The proximal-distal energy transfer between body segments occurs through the kinetic chain. Although some kinetic chain aspects have been investigated in individuals not engaged in sports, their relationship with shoulder pain in this population remains unclear. This cross-sectional study aimed to verify associations between kinetic chain factors and the presence of shoulder pain in adults.
Methods
Lumbopelvic stability (single-leg bridge test); active range of motion of the shoulder, trunk, and hip; and isometric peak strength of shoulder, trunk, hip, and knee muscles were assessed. A multivariate binary logistic regression analyzed the likelihood of shoulder pain based on these clinical results.
Results
Forty individuals (26.3 ± 10.4 years, 19 with shoulder pain) were assessed. The isometric strength of trunk extensor muscles significantly influenced the regression model (odds ratio = 0.99 [0.98–1.00]; p = 0.027), indicating that each 1 N increase in strength reduced the likelihood of shoulder pain by about 1%. No significant relationships were observed between other outcomes and shoulder pain.
Discussion
Isometric strength of trunk extensor muscles may be associated with shoulder pain. No associations were observed between shoulder pain and stability, mobility, and strength of other kinetic chain segments.
LucasJvan DoornPHegedusE, et al.A systematic review of the global prevalence and incidence of shoulder pain. BMC Musculoskelet Disord2022; 23: 1073.
2.
GreenbergDL. Evaluation and treatment of shoulder pain. Med Clin North Am2014; 98: 487–504.
3.
Doiron-CadrinPLafranceSSaulnierM, et al.Shoulder rotator cuff disorders: a systematic review of clinical practice guidelines and semantic analyses of recommendations. Arch Phys Med Rehabil2020; 101: 1233–1242.
4.
MachadoE de MHaikMNFerreiraJK, et al.Association of trunk and lower limb factors with shoulder complaints and sport performance in overhead athletes: a systematic review including GRADE recommendations and meta-analysis. Phys Ther Sport2023; 60: 112–131.
5.
Lluch-GirbésERequejo-SalinasNFernández-MatíasR, et al.Kinetic chain revisited: consensus expert opinion on terminology, clinical reasoning, examination, and treatment in people with shoulder pain. J Shoulder Elbow Surg2023; 32: e415–e428.
6.
OliverGDWasserbergerKde SwartA, et al.Hip range of motion and strength and energy flow during windmill softball pitching. J Athl Train2021; 56: 280–285.
7.
PontilloMButowiczCMEbaughD, et al.Comparison of core neuromuscular control and lower extremity postural stability in athletes with and without shoulder injuries. Clin Biomech2020; 71: 196–200.
8.
SekiguchiTHagiwaraYYabeY, et al.Restriction in the hip internal rotation of the stride leg is associated with elbow and shoulder pain in elite young baseball players. J Shoulder Elbow Surg2020; 29: 139–145.
9.
CopeTWechterSStuckyM, et al.The impact of lumbopelvic control on overhead performance and shoulder injury in overhead athletes: a systematic review. Int J Sports Phys Ther2019; 14: 500–513.
10.
GilmerGGWashingtonJKDugasJR, et al.The role of lumbopelvic-hip complex stability in softball throwing mechanics. J Sport Rehabil2019; 28: 196–204.
11.
PogettiLSNakagawaTHConteçoteGP,et al.Core stability, shoulder peak torque and function in throwing athletes with and without shoulder pain. Phys Ther Sport2018; 34: 36–42.
12.
ChoiMChungJ. Biomechanical and functional analysis of the shoulder complex and thoracic spine in patients with subacromial impingement syndrome: a case control study. Medicine (Baltimore)2023; 102: e32760.
13.
RebelattoMNAlburquerque-SendínFGavaV, et al.Cervical sensitivity, range of motion and strength in individuals with shoulder pain: a cross-sectional case control study. Musculoskelet Sci Pract2023; 67: 102834.
14.
HunterDJRivettDAMcKeirnanS, et al.Relationship between shoulder impingement syndrome and thoracic posture. Phys Ther2020; 100: 677–686.
15.
MeurerAGroberJBetzU, et al.Die BWS-beweglichkeit von impingementpatienten im vergleich zu gesunden - eine inklinometrische studie. Z Orthop Ihre Grenzgeb2004; 142: 415–420.
16.
