肩関節周囲筋弛緩のための重りつき振子運動

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veYde;lle]Eeg

19

_gee

6

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'-538

fi

(1992

tl!)

m

LoadedPendular

An

Exercise

for

Shoulder

Muscle

Electromyographic

Finding*Relaxat.Ion:

Shimpachiro･OGIWARAi),

and

KatsuhikoTsutomu

NAGATA2),

TACHINoi)

Abstract

Patients

with stiff and

_painful

shoulder condition are usually

instructed

to

carry out

Codman's

pendutar

exercise while

grasping

a

dumbbell

or

iron,

hence

it

is

known

as

the

`iron

exercisel

It

is

hypothesised

that

the

weight of such a

load

stretches the contracted soft tissues of the shoulder

joint,

together

with voluntary relaxation of

its

muscles.

The

_question

arose:

By

_grasping

a

load,

would not contraction of

the

forearm

and

hand

muscles

facilitate

contraction of

the

shoulder muscles, negating

the

purpose?

A

comparison was made of

the

integrated

electromyographic

(IEMG)

activities of

the

right

deltoid

and

infraspinatus

muscles when

_performing

_pendular

exercise with a

2-kilogramme

weighted

band

at

the

wrist

(WB

pattern)

and

the

same exercise

grasping

a

2-kilogramme

dumbbell

(DG

_pattern).

IEMG

activity of

these

muscles was a}so compared according

to

the

_plane

of

pendular

movement,

The

subjects were

15

healthy

male student

_{physiotherapists}

acting as

their

own control.

Significantly

_greater

IEMG

activity was obtained

for

all

the

muscles

in

the

DG

than

in

the

WB

pattern.

As

for

the

plane

of movement, sagittal

plane

$winging caused

least

IEMG

activity

in

the

middle

deltoid,

while

transverse

_plane

swinging and clockwise circumduction caused

least

in

the

anterior

deltoid.

The

_greatest

IEMG

actjvity recorded

for

all

the

movements was

in

the

infraspinatus

muscle.

The

results of

this

inve$tigation

suggest

that

wearing a weighted

band

and

limiting

_pendular

movement

to

sagittal and

transverse

plane

swinging, eliminating circumduction, may

_promote

less

contractile activity

in

the shoulder muscles when

_performing

_pendular

exercise.

Key

words

I'endular

exercise,

Shoulder

muscles,

Integratecl

electromyography

Pendular

exercise

has

traditionally

been

used

for

shoulder rnobilisation since

E,A.

Codman

first

described

it

in

1934i)

and

it

is

intended

to

be

a

purely

passive

treatment

of

the

shoulder2)3}.

R.W.

Sperry

modified

the

*

1)2)

ntcaenJfimamastawaoitthogDo3it-iffb:maig[*]##ts

thn

,

Division of Physical Therapy, School of Health Sciences,

The

University

of

Kanazawa

Department of Medical Rehabilitation

Services,

Matto

Ishikawa

Central

Hospital

(Received/

October

14,

l9911Accepted:

April

24,]992)

stooped

_posture

in

his

experiment

by

inclining

the

upper

body

and resting one

hand

on

the

edge of

the

table

(Fig.

1>4).

Since

then,

this

position

has

commonly

been

adopted

by

the

physiotherapist

administering

Codman's

pen-dular

exercise

in

the

clinic,

In

general,

this

position

is

rnuch easier

to

maintain

than

the

classical

Codman

position

in

which

the

feet

are

placed

together,

and

the

trunk

is

strongly

fiexed

at

the

hips

with

both

arms

hanging

shoul-532

_ve\rsza\ag

19

_tsee6

E-r.,

' a Sperry

Fig.

1.

""

,-lt"

hwith

a weighted wrist band

(f

1{

tt

position

a with a

durnbbe11

Sperry

_position

(modified

from

Hellebrandt,

et al6)) and

type

of

loading

during

the

experiment.

der

_joint

is

moved

_passively

through

the

sagit-tal

and

tran$verse

planes

and circumduction

arc

by

the

forces

of

gravity

and

through

the

momentum created

by

the

body

swaying.

There

is

a similar exercise

to

this

in

_prone

lying

recomrnended

by

Chandleri},

but

it

is

rarely

used

because

of

its

inherent

impracticality.

Pendular

exercise

is

used

for

_patients

with any stiff and

_painful

shoulder condition, such

as

frozen

shoulder syndrome.

Such

_patients

Codman

posttion

Fig.

2.

