Transforming Rehabilitation for Scapular Dyskinesia: The role of Modified Robbery Exercises in enhancing Muscle Function, reducing Disability, and improving Quality of Life
DOI:
https://doi.org/10.62464/ijoprp.v3i3.20Keywords:
Scapular Dyskinesia, Modified Robbery Exercises, Electromyography (EMG) Biofeedback, Muscle Activation, Functional Disability, Quality of LifeAbstract
Background: Scapular dyskinesia affects shoulder function, with significant implications for individuals, especially athletes. Rehabilitation approaches, including modified robbery exercises, aim to address this by improving scapular kinematics and muscle function. This study evaluates the effectiveness of modified robbery exercises supplemented with electromyography (EMG) biofeedback on muscle activation patterns and functional outcomes in individuals with scapular dyskinesia. Methods: A randomized controlled trial was conducted with 40 participants (20 in the control group receiving modified robbery exercises and ergonomic training, and 20 in the experimental group receiving modified robbery exercises with EMG biofeedback). Both interventions lasted 6 weeks, with sessions three times per week. Outcome measures included pain levels (Visual Analog Scale), muscle activation (EMG), functional disability (DASH questionnaire), and health-related quality of life (EQ-5D index and VAS). Independent samples t-tests were used to compare baseline and post-intervention differences between groups. Results: Post-intervention, the experimental group demonstrated significantly greater improvements in muscle activation for the Serratus Anterior, Upper Trapezius, and Lower Trapezius (p<0.001 for SA), indicating the benefit of EMG biofeedback. Both groups experienced pain reduction and functional improvements; however, the experimental group showed a more pronounced decrease in DASH scores (p=0.002) and a notable improvement in EQ-5D Index scores (p=0.008), pointing to enhanced functional outcomes and quality of life. Conclusions: Modified robbery exercises with EMG biofeedback are more effective than traditional exercises alone in improving muscle activation, reducing functional disability, and enhancing the quality of life in individuals with scapular dyskinesia. This study supports the integration of EMG biofeedback into rehabilitation programs for scapular dyskinesia, offering a promising approach for clinicians aiming to optimize recovery outcomes.
References
Burn, M. B., McCulloch, P. C., Lintner, D. M., Liberman, S. R., & Harris, J. D. (2016). Prevalence of scapular dyskinesis in overhead and nonoverhead athletes: a systematic review. Orthopaedic journal of sports medicine, 4(2), 2325967115627608. DOI: https://doi.org/10.1177/2325967115627608
Christensen, B. H., Andersen, K. S., Rasmussen, S., Andreasen, E. L., Nielsen, L. M., & Jensen, S. L. (2016). Enhanced function and quality of life following 5 months of exercise therapy for patients with irreparable rotator cuff tears–an intervention study. BMC musculoskeletal disorders, 17(1), 1-8. DOI: https://doi.org/10.1186/s12891-016-1116-6
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Lawrence Erlbaum Associates. This book provides a comprehensive overview of statistical power analysis, including formulas for calculating sample sizes.
Cools, A. M., Dewitte, V., Lanszweert, F., Notebaert, D., Roets, A., Soetens, B., . . . Witvrouw, E. E. (2007). Rehabilitation of scapular muscle balance: which exercises to prescribe? The American journal of sports medicine, 35(10), 1744-1751. DOI: https://doi.org/10.1177/0363546507303560
De Mey, K., Danneels, L., Cagnie, B., Borms, D., T'Jonck, Z., Van Damme, E., & Cools, A. M. (2014). Shoulder muscle activation levels during four closed kinetic chain exercises with and without Redcord slings. The Journal of Strength & Conditioning Research, 28(6), 1626-1635. DOI: https://doi.org/10.1519/JSC.0000000000000292
Dos Santos, C., Jones, M. A., & Matias, R. (2021). Short-and long-term effects of a scapular-focused exercise protocol for patients with shoulder dysfunctions—a prospective cohort. Sensors, 21(8), 2888. DOI: https://doi.org/10.3390/s21082888
Ellenbecker, T. S., & Cools, A. (2010). Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. British journal of sports medicine, 44(5), 319-327. DOI: https://doi.org/10.1136/bjsm.2009.058875
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). GPower 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175-191. DOI: https://doi.org/10.3758/BF03193146
Hawker, G. A., Mian, S., Kendzerska, T., & French, M. (2011). Measures of adult pain: Visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short‐form mcgill pain questionnaire (sf‐mpq), chronic pain grade scale (cpgs), short form‐36 bodily pain scale (sf‐36 bps), and measure of intermittent and constant osteoarthritis pain (icoap). Arthritis care & research, 63(S11), S240-S252. DOI: https://doi.org/10.1002/acr.20543
Hudak, P. L., Amadio, P. C., Bombardier, C., Beaton, D., Cole, D., Davis, A., . . . Marx, R. G. (1996). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head). American journal of industrial medicine, 29(6), 602-608. DOI: https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L
