{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T01:23:31Z","timestamp":1788312211652,"version":"build-2803163510"},"reference-count":38,"publisher":"National Athletic Trainers' Association","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6,1]]},"abstract":"<jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Individuals with shoulder impingement syndrome (SIS) exhibit changes in corticospinal excitability, scapular kinematics, and scapular muscle-activation patterns. To restore the scapular kinematics and muscle-activation patterns in individuals with SIS, treatment protocols usually include scapula-focused exercises, such as scapular-orientation and strength training.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To investigate whether scapular-orientation and strength training can reverse the altered corticospinal excitability of recreational overhead athletes with SIS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Randomized controlled clinical trial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>University laboratory.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients or Other Participants<\/jats:title>\n                  <jats:p>Forty-one recreational overhead athletes with SIS: 20 in the scapular-orientation group (age = 26.45 \u00b1 4.13 years, height = 171.85 \u00b1 7.88 cm, mass = 66.70 \u00b1 10.68 kg) and 21 in the strengthening group (age = 26.43 \u00b1 5.55 years, height = 171.62 \u00b1 5.87 cm, mass = 68.67 \u00b1 10.18 kg).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention(s)<\/jats:title>\n                  <jats:p>Both groups performed a 30-minute training protocol consisting of 3 exercises to strengthen the lower trapezius (LT) and serratus anterior muscles without overactivating the upper trapezius muscles. Participants in the scapular-orientation group were instructed to consciously activate their scapular muscles with electromyographic biofeedback and cues, whereas the strengthening group did not receive biofeedback or cues for scapular motion.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main Outcome Measure(s)<\/jats:title>\n                  <jats:p>Corticospinal excitability was assessed using transcranial magnetic stimulation. Scapular kinematics and muscle activation during arm elevation were also measured.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>After training, both groups demonstrated an increase in motor-evoked potentials in the LT (P = .004) and increases in scapular upward rotation (P = .03), LT activation (P &amp;lt; .001), and serratus anterior activation (P &amp;lt; .001) during arm elevation. Moreover, the scapular-orientation group showed higher LT activation levels during arm elevation after training than the strengthening group (P = .03).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>With or without biofeedback and cues, scapula-focused exercises improved scapular control and increased corticospinal excitability. Adding biofeedback and cues for scapular control during exercise helped facilitate greater LT activation, so feedback and cues are recommended during scapula-focused training.<\/jats:p>\n               <\/jats:sec>","DOI":"10.4085\/1062-6050-0066.23","type":"journal-article","created":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T23:14:17Z","timestamp":1693437257000},"page":"617-626","source":"Crossref","is-referenced-by-count":11,"title":["Scapula-Focused Exercises With or Without Biofeedback and Corticospinal Excitability in Recreational Overhead Athletes With Shoulder Impingement"],"prefix":"10.4085","volume":"59","author":[{"given":"Shi-Lun","family":"Luo","sequence":"first","affiliation":[{"name":"* Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Fen","family":"Shih","sequence":"additional","affiliation":[{"name":"* Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiu-Jenq","family":"Lin","sequence":"additional","affiliation":[{"name":"\u2020 School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin-Liang","family":"Lin","sequence":"additional","affiliation":[{"name":"* Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2557","published-online":{"date-parts":[[2024,6,26]]},"reference":[{"issue":"1","key":"2024062523513471900_i1938-162X-59-6-617-b01","first-page":"51","article-title":"Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes","volume":"6","author":"Page","year":"2011","journal-title":"Int J Sports Phys Ther"},{"issue":"14","key":"2024062523513471900_i1938-162X-59-6-617-b02","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1136\/bjsports-2013-092425","article-title":"Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the \u2018Scapular Summit.