Codman

po$ition

(frorn

Hellebrandt,

etal6)),

are

instructed

to

carry out

this

exercise

by

grasping

a

O.5-

to

3-kilogramme

(kg)

sandbag

or

dumbbelL

In

addition,

they

are often

recom-mended

to

grasp

an

iron

when

practising

this

exercise at

home,

hence,

in

Japan,

it

is

known

as

the

`iron

exercise'.

The

_purpose

of

loading

the

upper

limb

is

to

add

traction

to

the

depend-ent arm and mornenturn

to

the

_pendular

cycle,

thereby

supposedly

inducing

voluntary

relaxa-tion

of

the

shoulder muscles.

Taketomi

and associate5)

found

that

the

del-toid

and

latissimus

dorsi

muscles of one

healthy

individual

_produced

almost no electri-cal activity

during

forward/backward

swing-ing

of

the

arm

in

a stooped

_position

compared

to

those

of a

_patient

with

frozen

shoulder

syn-drome,

It

is,

however,

unclear whether

the

pendular

exercise was carried out

_grasping

a

1

to

2

kg

dumbbell

or with a wrist

band

of

the

same weight.

In

addition,

the

number of

sub-jects

was rather small

in

that

experiment.

Hellebrandt

and associates6) compared

in

detail

electromyographic activity of

the

shoul-der

muscles

during

_penduJar

exercise

in

the

NII-Electronic Library Service

Loaded

Pendular

Exercise

fer

Shoulder

Muscle

Relaxation

three

experimental conditions:

they

were

1)

no

loading

of

the

upper

limb

at

its

distal

end;

2)

grasping

a

five-pound

or

two-and-a-quarter-kg

dumbbell;

and

3)

carrying an equivalent

weight suspended

from

a wrist cuff.

They

found

that

the

latter

elicited

least

elec-tromyographic

activity.

However,

_pendular

movement was actively

initiated

in

all

the

groups.

Although

the

difference

in

the

contrac-tile

activities of

the

shoulder muscles was clearly

demonstrated

on

the

electromyogram$,

its

statistical significance was never computed.

Thus,

the

purpose

of our

investigation

was

to

compare and statistically analyse

the

state of shoulder muscle relaxation via

elec-tromyographic

activities when

_grasping

a

dumbbell

or when wearing a weighted wrist

band

during

passive

pendular

movement

cre-ated

by

the

body

swaying.

Method

Electromyographic

instrumentation

Integrated

electromyographic

(IEMG)

ac-tivitjes

were measured

by

using a

type

1205D

electromyogram and a

type

1310

integrator

(NEC

San-ei

Instruments,

Ltd,

12-1,

Okubo

1,

533

Shinjuku,

Tokyo

160),

of which

the

latter

had

the

advantage of

_quantifying

the

overall mus-cular activity which was an aggregation of action

_potentials.

These

IEMG

amplitudes

in-dicated

a

linear

correlation

to

the

muscle

ten-sion

_{generated7)8)9)･}

The

following

muscles were selected

for

IEMG

measurement:

the

anterior, middle and

posterior

fibres

of

_the

right

deltoid

and

the

right

infraspinatus

muscles

(Fig.

3)iO].

We

ex-cluded

the

rotator cuff muscles which would

have

necessitated

further

use of needle

elec-trodes.

A

pair

of one-centimetre

(cm)

in

diame-ter

surface electrodes

in

a

bipolar

lead

system was applied over

the

belly

of

these

muscles.

They

were

_placed

_parallel

to

the

muscle

fibres,

three

cms apart

from

each

other, and secured

to

the

skin

by

a

_piece

of

tape.

The

reference electrode was applied over

the

biceps

brachii.

The

electrode

_placement

was

_preceded

by

abra-sion

of

the

skin surface with an alcohol swab

to

reducc

its

impcdance.

The

speed of

_the

record-ing

paper

was set at

one

cm

per

second and

meaurements were

taken

for

five

seconds,

In

this

way,

five

consecutive

1-second

integrals

of electrical activity were obtained.

:t

posterior

(31ilsf

ettoi,

Fig.

3.Electrode

placement

for

the muscles

(from

BasmajianLO}).

infraspinatus

Giii

ft

534

va\esza#

Subjects

and

testing

procedures

The

subjects of

this

study were

fifteen

healthy

male student

_{physiotherapists}

with no noticeable

defects

in

musculoskeletal

function.

The

mean

age

of

the

subjects was

23.1,

ranging

'from

₁₉

_to

₃₀

years

old.

