【論文摘要】The Effects of Scapular Conscious Control Training and Strengthening Training on the Corticospinal System in Overhead Athletes With Shoulder Impingement Syndrome

【論文摘要】肩胛意識控制訓練與肌力訓練對肩關節夾擠症候群之過肩運動員在皮質脊髓神經系統的影響

羅士倫(Shi-Lun Luo) ； 林吟亮(Yin-Liang Lin)

《物理治療》 45卷4期 (2020/12) Pp. 297-298

https://doi.org/10.6215/FJPT.202012.O04

摘要

Background and Purpose: Shoulder impingement syndrome (SIS) is the most common cause of shoulder pain. Previous studies have found that patients with SIS demonstrate abnormal scapular kinematics and muscle activation patterns. Recent studies also show that patients with SIS demonstrate changes in corticospinal system, including decreases in corticospinal excitability and increases in corticospinal inhibition of scapular muscles. To restore scapular kinematics and muscle activation patterns in patients with SIS, treatment protocols usually include scapular-focused exercises, such as scapular conscious control training (CCT) and strengthening training (ST). It is still not well understood whether these two types of exercise can reverse the changes in corticospinal system in patients with SIS. Therefore, the purpose of this study was to investigate the immediately effects of 30-minute CCT and ST on the corticospinal system and neuromuscular control in patients with SIS. Methods: This is a randomized control trial. Forty-one individuals with SIS were randomly assigned into either a CCT group or ST group. The outcomes included parameters testing the corticospinal system, scapular muscle activation, and scapular kinematics. The parameters of the corticospinal system included active motor threshold, motor evoked potential (MEP), cortical silent period, short interval intracortical inhibition and facilitation. These parameters were tested with transcranial magnetic stimulation, targeting lower trapezius (LT) muscle but collecting data of serratus anterior (SA) muscle simultaneously. Outcomes were measured before and after a 30-minute intervention protocol, which included three exercises to strengthen LT and SA muscles. When performing these exercises, subjects in the CCT group were trained to consciously control their scapula with electromyographic (EMG) biofeedback while subjects in the ST group did not have the feedback. The immediate training effects in two groups on the corticospinal excitability and inhibition were tested by two-way mixed repeated measures ANOVA. Those of the scapular muscle activation and kinematics was assessed by three-way mixed repeated measures ANOVA. Results: Following the CCT or ST, both groups demonstrated a significant increase in corticospinal excitability (MEP) of LT (p = 0.004) and SA muscles (p = 0.030) with no group difference. In addition, both groups also showed a significant increase in activation of LT (p ＜ 0.001) and SA muscles (p ＜ 0.001) during arm elevation with no group difference. There was no change in the scapular kinematics in both groups. Conclusion: Both CCT and ST can increase corticospinal excitability and scapular muscle activation. Future work may apply a short-term or long-term treatment protocol and study whether changes in corticospinal system are associated with pain and functional improvement. Clinical Relevance: With or without EMG biofeedback, a 30-minute scapula-focused exercise protocol can induce changes in central nervous system and neuromuscular control. Therefore, in clinical practice, as long as the exercise is correctly performed, EMG biofeedback may not be necessary during exercise training.