• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.27 no.3
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• pp.37-46
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• 2021

Background: The increase in the activity of the upper trapezius (UT) muscle and decrease in the activity of the serratus anterior (SA) and lower trapezius (LT) muscle produce an abnormal scapulohumeral rhythem. Therefore, the SA is the focus of therapeutic exercise protocols for the rehabilitation. This study aimed to compare the activity of the muscles according to resistance levels during protraction exercise. Methods: Thirteen healthy 20 to 30 years old male and female subjected participated in the study. All subjects performed the scapular protraction exercise with the weights of 0, 5, and 10kg, combined with horizontal shoulder abduction and adduction. The electromyography data of the SA, UT, and pectoralis major (PM) during the exercise were recorded using surface electrodes. The ratios of PM/SA and UT/SA were calculated. Repeated one-way ANOVA was used to determine the statistical significance. Results: There was a significant difference in the muscle activity of the SA and PM (p<.05). Specifically, SA had the highest activity and PM had the lowest activity at an abduction resistance 10kg (p<.01). There was a significant difference in the ratios of UT/SA and PM/SA (p<.05). The ratio of PM/SA was the lowest at the abduction resistance of 10kg (p<.01). Conclusion: According to this study, for the selective activation of the serratus anterior, protraction exercises should be applied as a method of adding resistance to protraction and horizontal abduction.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2012.05a
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• pp.1201-1202
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• 2012

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.25 no.1
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• pp.29-36
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• 2019

Background: This study was conducted to investigate the effect of leg lift difference on the serratus anterior muscle and the upper trapezius muscle when a subject with winged scapula performs a scapula protraction exercise in a four-leg crawling posture. Method: Twenty normal adults and 20 subjects with winged scapula participated in the experiment. Surface EMG recordings were collected from serratus anterior muscle and back trapezius muscle during scapula protraction exercises. Scapular winging is measured with the lifting distance of scapula retraction to the back using an electronic digital caliper. In two groups of four-leg crawling posture, the two legs support, the dominant leg lifting, and the non-dominant leg lifting, including the scapula protraction, were performed. To examine the difference between groups in the variance analysis, the Bonferroni correction was used (significance level ${\alpha}=.017$). Statistical significance level ${\alpha}$ was .05. Results: There was a significant difference in serratus anterior muscle and upper trapezius muscle during push-up plus exercise in leg lifting in four-leg crawling posture, but there were no significant differences in muscle activity between serratus anterior muscle and upper trapezius muscle, and there was no significant difference according to the presence or absence of scapular winging. Conclusion: For the shoulder stability of the ipsilateral side with the serratus anterior muscle, the leg-lifting posture is effective in the four-leg crawling, and also when a subject with winged scapula chooses an exercise, lifting the ipsilateral side of leg with scapula protraction exercises at the same time may have a positive effect on scapula dysfunction.

• The Journal of Korean Physical Therapy
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• v.24 no.3
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• pp.229-234
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• 2012

Purpose: The purpose of this study was to compare a control group and an experimental group, consisting of arthroscopic shoulder surgery patients who had received acute rehabilitation treatment and who were to perform scapular stabilization exercise. Methods: Sixteen subjects were studied. The control group, n=8, received instruction for basic physical therapy intervention. An experimental group, n=8, received instruction for doing scapular stabilization exercise (protraction, retraction, elevation, depression) 10 times, 6 times per week. To evaluate the effects of exercise, subjects were evaluated using a joint position sense of shoulder (JPS), disability of the arm, shoulder index (DASH), shoulder pain and disability index (SPADI). Results: Participants showed after the intervention, both groups saw their JPS errors at $30^{\circ}$, $60^{\circ}$, and $90^{\circ}$ significantly decrease relative to before the intervention (p<0.05). Both groups saw their JPS rates at $90^{\circ}$ significantly decrease (p<0.05), with no significant changes in JPS at $30^{\circ}$ and $60^{\circ}$ (p>0.05). SPADI and DASH significantly decrease after the intervention (p<0.05), with no significant decreases before the intervention (p>0.05). The change rates of SPADI and DASH significantly reduced (p<0.05). Conclusion: Low-intensity scapular stabilization exercise is considered effective as a clinical treatment for arthroscopic shoulder surgery patients who receive acute rehabilitation treatment.

