DOI QR코드

DOI QR Code

Effects of Verbal Cue for Scapular Depression During Scapular Posterior Tilt Exercise on Scapular Muscle Activities and Clavicular Tilt Angle in Subjects With Rounded Shoulder Posture and Upper Trapezius Myofascial Pain

  • Choi, Sil-ah (Applied Kinesiology and Ergonomic Technology Laboratory, Dept. of Physical Therapy, The Graduate School, Yonsei University) ;
  • Cynn, Heon-seock (Applied Kinesiology and Ergonomic Technology Laboratory, Dept. of Physical Therapy, The Graduate School, Yonsei University) ;
  • Shin, A-reum (Applied Kinesiology and Ergonomic Technology Laboratory, Dept. of Physical Therapy, The Graduate School, Yonsei University) ;
  • Kim, Da-eun (Applied Kinesiology and Ergonomic Technology Laboratory, Dept. of Physical Therapy, The Graduate School, Yonsei University)
  • Received : 2017.08.10
  • Accepted : 2017.09.11
  • Published : 2017.09.17

Abstract

Background: Scapular posterior tilt (SPT) is important in the prevention of abnormal scapular movement and pain during elevation of the arm. However, previous studies have overlooked increased upper trapezius (UT) muscle activity interrupting the normal force couple of scapular motion and compensation of levator scapulae (LS) muscle activated simultaneously with UT during SPT exercise. Objects: The purpose of this study was to compare the effects of modified SPT with depression exercise versus SPT exercise on serratus anterior (SA), lower trapezius (LT), UT, and LS muscle activities and the clavicular tilt angle, in subjects with rounded shoulder posture (RSP) and myofascial pain in the UT muscle region. Methods: Eighteen subjects with RSP were recruited and randomly allocated to 2 groups; 9 in the SPT group and 9 in the SPT with depression group. All subjects met the specific RSP criteria and had myofascial pain of UT region. Depending on the allocated group, subjects performed the assigned SPT exercise and EMG data were recorded during the each exercise. Clavicular tilt angle was defined as the angle between the line joining the medial and lateral end of the clavicle and a horizontal line. Results: The SA muscle activity was significantly greater in SPT with depression than with SPT exercise (p<.05). The UT, LS muscle activity and the clavicular tilt angle was significantly lower in SPT with depression than with SPT exercise (p<.05). Conclusion: These findings were insightful because the potential risk of pain from overactivation of the UT and LS was considered, in contrast with SPT exercise. SPT with depression exercise can be implemented as an effective method to facilitate scapular muscle activity for stability and to prevent myofascial pain in the neck and shoulder.

