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marylin monroe
Showing posts with label shoulder. Show all posts
Showing posts with label shoulder. Show all posts

Impingement No More: Study Outlines 6 Week Protocol That Reduces, in 15% of the Cases Even Resolves Shoulder Pain

Image 1: A 1990 study by Lo et al. reports that 43.8% of athletes who are competing in sports with upper arm involvement complain about shoulder problems, 29% with constant pain (Lo. 1990)!
If you are thinking about sex, lies, ex-presidents and obese interns at the White House, when you hear the word "impingement" your language proficiency is not the best and / or you are one of those guys (or girls) who prefers his gossip weekly over the latest issue of a fitness, let alone a bodybuilding magazine (unlikely for SuppVersity students, but who knows?). If you don't belong to this group and / or have just begun to massage your aching shoulder, however, the results of a recently published study on the effectiveness of a 6-week scapular muscle rehabiliation exercise regimen that was specifically designed to alleviate the pain and improve the limited flexibility of athletes with mild to moderate shoulder impingement could be of great interest to you.

The scientifically proven 6-week anti-impingement protocol

For their trial, K. De May and his colleagues from the Department of Rehabilitation Sciences and Physiotherapy of the Faculty of Medicine and Health Sciences at the University Hospital in Ghent, Belgium, recruited 47 athletes (25 men and 22 women; mean 24.6 years); BMI 22.70kg/m²) who had been spending 6+ hours a week playing competitive overhead sports [volleyball (17), tennis (10), canoe polo (2), baseball (2), swimming (11), and badminton (5)] and had been suffering from recurrent or constant shoulder impingement symptoms for at least 3 months. After an initial screening in the course of which the impingement was diagnosed by experienced practitioners, the subjects were assigned to a pretty simple, daily exercise program that consisted of four exercises
  • Image 2 (De May. 2012): Images of the exercises in the same order as in the description to the left: Prone extensions, forward flexion, external rotation, horizontal abduction + external  rotation from 90° position of flexion
    Prone extension (view) - The subject is prone with the shoulders resting in 90° of forward flexion. From this position, the subject performs bilateral extension to a neutral position with the shoulder in neutral rotation. 
  • Forward flexion in side lying (similar, but lying on the side)- The subject is in a side-lying position, with the shoulder in neutral. The subject performs 90° of unilateral forward flexion in a sagittal plane.
  • External rotation in side lying (view) - The subject is side lying with the shoulder in neutral position and the elbow flexed 90°. From this position, the subject performs 90° of external rotation of the shoulder with a towel between the elbow and trunk to avoid compensatory movements.
  • Prone horizontal abduction with external rotation (like this, but with arms in position shown in image 2) - The subject is prone with the shoulders resting in 90° of forward flexion. From this position, the subject performs bilateral horizontal abduction to a horizontal position, with an additional external rotation of the shoulder at the end of the movement.
à 3 sets of 10 repetitions each, with 1 minute rest between sets and a weekly randomized exercise order (to ensure you train all muscle parts equally and don't just replace one imbalance with another one). Before and after the 6-week intervention period, the participants had to answer a standardized questionnaire (the Aside from a questionnaire, the so-called "Shoulder Pain and Disability Index" (SPADI; cf. Brechenridge. 2011) and were hooked up to an EMG apparatus to measure their specific muscular activation patterns.
Figure 1: Pre- and post maximum voluntary isometric contraction (MVIC) in manual muscle test positions specific to each muscle of interest (value expressed relative to mean EMG activity for all 4 muscles; left) and absolute changes in EMG activity during arm elevation (right) from pre- to post intervention (De Mey. 2012)
The MVC data in figure 1 (left) was obtained in manual muscle test positions specific to each muscle of interest and in 5-sec MVIC intervals with 5 seconds breaks in between the activation. And yielded the following insights (De Mey. 2012):
  • all 3 trapezius muscle parts exhibited increased maximum voluntary isometric contraction (MVIC) values after the exercise program (figure 1, left)
  • all 3 trapezius muscle did contract less forcefully during arm elevation, while no change was seen for the serratus anterior (figure 1, right)
  • the upper trapezius to serratus anterior (UT/SA) ratio significantly decreased after the training program, whereas the UT/ MT and UT/LT ratios did not change (data not shown).
Image 3: Illustration of the anatomy of the subacromial space
The significantly improved Shoulder Pain and Disability Index (SPADI) score (29.86 to 11.70 after 6 weeks; .60% reduction on average; 7 patients were basically pain-free after 6 weeks!) has therefore to be considered a result of a combined reduction of trapezius activation (not strength!) during the scapular plane elevation and the concomittant increase in the UT / SA ratio, which probably left more space for the impinged tendons to pass through the narrow subacromial space (see image 3).