• Clinics in Shoulder and Elbow
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• v.18 no.3
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• pp.152-158
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• 2015

Background: Acromioclavicular (AC) stability is maintained through a complex combination of soft-tissue restraints that include coracoclavicular (CC), AC ligament and overlying muscles. Among these structures, the role of the CC ligament has continued to be studied because of its importance on shoulder kinematics, especially after AC injury. This study was designed to determine the geometric change of conoid and trapezoid ligaments and resulting stresses on these ligaments according to various scapular motions. Methods: The scapuloclavicular (SC) complex was isolated from a fresh-frozen cadaver by removing all soft tissues except the AC and CC ligaments. The anatomically aligned SC complex was then scanned with a high-resolution computed tomography scanner into 0.6- mm slices. The Finite element model of the SC complex was obtained and used for calculating the stress on different parts of the CC ligaments with simulated movements of the scapula. Results: Average stress on the conoid ligament during anterior tilt, internal rotation, and scapular protraction was higher, whereas the stress on the trapezoid ligament was more prominent during posterior tilt, external rotation, and retraction. Conclusions: We conclude that CC ligament plays an integral role in regulating horizontal SC motion as well as complex motions indicated by increased stress over the ligament with an incremental scapular position change. The conoid ligament is the key structure restraining scapular protraction that might occur in high-grade AC dislocation. Hence in CC ligament reconstructions involving only single bundle, every attempt must be made to reconstruct conoid part of CC ligament as anatomically as possible.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.22 no.2
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• pp.15-20
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• 2016

Background: The purpose of this study was to compared of scapular position between operation side and non-operation side to the rotator cuff surgery. Methods: This study was carried out with a total 34 patients: male (n=14), female (n=20). Shoulder range of motion (ROM), the quadruple visual analogue scale (QVAS), the shoulder pain and disability index (SPADI), and the scapular index (SI) were used to assess shoulder posture and function. SI was the resting position of the scapular was determined by measuring the distance from the mid-point of the sternal notch (SN) to the medial aspect of the coracoid process (CP) and the horizontal distance from the posterolateral angle of the acromion (PLA) to the thoracic spine (TS) with a soft tape measure. The SI was calculated using the equation: [(SN to CP/PLA to TS) ${\times}$ 100]. Results: There were no significant difference in ROM, QVAS to rotator repair patients according to SI (p>.05). There were significant differences in SI between the operation side and the non-operation side (p<.01). Conclusions: Scapular position was operation side more internal rotation, protraction, abduction than non-operation side. Therefore, health professionals managing for rotator cuff tear repair patients should consider scapular position.

• Physical Therapy Korea
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• v.25 no.4
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• pp.1-8
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• 2018

Background: Round shoulder posture, results from excessive flexed posture of the thorax, is defined as a position of scapular protraction, anterior tipping, and downward rotation. However, previous studies have focused on only passive position of the thorax during scapular posterior tilting (SPT) and have not reported on SPT combined with correction of flexed posture. Objects: The aim of this study was to compare effects of SPT and SPT with prone trunk extension (SPT + PTE) on activities of the lower trapezius, serratus anterior, and thoracic erector spinae and degree of posture in subjects with round shoulder and flexed posture. Methods: Fifteen subjects with round shoulder and flexed posture were recruited. The caliper was used to measure the degree of round shoulder and flexed posture. Electromyography was performed to collect data of muscle activities. Paired t-test was used to compare two exercise (${\alpha}=.05$). Results: When SPT + PTE was applied, the degree of round shoulder posture (p=.001) and flexed posture (p=.039) significantly decreased compared with that when SPT was applied. The lower trapezius activity significantly increased in the SPT + PTE condition compared with that in the SPT condition (p=.026). There were no significant differences in serratus anterior activity between SPT + PTE and SPT. The thoracic erector spinae activity significantly increased in the SPT + PTE condition compared with that in the SPT condition (p=.014). Conclusion: SPT + PTE might be one of the effective methods to enhance activities of lower trapezius and thoracic erector spinae, and to reduce round shoulder posture and flexed posture in subjects with round shoulder and flexed posture.