Jester, A., Harth, A., Wind, G., Germann, G., & Sauerbier, M. (2005). Disabilities of the arm, shoulder and hand (DASH) questionnaire: determining functional activity profiles in patients with upper extremity disorders. Journal of hand surgery, 30(1), 23-28. DOI: https://doi.org/10.1016/J.JHSB.2004.08.008
Jung, S.-h., Hwang, U.-j., Kim, J.-h., Gwak, G.-T., & Kwon, O.-y. (2017). Effects of horizontal shoulder abduction and adduction on the activity and strength of the scapular protractors. Journal of Electromyography and Kinesiology, 37, 155-159. DOI: https://doi.org/10.1016/j.jelekin.2017.10.011
Kibler, W. B., & Sciascia, A. (2016). The role of the scapula in preventing and treating shoulder instability. Knee Surgery, Sports Traumatology, Arthroscopy, 24, 390-397. DOI: https://doi.org/10.1007/s00167-015-3736-z
Leong, H. T., Tsui, S. S. M., Ng, G. Y.-f., & Fu, S. N. (2016). Reduction of the subacromial space in athletes with and without rotator cuff tendinopathy and its association with the strength of scapular muscles. Journal of Science and Medicine in Sport, 19(12), 970-974. DOI: https://doi.org/10.1016/j.jsams.2016.03.011
Miyasaka, J., Arai, R., Ito, T., Shingu, N., Hasegawa, S., Ibuki, S., . . . Moritani, T. (2017). Isometric muscle activation of the serratus anterior and trapezius muscles varies by arm position: a pilot study with healthy volunteers with implications for rehabilitation. Journal of Shoulder and Elbow Surgery, 26(7), 1166-1174. DOI: https://doi.org/10.1016/j.jse.2016.11.010
Moeller, C. R., Bliven, K. C. H., & Valier, A. R. S. (2014). Scapular muscle-activation ratios in patients with shoulder injuries during functional shoulder exercises. Journal of athletic training, 49(3), 345-355. DOI: https://doi.org/10.4085/1062-6050-49.3.10
Moghadam, A. N., Rahnama, L., Dehkordi, S. N., & Abdollahi, S. (2020). Exercise therapy may affect scapular position and motion in individuals with scapular dyskinesis: a systematic review of clinical trials. Journal of Shoulder and Elbow Surgery, 29(1), e29-e36. DOI: https://doi.org/10.1016/j.jse.2019.05.037
Ouellet, P., Lafrance, S., Pizzi, A., Roy, J.-S., Lewis, J., Christiansen, D. H., . . . Desmeules, F. (2021). Region-specific exercises vs general exercises in the management of spinal and peripheral musculoskeletal disorders: a systematic review with meta-analyses of randomized controlled trials. Archives of Physical Medicine and Rehabilitation, 102(11), 2201-2218. DOI: https://doi.org/10.1016/j.apmr.2021.01.093
Rabin, A., Irrgang, J. J., Fitzgerald, G. K., & Eubanks, A. (2006). The intertester reliability of the scapular assistance test. Journal of Orthopaedic & Sports Physical Therapy, 36(9), 653-660. DOI: https://doi.org/10.2519/jospt.2006.2234
Robinson, P. M., Norris, J., & Roberts, C. P. (2017). Randomized controlled trial of supervised physiotherapy versus a home exercise program after hydrodilatation for the management of primary frozen shoulder. Journal of Shoulder and Elbow Surgery, 26(5), 757-765. DOI: https://doi.org/10.1016/j.jse.2017.01.012
Tsuruike, M., & Ellenbecker, T. S. (2015). Serratus anterior and lower trapezius muscle activities during multi-joint isotonic scapular exercises and isometric contractions. Journal of athletic training, 50(2), 199-210. DOI: https://doi.org/10.4085/1062-6050-49.3.80
Warner, J. J., & Navarro, R. A. (1998). Serratus anterior dysfunction: recognition and treatment. Clinical Orthopaedics and Related Research®, 349, 139-148. DOI: https://doi.org/10.1097/00003086-199804000-00017
Welbeck, A., Amilo, N., Le, D., Killelea, C., Kirsch, A., Zarzour, R., . . . Faherty, M. (2019). Examining the link between thoracic rotation and scapular dyskinesis and shoulder pain amongst college swimmers. Physical Therapy in Sport, 40, 78-84. DOI: https://doi.org/10.1016/j.ptsp.2019.08.013
Willmore, E. G., & Smith, M. J. (2016). Scapular dyskinesia: evolution towards a systems-based approach. Shoulder & Elbow, 8(1), 61-70. DOI: https://doi.org/10.1177/1758573215618857
Yesilyaprak, S. S., Turksan, H. E., & Karabay, D. (2022). Effects of A Progressive Rehabilitation Program on Shoulder Internal Rotation Range of Motion, Acromiohumeral Distance, And Pain in An Adolescent Female Swimmer with Subacromial Pain (Impingement) Syndrome. International Journal of Disabilities Sports and Health Sciences, 5(1), 56-65. DOI: https://doi.org/10.33438/ijdshs.1041097
Yuksel, E., & Yesilyaprak, S. S. (2024). Scapular stabilization exercise training improves treatment effectiveness on shoulder pain, scapular dyskinesis, muscle strength, and function in patients with subacromial pain syndrome: A randomized controlled trial. Journal of Bodywork and Movement Therapies, 37, 101-108. DOI: https://doi.org/10.1016/j.jbmt.2023.11.005
Zakharova-Luneva, E., Jull, G., Johnston, V., & O'Leary, S. (2012). Altered trapezius muscle behavior in individuals with neck pain and clinical signs of scapular dysfunction. Journal of manipulative and physiological therapeutics, 35(5), 346-353. DOI: https://doi.org/10.1016/j.jmpt.2012.04.011
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