeral translation were calculated from the MR image data for both abducting and adducting muscle activity. Adducting muscle activity led to significant increase of the subacromial space width in all arm positions. The scapulo-humeral rhythm (2.2-2.5) and scapular tilting (2-4 degrees) remained relatively constant during elevation, no significant difference was found between abducting and adducting muscle activity. The position of the humerus relative to the glenoid was, however, significantly (p < 0.05) different (inferior and anterior) for adducting versus abducting muscle activity in midrange elevation (60-120 degrees). These data show that the subacromial space can be effectively widened by adducting muscle activity, by affecting the position of the humerus relative to the glenoid. This effect may be employed for conservative treatment of the impingement syndrome.     

Effects of age and obesity on trunk kinetics and kinematics during dominant side one-handed carrying

The proportions of older and obese people are increasing in both the general and working populations worldwide. Older and obese individuals are more susceptible to work-related musculoskeletal disorders (MSDs) in comparison with healthy, younger individuals. Manual material handling (MMH) is associated with the development of work-related MSDs. Although previous research has suggested that one-handed carrying is a particularly undesirable method of MMH, the effects of one-handed carrying on trunk kinetics and kinematics among older and/or obese people have not been adequately studied. The objective of this study was to examine the effects of age and obesity on trunk angles and moments during dominant side one-handed carrying of various load magnitudes. Twenty (20) participants divided into four groups with respect to age (young and older) and obesity (obese and non-obese) carried different loads (No-load [0 kg], Light [5.67 kg], and Heavy [10.21 kg]) in their dominant hand for approximately 6 m. Three-dimensional (3D) trunk angles and moments approximately about the L4/L5 vertebral segment were calculated using Visual3D. The findings indicated that while carrying a load in the dominant hand plays an important role in changing trunk kinematics and kinetics, the results were not dependent on age and/or obesity category. Absolute moments were greatest among participants in the obese groups; however, these moments were mitigated when normalized to body weight and height (%BW * Ht). Age did not exacerbate the effects of load magnitude on trunk kinetics and kinematics.     

Differences in scapular kinematics and scapulohumeral rhythm during elevation and lowering of the arm between typical children and healthy adults

Scapular kinematics in healthy adults is well described in the literature but little is known on typical children. This study aimed to compare the three-dimensional (3-D) scapular kinematics and scapulohumeral rhythm during the elevation and lowering of the arm in the scapular plane in typical children and healthy adults. Twenty-six healthy adults (35.34 ± 11.65 years, 1.70 ± 0.10 m, 70.00 ± 12.30 kg) and 33 typical children (9.12 ± 1.51 years, 1.40 ± 0.10 m, 35.40 ± 10.45 kg) participated in this study. 3-D scapular kinematics were obtained using an electromagnetic tracking device. The subjects were asked to elevate and lower their arm in the scapular plane. Children showed less scapular protraction compared to adults at 120° during arm elevation, more anterior tilt than adults in the elevation and also at 60°, 90° and 120° during lowering of the arm. Children also showed higher scapulohumeral rhythm during lowering of the arm compared to adults from 90° to 60°. It was also found a low to little correlation between scapular position and age. The study showed small but significant differences in scapular kinematics and scapulohumeral rhythm between children and adults. These results can help clinicians to improve diagnosis and treatment protocols directed to children with dysfunction, as reference values on scapular kinematics in healthy children are also provided in this study.     

An electromyographical comparison of trunk muscle activity during isometric trunk and dynamic strengthening exercises

The purpose of this study was to compare rectus abdominis and erector spinae muscle activity during isometric (prone bridge [PB] and superman [SM]) and dynamic strengthening exercises (back squat, front squat [FS], and military press). Participants (n = 10, age 21.8 ± 2.6 years; body mass 82.65 ± 10.80 kg, 174.5± 7.2 cm), performed each exercise in a randomized order, using a repeated-measures design. Electromyographical (EMG) activity (sampling at 2,000 Hz) of the rectus abdominis (RA) and the erector spinae (ES) muscles was recorded throughout the duration of the exercises. Intraclass correlations demonstrated the highest levels of reliability for muscle activity during the isometric exercises; however, all exercises demonstrated high level of reliability (r = 0.764-0.998, p ≤ 0.01). The PB demonstrated significantly greater (p < 0.01) RA activity compared to all other exercises. The ES activity was significantly (p < 0.01) greater during the FS (1.010 ± 0.308 root mean square value [RMS (V)]) and SM (0.951 ± 0.217 RMS[V]) and compared to all other exercises, although there was no significant difference (p > 0.05) between the FS and the SM exercise. The PB may be the most suitable exercise for strengthening the RA, compared to dynamic exercises at a low to moderate load, because of a higher level of muscle activity. The FS may be a useful alternative to isometric exercises when strengthening the ES, because it results in slightly higher muscle activity levels when using only a light to moderate load. Because of the dynamic nature of the FS, this may also be more beneficial in transferring to activities of daily living and sporting environments.     

