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Effects of Shoulder Girdle Dynamic Stabilization Exercise on Hand Muscle Strength

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Effects of Shoulder Girdle Dynamic Stabilization Exercise on Hand Muscle Strength Isokinetics and Exercise Science 23 (2015) 21–32 21 DOI 10.3233/IES-140560 IOS Press Effects of shoulder girdle dynamic stabilization exercise on hand muscle strength Alena Kobesovaa,∗, Jan Dzvonika,PavelKolara, Angie Sardinab and Ross Andelb,c aDepartment of Rehabilitation and Sports Medicine, Second Medical Faculty, Charles University and University Hospital Motol, Prague, Czech Republic bSchool of Aging Studies, University of South Florida, Tampa, FL, USA cInternational Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic Received 7 September 2014 Accepted 22 September 2014 Abstract. BACKGROUND: Shoulder girdle stabilization influences hand strength but the effects of functional training remain unknown. OBJECTIVE: To determine the influence of shoulder girdle stabilization on hand muscle strength. METHODS: Handgrip strength (with hand in neutral position, supination, pronation) and tripod pinch strength were measured in 20 healthy volunteers (10 in training/control groups) weekly over six weeks. The training consisted of six specific Dynamic Neuromuscular Stabilization (DNS) exercises performed five times per week. The exercises were designed to obtain maximum joint stability within the shoulder. RESULTS: Using mixed effects models, the training group showed significant improvement relative to the control group on all measures of hand muscle strength (p<0.05). The gains were particularly pronounced in handgrip strength in the neutral position (dominant hand: Estimate = 0.26, standard error [SE] = 0.04, p<0.001; non-dominant hand: Estimate = 0.23, SE = 0.03, p<0.001). That is, the training group gained about 0.25 standard deviations over the control group per session for a total of 1.5 standard deviations (about 27 Newtons) across all sessions. CONCLUSIONS: Shoulder girdle exercises based on DNS may generate clinically significant gains in hand muscle strength. Keywords: Upper extremity, hand-held dynamometry, functional stabilization, Dynamic Neuromuscular Stabilization, rehabili- tation 1. Introduction ripheral nerve injury etc., as well as in many orthope- dic conditions (upper extremities fractures and/or soft Handgrip strength depends on the synergistic coor- tissue damage, joint dysfunction, burn injury etc.), but dination between finger and wrist flexors and exten- also while trying to improve daily or athletic perfor- sors. It is an important component in the proper exe- mance. cution of daily living activities as well as in various Many studies have emphasized the critical influ- sports movements. Hand strength training is one of ence of elbow or shoulder position on hand mus- the most important activities used to treat pathological cle strength [1–7]. For example, Alexander et al. [8] conditions such as neurological conditions after stroke, demonstrated that coordinated control of the shoul- spinal cord injury, multiple sclerosis, myopathy, pe- der girdle muscles is necessary to properly position the hand for delicate manipulation. However, to the best of our knowledge, only one study to date as- ∗Corresponding author: Alena Kobesova, Department of Rehabil- sessed the effectiveness of shoulder girdle stabilization itation and Sports Medicine, Second Medical Faculty, Charles Uni- on hand muscle strength [9]. Specifically, Thomas et versity and University Hospital Motol, V Uvalu 84, Prague 5, 159 00, Czech Republic. Tel.: +420 224 43 9264; Fax: +420 224 439 al. [9] used only general resistance training of upper 220; E-mail: [email protected]. extremities and still found significant gains in hand- ISSN 0959-3020/15/$35.00 c 2015 – IOS Press and the authors. All rights reserved 22 A. Kobesova et al. / Effects of shoulder girdle dynamic stabilization exercise on hand muscle strength grip strength after eight weeks of intervention. More imal isometric handgrip strength following the stan- research is needed to improve the understanding of the dardized testing procedure [13]. Tripod pinch strength efficacy of training to improve shoulder girdle stability was also assessed. During the testing, the participant on hand muscle strength. This is particularly so given was seated on an adjustable chair without armrests the critical role of shoulder girdle function for hand (Fig. 1A). The participant’s posture was adjusted to muscle strength in individuals with and without hand maintain an upright spine with the head in neutral po- muscle strength problems. sition and eyesight orientation in a horizontal plane, We built on this research by examining the effects shoulders relaxed. In order to place the pelvis in a of an exercise promoting maximum joint stability (i.e., neutral position, the participant was directed to bear fully functionally centrated exercise) on hand