The

subject

was

instructed

regarding

the

nature

_of

the

method and

instrumentation

of

the

experiment and

given

several

trials

to

become

familiar

with

the

patterns

of

the

pen-dular

movement.

During

the

experiment,

he

was asked

to

stoop

80

to

90

degrees

and

to

rest

his

left

hand

on

the

table

with elbow extended, and

to

let

his

right arm

hang

downwards

in

a relaxed

_position

(Fig.

Ia),

The

subject swung

his

right arm

in

three

motions:

forwards/

backwards,

sideways and

in

clockwise

circum-duction.

A

circle on

the

fioor

50

cms

in

diame-ter

served as a

guide

for

the

rnovement with a circumference as wide as

the

_practised

subject could make

it,

In

addition, we

placed

two

50-cm cross markers

inside

the

circle and

the

sub-ject

was asked

to

swing

his

arm within

the

diameter

of

the

circle

and

in

Iine

with

the

cross

markers

(Fig.

Ia).

The

subject carried

out

the

sequence of movement while wearing a

2-kg

weighted

band

at

the

wrist

(Fig,

lb),

which was

te'

19

ts

ag

6

termed

as

the

wrist-band-wearing

(WB)

_pattern

and

then

the

same movement

_grasping

a

2-kg

dumbbell

in

his

right

hand

(Fig.

Ic),

which was

termed

as

the

dumbbell-grasping

(DG)

pattern,

Each

subject

acted as

his

own

control and

the

sequence of

the

two

_patterns

was randomised.

Data

analysis

The

difference

in

the

average

IEMG

tude

between

the

WB

and

DG

patterns

was

analysed

by

the

Student's

t-test.

This

test

was

also employed

to

compute

the

average

IEMG

amplitude

for

the

_planes

of

_pendular

ment.

The

Ievel

of significance was set at

O.05.

The

null

hypothesis

was

that

there

would

be

no

difference

in

the

electrical activity of

the

muscles

in

either

the

WB

and

DG

_patterns,

nor

for

the

planes

Qf

_pendular

movement.

Results

A

typical

recording of electrical activity

for

the

posterior

deltoid

muscle

is

demonstrated

in

Fig,

4

which shows at

the

top

the

_pattern

of

the

electromyogram and on

the

bottom

the

_pattern

of

the

IEMG;

the

left

half

is

the

_pattern

duced

by

pendular

movement with

the

weight-ed

band

and

the

right

half

the

_pattern

with

the

dumbbelL

As

is

obviously apparent,

the

weighted

band

dumbbell

Fig.

4.

290"V

1

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NII-Electronic Library Service

Loaded

Pendular

Exercise

for

Shoulder

Muscle

Relaxation

535

800 rN Toe o as ua

-

600> q sooL. as

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4oo'tE 3ooko ]eo o

anterior middle pestertor

deltoid

deltoid

deltoid

$pinatus

Fig,5.

Electromyographic

activity and standard

deviations

(line

above

the

btocks)

during

the

WB

and

DG

_patterns.

electrical activity was

_greater

in

the

DG

pat-tern

than

in

the

WB

pattern.

Figure

5

created

from

values

in

Table

1

shows electrical acitivity of

the

shoulder

Table1.

Mean

(SD)

DG

patterns

muscles

tested

according

to

the

type

of

load-ing.

As

is

seen

in

_the

bar

_graph,

_IEMG

activity of

the

shoulder

muscles was signi

ficantly

great-er

in

the

DG

_pattern

than

in

thc

WB

pattern,

In

both

_patterns,

however,

the

infraspinatus

showed

_the

_greatest

amplitude.

Electrical

ac-tivity

was not evident

in

some subjects'

mus-cles,

which

resulted

in

larger

standard

devia-tions

than

expected.

In

Fig.

6

created

from

values

in

Table

2

the

IEMG

("V'sec)

bar

_graph

shows

the

amount of

IEMG

ampli-tude

produced

in

the

four

separate muscles according

to

the

direction

of

pendular

move-ment.

The

bar

on

the

left

is

the

amount

pro-duced

by

sagittal swinging,

the

centre

bar

by

transverse

_plane

swinging and

the

bar

on

the

right

by

circumduction, respectively.

