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http://dx.doi.org/10.12674/ptk.2019.26.3.001

Effect on the Activity and Ratio of the Serratus Anterior, Pectoralis Major, and Upper Trapezius according to the Angle of Abduction and External Weight During Shoulder Protraction Exercise for Winged Scapular Subjects  

BadamKhorl, Yadam (Dept. of Physical Therapy, The Graduate School, Daegu University)
Kim, Tae-ho (Dept. of Physical Therapy, College of Rehabilitation Science, Daegu University)
Park, Han-kyu (Dept. of Physical Therapy, Dong-ju College)
Publication Information
Physical Therapy Korea / v.26, no.3, 2019 , pp. 1-10 More about this Journal
Abstract
Background: Winged scapular (WS) causes muscle imbalance with abnormal patterns when moving the arm. In particular, the over-activation of the upper trapezius (UT) and decrease in activity of the lower trapezius (LT) and serratus anterior (SA) produce abnormal scapulohumeral rhythm. Therefore, the SA requires special attention in all shoulder rehabilitation programs. In fact, many previous studies have been devoted to the SA muscle strength training needed for WS correction. Objects: The purpose of this study was to investigate the effect of shoulder girdle muscle and ratio according to the angle of shoulder abduction and external weight in supine position. Methods: Twenty three WS patients participated in this experiment. They performed scapular protraction exercise in supine position with the weights of 0 kg, 1 kg, 1.5 kg, and 2 kg at shoulder abduction angles of $0^{\circ}$, $30^{\circ}$, $60^{\circ}$, and $90^{\circ}$. The angle and weight applications were randomized. Surface electromyography (EMG) was used to collect the EMG data of the SA, pectoralis major (PM), and UT during the exercise. The ratio of PM/SA and UT/SA was confirmed. Two-way repeated analyses of variance were used to determine the statistical significance of SA, PM, and UT and the ratios of PM/SA and UT/SA. Results: There was a significant difference in SA according to angle (p<.05). Significant differences were also identified depending on the angle and weight (p<.05). The angle of abduction at $0^{\circ}$, $30^{\circ}$ and weight of 2 kg showed the highest SA activity. However, there was no significant difference between PM and UT (p>.05). There was a significant difference between PM/SA and UT/SA in ratio of muscle activity according to angle (p<.05). Significant differences were found at PM/SA angles of $30^{\circ}$, $60^{\circ}$ and $90^{\circ}$ (p<.05). For UT/SA, significant difference was only observed at $90^{\circ}$ (p<.05). Conclusion: Based on the results of this study, in order to strengthen the SA, it was found to be most effective to use 1 and 1.5 kg weights with abduction angles of $0^{\circ}$ and $30^{\circ}$ at shoulder protraction in supine position.
Keywords
Pectoralis major; Serratus anterior; Shoulder protraction; Upper trapezius; Winged scapular;
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1 Hallstrom E, Karrholm J. Shoulder kinematics in 25 patients with impingement and 12 controls. Clin Orthop Relat Res. 2006;448:22-27. http://doi.org/10.1097/01.blo.0000224019.65540.d5   DOI
2 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. http://doi.org/10.2519/jospt.2006.2306   DOI
3 Jo YJ. Analytic comparison of trapezius and serratus anterior activities depending on shoulder complex movement. Seoul, Korea University, Master Thesis. 2014.
4 Kendall FP, McCreary EK, Provance PG. Muscles: Testing and Function With Posture and Pain. 5th ed. Baltimore, Lippincott Williams & Wilkin. 2005:180-218.
5 Keshavarz R, Bashardoust Tajali S, Mir SM, et al. The role of scapular kinematics in patients with different shoulder musculoskeletal disorders: A systematic review approach. J Bodyw Mov Ther. 2017;21(2):386-400. http://doi.org/10.1016/j.jbmt.2016.09.002   DOI
6 Ki HS, Kwon OY, Yi CH et al. Effects of the scapular taping on the muscle activity of the scapula rotators and pain in subjects with upper trapezius pain. Phys Ther Korea. 2010;17(1):77-85.
7 Kibler WB, Ludewig PM, McClure PW, et al. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the 'Scapular Summit'. Br J Sports Med. 2013;47(14):877-885. http://doi.org/10.1136/bjsports-2013-092425   DOI
8 Frank CC, Page P, Lardner R. Assessment and Treatment of Muscle Imbalance: The Janda approach. 1st ed. Illinois, Human Kinetics. 2009.
9 Kibler WB, Sciascia A. Current concepts: scapular dyskinesis. Br J Sports Med. 2010;44(5):300-305. http://doi.org/10.1136/bjsm.2009.058834   DOI
10 Kim JS, Kim MH, Ahn DH, et al. Comparison of shoulder protraction strength and electromyography activity of serratus anterior and pectoralis major in subjects with or without a winged scapula. J Sport Rehabil. 2019;28(3):272-277. http://doi.org/10.1123/jsr.2018-0059   DOI
11 Kim TH, Park HK. The comparison for serratus anterior muscle activity during protraction in open chain and closed chain exercises in healthy adults. J KEMA. 2018;2(1):1-5. https://doi.org/10.29273/jkema.2018.2.1.1   DOI
12 Leonard CT. The Neuroscience of Human Movement: Principles of reflex action and motor control. 1st ed. St Louis, Mosby. 1998.
