Rehabilitation of Scapular Muscle Balance

2007 ◽  
Vol 35 (10) ◽  
pp. 1744-1751 ◽  
Author(s):  
Ann M. Cools ◽  
Vincent Dewitte ◽  
Frederick Lanszweert ◽  
Dries Notebaert ◽  
Arne Roets ◽  
...  
Keyword(s):  
External Rotation ◽  
Trapezius Muscle ◽  
Electromyographic Activity ◽  
Shoulder Injury ◽  
Serratus Anterior ◽  
Upper Trapezius ◽  
Strengthening Exercises ◽  
Muscle Balance ◽  
Lower Trapezius ◽  
Balance Rehabilitation

Background Strengthening exercises for the scapular muscles are used in the treatment of scapulothoracic dysfunction related to shoulder injury. In view of the intermuscular and intramuscular imbalances often established in these patients, exercises promoting lower trapezius (LT), middle trapezius (MT), and serratus anterior (SA) activation with minimal activity in the upper trapezius (UT) are recommended. Hypothesis Of 12 commonly used trapezius strengthening exercises, a selection can be performed for muscle balance rehabilitation, based on a low UT/LT, UT/MT, or UT/SA muscle ratio. Study Design Controlled laboratory study. Methods Electromyographic activity of the 3 trapezius parts and the SA was measured in 45 healthy subjects performing 12 commonly described scapular exercises, using surface electromyography. Results For each intramuscular trapezius ratio (UT/LT, UT/MT), 3 exercises were selected for restoration of muscle balance. The exercises side-lying external rotation, side-lying forward flexion, prone horizontal abduction with external rotation, and prone extension were found to be the most appropriate for intramuscular trapezius muscle balance rehabilitation. For the UT/SA ratio, none of the exercises met the criteria for optimal intermuscular balance restoration. Conclusion In cases of trapezius muscle imbalance, some exercises are preferable over others because of their low UT/LT and UT/MT ratios. Clinical Relevance In the selection of rehabilitation exercises, the clinician should have a preference for exercises with high activation of the LT and MT and low activity of the UT.

scholarly journals Shoulder Muscle Activity in Sport Climbing in Naturally Chosen and Corrected Shoulder Positions

2017 ◽  
Vol 10 (1) ◽  
pp. 107-113
Author(s):  
Jiří Baláš ◽  
Alena Duchačová ◽  
David Giles ◽  
Kateřina Kotalíková ◽  
David Pánek ◽  
...  
Keyword(s):  
Muscle Activity ◽  
External Rotation ◽  
Voluntary Contraction ◽  
The Other ◽  
Electromyographic Activity ◽  
Serratus Anterior ◽  
Upper Trapezius ◽  
Shoulder Muscle ◽  
Sport Climbing ◽  
Lower Trapezius

Objective:The aim of the study was to determine electromyographic activity of the scapula stabilizing muscles in naturally chosen and corrected shoulder positions in typical static climbing postures.Methods:Six male participants undertook surface electromyography measurement in four climbing postures for two different shoulder positions. The activity of the lower, middle and upper trapezius, serratus anterior, pectoralis major, and sternocleidomastoid was recorded. Electromyographic activity was expressed as the percentage of maximal voluntary contraction (MVC) for each muscle.Results:Climbing postures induced higher activation of middle and lower trapezius in corrected shoulder positions (35.3 ± 11.8 and 61.7 ± 15.4% MVC respectively) than in naturally chosen shoulder positions (18.4 ± 8.9 and 30.1 ± 13.8% MVC respectively). The highest activity of the middle and lower trapezius was found in postures with the arm in external rotation and 90° abduction and in an overhanging posture. Low activation was stated for the other muscles in both shoulder conditions.Conclusion:Results showed that climbers naturally elevate the shoulder during typical static postures. Corrected shoulder positions induce higher activation of the scapula stabilizing muscles than naturally chosen shoulder positions.

scholarly journals Alterations in Shoulder Kinematics and Associated Muscle Activity in People With Symptoms of Shoulder Impingement

2000 ◽  
Vol 80 (3) ◽  
pp. 276-291 ◽  
Author(s):  
Paula M Ludewig ◽  
Thomas M Cook
Keyword(s):  
Occupational Exposure ◽  
Muscle Activity ◽  
Load Condition ◽  
Trapezius Muscle ◽  
Electromyographic Activity ◽  
Serratus Anterior Muscle ◽  
Serratus Anterior ◽  
Shoulder Impingement ◽  
Upper Trapezius ◽  
Load Conditions