Keywords

References

  1. Akel I, Pekmezci M, Hayran M, et al. Evaluation of shoulder balance in the normal adolescent population and its correlation with radiological parameters. Eur Spine J. 2008;17(3):348-354. https://doi.org/10.1007/s00586-007-0546-0
  2. Arlotta M, LoVasco G, McLean L. Selective recruitment of the lower fibers of the trapezius muscle. J Electromyogr Kinesiol. 2011;21(3):403-410. https://doi.org/10.1016/j.jelekin.2010.11.006
  3. Azevedo DC, de Lima Pires T, de Souza Andrade F, et al. Influence of scapular position on the pressure pain threshold of the upper trapezius muscle region. Eur J Pain. 2008;12(2):226-232. https://doi.org/10.1016/j.ejpain.2007.05.004
  4. Cole AK, McGrath ML, Harrington SE, et al. Scapular bracing and alteration of posture and muscle activity in overhead athletes with poor posture. J Athl Train 2013;48(1):12-24. https://doi.org/10.4085/1062-6050-48.1.13
  5. Criswell E. Cram's introduction to surface electromyography. 2nd ed. Sudbury, MA, Jones and Bartlett Publishers. 2010:268-297.
  6. Duyur Cakit B, Genc H, Altuntas V, et al. Disability and related factors in patients with chronic cervical myofascial pain. Clin Rheumatol. 2009;28(6):647-654. https://doi.org/10.1007/s10067-009-1116-0
  7. Dziedzig K, Hill J, Lewis M, et al. Effectiveness of manual therapy or pulsed shortwave diathermy in addition to advice and exercise for neck disorders: a pragmatic randomised controlled trail in physical therapy clinics. Arthritis Rheum 2005;53:214-222. https://doi.org/10.1002/art.21087
  8. Ebaugh DD, McClure PW, Karduna AR. Three-dimensional scapulothoracic motion during active and passive arm elevation. Clin Biomech (Bristol, Avon). 2005:20(7):700-709. https://doi.org/10.1016/j.clinbiomech.2005.03.008
  9. Ekstrom RA, Donatelli RA, Soderberg GL. Surface electromyographic analysis of exercises for the trapezius and serratus anterior muscles. J Orthop Sports Phys Ther 2003;33(5):247-258. https://doi.org/10.1016/j.jelekin.2004.09.006
  10. Ettinger L, Weiss J, Shapiro M, et al. Normalization to Maximal Voluntary Contraction is Influenced by Subacromial Pain. J Appl Biomech. 2016;32(5):433-440. https://doi.org/10.1123/jab.2015-0185
  11. Escamilla RF, Yamashiro K, Paulos L, et al. Shoulder muscle activity and function in common shoulder rehabilitation exercises. Sports Med. 2009;39(8):663-685. https://doi.org/10.2165/00007256-200939080-00004
  12. Fernandez de las Penas C, Alonso-Blanco C, Miangolarra JC. Myofascial trigger points in subjects presenting with mechanical neck pain: A blinded, controlled study. Man Ther 2006;12:29-33.
  13. Gemmell H, Miller P, Nordstrom H. Immediate effect of ischaemic compression and trigger point pressure release on neck pain and upper trapezius trigger points: A randomised controlled trial. Clin Chiropr. 2008;11(1):30-36. https://doi.org/10.1016/j.clch.2007.09.001
  14. Ha SM, Kwon OY, Cynn HS, et al. Comparison of electromyographic activity of the lower trapezius and serratus anterior muscle in different arm-lifting scapular posterior tilt exercises. Phys Ther Sport. 2012;13(4):227-232. https://doi.org/10.1016/j.ptsp.2011.11.002
  15. Ha SM, Kwon OY, Weon JH, et al. Reliability and validity of goniometric and photographic measurements of clavicular tilt angle. Man Ther. 2013;18(5):367-371. https://doi.org/10.1016/j.math.2012.12.006
  16. Hardwick DH, Beebe JA, McDonnell MK, et al. A comparison of serratus anterior muscle activation during a wall slide exercise and other traditional exercises. J Orthop Sports Phys Ther. 2006;36(12):903-910. https://doi.org/10.2519/jospt.2006.2306
  17. Hislop H, Montgomery J. Daniels and Worthingham's Muscle Testing: Techniques of manual examination. 8th ed. St. Louis, MO: Saunders, Elsevier. 2007:64-79.
  18. Hubbard DR. Myofascial trigger points show spontaneous needle EMG activity. Spine (Phila, Pa. 1976). 1993;18(13):1803-1807. https://doi.org/10.1097/00007632-199310000-00015
  19. Kannan P. Management of myofascial pain of upper trapezius: A three group comparison study. Glob J Health Sci. 2012;4(5):46-52. https://doi.org/10.5539/gjhs.v4n5p46
  20. Kibler WB, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg. 2003;11(2):142-151. https://doi.org/10.5435/00124635-200303000-00008
  21. Kibler WB, Sciascia A. Current concepts: Scapular dyskinesis. Br J Sports Med.2010;44(5):300-305. https://doi.org/10.1136/bjsm.2009.058834
  22. Kofler M. Functional organization of exteroceptive inhibition following nociceptive electrical fingertip stimulation in humans. Clin Neurophys. 2003;114(6):973-980. https://doi.org/10.1016/S1388-2457(03)00060-9
  23. Lee JH, Cynn HS, Choi WJ, et al. Various shrug exercises can change scapular kinematics and scapular rotator muscle activities in subjects with scapular downward rotation syndrome. Hum Mov Sci. 2016;45:119-129. https://doi.org/10.1016/j.humov.2015.11.016
