A Systematic Literature Review of the Resistance Exercises That Promote Maximal Muscle Activity of the Rotator Cuff in Normal Shoulders

Abstract

Background

There are numerous resistance exercises that can be used to activate the rotator cuff. However, the optimal exercises to achieve maximal muscle activation in supraspinatus, infraspinatus, subscapularis and teres minor remain unclear. Thus, the aim of this systematic review is to identify the optimal resistance exercises for producing maximal muscle activation of the rotator cuff in normal shoulders. Methods A literature search was completed using six key databases - MEDLINE, EMBASE, CINAHL, PEDro, SPORTdiscus and Cochrane Library (from inception to January 2012). The search yielded 452 records using terms relating to rotator cuff, exercise, and electromyography. Eighteen papers remained after duplicates were removed and selection criteria applied. Quality assessment, data extraction and data synthesis of included papers was undertaken.

Results

Prone horizontal abduction at 90–100° with external rotation, push-up-plus, empty can and full can produced greatest activity in supraspinatus; prone horizontal abduction at 90–100° with full external rotation, standing external rotation at 0° abduction and the push-up-plus exercise produced greatest activity in infraspinatus and push-up-plus and shoulder flexion exercise in subscapularis. There was limited data for teres minor.

Discussion

Exercises to elicit maximal activity of supraspinatus, infraspinatus and subscapularis in normal shoulders were identified.

Keywords

Rotator cuff electromyography rehabilitation EMG therapeutic exercise

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References

1 Reinold

Macrina

Wilk

. Electromyographic analysis of the supraspinatus and deltoid muscles during 3 common rehabilitation exercises. J Athl Train 2007; 42:464–9.

2 Reinold

Wilk

Fleisig

. Electromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises. J Orthop Sports Phys Ther 2004; 34:385–94.

3 Dark

Ginn

Halaki

. Shoulder muscle recruitment patterns during commonly used rotator cuff exercises: An electromyographic study. Phys Ther 2007; 87:1039–46.

4 Blackburn

McLeod

White

Wofford

. EMG analysis of posterior rotator cuff exercises. Athl Train 1990; 25:42–5.

5 Decker

Tokish

Ellis

Torry

Hawkins

. Subscapularis muscle activity during selected rehabilitation exercises. Am J Sports Med 2003; 31:126–34 (Research Support, Non-U.S. Gov't).

6 Malanga

Jenp

Growney

. EMG analysis of shoulder positioning in testing and strengthening the supraspinatus. Med. Sci. Sports Exercise 1996; 28:661–4.

7 Hintermeister

Lange

Schultheis

Bey

Hawkins

. Electromyographic activity and applied load during shoulder rehabilitation exercises using elastic resistance. Am J Sports Med 1998; 26:210–20.

8 McCann

Wootten

Kadaba

Bigliani

. A kinematic and electromyographic study of shoulder rehabilitation exercises. Clin Orthop Relat Res 1993; 288:179–88.

9 Cram

Criswell

. Cram's introduction to surface electromyography. Second edition. Sudbury: Jones and Bartlett Publishers, 2011.

10.

10 Stokes

. Reliability and repeatability of methods for measuring muscle in physiotherapy. Physiotherapy Theory Pract 1985; 1:71–6.

11.

11 Milgrom

Schaffler

Gilbert

Holsbeeck

. Rotator cuff changes in asymptomatic patients. J Bone Joint Surg 1995;77:296–8.

12.

12 Heers

Jenkyn

Desner

Klien

Basford

Kaufman

. Measurements of muscle activity with magnetic resonance elastography. Clin Biomech 2003;18:537–42.

13.

13 Herbert

. How to estimate treatments effects from reports of clinical trials. I: Continuous outcomes. Aust J Physiotherapy 2000; 46:229–35.

14.

14 Siegfried

Muller

Deeks

. HIV and male circumcision – a systematic review with assessment of the quality of studies. Lancet Infect Dis 2005; 5:165–73.

15.

15 Reeves

Deeks

Higgins

Wells

. Including non-randomized studies. In: Higgins

Green

, eds. Cochrane handbook for systematic reviews of interventions. Chapter 13. Oxford: John Wiley & Sons Ltd., 2008.

16.

16 Egger

Schneider

Smith

. Spurious precision? Meta-analysis of observational studies. Br Med J 1998; 316:140–4.

17.

17 Boettcher

Ginn

Cathers

. Which is the optimal exercise to strengthen supraspinatus? Med Sci Sports Exercise 2009; 41:1979–83.

18.

18 Myers

Pasquale

Laudner

Sell

Bradley

Lephart

. On-the-field resistance-tubing exercises for throwers: An electromyographic analysis. J Athl Train 2005; 40:15–22.

19.

19 Swanik

Bliven

Swanik

. Rotator-cuff muscle-recruitment strategies during shoulder rehabilitation exercises. J Sport Rehabil 2011; 20:471–86.

20.

20 Uhl

Carver

Mattacola

Mair

Nitz

. Shoulder musculature activation during upper extremity weight-bearing exercise. J Orthop Sports Phys Ther 2003; 33:109–17.