AbstractBackground and Purpose. Treatment of patients with impingement symptoms commonly includes exercises intended to restore “normal” movement patterns. Evidence that indicates the existence of abnormal patterns in people with shoulder pain is limited. The purpose of this investigation was to analyze glenohumeral and scapulothoracic kinematics and associated scapulothoracic muscle activity in a group of subjects with symptoms of shoulder impingement relative to a group of subjects without symptoms of shoulder impingement matched for occupational exposure to overhead work. Subjects. Fifty-two subjects were recruited from a population of construction workers with routine exposure to overhead work. Methods. Surface electromyographic data were collected from the upper and lower parts of the trapezius muscle and from the serratus anterior muscle. Electromagnetic sensors simultaneously tracked 3-dimensional motion of the trunk, scapula, and humerus during humeral elevation in the scapular plane in 3 hand-held load conditions: (1) no load, (2) 2.3-kg load, and (3) 4.6-kg load. An analysis of variance model was used to test for group and load effects for 3 phases of motion (31°–60°, 61°–90°, and 91°–120°). Results. Relative to the group without impingement, the group with impingement showed decreased scapular upward rotation at the end of the first of the 3 phases of interest, increased anterior tipping at the end of the third phase of interest, and increased scapular medial rotation under the load conditions. At the same time, upper and lower trapezius muscle electromyographic activity increased in the group with impingement as compared with the group without impingement in the final 2 phases, although the upper trapezius muscle changes were apparent only during the 4.6-kg load condition. The serratus anterior muscle demonstrated decreased activity in the group with impingement across all loads and phases. Conclusion and Discussion. Scapular tipping (rotation about a medial to lateral axis) and serratus anterior muscle function are important to consider in the rehabilitation of patients with symptoms of shoulder impingement related to occupational exposure to overhead work.

scholarly journals Shoulder External Rotation Fatigue and Scapular Muscle Activation and Kinematics in Overhead Athletes

2011 ◽  
Vol 46 (4) ◽  
pp. 349-357 ◽  
Author(s):  
Mithun Joshi ◽  
Charles A. Thigpen ◽  
Kevin Bunn ◽  
Spero G. Karas ◽  
Darin A. Padua
Keyword(s):  
Muscle Fatigue ◽  
Muscle Activation ◽  
External Rotation ◽  
Shoulder Injuries ◽  
Serratus Anterior ◽  
Overhead Athletes ◽  
Scapular Kinematics ◽  
Fatigue Protocol ◽  
Upper Trapezius ◽  
Lower Trapezius

Context: Glenohumeral external rotation (GH ER) muscle fatigue might contribute to shoulder injuries in overhead athletes. Few researchers have examined the effect of such fatigue on scapular kinematics and muscle activation during a functional movement pattern. Objective: To examine the effects of GH ER muscle fatigue on upper trapezius, lower trapezius, serratus anterior, and infraspinatus muscle activation and to examine scapular kinematics during a diagonal movement task in overhead athletes. Setting: Human performance research laboratory. Design: Descriptive laboratory study. Patients or Other Participants: Our study included 25 overhead athletes (15 men, 10 women; age = 20 ± 2 years, height = 180 ± 11 cm, mass = 80 ± 11 kg) without a history of shoulder pain on the dominant side. Intervention(s): We tested the healthy, dominant shoulder through a diagonal movement task before and after a fatiguing exercise involving low-resistance, high-repetition, prone GH ER from 0° to 75° with the shoulder in 90° of abduction. Main Outcome Measure(s): Surface electromyography was used to measure muscle activity for the upper trapezius, lower trapezius, serratus anterior, and infraspinatus. An electromyographic motion analysis system was used to assess 3-dimensional scapular kinematics. Repeated-measures analyses of variance (phase × condition) were used to test for differences. Results: We found a decrease in ascending-phase and descending-phase lower trapezius activity (F1,25 = 5.098, P = .03) and an increase in descending-phase infraspinatus activity (F1,25 = 5.534, P = .03) after the fatigue protocol. We also found an increase in scapular upward rotation (F1,24 = 3.7, P = .04) postfatigue. Conclusions: The GH ER muscle fatigue protocol used in this study caused decreased lower trapezius and increased infraspinatus activation concurrent with increased scapular upward rotation range of motion during the functional task. This highlights the interdependence of scapular and glenohumeral force couples. Fatigue-induced alterations in the lower trapezius might predispose the infraspinatus to injury through chronically increased activation.