13 Lim JY. The effects of closed and open kinematic chain exercises for scapular winging. Daegu, Daegu University, Master Thesis. 2010.
14 Madeleine P, Mathiassen SE, Arendt-Nielsen L. Changes in the degree of motor variability associated with experimental and chronic neck-shoulder pain during a standardised repetitive arm movement. Exp Brain Res. 2008;185(4):689-698. http://doi.org/10.1007/s00221-007-1199-2   DOI
15 Ludewig PM, Hoff MS, Osowski EE, et al. Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises. Am J Sports Med. 2004;32(2):484-493. http://doi.org/10.1177/0363546503258911   DOI
16 Lukasiewicz AC, McClure P, Michener L, et al. Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement. J Orthop Sports Phys Ther. 1999;29(10):574-583. http://doi.org/10.2519/jospt.1999.29.10.574   DOI
17 Madeleine P, Leclerc F, Arendt-Nielsen L, et al. Experimental muscle pain changes the spatial distribution of upper trapezius muscle activity during sustained contraction. Clin Neurophysiol. 2006;117(11):2436-2445. http://doi.org/10.1016/j.clinph.2006.06.753   DOI
18 Mase S, Tuzzo D, Salina C, et al. [Injury of the long thoracic nerve after LRA, which etiology? Clinical case]. Minerva Anestesiol. 2000;66(3):153-156.
19 Moseley JB Jr, 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. http://doi.org/10.1177/036354659202000206   DOI
20 McClure PW, Michener LA, Sennett BJ, et al. Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elbow Surg. 2001;10(3):269-277. http://doi.org/10.1067/mse.2001.112954   DOI
21 Neumann DA. Kinesiology of the Musculoskeletal System: Foundations for rehabilitation. 2nd ed. St Louis, Mosby. 2009:121-172.
22 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. http://doi.org/10.1016/j.jelekin.2012.11.013   DOI
23 Warner JJ, Micheli LJ, Arslanian LE, et al. Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome a study using Moire topographic analysis. Clin Orthop Relat Res. 1992;285:191-199. http://doi.org/10.1097/00003086-199212000-00024
24 Sahrmann S. Diagnosis and Treatment of Movement Impairment Syndromes. St Louis, Mosby. 2002:216-231.
25 Stuart I. Human Physiology: Mechanism of contraction and neural control. 10th ed. New York, McGraw-Hill, 2007.
26 Uhl TL, Carver TJ, Mattacola CG, et al. Shoulder musculature activation during upper extremity weight-bearing exercise. J Orthop Sports Phys Ther. 2003;33(3):109-117. http://doi.org/10.2519/jospt.2003.33.3.109   DOI
27 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. http://doi.org/10.1177/0363546507303560   DOI
28 Andersen CH, Zebis MK, Saervoll C, et al. Scapular muscle activity from selected strengthening exercises performed at low and high intensities. J Strength Cond Res. 2012;26(9):2408-2416. http://doi.org/10.1519/JSC.0b013e31823f8d24   DOI
29 Chance-Larsen K, Littlewood C, Garth A. Prone hip extension with lower abdominal hollowing improves the relative timing of gluteus maximus activation in relation to biceps femoris. Man Ther. 2010;15(1):61-65. http://doi.org/10.1016/j.math.2009.07.001.   DOI
30 Choi WJ, Yoon TL, Choi SA, et al. Different weight bearing push-up plus exercises with and without isometric horizontal abduction in subjects with scapular winging: A randomized trial. J Bodyw Mov Ther. 2017;21(3):582-588. http://doi.org/10.1016/j.jbmt.2016.08.018.   DOI
31 Decker MJ, Hintermeister RA, Faber KJ, et al. Serratus anterior muscle activity during selected rehabilitation exercises. Am J Sports Med. 1999;27(6): 784-791. http://doi.org/10.1177/03635465990270061601   DOI
32 Didesch JT, Tang P. Anatomy, etiology, and management of scapular winging. J Hand Surg Am. 2019; 44(4):321-330. http://doi.org/10.1016/j.jhsa.2018.08.008   DOI
33 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. http://doi.org/10.2519/jospt.2003.33.5.247   DOI
34 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. http://doi.org/10.2165/00007256-200939080-00004   DOI
35 Fitchet SM. Injury of the serratus magnus (anterior) muscle. N Engl J Med. 1930;203(17):818-823.   DOI
36 Farina D, Leclerc F, Arendt-Nielsen L, et al. The change in spatial distribution of upper trapezius muscle activity is correlated to contraction duration. J Electromyogr Kinesiol. 2008;18(1):16-25. http://doi.org/10.1016/j.jelekin.2006.08.005   DOI