The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome

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Abstract

Purpose

This study aimed to investigate the effect of elastic taping on kinematics, muscle activity and strength of the scapular region in baseball players with shoulder impingement.

Scope

Seventeen baseball players with shoulder impingement were recruited from three amateur baseball teams. All subjects received both the elastic taping (Kinesio TexTM) and the placebo taping (3 M Micropore tape) over the lower trapezius muscle. We measured the 3-dimensional scapular motion, electromyographic (EMG) activities of the upper and lower trapezius, and the serratus anterior muscles during arm elevation. Strength of the lower trapezius was tested prior to and after each taping application. The results of the analyses of variance (ANOVA) with repeated measures showed that the elastic taping significantly increased the scapular posterior tilt at 30° and 60° during arm raising and increased the lower trapezius muscle activity in the 60–30° arm lowering phase (p < 0.05) in comparison to the placebo taping.

Conclusions

The elastic taping resulted in positive changes in scapular motion and muscle performance. The results supported its use as a treatment aid in managing shoulder impingement problems.

Introduction

Subacromial impingement syndrome is the most common shoulder complaint in orthopedic clinics (44–65%) (Michener et al., 2003) and the most frequent cause of shoulder pain in overarm athletes (Jobe et al., 2000). Many factors, such as anatomic morphology, overuse, and instability of the glenohumeral (GH) joint, have been shown to contribute to the occurrence of the subacromial impingement. In addition, the role of the scapular control in the impingement problems of the overarm athletes has aroused major interests after the Kibler’s report (Kibler, 1998). The scapula, along with the humerus, clavicle, and thorax, makes up the shoulder complex. The scapula plays the key link between the upper extremity and the axial skeleton, and the musculature around it provides the proximal stability for the upper extremity activities. This function is important particularly for overarm athletes such as baseball players (Kibler, 1998, Wilk et al., 2002). These athletes must possess a stabilized scapula and the coordinated motion between the scapula and the humerus to deliver repetitive overarm movements with great speed and power (Kibler, 1998). Studies have revealed that scapular dysfunction might lead to a vicious cycle involving microtrauma and chronic pain conditions and relate to the shoulder pain in baseball players (Kibler and McMullen, 2003).

The coordinated scapular movements are accomplished by the sophisticated neuromuscular control of the muscles attaching to it. Of all these muscles, the trapezius and serratus anterior are paired to form the important force couple which controls the movement of the scapular upward rotation and posterior tilt. These components of scapular movement are important for widening the subacromial space to prevent the impingement of the subacromial tissues (Michener et al., 2003, Solem-Bertoft et al., 1993). Altered function of these two muscles has been found to influence the scapular movement, and associate with subsequently poor shoulder function and chronic impingement problems (Kibler and McMullen, 2003). Cools et al., 2003, Ludewig and Cook, 2000 observed inhibition of the serratus anterior and lower trapezius, and over activation of the upper trapezius muscle in the subjects with shoulder impingement syndrome. Tai et al. (2005) identified the weakness of the lower trapezius in the amateur baseball players with chronic shoulder pain. The changes of scapular kinematics in the subjects with shoulder impingement including increased scapular winging during arm elevation, decreased scapular upward rotation and posterior tilt, and increased scapular superior translation were also documented (Lin et al., 2005, Ludewig and Cook, 2000, Michener et al., 2003).

The close relation between the scapular and shoulder function lead to the emphasis of the restoration of the scapular control in the rehabilitation programs for shoulder impingement (Kibler and McMullen, 2003, Mottram, 1997). One of the useful methods to facilitate the control of scapula is taping (Mottram, 1997). Although the underlying mechanisms of the taping effects are still unclear, many believed that taping works by offering constant proprioceptive feedback or providing alignment correction during dynamic movements (Alexander et al., 2003, Ackermann et al., 2002). Researchers have demonstrated that taping effectively improved the posture alignment, increased the shoulder range of motion, and reduced pain and discomfort of the shoulder and the patellofemoral joints (Lewis et al., 2005, Christou, 2004, Whittingham et al., 2004). However, little was mentioned in the literature about the effects of scapular taping on the scapular kinematics and muscle performance. McConnell taping for the shoulder impingement syndrome (a rigid tape across the muscle belly of the upper trapezius and along the lower trapezius) seemed to reduce pain and improve range of motion of the shoulder, but produced no significant alteration on the electromyographic activities of the two taped muscles (Cools et al., 2002, Wang et al., 2001). Ackermann et al. (2002) applied a rigid tape in the professional violinists and found negative effects on the upper trapezius activity and violin performance. They explained that the rigid tape and correctional taping techniques might have caused movement restriction and skin irritation, and thus were disadvantageous for fine movement control of the upper extremity. From our clinical experiences, the elastic taping causes minimal movement restriction while providing some degree of support and cutaneous inputs, which would be a better choice for treating the overarm athletes such as baseball players with shoulder impingement syndrome. To our knowledge, no study exists discussing the effects of elastic taping on shoulder function in this population. Therefore, the aim of this study was to investigate the effects of elastic taping on the scapular kinematics, muscle strength and electromyographic activity in the baseball players with shoulder impingement problems.