TheisenCvan WagensveldATimmesfeldN, et al.Co-occurrence of outlet impingement syndrome of the shoulder and restricted range of motion in the thoracic spine - a prospective study with ultrasound-based motion analysis. BMC Musculoskelet Disord2010; 11: 135.
17.
Fonseca FialhoHRGavaVFonsecaRNS, et al.Thinking outside the shoulder: a systematic review and metanalysis of kinetic chain characteristics in non-athletes with shoulder pain. PLoS One2024; 19: e0314909.
18.
MacielNFBde Oliveira SousaC. Motor alterations in the kinetic chain in individuals with chronic shoulder pain. Gait Posture2022; 93: 183–190.
19.
BaierleTKromerTPetermannC, et al.Balance ability and postural stability among patients with painful shoulder disorders and healthy controls. BMC Musculoskelet Disord2013; 14: 282.
20.
VandenbrouckeJPvon ElmEAltmanDG, et al.Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Int J Surg2014; 12: 1500–1524.
21.
PiresEDCamargoPR. Analysis of the kinetic chain in asymptomatic individuals with and without scapular dyskinesis. Clin Biomech2018; 54: 8–15.
22.
HaikMNAlburquerque-SendínFCamargoPR. Short-term effects of thoracic spine manipulation on shoulder impingement syndrome. Arch Phys Med Rehabil2017; 98: 1594–1605.
23.
de Oliveira ScatolinRHottaGHCoolsAM, et al.Effect of conscious abdominal contraction on the activation of periscapular muscles in individuals with subacromial pain syndrome. Clin Biomech2021; 84: 105349.
24.
Silva BarrosBR daCavalcantiIBSSilva JúniorN da,et al.Correlation between upper limb function and clinical measures of shoulder and trunk mobility and strength in overhead athletes with shoulder pain. Phys Ther Sport2022; 55: 12–20.
25.
BoaratiE de LHottaGHMcQuadeKJ,et al.Acute effect of flexible bar exercise on scapulothoracic muscles activation, on isometric shoulder abduction force and proprioception of the shoulder of individuals with and without subacromial pain syndrome. Clin Biomech2020; 72: 77–83.
26.
GrimesJKPuenteduraEJChengMS,et al.The comparative effects of upper thoracic spine thrust manipulation techniques in individuals with subacromial pain syndrome: a randomized clinical trial. J Orthop Sport Phys Ther2019; 49: 716–724.
27.
PortneyLGWatkinsMP. Foundations of clinical research: applications to evidence-based practice. 4th ed. Philadelphia, Pennsylvania: F. A. Davis, 2020.
28.
RoachKEBudiman-MakESongsiridejN,et al.Development of a shoulder pain and disability index. Arthritis Rheum1991; 4: 143–149.
29.
PugaVODOLopesADShiwaSR, et al.Clinimetric testing supports the use of 5 questionnaires adapted into Brazilian Portuguese for patients with shoulder disorders. J Orthop Sport Phys Ther2013; 43: 404–413.
30.
CraigCMarshallASjöströmM, et al.International physical activity questionnaire: 12-country reliability and validity. Med Sci Sport Exerc2003; 35: 1381–1395.
31.
MatsudoSAraújoTMatsudoV, et al.Questionário internacional de atividade física (IPAQ): estudo de validade e reprodutibilidade no brasil. Rev Bras Atividade Física Saúde2001; 6: 5–18.
32.
Ruescas-NicolauMASánchez-SánchezMLCortés-AmadorS, et al.Validity of the international physical activity questionnaire long form for assessing physical activity and sedentary behavior in subjects with chronic stroke. Int J Environ Res Public Health2021; 18: 4729.
33.
ResendeRAJardimSHOFilhoRGT, et al.Does trunk and hip muscles strength predict performance during a core stability test?Brazilian J Phys Ther2020; 24: 318–324.
34.
TozzoMCAnsanelloWMartinsJ, et al. Inclinometer reliability for shoulder ranges of motion in individuals with subacromial impingement syndrome. Journal of Manipulative and Physiological Therapeutics2021; 44(3): 236–243.
35.
MäättäJTakataloJLeinonenT, et al. Lower thoracic spine extension mobility is associated with higher intensity of thoracic spine pain. Journal of Manual & Manipulative Therapy2022; 30(5): 300–308.
36.
TakataloJYlinenJPienimäkiT, et al. Intra- and inter-rater reliability of thoracic spine mobility and posture assessments in subjects with thoracic spine pain. BMC Musculoskeletal Disorders2020; 21(1): 77.