\u2019","volume":"47","author":"Kibler","year":"2013","journal-title":"Br J Sports Med"},{"issue":"2","key":"2024062523513471900_i1938-162X-59-6-617-b03","doi-asserted-by":"crossref","first-page":"90","DOI":"10.2519\/jospt.2009.2808","article-title":"The association of scapular kinematics and glenohumeral joint pathologies","volume":"39","author":"Ludewig","year":"2009","journal-title":"J Orthop Sports Phys Ther"},{"issue":"1","key":"2024062523513471900_i1938-162X-59-6-617-b04","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.math.2010.08.004","article-title":"Shoulder impingement: biomechanical considerations in rehabilitation","volume":"16","author":"Ludewig","year":"2011","journal-title":"Man Ther"},{"issue":"10","key":"2024062523513471900_i1938-162X-59-6-617-b05","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1177\/0363546507303560","article-title":"Rehabilitation of scapular muscle balance: which exercises to prescribe","volume":"35","author":"Cools","year":"2007","journal-title":"Am J Sports Med"},{"issue":"1","key":"2024062523513471900_i1938-162X-59-6-617-b06","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jelekin.2012.09.007","article-title":"EMG biofeedback effectiveness to alter muscle activity pattern and scapular kinematics in subjects with and without shoulder impingement","volume":"23","author":"Huang","year":"2013","journal-title":"J Electromyogr Kinesiol"},{"issue":"8","key":"2024062523513471900_i1938-162X-59-6-617-b07","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1016\/j.jse.2018.04.006","article-title":"Progressive conscious control of scapular orientation with video feedback has improvement in muscle balance ratio in patients with scapular dyskinesis: a randomized controlled trial","volume":"27","author":"Huang","year":"2018","journal-title":"J Shoulder Elbow Surg"},{"key":"2024062523513471900_i1938-162X-59-6-617-b08","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.clinbiomech.2017.12.005","article-title":"Scapular-focused exercise treatment protocol for shoulder impingement symptoms: three-dimensional scapular kinematics analysis","volume":"51","author":"Hotta","year":"2018","journal-title":"Clin Biomech (Bristol, Avon"},{"issue":"4","key":"2024062523513471900_i1938-162X-59-6-617-b09","doi-asserted-by":"crossref","first-page":"e11","DOI":"10.1016\/j.jse.2012.06.010","article-title":"Motor control retraining exercises for shoulder impingement: effects on function, muscle activation, and biomechanics in young adults","volume":"22","author":"Worsley","year":"2013","journal-title":"J Shoulder Elbow Surg"},{"issue":"2","key":"2024062523513471900_i1938-162X-59-6-617-b10","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.clinph.2014.05.035","article-title":"Alterations in central motor representation increase over time in individuals with rotator cuff tendinopathy","volume":"126","author":"Ngomo","year":"2015","journal-title":"Clin Neurophysiol"},{"issue":"5","key":"2024062523513471900_i1938-162X-59-6-617-b11","doi-asserted-by":"crossref","first-page":"e0268533","DOI":"10.1371\/journal.pone.0268533","article-title":"Altered corticospinal excitability of scapular muscles in individuals with shoulder impingement syndrome","volume":"17","author":"Chung","year":"2022","journal-title":"PloS One"},{"issue":"1","key":"2024062523513471900_i1938-162X-59-6-617-b12","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12891-015-0480-y","article-title":"Is neuroplasticity in the central nervous system the missing link to our understanding of chronic musculoskeletal disorders","volume":"16","author":"Pelletier","year":"2015","journal-title":"BMC Musculoskelet Disord"},{"issue":"12","key":"2024062523513471900_i1938-162X-59-6-617-b13","doi-asserted-by":"crossref","first-page":"2479","DOI":"10.1007\/s00421-017-3736-4","article-title":"The corticospinal responses of metronome-paced, but not self-paced strength training are similar to motor skill training","volume":"117","author":"Leung","year":"2017","journal-title":"Eur J Appl Physiol"},{"issue":"4","key":"2024062523513471900_i1938-162X-59-6-617-b14","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1152\/japplphysiol.01408.2004","article-title":"Motor skill training