The Journal of Korean Academy of Orthopedic Manual Physical Therapy (대한정형도수물리치료학회지)

Korean Academy of Orthopedic Manual Physical Therapy (대한정형도수물리치료학회)
권호 표지

Changes in Serratus Anterior Muscle Activity According to Sling Angle in Participants with Shoulder Instability

어깨 불안정성환자에게 각도에 따른 슬링 운동이 앞톱니근의 근 활성도 변화

  • 박찬희 (연세대학교 물리치료학과)
  • Received : 2021.01.11
  • Accepted : 2021.01.30
  • Published : 2021.04.30
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Abstract

Background: The serratus anterior and upper trapezius muscles act synergistically to allow for an appropriate scapulothoracic rhythm. However, a decrease in serratus anterior activation causes the upper trapezius to become overactivated, resulting in dysfunction. This study compared serratus anterior and upper trapezius muscle activity according to sling angle and compared serratus anterior strength between healthy adults and patients with shoulder instability. Methods: Twenty participants (10 healthy adults and 10 patients with shoulder instability) were included in this study. The participants had their arms extended at sling angles of 30°, 60°, and 90° in reach forward with shoulder flexion using goniometer. Serratus anterior strength was measured three times while the participants were supine. The outcome measures were surface electromyography amplitude of the upper trapezius and serratus anterior and serratus anterior strength. Results: The Wilcoxon signed-rank test indicated that the upper trapezius was significantly different between healthy group and shoulder instability group at a sling angle of 60°, and both the upper trapezius and serratus anterior exhibited significant differences at 90°. Moreover, a significant difference was noted in the muscle strength of the serratus anterior. Conclusion: Our results provide novel and promising clinical evidence that patients with shoulder instability have decreased serratus anterior activation and upper trapezius overactivation, resulting in muscle imbalance. In addition, there was a significant difference between the healthy group and shoulder instability group in the serratus anterior muscle strength

