Title: Shoulder Electromyography Measurements During Activities of Daily Living and Routine Rehabilitation Exercises Authors: Gurney A, Mermier C, Laplante M, Majumdar A, O’Neill K, Shewman T, Gurney J Journal: Journal of Orthopedic and Sport Physical Therapy Year: 2016
Protocols vary from super conservative to more aggressive approaches after rotator cuff surgeries. The usual progression of exercises is PROM to AAROM to AROM to resistance training, but how much do you really use each muscle of the shoulder during these beginner, phase 1 exercises?
This study looked at the activation of specific rotator cuff muscles through EMG during common phase 1 shoulder exercises, as well as during common post surgical ADLs.
Nitty Gritty
Who: 28 volunteers What: Electromyography measures of Biceps, Upper Trapezius, Middle Deltoid, Teres Minor, Supraspinatus, Infraspinatus, Subscapularis. How: 28 healthy volunteers were chosen for this study. The participants were instructed how to properly perform the following exercises and EMG data were collected during:
AAROM pulleys in sagittal plane and in scapular plane
Pendulums
AAROM Wand/Dowel Flexion
AAROM Self Ranging (interlocked fingers) Flexion
The shoulder muscle activity was also measured while walking 10 steps, donning and doffing a button down shirt, donning and doffing a shoulder sling
Results: (see table below for more detailed information)
High supraspinatus, infraspinatus and subscapularis activity during ambulation.
Donning/Doffing sling yielded high infraspinatus, subscapularis and biceps activation.
Donning/Doffing shirt showed high supraspinatus, infraspinatus, subscapularis and teres minor activation.
Higher rotator cuff activation during scapular plane pulleys than sagittal plane pulley
Pendulum exercise had more muscle activation than AAROM with interlocking fingers.
Limitation: healthy individuals be pathological individuals. After surgery people may be even less inclined to activate those muscles during their daily activities in attempt to protect themselves or avoid pain so the recruitment may differ.
Clinical Relevance
Logical progression of pulleys is to start a patient using the pulleys in the sagittal plane and then gradually progress to scapular plane exercise due to increased activation of RTC in scapular plane.
As new grads especially, PTs are sometimes overly cautious when prescribing exercises to patients in order to protect the healing tissues. Some PTs may be nervous to give 1-2# dumbbells to grandma in fear of hurting her, when in reality grandma is lifting 1-2# objects around her home doing every day chores without even realizing it. This leads me to the interesting finding of this study. The ADLs listed in this study yielded the higher activation of rotator cuff muscles than any of the exercises performed. This further supports the safety of the phase 1 exercises given to post surgical patients. If the patient is taking his/her sling off and shirts off independently than they are able to do some gentle AAROM exercises without over stressing the healing muscles.
Citation: Gurney AB, Mermier C, Laplante M, et al. Shoulder Electromyography Measurements During Activities of Daily Living and Routine Rehabilitation Exercises. J Orthop Sports Phys Ther. 2016;46(5):375-83.