• Physical Therapy Korea
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• v.14 no.2
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• pp.44-52
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• 2007

This study was carried out to compare the muscle activities of the shoulder stabilizers between persons with and without winging scapular during push-up plus exercise (adds the scapular protraction to the general push-up exercise). For this study, eleven males with winging scapular and eleven healthy males were recruited. Surface electromyographic (EMG) activity was recorded from the serratus anterior, upper trapezius, lower trapezius, infraspinatus, and pectoralis major while the subjects performed the push-up plus. Each push-up plus was subdivided into three phases according to the elbow position which was measured using the 3-D motion analysis system: elbow flexion (EF), elbow extension (EE), and shoulder protraction phases (SP). Two-way repeated measure ANOVA (phase ${\times}$ group) were used for statistical analysis. There was significant phase by group interaction only on the EMG composition ratio of the serratus anterior (p>.05). The EMG composition ratio of the serratus anterior was significantly higher in SP than in either EF or EE however, it was not different between winging scapular and normal groups. For both groups, the EMG composition ratio of upper trapezius, lower trapezius, and pectoralis major was significantly different across the phases of push-up plus, but the infraspinatus EMG composition ratio was not. For both groups, in EF and EE phases, the EMG composition ratio of both pectoralis major and serratus anterior were relatively higher than that of other muscles. However, in both groups, the EMG composition ratio of the serratus anterior became much more predominant than that of the pectoralis major. In addition, infraspinatus activated greater than pectoralis major. These results showed that the push-up plus exercise is effective to selectively strengthen the serratus anterior for both individuals with and without winging scapular, but not equally effective for other shoulder stabilizers.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.24 no.2
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• pp.29-36
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• 2018

Background: The purpose of this study was to investigate the effect of leg lift difference on serratus and upper trapezius when exercising in a scapula in a prone position, a typical waist stabilization exercise for subjects with a winged scapula. Method: Twenty normal adults and 20 subjects with winged scapula participated in the experiment. The surface EMG recordings were obtained from external oblique muscle and internal oblique muscle during scapula protraction exercise. The presence or absence of winging of the shoulder bone was measured using an electronic digital caliper for the distance the medial border of the scapula is lifted to the rear. In prostrate pier movement posture in both groups, both legs supporting, dominant leg lifting, and non-dominant leg lifting including the scapula protraction were conducted respectively. Results: In the results of comparison between the two groups, the dominant external oblique muscle and the non-dominant internal oblique muscle tended to increase according to the difference of the leg lifting of normal people. In the winged scapula group, internal oblique muscle showed increased muscle activity more than external oblique muscle. Conclusion: It was most effective to exercise with lifting the same position leg for strengthening the same external oblique muscle, and the opposite internal oblique muscle. Also, it is effective to exercise in prone pier movement posture for trunk stability. In addition, internal oblique muscle shows increased muscle activity in subjects with winged scapula. Therefore, appropriate adjustment of external oblique muscle and internal oblique muscle may have a positive effect on scapula dysfunction for trunk stability.

• Journal of Korean Physical Therapy Science
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• v.31 no.1
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• pp.33-45
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• 2024

Background: This study aimed to investigate the effect of elastic band-resistive exercise using audio-visual medium on pain, proprioception, and motor function in adults with chronic neck and shoulder pain. Design: One group pretest-posttest follow-up experimental design. Method: Twenty adult women with neck and shoulder pain voluntarily participated in this study. Elastic band-resistive exercise using audio-visual medium including cervical flexion and extension, shoulder external rotation, and scapular retraction-protraction motions was conducted 5 times a week for 3 weeks. The Numerical Rating Scale, pressure threshold tool, CROM goniometer, and Image J software were used to assess subjective pain level, tenderness threshold (pain), joint position sense error (proprioception), joint range of motion, and postural alignment (motor function), respectively. Result:: The pain intensity and threshold and joint position sense error showed significant decreases after the intervention, whereas the joint range of motion angle revealed significant increases. The postural alignment including forward head posture and rounded shoulder revealed significant improvements after the intervention. Conclusions: Therefore, we suggest that elastic band-resistive exercise through audio-visual medium would be helpful in preventing and managing pain and physical dysfunction in individuals with chronic neck and shoulder pain, and then it would support the development of health management-related online education content.