and strength training are associated with different plastic changes in the central nervous system","volume":"99","author":"Jensen","year":"2005","journal-title":"J Appl Physiol (1985"},{"issue":"11","key":"2024062523513471900_i1938-162X-59-6-617-b15","doi-asserted-by":"crossref","first-page":"2648","DOI":"10.1111\/ejn.13710","article-title":"Corticospinal responses following strength training: a systematic review and meta-analysis","volume":"46","author":"Kidgell","year":"2017","journal-title":"Eur J Neurosci"},{"issue":"5","key":"2024062523513471900_i1938-162X-59-6-617-b16","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.math.2010.05.008","article-title":"The role of motor learning and neuroplasticity in designing rehabilitation approaches for musculoskeletal pain disorders","volume":"15","author":"Boudreau","year":"2010","journal-title":"Man Ther"},{"issue":"1","key":"2024062523513471900_i1938-162X-59-6-617-b17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clinbiomech.2010.08.001","article-title":"Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both","volume":"26","author":"Seitz","year":"2011","journal-title":"Clin Biomech (Bristol, Avon"},{"issue":"8","key":"2024062523513471900_i1938-162X-59-6-617-b18","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1016\/j.clinph.2010.12.037","article-title":"Screening questionnaire before TMS: an update","volume":"122","author":"Rossi","year":"2011","journal-title":"Clin Neurophysiol"},{"issue":"6","key":"2024062523513471900_i1938-162X-59-6-617-b19","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1016\/j.jelekin.2008.11.003","article-title":"The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome","volume":"19","author":"Hsu","year":"2009","journal-title":"J Electromyogr Kinesiol"},{"issue":"3","key":"2024062523513471900_i1938-162X-59-6-617-b20","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1093\/ptj\/80.3.276","article-title":"Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement","volume":"80","author":"Ludewig","year":"2000","journal-title":"Phys Ther"},{"issue":"2","key":"2024062523513471900_i1938-162X-59-6-617-b21","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1115\/1.1351892","article-title":"Dynamic measurements of three-dimensional scapular kinematics: a validation study","volume":"123","author":"Karduna","year":"2001","journal-title":"J Biomech Eng"},{"issue":"5","key":"2024062523513471900_i1938-162X-59-6-617-b22","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1016\/j.jbiomech.2004.05.042","article-title":"ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion\u2014part II: shoulder, elbow, wrist and hand","volume":"38","author":"Wu","year":"2005","journal-title":"J Biomech"},{"issue":"12","key":"2024062523513471900_i1938-162X-59-6-617-b23","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1016\/S0021-9290(00)00141-X","article-title":"The position of the rotation center of the glenohumeral joint","volume":"33","author":"Veeger","year":"2000","journal-title":"J Biomech"},{"issue":"6","key":"2024062523513471900_i1938-162X-59-6-617-b24","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/j.clinph.2015.02.001","article-title":"Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee","volume":"126","author":"Rossini","year":"2015","journal-title":"Clin Neurophysiol"},{"issue":"12","key":"2024062523513471900_i1938-162X-59-6-617-b25","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1002\/jor.20675","article-title":"Standard maximum isometric voluntary contraction tests for normalizing shoulder muscle EMG","volume":"26","author":"Boettcher","year":"2008","journal-title":"J Orthop Res"},{"issue":"4","key":"2024062523513471900_i1938-162X-59-6-617-b26","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.jelekin.2004.09.006","article-title":"Normalization procedures using maximum voluntary isometric contractions for the serratus anterior and trapezius muscles during surface EMG analysis","volume":"15","author":"Ekstrom","year":"2005","journal-title":"J Electromyogr Kinesiol"},{"issue":"7","key":"2024062523513471900_i1938-162X-59-6-617-b27","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1097\/00005768-199807000-00023","article-title":"Monitoring training in athletes with reference to overtraining syndrome","volume":"30","author":"Foster","year":"1998","journal-title":"Med Sci Sports