21.

21 Wattanaprakornkul

Cathers

Halaki

Ginn

. The rotator cuff muscles have a direction specific recruitment pattern during shoulder flexion and extension exercises. J Sci Med Sport 2011; 14:376–82 (Research Support, Non-US Govt).

22.

22 Worrell

Corey

York

Santiestaban

. An analysis of supraspinatus EMG activity and shoulder isometric force development. Med Sci Sports Exerc 1992; 24:744–8.

23.

23 Yasojima

Kizuka

Noguchi

Shiraki

Mukai

Miyanaga

. Differences in EMG activity in scapular plane abduction under variable arm positions and loading conditions. Med Sci Sports Exerc 2008; 40:716–21.

24.

24 Illyes

Kiss

. Electromyographic analysis during pull, forward punch, elevation and overhead throw after conservative treatment or capsular shift at patient with multidirectional shoulder joint instability. J Electromyogr Kinesiol 2009; 19:438–47 (Research Support, Non-US Govt).

25.

25 Illyes

Kiss

. Shoulder muscle activity during pushing, pulling, elevation and overhead throw. J Electromyogr Kinesiol 2005; 15:282–9 (Comparative Study Research Support, Non-US Govt).

26.

26 Suenaga

Minami

Fujisawa

. Electromyographic analysis of internal rotational motion of the shoulder in various arm positions. J Shoulder Elbow Surg 2003; 12:501–5.

27.

27 Townsend

Jobe

Pink

Perry

. Electromyographic analysis of the glenohumeral muscles during a baseball rehabilitation program. Am J Sports Med 1991; 19:264–72.

28.

28 McCann

Cordasco

Ticker

. An anatomic study of the subscapular nerves: A guide for the electromyographic analysis of the subscapularis muscle. J Shoulder Elbow Surg 1994; 3:94–9.

29.

29 Saha

. Mechanism of shoulder movements and a plea for the recogition of zero position of glenohumeral joint. Indian J Surg 1950; 12:153–65.

30.

30 Soderberg

Knutson

. A guide for use and interpretation of kinesiologic electromyographic data. Phys Ther 2000; 80:485–98.

31.

31 Poolman

Strujis

Krips

. Reporting of outcomes in orthopaedic randomized trials: Does blinding of outcome assessors matter? J Bone Joint Surg 2007; 89:550–8.

32.

32 Boettcher

Ginn

Cathers

. Standard maximum isometric voluntary contraction tests for normalizing shoulder muscle EMG. J Orthop Res 2008; 26:1591–7.

33.

33 Escamilla

Yamashiro

Paulos

Andrews

. Shoulder muscle activity and function in common shoulder rehabilitation exercises. Sports Med 2009; 39:663–85.

34.

34 Tino

Hillis

. The full can exercise as the recommended exercise for strengthening the supraspinatus while minimizing impingement. Strength Cond Res 2010; 32:33–5.

35.

35 Roberts

Davila

Hushek

. Magnetic resonance imaging analysis of the subacromial space in the impingement sign positions. J Shoulder Elbow Surg 2002; 11:595–9.

36.

36 Reinold

Escamilla

Wilk

. Current concepts in the scientific and clinical rationale behind exercises for glenohumeral and scapulothoracic musculature. J Orthop Sports Phys Ther 2009; 39:105–17.

37.

37 Hughes

. Force analysis of rotator cuff muscles. Clin Orthop Relat Res 1996; 330:75–83.

38.

38 Otis

Jiang

Wickiewicz

Peterson

Warren

Santner

. Changes in the moment arms of the rotator cuff and deltoid muscles with abduction and rotation. J Bone Joint Surg 1994; 76:667–76.

39.

39 Hess

Richardson

Darnell

Friis

Lisle

Myers

. Timing of rotator cuff activation during shoulder external rotation in throwers with and without symptoms of pain. J Orthop Sports Phys Ther 2005; 35:812–22.

40.

40 Ekstrom

Donatelli

Soderburg

. Surface electromyographic analysis of exercises for the trapezius and serratus anterior muscles. J Orthop Sports Phys Ther 2003; 33:247–58.

41.

41 Lear

Gross

. An electromyographical analysis of scapular stabilizing synergists during a push-up progression. J Orthop Sports Phys Ther 1998; 28:146–57.

42.

42 Burkhart

Morgan

Kibler

. The disabled throwing shoulder: Spectrum of pathology part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. J Arthroscopic Relat Surg 2003; 19:641–61.

43.

43 Lunden

Baraman

LaPrade

Ludewig

. Shoulder kinematics during the push-up plus exercise. J Shoulder Elbow Surg 2010; 19:216–23.

44.

44 Cricchio

Frazer

. Scapulothoracic and scapulohumeral exercises: A narrative review of electromyographic studies. J Hand Ther 2011; 24:322–34.

45.

45 Sharkey

Marder

. The rotator cuff opposes superior migration of the humeral head. Am J Sports Med 1995; 23:270–5.

46.

46 Wuelker

Korell

Thren

. Dynamic glenohumeral joint stability. J Shoulder Elbow Surg 1998; 7:43–52.