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 Aug;40(8):1906-15. doi: 10.1177/0363546512453297. Epub 2012 Jul 11.


Background: Previous research has identified some specific exercises to correct scapular muscle balance and onset timing in healthy subjects. However, evidence for their effectiveness in overhead athletes with impingement symptoms has been lacking until now.

Hypothesis: A 6-week exercise program consisting of previously selected exercises is able to improve muscle activation and onset timing during shoulder elevation. This program may also change pain and functionality levels in overhead athletes with mild impingement symptoms.

Study design: Case series; Level of evidence, 4.

Methods: Forty-seven overhead athletes with mild impingement symptoms (25 men and 22 women) were enrolled in this study. Before and after the 6-week training program, the Shoulder Pain and Disability Index (SPADI) score was individually obtained and maximum voluntary isometric contraction (MVIC) values were determined by surface electromyography. Mean muscle activation levels, muscle ratio data, and muscle onset timing were assessed for the upper (UT), middle (MT), and lower (LT) trapezius and serratus anterior (SA) muscle during arm elevation in the scapular plane.

Results: Forty participants completed the exercise program. The SPADI scores significantly decreased from 29.86 ± 17.03 during initial assessment to 11.7 ± 13.78 during postmeasurements (P < .001). The 3 trapezius muscle parts showed increased MVIC values and decreased activation levels during arm elevation, whereas this was not the case for the SA muscle. After the training program, UT/SA significantly decreased, whereas UT/MT and UT/LT did not change (P < .05). No differences in muscle timing between pre- and postmeasurements could be identified. The LT showed significant earlier activation compared with UT (-0.47; P < .001) and MT (-0.49; P < .001). The serratus anterior showed significant earlier activation compared with the UT (-0.74; P < .001), MT (-0.76; P < .001), and LT muscles (F = 0.27; P = .046).

Conclusion: This is the first longitudinal study to demonstrate that previously selected exercises (1) improve pain and function based on SPADI scores, (2) reduce relative trapezius muscle activation, and (3) alter UT/SA ratios. However, they were unable to change the timing of the scapular muscles during arm elevation when compared before and after a 6-week training program in overhead athletes with mild impingement symptoms.

MeSH terms

  • Adolescent
  • Adult
  • Athletic Injuries / physiopathology
  • Athletic Injuries / rehabilitation*
  • Exercise Therapy
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Muscle Contraction / physiology*
  • Muscle, Skeletal / physiopathology*
  • Recovery of Function
  • Scapula / physiopathology*
  • Shoulder Impingement Syndrome / physiopathology
  • Shoulder Impingement Syndrome / rehabilitation*
  • Young Adult