Muscle activation patterns in shoulder impingement patients

Introduction: Shoulder impingement is one of the most common presentations of shoulder joint problems 1. It appears to be caused by a reduction in the sub-acromial space as the humerus abducts between 60o -120o – the 'painful arc'. Structures between the humeral head and the acromion are thus pinched causing pain and further pathology 2. Shoulder muscle activity can influence this joint space but it is unclear whether this is a cause or effect in impingement patients. This study aimed to observe muscle activation patterns in normal and impingement shoulder patients and determine if there were any significant differences. Method: 19 adult subjects were asked to perform shoulder abduction in their symptomatic arm and non-symptomatic. 10 of these subjects (age 47.9 ± 11.2) were screened for shoulder impingement, and 9 subjects (age 38.9 ± 14.3) had no history of shoulder pathology. Surface EMG was used to collect data for 6 shoulder muscles (Upper, middle and lower trapezius, serratus anterior, infraspinatus, middle deltoids) which was then filtered and fully rectified. Subjects performed 3 smooth unilateral abduction movements at a cadence of 16 beats of a metronome set at 60bpm, and the mean of their results was recorded. T-tests were used to indicate any statistical significance in the data sets. Significance was set at P<0.05. Results: There was a significant difference in muscle activation with serratus anterior in particular showing a very low level of activation throughout the range when compared to normal shoulder activation patterns (<30%). Middle deltoid recruitment was significantly reduced between 60-90o in the impingement group (30:58%).Trends were noted in other muscles with upper trapezius and infraspinatus activating more rapidly and erratically (63:25%; 60:27% respectively), and lower trapezius with less recruitment (13:30%) in the patient group, although these did not quite reach significance. Conclusion: There appears to be some interesting alterations in muscle recruitment patterns in impingement shoulder patients when compared against their own unaffected shoulders and the control group. In particular changes in scapula control (serratus anterior and trapezius) and lateral rotation (infraspinatus), which have direct influence on the sub-acromial space, should be noted. It is still not clear whether these alterations are causative or reactionary, but this finding gives a clear indication to the importance of addressing muscle reeducation as part of a rehabilitation programme in shoulder impingement patients.

The influence of crank configuration on muscle activity and torque production during arm crank ergometry

This study investigated the effect of crank configuration on muscle activity and torque production during submaximal arm crank ergometry. Thirteen non-specifically trained male participants volunteered. During the research trials they completed a warm-up at 15 W before two 3-min exercise stages were completed at 50 and 100 W; subjects used either a synchronous or asynchronous pattern of cranking. During the final 30-s of each submaximal exercise stage electromyographic and torque production data were collected. After the data had been processed each parameter was analysed using separate 2-way ANOVA tests with repeated measures. The activity of all muscles increased in line with external workload, although a shift in the temporal pattern of muscle activity was noted between crank configurations. Patterns of torque production during asynchronous and synchronous cranking were distinct. Furthermore, peak, minimum and delta (peak-minimum) torque values were different (P < 0.05) between crank configurations at both workloads. For example, at 100 W, peak torque using synchronous [19.6 (4.3) Nm] cranking was higher (P < 0.05) compared to asynchronous [16.8 (1.6) Nm] cranking. In contrast minimum torque was lower (P < 0.05) at 100 W using synchronous [4.8 (1.7) Nm] compared to asynchronous [7.3 (1.2) Nm] cranking. There was a distinct bilateral asymmetry in torque production during asynchronous cranking with the dominant transmitting significantly more force to the crank arm. Taken together, these preliminary data demonstrate the complex nature of muscle activity during arm crank ergometry performed with an asynchronous or synchronous crank set-up. Further work is required to determine how muscle activity (EMG activity) and associated patterns of torque production influence physiological responses and functional capacity during arm crank ergometry.