Scapular Stabilization and Muscle Strength in Manual Wheelchair Users with Spinal Cord Injury and Subacromial Impingement

Top Spinal Cord Inj Rehabil, 2016 · DOI: 10.1310/sci2201-60 · Published: January 1, 2016

Spinal Cord Injury Orthopedics Rehabilitation

Simple Explanation

Shoulder pain is common in individuals with spinal cord injuries (SCI), often due to overuse and muscle imbalances from activities like wheelchair propulsion and transfers. This pain is frequently linked to subacromial impingement. The study investigates whether muscle imbalances and impaired shoulder blade (scapular) stabilization patterns in able-bodied (AB) individuals with shoulder impingement differ from those in manual wheelchair users with SCI and impingement. The findings suggest that rehabilitation strategies targeting the posterior shoulder girdle, similar to those used for AB adults, are suitable for manual wheelchair users with SCI and impingement, focusing on strengthening scapular retractors and arm adductors.

Study Duration

Not specified

Participants

22 adults with subacromial impingement (11 SCI, 11 AB)

Evidence Level

Cohort study

Key Findings

1
Shoulders with impingement had significantly higher upper trapezius to lower trapezius (UT:LT) activation compared to shoulders without impingement, regardless of wheelchair user status.
2
Participants with SCI had a significantly greater abduction to adduction (ABD:ADD) ratio and push to pull (PUSH:PULL) ratio than AB participants.
3
The differences in ABD:ADD and PUSH:PULL ratios were primarily due to decreased strength in adduction and pull movements in the SCI group.

Research Summary

This study compared scapular stabilization and muscle strength between manual wheelchair users with SCI and able-bodied adults, both with and without subacromial impingement. The results indicated that shoulders with impingement had higher UT:LT activation, regardless of SCI/AB status, suggesting that impaired scapular stabilization is related to the shoulder pathology itself. Manual wheelchair users with SCI showed an altered muscle balance, specifically decreased strength in adduction and pulling, suggesting the need for targeted strengthening of the posterior shoulder muscles.

Practical Implications

Rehabilitation Strategies

Rehabilitation programs for manual wheelchair users with SCI and impingement should focus on scapular stabilization exercises, similar to those used for able-bodied adults with impingement.

Posterior Shoulder Strengthening

Targeted strengthening of the posterior shoulder muscles, including scapular retractors and arm adductors, is essential for both prophylactic and therapeutic interventions.

Rotator Cuff Consideration

Rotator cuff strengthening may be of lesser importance in this population compared to strengthening the posterior shoulder girdle, given the study's findings.

Study Limitations

1
The study was limited by EMG measurements restricted to the upper and lower trapezius muscles.
2
The study lacked direct measurement of scapular kinematics during testing.
3
The sample size was not sufficient to stratify the results by injury level.

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