37.
FurnessJSchramBCoxAJ, et al. Reliability and concurrent validity of the iPhone ® Compass application to measure thoracic rotation range of motion (ROM) in healthy participants. PeerJ2018; 6: e4431.
38.
ClapisPADavisSMDavisRO. Reliability of inclinometer and goniometric measurements of hip extension flexibility using the modified Thomas test. Physiotherapy Theory and Practice2009; 24(2): 135–141.
39.
de OliveiraIOPilzBSantosRLG, et al. Reference values and reliability for lumbopelvic strength and endurance in asymptomatic subjects. Brazilian Journal of Physical Therapy2018; 22(1): 33–41.
40.
AlmeidaGPLdas Neves RHLde FreitasBW, et al. Reliability and validity of the hip stability isometric test (HipSIT): A new method to assess hip posterolateral muscle strength. Journal of Orthopaedic & Sports Physical Therapy2017; 47(12): 906–913.
41.
HiranoMKatohMGomiM, et al. Validity and reliability of isometric knee extension muscle strength measurements using a belt-stabilized hand-held dynamometer: a comparison with the measurement using an isokinetic dynamometer in a sitting posture. Journal of Physical Therapy Science2020; 32(2): 120–124.
42.
PallantJ. SPSS Survival manual. 6th ed. Maidenhead: Open University Press, 2016.
43.
HuijingPA. Epimuscular myofascial force transmission: a historical review and implications for new research. J Biomech2009; 42: 9–21.
44.
KrauseFWilkeJVogtL,et al.Intermuscular force transmission along myofascial chains: a systematic review. J Anat2016; 228: 910–918.
45.
AdeelMLinBSChaudharyMA, et al.Effects of strengthening exercises on human kinetic chains based on a systematic review. J Funct Morphol Kinesiol2024; 9: 22.
46.
SciasciaAThigpenCNamdariS,et al.Kinetic chain abnormalities in the athletic shoulder. Sports Med Arthrosc2012; 20: 16–21.
47.
KaurNBhanotKBrodyLT, et al.Effects of lower extremity and trunk muscles recruitment on serratus anterior muscle activation in healthy male adults. Int J Sports Phys Ther2014; 9: 924–937.
48.
Silva BarrosBR daBarrosACM dada Silva JúniorN, et al.Motor alterations along the kinetic chain in amateur volleyball and handball athletes with shoulder pain: an observational comparative study. J Bodyw Mov Ther2024; 39: 364–372.
49.
CarvalhaisVO do COcarinoJ de MAraújoVL, et al.Myofascial force transmission between the latissimus dorsi and gluteus maximus muscles: an in vivo experiment. J Biomech2013; 46: 1003–1007.
50.
NeumannDACamargoPR. Kinesiologic considerations for targeting activation of scapulothoracic muscles - part 1: serratus anterior. Brazilian J Phys Ther2019; 23: 459–466.
51.
Hazar KanikZPalaOOGunaydinG, et al.Relationship between scapular muscle and core endurance in healthy subjects. J Back Musculoskelet Rehabil2017; 30: 811–817.
52.
RichardsonELewisJSGibsonJ, et al.Role of the kinetic chain in shoulder rehabilitation: does incorporating the trunk and lower limb into shoulder exercise regimes influence shoulder muscle recruitment patterns? Systematic review of electromyography studies. BMJ Open Sport Exerc Med2020; 6: e000683.
53.
CookCLearmanKHoughtonS, et al.The addition of cervical unilateral posterior–anterior mobilisation in the treatment of patients with shoulder impingement syndrome: a randomised clinical trial. Man Ther2014; 19: 18–24.
54.
HunterDJRivettDAMcKiernanS, et al.Thoracic manual therapy improves pain and disability in individuals with shoulder impingement syndrome compared with placebo: a randomized controlled trial with 1-year follow-up. Arch Phys Med Rehabil2022; 103: 1533–1543.
55.
TurgutEDuzgunIBaltaciG. Effects of scapular stabilization exercise training on scapular kinematics, disability, and pain in subacromial impingement: a randomized controlled trial. Arch Phys Med Rehabil2017; 98: 1915–1923.e3.
56.
HodgettsCJLeboeuf-YdeCBeynonA, et al. Shoulder pain prevalence by age and within occupational groups: a systematic review. Archives of Physiotherapy2021; 11(1): 73.
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