As

is

seen,

the

IEMG

amplitude

for

the

anterior

del-toid

was

significantly

greater

for

circum-amplitude

in

the

WB

and

Muscles

WB

PaLternDG

PatLernp

anterlor

DELTOID

rniddle

posLe-or

INFRASPINATUS

123.6

±

115.8

140.7

±

134.8

173.8

±

160.8

275,6

±

322.4

206,7

±

242,9

<.Ol

204.4

±

194.1

<.05

224.4

±

205.7

<,Ol

352.4

±

4e3,7

<.Ol

Table

2.Mean

(SD)

IEMG

arnplitude

for

the

_plane

of movement

(pV

' _scc)

Plane

of

MovementantemorDELTOID

rniddle

posterior

INFRASPINATUS

SagiLtal

Transverse

Circumduction

168.e

±

193,3

117.3

±

89.5

210.0

±

253,2

87.0

±

103.0

162.7

±

125.5

265.3

±

209.0

160.e

±

168.8

190.7

±

156.5

246.7

±

217.5

329.3

±

402.8

284.0

±

31e,7

328.7

±

380.4

Table

3.Student's

t-test

for

the

plane of movement

Plane

of

Movernent

DELrliOID

anterior middlepostrlorINFRA-

SPINATUS

Sagittal

vs.

Transverse

Sagittal

vs.

Circumduction

Transverse

vs,

Cireumduction

NSNS<.05

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Fig.

6.

anterior middle posterior

infFaspinatus

deltoid

deltoid

deltoid

Electromyographic

activity and standard

deviations

{line

above

the

blocks)

fOr

the

_plane

of

_pendular

move-ment.

duction

than

in

transverse

plane

swinging,

but

there

was no statistically significant

difference

among

the

_planes

of movement

(Table

3).

For

the

middle

deltoid

the

greatest

IEMG

ampli-tude

was

in

circumduction,

followed

by

that

of

transverse

_plane

swinging and

the

smallest

amplitude was

in

sagittal

plane

swinging, allof which were statistically significant

(Table

3).

For

the

posterior

deltoid

the

IEMG

amplitude was significantly

_greater

for

circumduction

than

in

transverse

and sagittal

_plane

swinging,

but

there

was no statistically significant

differ-ence

between

that

of sagittal and

transverse

plane

swinging

(Table

3),

Finally,

for

the

in-fraspinatus

there

was no statistically

sig-nificant

difference

among

the

planes

of move-ment

(Table

3).

Discussion

Despite

prior

practice

to

the

experiment, complete relaxation of

the

shoulder muscles was not achieved.

The

majerity of subjects

in

the

WB

and

DG

_patterns

demonstrated

electri-cal activity which was

in

agreement

with

HellebrandVs

report.

This

may

have

been

due

to

the

following

reasons;

1)

the

2-kg

weight

was

too

heavy

a

load

for

the

_glenohumeral

articulation, causing

protective

contraction of

the

shoulder muscles;

2)

in

spite of

the

instruc-tion

of

initiating

passive

pendular

movement

by

body

swaying,

the

subject

unintentionally

initiated

active contraction of

the

shoulder muscles;

3)

the

contraction of

the

forearm

and

hand

muscles

by

_grasping

the

dumbbell

caused overflow of nerve

impulses

into

the

shoulder muscles, resulting

in

increased

tone

_of

_these

while swinging

the

arm; and

4)

increased

psy-chological

tension

on

the

subjects'

part

possi-bly

caused co-contraction of

the

shoulder muscles,

However,

the

amount of electrical activity elicited was significantly

less

in

the

WB

_pattern

than

in

the

DG

_pattern.

Thus,

relaxation ef

the

shoulder muscles may

be

best

achieved

by

_pendular

exercise

with a

_passive

initiation

of movement, and

by

wearing a wrist

band

of a suitable weight,

preferably

around

2

kgs,

because

it

was

found

to

be

the

most

fa-voured

Ioad

our subjects chose

before

the

'perlment.

Uyedaii)

reported

that

zero

loading

and

load-ing

with a

1-,

2-,

or

3-kg

sandbag attached

to

NII-Electronic Library Service

Loaded

PenduLar

Exercise

for

Shoulder

Muscle

Relaxation

individuals

without swinging

the

arm elicited

no clectrical activity of

the

shoulder muscles,

In

contrast,

dynamic

loading

in

our experiment clearly

demonstratedelectrical

activity,

There-fore,

it

may

be

suggested

that,

in

order

to

relax

the

shoulder muscles, static

loading

alone

in

a stooped

_position

may

have

an advantage over

Codman's

_pendular

exercise, especially

for

pa-tients

with

frozen

shoulder syndrome

in

the

acute

_and

subacute stages when

_pain

and

pro-tective

spasm of

the

shoulder muscles are

the

main symptoms12}i3)i4).

The

plane

of

_pendular

movement seems

to

cause a variance

in

electrical

activity of

_these

muscles.