Exerc"},{"key":"2024062523513471900_i1938-162X-59-6-617-b28","first-page":"286","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen","year":"1988","edition":"2nd ed"},{"issue":"6","key":"2024062523513471900_i1938-162X-59-6-617-b29","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1007\/s40279-020-01258-z","article-title":"Determining the sites of neural adaptations to resistance training: a systematic review and meta-analysis","volume":"50","author":"Siddique","year":"2020","journal-title":"Sports Med"},{"issue":"3","key":"2024062523513471900_i1938-162X-59-6-617-b30","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/S1474-4422(03)00321-1","article-title":"Transcranial magnetic stimulation in neurology","volume":"2","author":"Kobayashi","year":"2003","journal-title":"Lancet Neurol"},{"issue":"4","key":"2024062523513471900_i1938-162X-59-6-617-b31","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.brs.2011.11.005","article-title":"Plasticity of motor threshold and motor-evoked potential amplitude\u2013a model of intrinsic and synaptic plasticity in human motor cortex","volume":"5","author":"Delvendahl","year":"2012","journal-title":"Brain Stimul"},{"issue":"8","key":"2024062523513471900_i1938-162X-59-6-617-b32","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1016\/j.ejpain.2010.01.001","article-title":"Driving plasticity in the motor cortex in recurrent low back pain","volume":"14","author":"Tsao","year":"2010","journal-title":"Eur J Pain"},{"key":"2024062523513471900_i1938-162X-59-6-617-b33","doi-asserted-by":"crossref","first-page":"904002","DOI":"10.3389\/fneur.2022.904002","article-title":"Sling exercise can drive cortical representation of the transversus abdominis and multifidus muscles in patients with chronic low back pain","volume":"13","author":"Li","year":"2022","journal-title":"Front Neurol"},{"issue":"8","key":"2024062523513471900_i1938-162X-59-6-617-b34","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1002\/j.1532-2149.2014.487.x","article-title":"Effect of training on corticomotor excitability in clinical neck pain","volume":"18","author":"Rittig-Rasmussen","year":"2014","journal-title":"Eur J Pain"},{"key":"2024062523513471900_i1938-162X-59-6-617-b35","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.sjpain.2016.03.005","article-title":"Influence of paravertebral muscles training on brain plasticity and postural control in chronic low back pain","volume":"12","author":"Mass\u00e9-Alarie","year":"2016","journal-title":"Scand J Pain"},{"issue":"7","key":"2024062523513471900_i1938-162X-59-6-617-b36","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1002\/ejp.841","article-title":"Altered function of intracortical networks in chronic lateral epicondylalgia","volume":"20","author":"Burns","year":"2016","journal-title":"Eur J Pain"},{"issue":"1","key":"2024062523513471900_i1938-162X-59-6-617-b37","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s00221-012-3008-9","article-title":"Corticomotor control of deep abdominal muscles in chronic low back pain and anticipatory postural adjustments","volume":"218","author":"Mass\u00e9-Alarie","year":"2012","journal-title":"Exp Brain Res"},{"issue":"9","key":"2024062523513471900_i1938-162X-59-6-617-b38","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1097\/AJP.0b013e318276a058","article-title":"Peripheral neurostimulation and specific motor training of deep abdominal muscles improve posturomotor control in chronic low back pain","volume":"29","author":"Mass\u00e9-Alarie","year":"2013","journal-title":"Clin J Pain"}],"container-title":["Journal of Athletic Training"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/meridian.allenpress.com\/jat\/article-pdf\/59\/6\/617\/3390751\/i1938-162x-59-6-617.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/meridian.allenpress.com\/jat\/article-pdf\/59\/6\/617\/3390751\/i1938-162x-59-6-617.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T19:00:22Z","timestamp":1749668422000},"score":1,"resource":{"primary":{"URL":"https:\/\/nata.kglmeridian.com\/view\/journals\/attr\/59\/6\/article-p617.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,1]]},"references-count":38,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6,26]]},"published-print":{"date-parts":[[2024,6,1]]}},"URL":"https:\/\/doi.org\/10.4085\/1062-6050-0066.23","relation":{},"ISSN":["1938-162X","1062-6050"],"issn-type":[{"value":"1938-162X","type":"electronic"},{"value":"1062-6050","type":"print"}],"subject":[],"published":{"date-parts":[[2024,6,1]]}}}