Keywords

References

  1. Bigliani LU, Levine WN. Current concepts review-subacromial impingement syndrome. JBJS. 1997;79(12):1854-1868. https://doi.org/10.2106/00004623-199712000-00012.
  2. Bruce M. Frank WJ, Marilyn P, 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.
  3. Comerford, MJ, Mottram, SL. Movement and stability dysfunction-contemporary developments. Man Ther. 2001;6(1):15-26. https://doi.org/10.1054/math.2000.0388.
  4. Cools AM, Dewitte V, Lanszweert F, et al. Rehabilitation of scapular muscle balance: which exercises to prescribe?. Am J Sports Med. 2007;35(10):1744-1751. https://doi.org/10.1177/0363546507303560.
  5. Cram, JR. Biofeedback applications. Electromyography: Physiology, engineering, and noninvasive applications. hoboken (NJ): John Wiley & Sons, Inc. 2004;435-452.
  6. De araujo RC, Tucci HT, De andrade R, et al. Reliability of electromyographic amplitude values of the upper limb muscles during closed kinetic chain exercises with stable and unstable surfaces. J Electromyogr Kinesiol. 2009;19(4):685-694. https://doi.org/10.1016/j.jelekin.2007.11.014.
  7. De mey K, Danneels L, Cagnie B, et al. Shoulder muscle activation levels during four closed kinetic chain exercises with and without Redcord slings. The Journal of Strength & Conditioning Research. 2014;28(6):1626-1635. https://doi.org/doi:10.1519/JSC.0000000000000292.
  8. Didesch JT, Tang P. Anatomy, etiology, and management of scapular winging. J Hand Surg Eur Vol. 2019;44(4):321-330. https://doi.org/doi:10.1016/j.jhsa.2018.08.008
  9. Ekstrom RA, Bifulco KM, Lopau CJ, et al. Comparing the function of the upper and lower parts of the serratus anterior muscle using surface electromyography. Journal of Orthopaedic & Sports Physical Therapy. 2004;34(5):235-243. https://doi.org/10.2519/jospt.2004.34.5.235.
  10. Eom, MY, Chung, SH, Ko, TS. Effects of bridging exercise on different support surfaces on the transverse abdominis. Journal of Physical Therapy Science. 2013;25(10):1343-1346. https://doi.org/10.1589/jpts.25.1343.
  11. Gwak, GT, Ahn SH, Kim JH, et al. Prediction Model for the Risk of Scapular Winging in Young Women Based on the Decision Tree. Physical Therapy Korea. 2020;27(2):140-148. https://doi.org/10.12674/ptk.2020.27.2.140.
  12. Hanchard NC, Lenza M, Handoll HH, et al. Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement. Cochrane Database of Systematic Reviews. 2013;4.CD007427. https://doi.org/10.1002/14651858.CD007427.pub2.
  13. Hody S, Croisier JL, Bury T, et al. Eccentric muscle contractions: risks and benefits. Frontiers in Physiology. 2019;10:1-18. https://doi.org/10.3389/fphys.2019.00536.
  14. Huang JS, Pietrosimone BG, Ingersoll CD, et al. Sling exercise and traditional warm-up have similar effects on the velocity and accuracy of throwing. The Journal of Strength & Conditioning Research. 2011;25(6):1673-1679. https://doi.org/doi:10.1519/JSC.0b013e3181da7845.
  15. Inman VT, Abbott LC. Observations of the function of the shoulder joint. Clin Orthop Relat Res. 1996;330:3-12. https://doi.org/10.1097/00003086-199609000-00002.
  16. Jeong, SY, Chung, SH, Shim, JH. Comparison of upper trapezius, anterior deltoid, and serratus anterior muscle activity during push-up plus exercise on slings and a stable surface. Journal of Physical Therapy Science. 2014;26(6):937-939. https://doi.org/10.1589/jpts.26.937.
  17. Karandikar N, Vargas O, Oscar O. Kinetic chains: A review of the concept and its clinical applications. PM&R. 2011;3(8):739-745. https://doi.org/10.1016/j.pmrj.2011.02.021.
  18. Kendall FP, McCreary EK, Provance PG, et al. Muscles: Testing and Function with Posture and Pain. Baltimore, MD: Williams & Wilkins.
  19. Kim, SH, Park JC, Park JS, et al. Painful jerk test: A predictor of success in nonoperative treatment of posteroinferior instability of the shoulder. Am J Sports Med. 2004;32(8):1849-1855. https://doi.org/10.1177/0363546504265263.
  20. Lear LJ, Gross MT. An electromyographical analysis of the scapular stabilizing synergists during a push-up progression. Journal of Orthopaedic & Sports Physical Therapy. 1998;28(3):146-157. https://doi.org/10.2519/jospt.1998.28.3.146.
  21. Ludewig PM, Cook TM. Translations of the humerus in persons with shoulder impingement symptoms. J Orthop Sports Phys Ther. 2002;32(6):248-259. https://doi.org/10.2519/jospt.2002.32.6.248.
  22. Mckenna LJ, Bonnett L, Panzich K, et al. The addition of real-time ultrasound visual feedback to manual facilitation increases serratus anterior activation in adults with painful shoulders: A randomized crossover trial. Physical Therapy and Rehabilitation Journal. 2021;101(3):pzaa208. https://doi.org/10.1093/ptj/pzaa208.
  23. Mcmullen J, Uhl TL. A kinetic chain approach for shoulder rehabilitation. J Athl Train. 2000;35(3):329-337.
  24. Page P. Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes. International Journal of Sports Physical Therapy. 2011;6(1):51-68.
  25. Rundquist PJ, Ludewig PM. Patterns of motion loss in subjects with idiopathic loss of shoulder range of motion. Clinical Biomechanics. 2004;19(8):810-818. https://doi.org/10.1016/j.clinbiomech.2004.05.006.
  26. Sahrmann, SA. Diagnosis and Treatment of Movement Impairment Syndromes. Elsevier Health Sciences. London. 2013.
  27. Santos MJ, Aruin AS. Effects of lateral perturbations and changing stance conditions on anticipatory postural adjustment. J Electromyogr Kinesiol. 2009;19(3):532-541. https://doi.org/10.1016/j.jelekin.2007.12.002.
  28. Selkowitz DM, Chaney C, Stuckey SJ, et al. the effects of scapular taping on the surface electromyographic signal amplitude of shoulder girdle muscle during upper extremity elevation in individuals with suspected shoulder impingement syndrome. J Orthop Sports Phys Ther. 2007;37(11):694-702. https://doi.org/10.2519/jospt.2007.2467ospt.2007.24677
  29. Smith TO, Dainty JR, Williamson E, et al. Association between musculoskeletal pain with social isolation and loneliness: analysis of the English Longitudinal Study of Ageing. British Journal of Pain. 2019;13(2):82-90. https://doi.org/10.1177/2049463718802868.