Effects of fatigue on lower limb,pelvis and trunk kinematics and muscle activation: Gender differences

Background: Muscle fatigue is associated with biomechanical changes that may lead to anterior cruciate ligament (ACL) injuries. Alterations in trunk and pelvis kinematics may also be involved in ACL injury. Although some studies have compared the effects of muscle fatigue on lower limb kinematics between men and women, little is known about its effects on pelvis and trunk kinematics. The aim of the study was to compare the effects of fatigue on lower limb, pelvis and trunk kinematics and muscle activation between men and women during landing. Methods: The participants included forty healthy subjects. We performed kinematic analysis of the trunk, pelvis, hip and knee and muscle activation analysis of the gluteal muscles, vastus lateralis and biceps femoris, during a single-leg landing before and after fatigue. Results: Men had greater trunk flexion than women after fatigue. After fatigue, a decrease in peak knee flexion and an increase in Gmax and BF activation were observed. Conclusion: The increase in the trunk flexion can decrease the anterior tibiofemoral shear force resulted from the lower knee flexion angle, thereby decreasing the stress on the ACL.     

Chest wall and trunk muscle activity during inspiratory loading.

We measured the electromyographic (EMG) activity in four chest wall and trunk (CWT) muscles, the erector spinae, latissimus dorsi, pectoralis major, and trapezius, together with the parasternal, in four normal subjects during graded inspiratory efforts against an occlusion in both upright and seated postures. We also measured CWT EMGs in six seated subjects during inspiratory resistive loading at high and low tidal volumes [1,280 +/- 80 (SE) and 920 +/- 60 ml, respectively]. With one exception, CWT EMG increased as a function of inspiratory pressure generated (Pmus) at all lung volumes in both postures, with no systematic difference in recruitment between CWT and parasternal muscles as a function of Pmus. At any given lung volume there was no consistent difference in CWT EMG at a given Pmus between the two postures (P > 0.09). However, at a given Pmus during both graded inspiratory efforts and inspiratory resistive loading, EMGs of all muscles increased with lung volume, with greater volume dependence in the upright posture (P < 0.02). The results suggest that during inspiratory efforts, CWT muscles contribute to the generation of inspiratory pressure. The CWT muscles may act as fixators opposing deflationary forces transmitted to the vertebral column by rib cage articulations, a function that may be less effective at high lung volumes if the direction of the muscular insertions is altered disadvantageously.     

EMG biofeedback effectiveness to alter muscle activity pattern and scapular kinematics in subjects with and without shoulder impingement

BackgroundMuscle imbalance between serratus anterior (SA), upper trapezius (UA), middle trapezius (MT), and lower trapezius (LT) muscles has been observed in subjects with subacromial impingement syndrome (SAIS).Objective(1) To investigate the effect of electromyography (EMG) biofeedback training on muscle balance ratios and scapular kinematics in healthy adults and subjects with SAIS. (2) To investigate whether the effects of EMG biofeedback on muscle balance ratios are different between groups.DesignTwelve healthy adults and 13 subjects with SAIS were recruited in this study. EMG was used to record the activity of scapular muscles. The ratios (UT/SA, UT/MT, and UT/LT) during exercises with/without EMG biofeedback were calculated. Scapular kinematics were recorded before and after exercises with/without EMG biofeedback.ResultsFor the subjects with SAIS, muscle balance ratios were lower during forward flexion with EMG biofeedback than during exercise only (UT/SA: 70.3–45.2; UT/LT: 124.8–94.6). Additionally, similar results were found during side-lying external rotation (UT/MT: 58.5–36.4). For the scapular upward rotation and tipping in both groups, there were no significant differences with and without EMG biofeedback.ConclusionEMG biofeedback improved the scapular muscular balance during training exercises in both groups. Further clinical trials should investigate the long-term effects of EMG biofeedback.     

