Annelies Maenhout: Applied Practice Through a Research Journey

In this episode of the Athletic Shoulder Podcast, Ben Ashworth is joined by Annelies Maenhout, a visiting professor at Ghent University’s Department of Rehabilitation Sciences and a leading researcher in shoulder rehabilitation. As a core member of the university’s Upper Limb Research Team, Annelies has contributed significantly to the field through her work on EMG, motor learning, and kinetic chain mechanics.

Her research bridges cutting-edge science with clinical practice, offering insights into how shoulder rehab can be refined through eccentric loading, implicit motor learning, and neuromechanics. With a forward-thinking approach, she explores how VR, brain activity, and reaction time play a role in optimizing rehab for overhead athletes.

Topics Discussed:

• EMG research on kinetic chain and plyometric exercises

• How her view on GIRD (glenohumeral internal rotation deficit) evolved over time

• Key findings from eccentric training research

• Transitioning from internal to external attentional focus in rehab

• Applying implicit motor learning in shoulder rehabilitation

• The current gap in research on reaction time in overhead athletes

• Exploring the potential of VR and neuroscience in shoulder rehab

• Future directions in shoulder research: muscle synergies and brain activity

Key Points:

• Electromyography (EMG) studies have shown that the positioning of the lower limbs during upper body exercises can significantly impact the activation of scapular stabilizing muscles. For example, performing a push-up plus with the contralateral leg extended can increase serratus anterior activity, while posterior chain extension can enhance lower and middle trapezius activation. This knowledge allows physiotherapists to manipulate kinetic chain involvement to target specific muscle groups more effectively during early-stage shoulder rehabilitation, providing a nuanced approach to exercise selection and progression that aligns with the demands of professional sport.

• The use of surface EMG biofeedback in shoulder rehabilitation has evolved, moving away from instructing patients to consciously recruit specific muscles. Instead, current best practice emphasizes functional, dynamic exercises that challenge the scapula without explicit muscle activation cues. This approach is supported by evidence suggesting that an external focus of attention, rather than an internal focus on muscle recruitment, promotes more natural and efficient movement patterns. This shift aligns rehabilitation with how athletes move in sport, optimizing both neuromuscular control and overall shoulder function.

• Incorporating plyometric and high-velocity exercises into shoulder rehabilitation programs has been shown to elicit greater activation of key scapular stabilizers, such as the serratus anterior, compared to traditional isolated strengthening exercises. These dynamic exercises, especially when performed at higher shoulder elevations, create higher neuromuscular demand and co-contraction, which more closely mimic the functional requirements of athletic performance. This approach not only improves shoulder stability but also prepares athletes for the high-speed, high-load movements encountered in professional sport.

• The traditional management of glenohumeral internal rotation deficit (GIRD) has focused on identifying a 20-degree side-to-side difference and prescribing static passive stretches like the sleeper stretch. However, recent research suggests that not all athletes with measured deficits require intervention. The decision to address internal rotation should be based on clinical relevance, considering the athlete’s symptoms and the specific demands of their sport. This more individualized approach prevents unnecessary interventions and ensures that treatment is both targeted and effective.

• There is a paradigm shift away from passive stretching to address internal rotation deficits, with a growing preference for high-load, end-range strengthening exercises. These exercises are more functional and sport-specific, addressing the underlying causes of stiffness by improving strength throughout the range of motion. Evidence indicates that this method not only restores mobility but also enhances functional capacity, particularly in athletes exposed to repetitive high loads, such as those in overhead sports.

• The decision to intervene on internal rotation deficits should be highly individualized, taking into account the athlete’s sport, the required symmetry for performance, and the relationship between the deficit and symptoms. For example, it is common for unilateral overhead athletes to have more stiffness on their dominant side without it being pathological, whereas sports like swimming may require more symmetrical shoulder profiles. This nuanced clinical reasoning ensures that interventions are relevant and tailored to the athlete’s specific needs.

• Clinical reasoning is crucial in determining the necessity and type of mobility intervention for shoulder deficits. Physiotherapists should assess whether the internal rotation deficit is directly contributing to pain or dysfunction before prescribing any intervention. In cases where a deficit is not clearly linked to symptoms or performance limitations, unnecessary stretching or strengthening should be avoided. This approach ensures that interventions are both evidence-based and athlete-centered, optimizing outcomes in professional sport settings.

• The use of test-retest methodology is highlighted as essential in effective shoulder rehabilitation. By immediately reassessing pain or range of motion following an intervention, such as an eccentric internal rotation exercise, clinicians can quickly determine the efficacy of the exercise. This rapid feedback loop supports agile clinical decision-making, ensuring that prescribed exercises are both effective and relevant to the athlete’s current presentation, and allows for timely modifications to the rehabilitation program as needed.

• Promoting athlete self-management is a key strategy in shoulder rehabilitation, especially in professional sport environments with large squads and limited clinician time. Educating athletes to monitor their own range of motion and symptoms, and empowering them to perform corrective exercises independently, not only reduces the burden on clinicians but also encourages long-term adherence to maintenance programs. This autonomy is crucial for sustaining shoulder health and performance throughout the season.

• The overarching goal in shoulder health and rehabilitation is to equip athletes with the knowledge and skills to self-manage their symptoms and maintain optimal function beyond the clinical setting. This patient-centered approach is particularly valuable in professional sport, where athletes must rapidly adapt and take responsibility for their own recovery and performance. By fostering this understanding and autonomy, physiotherapists can ensure sustained shoulder health and resilience in high-performance environments.

Where you can find Annelies:

• LinkedIn
• ResearchGate

Sponsors

VALD Performance, makers of the Nordbord, Forceframe, ForeDecks and HumanTrak. VALD Performance systems are built with the high-performance practitioner in mind, translating traditionally lab-based technologies into engaging, quick, easy-to-use tools for daily testing, monitoring and training

Hytro: The world’s leading Blood Flow Restriction (BFR) wearable, designed to accelerate recovery and maximise athletic potential using Hytro BFR for Professional Sport.