Judged based on the results of other studies and what is generally described as a significant improvement in SPADI scores (8-13.2pts) in the literature, the researchers point out that
...[i]n our study, this was the case in 23 athletes. In 7 players, full recovery was attained based on a SPADI score of 0 during postmeasurements. The results of this study are very promising since limiting shoulder symptoms in active overhead athletes suffering from persistent mild symptoms might serve as a secondary injury prevention measure, limiting continued low-grade shoulder pain, fear avoidance, and ultimately surgical management requirement. (De Mey. 2012)
If the prospect of surgery-free total pain relief is not enough to invest a couple of minutes into rehab everyday, you are either the laziest slacker, I know, or don't know how f*** bad that hurts and how debilitating a chronic injury like this can be!

Implications: So, regardless of whether your shoulder does already hurt or you are smart and willing enough to spend a couple of extra minutes on "prehab" exercises I highly suggest that you
  • don't be stupid and take 2-3 weeks off from all your regular upper body exercises and focus on working on the muscular imbalances which are the underlying reason of existing shoulder pain in 90% of the cases to then gradually resume your regular training with light weights and low(er) volume on all those pushing movement the average gymbro loves to do
  • be smart and incorporate 2 of the exercises into every other workout to make sure that you can preserve your presently pain-free state and don't end up ruining your progress, just because your ego told you that it would look better to do another 5 sets of bench presses than a couple of prone extensions and external rotations
And don't forget to revise your complete training regimen - are you doing the same number of sets for your upper chest and front delts as you do for your whole back? If so, it's about time for a more balanced regimen, one that will not only help you prevent muscular imbalances in the first place, but also facilitate constant progress towards a symmetrical and aesthetic physique.

You Want to Learn About the 'Best' Exercises for Shoulders & Co? Look No Further!

ChestBicepsBackCoreLegsTricepsShoulders
The SuppVersity EMG Series can help you in deciding which exercises should be part of your next workout routine.

References:

  • Breckenridge JD, McAuley JH. Shoulder Pain and Disability Index (SPADI). J Physiother. 2011;57(3):197.
  • De Mey K, Danneels L, Cagnie B, Cools AM. Scapular Muscle Rehabilitation Exercises in Overhead Athletes With Impingement Symptoms: Effect of a 6-Week Training Program on Muscle Recruitment and Functional Outcome. Am J Sports Med. 2012 Jul 11.
  • Lo YP, Hsu YC, Chan KM. Epidemiology of shoulder impingement in upper arm sports events. Br J Sports Med. 1990 Sep;24(3):173-7.

Dumbbell Chest & Shoulder Training Shoot Out: New EMG Data from Experienced and Novice Female Lifters

Does a woman's pectoralis react the same way to dumbbell bench, incline and shoulder presses as the one of their male training partners? Does it make a difference whether you are a novice or an advanced trainee? What about light vs. heavy weights - any effect on the activation patterns of pectoralis, delts, trapezius & co? Learn the answers to these & other questions in today's SuppVersity article (photo bodybuilding.com)
The SuppVersity EMG Series is still one of the the most popular article series, here at the SuppVersity and that despite the fact that I guess most of you will already know the results by heart. Therefore I am happy to present you some additional data from a recently conducted study from the Biodynamics and Human Performance Center at the Armstrong Atlantic State University in Abercorn. The study that was published in the Journal of Sports Medicine a couple of days ago is - according to the authors - the first to investigate, whether the previously observed differences in muscular activation patterns in response to modified trunk inclination angle on muscle activation using barbells and Smith machines in men would occur in women, as well.

Another distinctive feature of the experimental protocol, Joshua Luczak, Andy Bosak, and Bryan L. Riemann devised is the use of both experienced and novice trainees and the separate analysis of the eccentric and concentric potion of the dumbbell bench press, incline bench press and shoulder press.

Who? What? How?

