{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T08:43:24Z","timestamp":1782895404730,"version":"3.54.5"},"reference-count":49,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sports Health: A Multidisciplinary Approach"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Exercise therapy using electromyography biofeedback (EB) is applied widely for pitchers with shoulder impingement syndrome (SIS). However, few studies have targeted adolescent athletes and evaluated various functional outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis:<\/jats:title>\n                    <jats:p>Scapular-focused exercise (SFE) with EB would lead to greater improvements in muscle activity, strength, function, and pain compared with SFE alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Randomized controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A total of 36 high-school baseball pitchers diagnosed with SIS were assigned randomly to either the SFE+EB group (n\u2009=\u200918) or the SFE group (n\u2009=\u200918), while 9 were excluded before analysis. Both groups participated in a 4-week intervention (3 sessions per week, 60 minutes per session). The SFE+EB group received real-time visual feedback using surface electromyography targeting the upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA). The SFE group received verbal and tactile feedback from a physical therapist. Pre- and postintervention assessments included muscle activity, strength, Shoulder Pain and Disability Index, and Numeric Pain Rating Scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      No significant differences were found in baseline characteristics between groups except for glenohumeral internal rotation deficit. The SFE+EB group showed significantly greater improvements in MT activity at 90\u00b0 (13.14\u2009\u00b1\u20097.38) compared with the SFE group (7.48\u2009\u00b1\u20096.62) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u20090.05). Within-group analysis demonstrated significant increase in UT activity in the SFE+EB group at 60\u00b0, whereas MT, LT, SA activity, and UT:MT, UT:LT, and UT:SA ratios improved in both groups. Furthermore, LT and SA muscle strength, along with function and pain scores showed similar changes across groups after the intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>SFE with EB significantly enhances MT activation and symptom relief in high-school baseball pitchers with SIS. In addition, therapist-guided SFE without EB also yields clinically meaningful improvements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>EB may optimize scapular muscle activation. However, individualized therapist feedback remains an effective and accessible alternative for injury prevention and rehabilitation in young athletes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19417381261433558","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T06:34:16Z","timestamp":1779258856000},"page":"772-784","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effect of Scapular-Focused Exercise With or Without Electromyography Biofeedback in High-School Baseball Pitchers With Shoulder Impingement Syndrome: A Randomized Controlled Trial"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2629-5054","authenticated-orcid":false,"given":"Woo Yong","family":"Chung","sequence":"first","affiliation":[{"name":"Department of Physical Therapy, Sahmyook University, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9978-1924","authenticated-orcid":false,"given":"Yongwoo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Sahmyook University, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13102-020-00168-x"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.2147\/oajsm.S281100"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518765158"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2015.06.004"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18179293"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjpt.2017.09.007"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.humov.2019.01.005"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0838.2006.00570.x"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546512453297"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2022.105596"},{"key":"e_1_3_2_12_2","volume-title":"Normative Values of Clinical Measurements Around the Scapula in Healthy Subjects","author":"Desauter L","year":"2018","unstructured":"Desauter L. 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