The

least

electrical activity

demon-strated was

in

sagittal and

transverse

plane

swinging.

In

other words,

the

easiest move-ments

to

_produce

with

body

swaying appear

to

be

along

these

two

_planes.

In

contrast,

the

most

dithcult

movement

for

the

body

to

per-form

seems

to

be

the

circular movement of

the

arm.

In

conclusion,

_pendular

exercise should

be

carried out

by;

1)

loading

the

arm

distally

with a weighted wrist

band;

and

2)

swinging

the

arm only

in

the

sagittal and

transverse

_planes,

This

conclusion,

however,

cannot

be

applied uniformly

because,

in

this

study,

the

results

demonstrated

large

standard

deviation.

Fur-thermore,

our study was somewhat

limited

be-cause we used

_young

healthy

volunteer

sub-jects

for

the

experiment.

Our

findings,

there-537

fore,

may

not

be

extrapolated

directly

to

pa-tients.

Further

research will

be

required

to

find

out

the

amount of

IEMG

actjvity

in

the

shoul-der

muscles

during

pendular

exercise without

loading

the

arm,

References

1)

Codman

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538

理

学 療法学　 第 19

巻 第

6

号

〈

要

　 旨〉

肩 関 節 周 囲 筋 弛 緩の た めの重 りつ き振 子 運 動 ：

_筋

_{電 図}

_学

_{的 所 見} 荻 原 新 八 郎’ 長 田

　

勉” ± 立 野 勝 彦＊ ＊ 金

沢大 学

医 療 技 術 短 期 大 学 部 理

学療法学 科

＊

＊

公 立松 任 石 川 中央 病 院リハ ビ リテ

ー

ショ ン部

　

肩 関 節

周 囲炎

患

者

に は たい て い鉄 亜 鈴 また はア イロ ンを持た せ

，

アイロ ン休

操

と

称

して コ ドマ ンの振 子運 動を

行

わ せて いる。 そ の理

論

は， 重り が肩 関 節の軟 部 組 織 を伸

張

し， そ の

周

囲

筋

の弛 緩 を 助 長さ せ る と

考

え ら れて い る。 しか

し

重り を

手

で握る ことに よ る手

部

・

前腕

の筋 群の収 縮が

肩関節 周

_囲

筋

_の収 縮を生じさ せ_， それが

_振

_{予 運 動}の _{目的 を 損}なうので はなか ろ う か？ 右 手 首に

2kg

の重 錘バ _{ン ドを巻か} せ る か

，

あるいは

同

じ重さの

鉄

亜

鈴

を持たせ

，

振 子 運 動

時

の三角 筋お よ び棘 ド筋の

_{積分 筋}

_{電 図}を比 較 し た。 ま た

振

子 連

動

の方 向 別

，

すなわ ち前 後

，

左

右

，

お よ び

時 計

回 り分 回 し運 動によ る比

較

も

検

討 した

。

被験

者

は

15

名の 理学 療 法 学 科の

_{男 子学}

生で，

被験 者

自身 も対 照 群 とし た。 その

結

果

，

積 分 値はすべての

筋

に お いて重 錘バ _{ン ドを 巻い て振}

子

運

動

を

行

うより も

鉄

亜 鈴 を持っ て

行

う

方

が有 意に大 きかっ た_。

振

子 運動の方 向 別にっ い て は，

前後方 向

の

動

きの場 合に は三 角 筋

中部線 維

の

積

分 値が有 意に小さ く

，

左 右

方

向と時 計 回 り分 回し運

動

の

_場合

に は 三角 筋 前 部 線 維の そ れ が

有

意に小さ かっ た_。

棘下 筋

の

積

分 値はすべ ての

_{方 向}

の

動

き に おい て有 意に大 きかっ た_。 こ の

実験

の

結

果

，

重 錘バ ン ド

・

鉄 亜

鈴

を用いた振 子 運 動と もに肩 関

節

周 囲 筋の収 縮は生 じ た が，

前者

の

場

合

，

その程 度 が 小さい こと が

判

っ た。 し たがっ て重 錘バ ン ドを用い る方 が 口的 を達 するの に適 して い る の で はなか ろ う か。 ま た振 ア運 動は

前後

左

右

の動 きのみ 行 わせ

，

分

回

し運

動

は

避

け る方が よい であろう。

−

L

肢

の

末端部

に重 りをっ けない振 子 運

動 時

の積 分 筋 電 図 も以 上の

結果

と比

較

・

検討

して み る必 要が あ る

。