The researchers recruited 24 healthy college-aged (mean age 22.5 years) recreational female athletes as subjects and divided them into two groups, twelve per group, based on their experience with upper body weight training.
"One group was identified as experienced resistance trained exercisers by regularly participating in upper body resistance exercise at least 1–3 times per week for the last six months. The second group was comprised of novice resistance trained females who did not regularly participate in upper body resistance training exercises but instead were physically active in cardiovascular exercise at least 1–3 times per week." (Lukczak. 2013)
Within the 2-way repeated measures design of the study the exercise protocols were administered in a
between-subjects counterbalanced order, to ...
"[...] measure muscle activity in the anterior deltoid, pectoralis major (clavicular and sternal portions), and upper trapezius muscles by way of surface  electromyography data collection during flat bench (0° trunk inclination), incline bench (45°), and shoulder (85°) presses and then compare the muscle activation data between the novice and experienced groups as well as between the different exercises during the concentric and eccentric phases." (Lukczak. 2013)
After being familiarized with the correct execution of the exercises, the participants completed one set of five repetitions of each of the exercises with pretty light (4.5 kg) dumbbells. The order of the exercises was completed according to the counterbalanced protocol that each subject was assigned. Initiation of each set of repetitions was self-initiated and three minutes of rest were given between sets.
Figure 1: Normalized EMG activity for all subjects (no inter-group differences measured) during the dumbbell bench, inlcine and shoulder press (Lukczak. 2013)
Due to the use of the light weights I had to normalize the EMG data on a per muscle base before plotting it in figure 1. What you are seeing here are thus not the absolute values, but the EMG activity expressed relative to the mean activation pattern for a given muscle group on the concentric / eccentric potion of the exercise.... hah? I guess, I better give you an example:
  • the absolute EMG value for the upper trapezius activity during the concentric phase of the bench, the incline and the shoulder press were 103.5, 374.0 and 1,164.7, respectively
It goes without saying that plotting these values would have made it very difficult to read the diagram, so I calculated the mean of these three values and plotted the ratio of the actually measured EMG value to this very mean - got it?

But didn't we know most of that already?

What we knew already: According to the study the SuppVersity EMG Series is based on, the best exercises for the pectoralis major using standard equipment are:
  1. BB Bench Press
  2. Cable Cross*
  3. DB Bench Press
  4. Pec Deck
  5. DB Flys
  6. DB Pullovers
* the cable cross exercise should be performed actually crossing one's arms low before your body (learn more)
Basically the way the data is displayed does not really change anything about what it's telling you and that's more or less what both previous studies and bro-science have told you as well:
"The results of this study largely confirm previous research related to performing these exercises with barbells. Specifically, the bench and incline presses produced the greatest activation for the two portions of the pectoralis major muscle, while the shoulder press elicited the greatest activation for the anterior deltoid and upper trapezius muscles." (Lukczak. 2013)
Moroever, the hypothesis that the activation patterns of novice and advanced trainees would differ was not confirmed. When the form is picture perfect and the weight light enough to keep this picture perfect form over the whole set, the activation patterns are identical. In that, it's actually important to point out that the same results have been observed in previous studies using different weights (in % of 1RM) for rookies and pros (Lagally. 2004; Schick. 2010) - so this is not a consequence of using "too little weight", guys ;-)

Ah, and lastly, the observed increased activation of the muscle during the concentric phase of pressing movements are likely related to the light weights, used in the study at hand, which did, as the scientists point out, not require "for as much stabilization of the weight during the descent" compared to what is required during the completion of the same exercise with higher weights.This hypothesis is supported by previous studies by Goodman et al. (2008) and Uribe et al. (2010), in which the subjects had to bench close to their 1RM or with still submaximal  but heavy weights and where no differences in the activation patterns between the eccentric and concentric phase were observed.



Bottom line: I am sorry to say that, but the study at hand does not really bring anything new to the table. You want more shoulder involvement? Increase the angle! ... ah, and don't forget that the eccentric potion of the exercise has it's merits as well - specifically, when you are using practically relevant loads in the 70% 1-RM range. Now get back to the gym and rock the weights!

References:
  • Goodman CA, Pearce AJ, Nicholes CJ, Gatt BM, Fairweather IH. No difference in 1RM strength and muscle activation during the barbell chest press on a stable and unstable surface. J Strength Cond Res. 2008 Jan;22(1):88-94.
  • Lagally KM, McCaw ST, Young GT, Medema HC, Thomas DQ. Ratings of perceived exertion and muscle activity during the bench press exercise in recreational and novice lifters. J Strength Cond Res. 2004 May;18(2):359-64.
  • Luczak L, Bosak A, Riemann BL. Shoulder Muscle Activation of Novice and Resistance Trained Women during Variations of Dumbbell Press Exercises. Journal of Sports Medicine. 2013; article ID 612650.
  • Schick EE, Coburn JW, Brown LE, Judelson DA, Khamoui AV, Tran TT, Uribe BP. A comparison of muscle activation between a Smith machine and free weight bench press. J Strength Cond Res. 2010 Mar;24(3):779-84.
  • Uribe BP, Coburn JW, Brown LE, Judelson DA, Khamoui AV, Nguyen D. Muscle activation when performing the chest press and shoulder press on a stable bench vs. a Swiss ball. J Strength Cond Res. 2010 Apr;24(4):1028-33.