Comparison of scapular upward rotator muscle activities and activity ratios during three scapular upward rotator strengthening exercises

2021 ◽  
pp. 1-8
Author(s):  
Jun-Hee Kim ◽  
Oh-Yun Kwon ◽  
Ui-Jae Hwang ◽  
Sung-Hoon Jung ◽  
Sun-Hee Ahn ◽  
...  
Keyword(s):  
Young Adult ◽  
Moderate Intensity ◽  
Serratus Anterior ◽  
Healthy Young Adult ◽  
Adult Men ◽  
Muscle Imbalance ◽  
Upper Trapezius ◽  
Strengthening Exercises ◽  
Activity Ratios ◽  
Lower Trapezius

BACKGROUND: The focus of exercises for restoring the imbalance between scapular upward rotator muscles – upper trapezius (UT), serratus anterior (SA), and lower trapezius (LT) – commonly aims to increase SA and LT activities while not increasing UT activity. OBJECTIVES: The purpose of this study was to compare the activity of the UT, SA, and LT muscles during scapation and protraction exercises, which are two traditional exercises, and during a newly designed scapular upward rotation (SUR) exercise. METHODS: A total of 29 healthy young adult men performed all three exercises with maximum isometric contraction. The electromyographic activities of the UT, SA, and LT were recorded. RESULTS: UT demonstrated the highest activity during scapation. SA activity was the lowest during protraction. However, no difference was found in SA activity during the performance of scapation and SUR. The SA/UT ratio was the highest during scapation. CONCLUSIONS: SUR is a new exercise that can be performed at moderate intensity for shoulder rehabilitation to restore scapular upward rotator muscle imbalance.

scholarly journals Scapular Muscle Tests in Subjects With Shoulder Pain and Functional Loss: Reliability and Construct Validity

2005 ◽  
Vol 85 (11) ◽  
pp. 1128-1138 ◽  
Author(s):  
Lori A Michener ◽  
N Douglas Boardman ◽  
Peter E Pidcoe ◽  
Angela M Frith
Keyword(s):  
Construct Validity ◽  
Shoulder Pain ◽  
Muscle Activity ◽  
Trapezius Muscle ◽  
Muscle Performance ◽  
Serratus Anterior ◽  
Functional Loss ◽  
Upper Trapezius ◽  
Lower Trapezius ◽  
Isometric Muscle

Abstract Background and Purpose. Scapular muscle performance evaluated with a handheld dynamometer (HHD) has been investigated only in people without shoulder dysfunction for test-retest reliability of data obtained with a single scapular muscle test. The purpose of this study was to assess the reliability, error, and validity of data obtained with an HHD for 4 scapular muscle tests in subjects with shoulder pain and functional loss. Subjects and Methods. Subjects (N=40) with shoulder pain and functional loss were tested bymeasuring the kilograms applied with an HHD during 3 trials for muscle tests for the lower trapezius, upper trapezius, middle trapezius, and serratus anterior muscles. Concurrently, surface electromyography (sEMG) data were collected for the 4 muscles. The same procedures were performed 24 to 72 hours after the initial testing by the same tester. Muscle tests were performed 3 times, and the results were averaged for data analysis. Results. Intraclass correlation coefficients for intratester reliability of measurements of isometricforce obtained using an HHD ranged from .89 to .96. The standard error of the measure (90% confidenceinterval [CI]) ranged from 1.3 to 2.7 kg; the minimal detectable change (90% CI) ranged from 1.8 to 3.6 kg. Construct validity assessment, done by comparing the amounts of isometric muscle activity (sEMG) for each muscle across the 4 muscle tests, revealed that the muscle activity of the upper trapezius and lower trapezius muscles washighest during their respective tests. Conversely, the isometric muscle activity of the middle trapezius and serratus anterior muscles was not highest during their respective tests. Discussion and Conclusion. In people with shoulder pain and functional loss, the intrarater reliability and error over 1 to 3 days were established using an HHD for measurement of isometric force for the assessment of scapular muscle performance. Error values can be used to make decisions regarding individual patients. Construct validity was established for the lower and upper trapezius muscle tests; therefore, these tests are advocated for use. However, construct validity was not demonstrated for the serratus anterior and middle trapezius muscle tests as performed in this study. Further investigation of these muscle tests is warranted.