muscle weight on her ischial tuberosities. The hips were po- strength in the pronated, neutral and supine position, sitioned at 90 degrees of flexion and slight abduction, and tripod pinch strength. The intervention was based with both feet supported on the ground. The tested arm on the proximal Dynamic Neuromuscular Stabiliza- was adducted along the trunk with 90-degree elbow tion (DNS) exercise paradigm [10–12], which includes flexion. To test handgrip strength, three forearm posi- a comprehensive stabilization of all elements of the tions were utilized: 1) pronation; 2) neutral position; trunk. Trunk and shoulder girdle stabilization is an im- and 3) supination. portant factor in the overall function of upper body When measuring tripod pinch strength, the forearm musculature, presumably including the hand muscles. was kept in the neutral position. The other arm was re- We hypothesized that a 6-week intervention with an laxed along the trunk (Fig. 1B). Participants received exercise program designed to stabilize the shoulder instruction to maintain the testing posture during the girdle would have significant effects on hand muscle whole process of measurement and were familiarized strength. with the dynamometer. The test was performed three times on each hand for each testing position: handgrip with the forearm in neutral position, pronation, supina- 2. Methods tion and then tripod pinch first on the dominant, second on the non-dominant hand. The participant was con- 2.1. Participants tinually verbally encouraged by the test administrator to develop maximum isometric grip (pinch) strength. A total of 20 healthy volunteers, all female students nd Maximum force (in Newtons) was automatically dis- from the Physiotherapy Program at the 2 Medical played by the dynamometer after five seconds of iso- Faculty, University Hospital Motol, Prague, Czech Re- metric grip (pinch). Only the test administrator was public, between 18 and 26 years of age, participated able to read the values, the participant was not made in the study. Eighteen individuals were right handed, two were left handed. The first 10 participants were aware of the values achieved. There was approximately assigned to the training group. An additional 10 par- a 45-second rest interval between each trial. In accor- ticipants were recruited to form the control group. dance with Mathiowetz et al. [13] the mean of the three General characteristics of each group are given in Ta- trials was used for statistical analysis. To reduce mea- ble 1. Exclusion criteria were injury, pain or any symp- surement error, only trials that were within 10% of one tomatic neurologic, orthopedic or musculoskeletal dys- another were averaged. function, and any sport activity performed on a com- Testing was performed between 12 and 6 p.m. once petitive level or more frequently than twice a week. a week with a seven-day interval between measure- During the study participants were allowed to per- ments. A total of seven measurements were obtained form non-strenuous recreational sports activity twice from each participant. The first measurement was a week. Written informed consent was obtained from taken before introducing the training program to the all participants. The study was approved by the ethics training group. Then subsequent measurements were committee at 2nd Medical Faculty, University Hospital taken each week with the last measurement occurring Motol, Prague, Czech Republic. after six weeks. 2.2. Assessments 2.3. Intervention Using the CITEC digital dynamometer (Citec, C.I.T. DNS represents a new rehabilitation strategy based Technics, Haren, The Netherlands) we assessed max- on the principles of developmental kinesiology and A. Kobesova et al. / Effects of shoulder girdle dynamic stabilization exercise on hand muscle strength 23 Table 1 Descriptive characteristics of the sample at baseline assessment Training group Control group Variable Mean SD Min Max Mean SD Min Max p-valuea Age (years) 23.3 2.0 18.0 25.0 24.3 1.1 23.0 26.0 0.180 Height (m) 1.70 0.6 1.62 1.80 1.70 0.5 1.64 1.77 0.648 Weight (kg) 63.2 7.5 56.0 80.0 59.4 3.5 54.0 67.0 < 0.001 Body mass index (kg/m2) 21.8 1.2 20.6 24.7 20.5 0.9 19.3 22.0 0.010 Hand muscle strength (in Newtons) Tripod pinch DH 82.5 11.3 69.0 99.0 80.6 6.3 70.0 87.0 0.648 Tripod pinch NDH 80.2 10.9 66.0 96.0 77.6 5.9 71.0 87.0 0.517 Handgrip overall DH 205.6 13.1 187.3 228.7 220.7 8.4 209.3 234.0 0.007 Handgrip overall NDH 199.0 14.6 180.0 221.3 207.9 11.5 190.0 228.7 0.148 Handgrip pronation DH 199.8 13.1 180.0 226.0 207.4 8.8 190.0 222.0 0.147 Handgrip pronation NDH 197.4 13.3 178.0 218.0 194.2 13.8 178.0 218.0 0.605 Handgrip neutral DH 206.0 13.4 188.0 232.0 231.8 8.3 220.0 242.0 < 0.001∗ Handgrip neutral NDH 199.8 12.7 182.0 224.0 216.4 13.3 196.0 240.0 0.010 Handgrip supine DH 211.0 15.6 190.0 230.0 223.0 13.8 198.0 240.0 0.086 Handgrip supine NDH 199.8 20.0 180.0 228.0 213.0 14.8 196.0 236.0 0.111 Notes.
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