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.
So after a EXTREMELY short summer, we are back in session. My condolences to y’all. Try not to panic during your first practicals, drink some coffee, and make sure to stretch out those pec minors bc hunching over a book all day will ROUND those shoulders ✌🏻
As you are a physical therapist I thought you might be interested in the work of Crip Video Productions. Crip Video Productions is created by a filmmaker with Cerebral Palsy whose mission is to increase understanding of disability through storytelling with their independent short youtube films. They have created 3 films so far titled “Drama Sighted” “Only Those Who Limp Allowed” and “Crips Not Creeps”. Since the films depict people with disabilities living very full,vibrant active lifestyles with jobs many physical therapists have found their work to my very useful and informative,especially physical therapy students who want an idea of what living with a disability is actually like for patients. Now Crip Video Productions is casting a new film about a student with Cerebral Palsy who helps her professor who is a stroke survivor adapt to life with a neurologic disability including helping him with physical therapy related stuff! Check out the casting link for more details! They are still looking for various able bodied and disabled actors to be in the production pro bono.
Some days your case study makes sense, and other days you’re sitting through another PNF lecture.
Either way, I feel this weird animation of the zygomaticus mm tho