scholarly journals Serratus Anterior and Lower Trapezius Muscle Activities During Multi-Joint Isotonic Scapular Exercises and Isometric Contractions

2015 ◽  
Vol 50 (2) ◽  
pp. 199-210 ◽  
Author(s):  
Masaaki Tsuruike ◽  
Todd S. Ellenbecker
Keyword(s):  
External Rotation ◽  
Health Science ◽  
Free Motion ◽  
Isometric Contractions ◽  
Electromyographic Activity ◽  
Serratus Anterior ◽  
Lawn Mower ◽  
Shoulder Flexion ◽  
Motion Exercise ◽  
Lower Trapezius

Context: Proper scapular function during humeral elevation, such as upward rotation, external rotation, and posterior tilting of the scapula, is necessary to prevent shoulder injury. However, the appropriate intensity of rehabilitation exercise for the periscapular muscles has yet to be clarified. Objective: To identify the serratus anterior, lower trapezius, infraspinatus, and posterior deltoid muscle activities during 2 free-motion exercises using 3 intensities and to compare these muscle activities with isometric contractions during quadruped shoulder flexion and external rotation and abduction of the glenohumeral joint. Design: Cross-sectional study. Setting: Health Science Laboratory. Patients or Other Participants: A total of 16 uninjured, healthy, active, male college students (age = 19.5 ± 1.2 years, height = 173.1 ± 6.5 cm, weight = 68.8 ± 6.6 kg). Main Outcome Measure(s): Mean electromyographic activity normalized by the maximal voluntary isometric contraction was analyzed across 3 intensities and 5 exercises. Intraclass correlation coefficients were calculated for electromyographic activity of the 4 muscles in each free-motion exercise. Results: Significant interactions in electromyographic activity were observed between intensities and exercises (P < .05). The quadruped shoulder-flexion exercise activated all 4 muscles compared with other exercises. Also, the modified robbery free-motion exercise activated the serratus anterior, lower trapezius, and infraspinatus compared with the lawn-mower free-motion exercise. However, neither exercise showed a difference in posterior deltoid electromyographic activity. Conclusions: Three intensities exposed the nature of the periscapular muscle activities across the different exercises. The free-motion exercise in periscapular muscle rehabilitation may not modify serratus anterior, lower trapezius, and infraspinatus muscle activities unless knee-joint extension is limited.

scholarly journals Comparison of Activity in Scapular Stabilizing Muscles during Knee Push-Up Plus and Modified Vojta’s 3-Point Support Exercises

Healthcare ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1636
Author(s):  
Hyoungwon Lim
Keyword(s):  
Muscle Activity ◽  
Surface Emg ◽  
Emg Activity ◽  
Shoulder Injury ◽  
Serratus Anterior ◽  
Point Support ◽  
Upper Trapezius ◽  
The Difference ◽  
Lower Trapezius ◽  
Push Up

Selective serratus anterior (SA) strengthening without compensatory movement of the shoulder stabilizers is essential for shoulder stability and functional movement without causing shoulder injury and dysfunction. The purpose of this study was to compare electromyographic (EMG) activity between the SA, upper trapezius (UT), lower trapezius (LT), and pectoralis major (PM) during the knee push-up plus (KPUP) and modified Vojta’s 3-point support (MV3PS) exercises. Scapular stabilizer muscle activity (UT, LT, SA, and PM) was investigated during the KPUP and MV3PS exercises in 40 healthy adults (19 males, 21 females) using surface EMG. Muscle activity of the SA was significantly higher during the MV3PS exercise than during the KPUP (p < 0.05). However, muscle activity in the PM was significantly lower during the MV3PS exercise (p < 0.05). In addition, the LT and UT showed less muscle activity during the MV3PS exercise, although the difference was not statistically significant (p > 0.05). These findings suggest that the MV3PS exercise better activates the SA than KPUP.