  24. Lee JH, Cynn HS, Yoon TL, et al. The effect of scapular posterior tilt exercise, pectoralis minor stretching, and shoulder brace on scapular alignment and muscles activity in subjects with round-shoulder posture. J Electromyogr Kinesiol. 2015;25(1):107-114. https://doi.org/10.1016/j.jelekin.2014.10.010
  25. Lewis JS, Wright C, Green A. Subacromial impingement syndrome: The effect of changing posture on shoulder range of movement. J Orthop Sports Phys Ther. 2005;35(2):72-87. https://doi.org/10.2519/jospt.2005.35.2.72
  26. Ludewig PM, Braman, JP. Shoulder impingement: Biomechanical considerations in rehabilitation. Man Ther. 2011;16(1):33-39. https://doi.org/10.1016/j.math.2010.08.004
  27. Ludewig PM, Cook, TM, Nawoczenski DA. Threedimensional scapular orientation and muscle activity at selected positions of humeral elevation. J Orthop Sports Phys Ther. 1996;24(2):57-65. https://doi.org/10.2519/jospt.1996.24.2.57
  28. Ludewig PM, Phadke V, Braman JP, et al. Motion of the shoulder complex during multiplanar humeral elevation. J Bone Joint Surg Am 2009;91(2):378-389. https://doi.org/10.2106/JBJS.G.01483
  29. McCabe RA, Orishimo KF, McHugh MP, et al Surface electromygraphic analysis of the lower trapezius muscle during exercises performed below ninety degrees of shoulder elevation in healthy subjects. N Am J Sports Phys Ther. 2007;2(1):34-43.
  30. McClure PW, Bialker J, Neff N, et al. Shoulder function and 3-dimensional kinematics in people with shoulder impingement syndrome before and after a 6-week exercise program. Phys Ther 2004;84(9):832-848.
  31. Michener LA, Pidcoe PE, Frith AM. Reliability and validity of scapular muscle strength testing in patients with shoulder pain and functional loss. Med Sci Sport Exer. 2003;35(5):S242.
  32. Moseley JB, Jobe FW, Pink M, et al. EMG analysis of the scapular muscles during a shoulder rehabilitation program. Am J Sports Med. 1992;20(2):128-134. https://doi.org/10.1177/036354659202000206
  33. Neumann DA. Kinesiology of the Musculoskeletal System: Foundations for physical rehabilitation. 1st ed. St Louis, Mosby, 2002:114-125.
  34. Oliveira-Campelo NM, de Melo CA, Alburquerque-Sendin F, et al. Short-and medium-term effects of manual therapy on cervical active range of motion and pressure pain sensitivity in latent myofascial pain of the upper trapezius muscle: A randomized controlled trial. J Manipulative Physiol Ther. 2013;36(5):300-309. https://doi.org/10.1016/j.jmpt.2013.04.008
  35. Olson SL, O'Connor DP, Birmingham G, et al. Tender point sensitivity, range of motion, and perceived disability in subjects with neck pain. J Orthop Sports Phys Ther. 2000;30(1):13-20. https://doi.org/10.2519/jospt.2000.30.1.13
  36. Page P, Frank CC, Lardner R. Assessment and Treatment of Muscle Imbalance: The janda approach. 1st ed. Champaign, IL, Human Kinetics. 2009:52-55.
  37. Park KM, Cynn HS, Yi CH, et al. Effect of isometric horizontal abduction on pectoralis major and serratus anterior EMG activity during three exercises in subjects with scapular winging. J Electromyogr Kinesiol. 2013;23(2):462-468. https://doi.org/10.1016/j.jelekin.2012.11.013
  38. Pontillo M, Orishimo KF, Kremenic IJ, et al. Shoulder musculature activity and stabilization during upper extremity weight-bearing activities. N Am J Sports Phys Ther. 2007;2(2):90-96.
  39. Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndrome. 1st ed. St. Louis, Mosby, 2002:210-227.
  40. Simons DG, Travell JG, Simons LS, et al. Myofascial Pain and Dysfunction: The trigger point manual. 2nd ed. Baltimore, Williams and Wilkins. 1999:285-288.
  41. Smith J, Dahm DL, Kaufman KR, et al. Electromyographic activity in the immobilized shoulder girdle musculature during scapulothoracic exercises. Arch Phys Med Rehabil. 2006;87(7):923-927. https://doi.org/10.1016/j.apmr.2006.03.013
  42. Solem-Bertoft E, Thuomas KA, Westerberg CE. The influence of scapular retraction and protraction on the width of the subacromial space: An MRI study. Clinical Orthopaedics and Related Research. 1993;296:99-103.
  43. Szeto GP, Straker L, Raine S. A field comparison of neck and shoulder postures in symptomatic and asymptomatic office workers. Appl Ergon. 2002;33(1):75-84. https://doi.org/10.1016/S0003-6870(01)00043-6
  44. Thigpen CA, Padua DA, Michener LA, et al. Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks. J Electromyogr Kinesiol. 2010;20(4):701-709. https://doi.org/10.1016/j.jelekin.2009.12.003
  45. Weon JH, Oh JS, Cynn HS, et al. Influence of forward head posture on scapular upward rotators during isometric shoulder flexion. J Bodyw Mov Ther. 2010;14(4):367-374. https://doi.org/10.1016/j.jbmt.2009.06.006