A case report of shoulder fatigue imbalance in wheelchair rugby: implications to pain and injury

Abstract

The purpose of this case-control study was to examine potential agonist-antagonist fatigue imbalance during wheelchair rugby activity. A 16-channel NORAXON electromyography (EMG) system 1400A with telemetry was used to assess EMG activity in a 39-year-old male with a C6 complete spinal cord injury (American Spinal Injury Association Impairment Scale (AIS) A), 17.5 years post injury. Mean amplitude and median frequency were determined for push-phase agonists (anterior deltoid and pectoralis major) and antagonist (posterior deltoid) across four training sessions at a community fitness and Paralympic training facility. Unlike continuous wheelchair pushing, acute muscle imbalances between agonists and antagonists (that is, push and recovery muscles) were not demonstrated. Wheelchair sports such as rugby may reduce risk of shoulder pain and overuse injury due to intermittent activity rather than continuous pushing. The current study is one of the first to document sport fatigue through electromyography during intermittent, live play rather than clinical conditions (that is, continuous pushing). 1 Electromyography (EMG) analysis has been used in wheelchair sport to identify sport-specific prime movers and onset of fatigue in attempts to build effective training and rehabilitation methods for participants. Spinal Cord Series and Cases2 To date, most EMG studies have examined sport participants in a clinical setting, assessing continuous, cyclical exercise that is atypical of many wheelchair sports. Although these data have helped to identify prime movers during the push and recovery phases of forward wheelchair motion, they are limited in the ability to examine fatigue and its associated ramifications under actual training and gameplay conditions (for example, start/stop, braking and so on).Fortunately, EMG technology and analyses have been extended to non-laboratory settings, allowing the assessment of wheelchair sport mechanics during actual therapeutic exercise and training.

Wearable Sensors in Sports for Persons with Disability: A Systematic Review

“…As regards quality assessment results, 28 papers had a quality score between 0.81 and 1 [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ], 10 papers were between 0.61 and 0.8 [ 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ] and only one paper was below 0.6 [ 74 ]. Overall, the checklist items that reported the lower levels of scoring (e.g., partial or no score) were those concerning (a) the adequacy of sample size (16 papers), (b) the description/appropriateness of the strategy of subject/comparison group selection (10 papers).…”

“…A large variety of sports were investigated, including team sports, cyclic sports and other sports ( Table 2 ). The most common were wheelchair sports, with studies on wheelchair basketball [ 41 , 42 , 49 , 64 , 71 , 73 ], rugby [ 36 , 43 , 44 , 45 , 51 , 66 ], racing [ 40 , 47 , 53 , 54 , 67 ], tennis [ 50 , 63 ] and curling [ 48 ] covering almost 50% of the analyzed papers. The other half included cyclic sports (running [ 60 , 61 , 62 , 72 ], handcycling [ 57 , 58 , 59 , 70 ], swimming [ 37 , 38 , 39 ], cycling [ 52 , 65 ], rowing [ 46 ]) and other sports (weightlifting [ 69 ], boccia [ 55 ], cross-country sit-skiing [ 56 , 68 ] and downhill skiing [ 74 ]).…”

“…The experimental setting was in the laboratory in 13 studies [ 40 , 46 , 47 , 52 , 53 , 54 , 55 , 57 , 58 , 59 , 68 , 70 , 71 ], while in 23 studies testing was performed in the field [ 36 , 37 , 38 , 39 , 41 , 42 , 43 , 44 , 45 , 49 , 50 , 51 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 69 , 72 , 73 , 74 ]. Both laboratory and in-field setting were observed in one study comparing cross-country sit-skiing performance in the laboratory and in a skiing tunnel [ 56 ], whereas information about the setting was not clearly retrievable from two studies [ 48 , 67 ].…”

“…Sample size was lower than 10 participants in 31% of the included papers, with seven of them being case-studies [ 40 , 45 , 48 , 51 , 68 , 70 , 74 ], 51% involved 11 to 20 participants and 18% had a sample size greater than 20 participants. Only one study had a sample size greater than 30 (52 participants) [ 36 ].…”

“…Injury prevention was dealt with in three studies using different types of sensors directly in-field [ 51 , 72 , 73 ]. In their case-study, Barfield et al [ 51 ] used an EMG device to measure shoulder muscles activity from an elite wheelchair rugby player during actual training sessions, with the intent of quantifying agonist-antagonist imbalances that could increase the risk of shoulder pain and injury. The results indicated that fatigue was equally present in both agonist and antagonist muscles related to wheelchair pushing, across and within training sessions.…”