The Effect of Upper Trapezius Taping on Electromyographic Activity in the Upper and Middle Trapezius Region

1997 ◽  
Vol 6 (4) ◽  
pp. 309-318 ◽  
Author(s):  
Gary E. Morin ◽  
David Tiberio ◽  
Gary Austin
Keyword(s):  
Isometric Contraction ◽  
Trapezius Muscle ◽  
Emg Activity ◽  
Electromyographic Activity ◽  
Upper Trapezius ◽  
Shoulder Muscles ◽  
Lower Trapezius ◽  
The Right ◽  
Relationship Of ◽  
Muscular Imbalance

A characteristic of scapulothoracic dysfunction is the tendency for the upper regions of the trapezius to hypertrophy in relation to its middle and lower portions. This creates a muscular imbalance that can alter scapular position and subsequently the length–tension relationship of the shoulder muscles. Tape was applied over the right upper trapezius to inhibit electrical activity in the muscles of 10 uninjured subjects. EMG activity was recorded in two locations of the upper trapezius and one location in the middle to lower trapezius region while each subject maintained an isometric contraction designed to activate both muscles. With the tape applied, there was a statistically significant reduction in EMG activity of the upper trapezius with a corresponding increase in the middle/lower trapezius. The ability of the tape to alter trapezius activity in this fashion may help correct muscular imbalances in the trapezius muscle.

Normalization to Maximal Voluntary Contraction is Influenced by Subacromial Pain

2016 ◽  
Vol 32 (5) ◽  
pp. 433-440 ◽  
Author(s):  
Lucas Ettinger ◽  
Jason Weiss ◽  
Matthew Shapiro ◽  
Andrew Karduna
Keyword(s):  
Trapezius Muscle ◽  
Pain Scale ◽  
Voluntary Contraction ◽  
Subacromial Impingement Syndrome ◽  
Serratus Anterior ◽  
Upper Trapezius ◽  
Subacromial Injection ◽  
Shoulder Muscle ◽  
Before And After ◽  
Lower Trapezius

In this study, we aimed to determine if electromyography (EMG) normalization to maximal voluntary isometric contractions (MVIC) was influenced by subacromial pain in patients with subacromial impingement syndrome. Patients performed MVICs in unique testing positions for each shoulder muscle tested before and after subacromial injection of local anesthetic. In addition to collection of MVIC data, EMG data during an arm elevation task were recorded before and after injection. From a visual analog pain scale, patients had a 64% decrease in pain following the injection. Significant increases in MVICs were noted in 4 of the 7 shoulder muscles tested: anterior, middle and posterior deltoid, and lower trapezius. No significant differences were noticed for the upper trapezius, latissimus dorsi, or serratus anterior. MVIC condition (pre and post injection) had a significant influence on EMG normalization for the anterior deltoid and lower trapezius muscle. Results indicate that subacromial pain can influence shoulder muscle activity, especially for the deltoid muscles and lower trapezius. In addition, normalization to MVIC in the presence of pain can have unpredictable results. Caution should be taken when normalizing EMG data to MVIC in the presence of pain.

Prevalence of Upper Cross Syndrome in Different Occupations

2021 ◽  
pp. 04-08
Author(s):  
Rizmi Naseer ◽  
Sana Tauqeer
Keyword(s):  
Rating Scale ◽  
Neck Disability Index ◽  
Trapezius Muscle ◽  
Cross Sectional Study ◽  
Study Data ◽  
Pectoralis Major ◽  
Serratus Anterior ◽  
Cross Sectional ◽  
Upper Trapezius ◽  
Lower Trapezius

Upper crossed syndrome is caused by weak lower and middle trapezius, tight upper trapezius and levator scapulae, weak deep-neck flexors, tight sub occipital muscles and sternocleidomastoid, weak serratus anterior, and tight pectoralis major and minor Objective: To find prevalence of upper cross syndrome in different occupations Methodology: In this cross sectional study data was collected from department of physical therapy Hamza Medical Centre, Islamabad. Study was conducted in 6 months (June 2019 to December 2019).Sample size was 37 that was collected through Epitool calculator. Participants were made aware of the study Pectoralis major contracture test was performed to check the pectoral muscles tightness. After that, trapezius weakness test was performed. In this test weakness of middle and lower trapezius muscle was assessed Verbal consent form was taken. Data collection tools were Numeric pain rating scale (NPRS) and Neck disability index (Pain).Data was analyzed by using SPSS version 20. Results: Total 37 participants were recruited for this The mean age for the participants was 32.11+ 5.606.There were 54.5% male participants and 45.95 female participants.%. Prevalence of upper cross syndrome in desk workers was (12)32.43%.Pravalence of Upper Cross syndrome in Drivers was (9)924.325.Pravalence of upper cross syndrome in House wives was (10)27.035.Pravalence of Upper cross syndrome in teachers was (6)16.22%. Conclusion: This research concluded that there is prevalence of upper cross syndrome in different occupations. This study also concluded that rest and medicine are reliving factors for upper cross syndrome participants

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