Report

Shoulder tendon adaptations in highly trained wheelchair rugby athletes with different impairments.

Acute biceps tendon adaptations occur in response to a GXT in highly trained WR athletes which may play a role in the prevalence of shoulder problems.

Lead academic:
Fransiska Bossuyt, Barry Mason, Simon Briley
Additional academics:
T O'Brien, M Boninger, U Arnet, V Goosey-Tolfrey
Funder:
Peter Harrison Foundation and the Swiss Paraplegic Research.

Introduction:

In wheelchair rugby (WR) where overhead activities are prominent, the demands placed on the shoulder and the potential risk of injury and shoulder pain are elevated. However, the extent of the demands during WR and the risk of pain and pathology in WR athletes remains unclear.

Supraspinatus and biceps tendinopathy has been associated with impingement due to a reduction in the sub-acromial space and therefore a greater occupation ratio [i.e., thickness of the tendon relative to the acromio-humeral distance (AHD)], which naturally occurs during overhead and propulsion activities.

Monitoring tendon adaptations in response to acute loading is needed to better understand the development of tendon degeneration, and ultimately to be able to intervene and prevent injuries.

Study aim:

1) To identify acute changes in biceps and supraspinatus tendon characteristics following a graded exercise test to exhaustion (GXT) in highly trained WR athletes.

2) To define differences in chronic tendon adaptations related to the impairment of the athlete and the occupation ratio.

Methods:

Twelve WR athletes with different impairments completed 3-min blocks of exercise, where speed was increased by 0.2 m/s (m.s−1) for low functioning participants or 0.3 m.s−1 for higher functioning participants. Termination of the submaximal test occurred when blood lactate concentration exceeded 4 mmol/l and/or a Rate of Perceived Exertion (RPE) of 17 was reached.

Performance Corrected Wheelchair Users Shoulder Pain Index was used to quantify shoulder pain. Quantitative Ultrasound Protocols (QUS) were used to define supraspinatus and biceps tendon thickness, echogenicity, and echogenicity ratio of both dominant and non-dominant shoulder before and after the GXT. The acromio-humeral distance (AHD) defined from ultrasound (US) images was used to calculate the occupation ratios.

Main findings:

  • There was a significant reduction in the echogenicity of the biceps following GXT whilst controlling for impairment [spinal cord injury (SCI) and non-SCI] and the occupation ratio.
  • All other tendon characteristics did not significantly change post-GXT.
  • Fluid inflow into the tendon may be related to overload and acute inflammation.
  • Persons with a SCI had a thicker supraspinatus tendon in comparison to persons with non-SCI which may be related to chronic tendon adaptations.
  • Biceps and supraspinatus tendon thickness were positively associated with the occupation ratio.
  • A greater occupation ratio was associated with signs of tendinopathy.
  • No relationships between tendon characteristics and shoulder pain were observed pre-exercise. Post-exercise revealed that decreased echogenicity of the supraspinatus tendon was correlated with increased pain.

Reference:

Bossuyt FM, Mason BS, Briley S, O'Brien TJ, Boninger ML, Arnet U, Goosey-Tolfrey VL. Shoulder Tendon Adaptations Following a Graded Exercise Test to Exhaustion in Highly Trained Wheelchair Rugby Athletes With Different Impairments. Front Rehabil Sci. 2022 Jan 18;2:755466. DOI: 10.3389/fresc.2021.755466. PMID: 36188798; PMCID: PMC9397820.