Section snippets

Methods

A cross-over, pretest/posttest repeated measures design was used to compare the effects of elastic and placebo taping for baseball players with shoulder impingement syndrome. All subjects received both types of taping with the order of taping randomly assigned as the elastic taping first or the placebo taping first. Two taping sessions were separated by at least three days to avoid accumulation of the taping effects. The study was approved by the Institutional Review Board of National Yang Ming

Description of subjects

A total of seventeen baseball players completed the tests. The basic data of these subjects were averaged: age = 23 ± 2.8 years old; BMI = 25.5 ± 2.3 kg/m2; duration of participation in baseball = 14 ± 2.9 years. The duration of shoulder symptoms ranged from 0 to 24 months (median = 2 months); the maximal pain intensity in the last 24 h was between 0 and 8 (median = 3). Among the subjects, nine were pitchers and eight were fielders of various positions. Five pitchers were assigned in the elastic taping first and

Baseline data characteristics

The scapular movement pattern observed in this investigation agreed with those in the literature (Karduna et al., 2001, Myers et al., 2005). The ranges of the scapular upward rotation (31°) and posterior tilt (12°) during 30° to 120° of shoulder scaption were comparable to the previous data.

The EMG normalization method used in this study was a static test, during which the muscle activities of the upper and lower trapezius and the serratus anterior were measured simultaneously while subjects

Conclusion

This is the first study to investigate the effects of Kinesio taping on the scapular kinematics and muscle performance in the baseball players with shoulder impingement syndrome. The application of Kinesio taping over the lower trapezius muscle improved the lower trapezius activity during 60–30° of the lowering phase of arm scaption, and increased scapular posterior tilt at 30° and 60° of arm scaption. These results suggested that Kinesio taping could be a useful therapeutic and prophylactic

Acknowledgement

We would like to thank all the baseball players and their coaches who assisted and participated in the experiment. Special thanks to Hong-Ren Lai and Chi-Feng Hung for developing the acquiring and analysing programs for our data collection and data management. This study is sponsored by China Medical University (CMU94-038) and Taipei City Hospital.

Yin-Hsin Hsu received her BS and MS in Physical Therapy from the National Yang-Ming University in 2003 and 2006. She is currently a physical therapist in Cathay General Hospital Sijhih. Her current research interests include the motion and muscle performance of the upper extremity during functional activities and rehabilitation.

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    Yin-Hsin Hsu received her BS and MS in Physical Therapy from the National Yang-Ming University in 2003 and 2006. She is currently a physical therapist in Cathay General Hospital Sijhih. Her current research interests include the motion and muscle performance of the upper extremity during functional activities and rehabilitation.

    Wen-Yin Chen is an Assistant Professor at Department of Physical Therapy, National Yang Ming University of Taiwan. Her research interests are focused upon clinical and electromyographic analysis in musculoskeletal rehabilitation.

    Hsiu-Chen Lin is a Lecturer at Department of Physical Therapy, China Medical University of Taiwan. Her research interests are focused upon biomechanical analysis of the pathomechanics and the rehabilitation in persons with orthopedic disorders of the extremities.

    Wendy T.J. Wang is an Associate Professor at Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan. Her area of research includes evidence-based physical therapist practice, identification of subgroups of patients that are likely to benefit from physical therapy approaches, and effectiveness of motor control interventions for a variety of patients with musculoskeletal disorders.

    Yi-Fen Shih is an Assistant Professor of Physical Therapy at National Yang-Ming University, Department of Physical Therapy and Assistive Technology, Taiwan. She received her Ph.D. in biomechanics in 2003, from Imperial College of Science, Technology and Medicine, London. Her research interests include pathomechanics and treatment intervention in persons with chronic musculoskeletal dysfunction.

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    Wen-Yin Chen and Hsiu-Chen Lin equally contributed to this work.

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