External loading alters trunk kinematics and lower extremity muscle activity in a distribution-specific manner during sitting and rising from a chair

BackgroundExcess body mass alters gait biomechanics in a distribution-specific manner. The effects of adding mass centrally or peripherally on biomechanics during sitting and rising from a chair are unknown.MethodsMotion analysis and lower extremity EMG were measured for fifteen healthy, normal weight subjects during sit-to-stand (SitTS) and stand-to-sit (StandTS) from a chair under unloaded (UN), centrally loaded (CL), and peripherally loaded (PL) conditions.ResultsCompared to UN, PL significantly increased support width (SitTS and StandTS), increased peak trunk flexion velocity (SitTS), and trended to increase peak trunk flexion angle (SitTS). During StandTS, CL significantly reduced peak trunk flexion compared to UN and PL. EMG activity of the semitendinosus, vastus lateralis and/or medialis was significantly increased in CL compared to UN during SitTS and StandTS.ConclusionsAdding mass centrally or peripherally induces contrasting biomechanical strategies to successfully sit or rise from a chair. CL limits trunk flexion and increases knee extensor muscle activity whereas; PL increases support width and trunk flexion, thus preventing increased EMG activity.     

Effect of changes in orientation and position of external loads on trunk muscle activity and kinematics in upright standing

Forces at different heights and orientations are often carried by hands while performing occupational tasks. Trunk muscle activity and spinal loads are likely dependent on not only moments but also the orientation and height of these forces. Here, we measured trunk kinematics and select superficial muscle activity of 12 asymptomatic subjects while supporting forces in hands in upright standing. Magnitude of forces in 5 orientations (−25°, 0°, 25°, 50° and 90°) and 2 heights (20 cm and 40 cm) were adjusted to generate flexion moments of 15, 30 and 45 N m at the L5-S1 disc centre. External forces were of much greater magnitude when applied at lower elevation or oriented upward at 25°. Spinal kinematics remained nearly unchanged in various tasks.Changes in orientation and elevation of external forces substantially influenced the recorded EMG, despite similar trunk posture and identical moments at the L5-S1. Greater EMG activity was overall recorded under larger forces albeit constant moment. Increases in the external moment at the L5-S1 substantially increased EMG in extensor muscles (p < 0.001) but had little effect on abdominals; e.g., mean longissimus EMG for all orientations increased by 38% and 75% as the moment level altered from 15 N m to 30 N m and to 45 N m while that in the rectus abdominus increased only by 2% and 4%, respectively. Under 45 N m moment and as the load orientation altered from 90° to 50°, 25°, 0° and −25°, mean EMG dropped by 3%, 12%, 12% and 1% in back muscles and by 17%, 17%, 19% and 13% in abdominals, respectively. As the load elevation increased from 20 cm to 40 cm, mean EMG under maximum moment decreased by 21% in back muscles and by 17% in abdominals.Due to the lack of EMG recording of deep lumbar muscles, changes in relative shear/compression components and different net moments at cranial discs despite identical moments at the caudal L5-S1 disc, complementary model studies are essential for a better comprehension of neuromuscular strategies in response to alterations in load height and orientation.     

Effects of muscle kinematics on surface EMG amplitude and frequency during fatiguing dynamic contractions

Potvin, J. R. Effects of muscle kinematics on surfaceEMG amplitude and frequency during fatiguing dynamic contractions. J. Appl. Physiol. 82(1): 144-151, 1997.Fifteen male subjects performed a repetitive elbowflexion/extension task with a 7-kg mass until exhaustion. Average jointangle, angular velocity, and biceps brachii surface electromyographic(EMG) amplitude (aEMG) and mean powerfrequency (MPF) were calculated with each consecutive 250-ms segment ofdata during the entire trial. Data were separated into concentric oreccentric phases and into seven 20°-ranges from 0 to 140° ofelbow flexion. A regression analysis was used to estimate the restedand fatigued aEMG and MPF values. aEMG values were expressed as apercentage of amplitudes from maximum voluntary contractions (MVC).Under rested dynamic conditions, the average concentric aEMG amplitudewas 10% MVC higher than average eccentric values. Rested MPF valueswere similar for concentric and eccentric phases, although valuesincreased ~20 Hz from the most extended to flexed joint angles.Fatigue resulted in an average increase in concentric and eccentricaEMG of 35 and 10% MVC, respectively. The largest concentric aEMGincreases (up to 58% MVC) were observed at higher joint velocities,whereas eccentric increases appeared to be related to decreases invelocity. Fatigue had a similar effect on MPF during both concentricand eccentric phases. Larger MPF decreases were observed at shortermuscle lengths such that values within each angle range were verysimilar by the end of the trial. It was hypothesized that this findingmay reflect a biological minimum in conduction velocity beforepropagation failure occurs.