• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.27 no.1
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• pp.13-20
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• 2021

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

• Physical Therapy Korea
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• v.26 no.4
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• pp.29-34
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• 2019

Background: The serratus anterior is one of the most important muscle for maintaining good scapular alignment in the shoulder joint. The pectoralis major and upper trapezius may also compensate for weak serratus anterior muscles. The push-up plus exercise has been identified as the optimal exercise for maximum activation of the serratus anterior. Objects: The purpose of this study was to examine differences in surface electromyography (EMG) activity of upper trapezius, pectoralis major, and serratus anterior muscles during push-up plus exercises on variously angled surfaces in subjects with winged scapula. Methods: Sixteen subjects with winged scapula (male=5, female=11) volunteered for this study. The subjects performed push-up plus exercise on four different tilt angles, namely $0^{\circ}$, $30^{\circ}$, $60^{\circ}$, and $90^{\circ}$. EMG activities in the serratus anterior, upper trapezius, and pectoralis major muscles during performance of push-up plus exercise were measured in all subjects. Data were processed from repeated measures one-way analysis of variance. Results: There was significant difference in the muscle activity of the serratus anterior on the different surface angles (p<.05). The results of the post-hoc analysis showed significantly greater serratus anterior muscle activity on a surface at a $0^{\circ}$ angle than at others tilt angles (p<.05). There was also significant difference in the ratio of serratus anterior to upper trapezius and serratus anterior to pectoralis major across the four surfaces (p<.05), and post-hoc analysis showed significantly greater values on the $0^{\circ}$ surface than on other tilts (p<.05). Conclusion: This study found that performing push-up plus exercises on a flat surface with $0^{\circ}$ and $30^{\circ}$ tilt angle achieves high activation of the serratus anterior muscle for selective strengthening. It can also take into account the sequential application, which is first performed at a $30^{\circ}$ and at a $0^{\circ}$ tilt angle for and effective but not excessive muscle activation.

• Journal of International Academy of Physical Therapy Research
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• v.11 no.1
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• pp.1975-1980
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• 2020

Background: It has been argued that changes in muscle activity in the upper trapezius and serratus anterior may or may not cause shoulder joint pain and dysfunction. Objective: To investigate the effects of active vibration exercise on muscle activity regarding scapular stabilization using a flexi-bar. Design: A randomized controlled trial. Methods: A total of 24 subjects were randomly assigned to a flexi-bar group with active vibration and general stick group with non-active vibration. Both groups performed the same four action programs for 6 weeks, three times a week for 30 minutes at a time. The upper trapezius muscle, middle trapezius muscle, lower trapezius muscle and serratus anterior muscle of the dominant side was measured by electromyography before and after the 6 weeks of exercise. The independent t-test and paired t-test were used to analyze data. Results: There was a significant difference between groups in upper trapezius muscle and serratus anterior muscle activity after exercise (P<.05). Also, there was a significant difference in upper trapezius muscle and serratus anterior muscle activity before and after exercise in the flexi-bar group (P<.05). Conclusion: This study demonstrates that active vibration exercise using a flexi-Bar contribute to reduce the activity of the upper trapezius muscle and promote the activity of the serratus anterior muscle.

• Journal of The Korean Society of Integrative Medicine
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• v.4 no.2
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• pp.29-36
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• 2016

Purpose : The purpose of this study was to find out the effects on muscle activations of serratus anterior and upper trapezius muscles when push-up plus exercise togu applied differently depending on the body part. Method : Thirty six volunteers took part in this study and we divided into three groups(upper arm togu group 12, leg togu group 12, upper arm-leg togu group 12). Each experimental group performed push-up plus exercise. All volunteers received a total of 18 exercise session over a 6 week period (three times per week). Exercise program was composed of serratus anterior and upper trapezius push-up plus exercise. Then we measured muscle activation of scapular stabilizer by electromyography. Repeated ANOVA was used to examine the effects of the intervention on each outcome measure. Result : After the six week intervention, there was a significant difference between the pre and 6 week in serratus anterior and upper trapezius muscle activity(p<0.05). After the six week intervention, there was a significant difference among the three group in serratus anterior muscle activity but no significant difference in upper trapezius muscle activity(p>.05). Conclusion : Serratus anterior and upper trapezius showed high muscle activity during push-up plus exercise. Therefore have a positive impact of scapular stabilizer. The larger the area of the unstable support surface, the larger muscle activity was larger of variation quantity.

• Journal of The Korean Society of Integrative Medicine
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• v.7 no.2
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• pp.39-47
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• 2019

Purpose : This study was investigated effects of vibration on scapular winging of knee push-up plus exercise. Methods : Twenty-eight female subjects with scapular winging were evaluated after performing knee push-up plus exercise, with or without vibration, three times a week for four weeks. Muscle activation of the serratus anterior and upper trapezius, and the ratio of activation of the upper trapezius to serratus anterior were measured using surface EMG; and scapular winging length was measured by using the caliper. Results : The findings showed that knee push-up plus exercise -with and without- vibration induced a significant increase in muscle activation of serratus anterior (p<.05) and a significant decrease in muscle activation of the upper trapezius (p<.05), the ratio of muscle activation of the upper trapezius to the serratus anterior (p<.05) and scapular winging length (p<.05). There was also a significant difference in muscle activation of the serratus anterior (p<.05) and upper trapezius (p<.05) between control and experimental group at post-test. Conclusion : This study suggests positive clinical effects of knee push-up plus exercise with vibration which enhanced muscle activation of serratus anterior and reduced muscle activation of upper trapezius in person with scapular winging. However, vibration had no effectiveness to improve muscle imbalance between serratus anterior and upper trapezius, and reduce the scapular winging length.

• PNF and Movement
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• v.19 no.2
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• pp.269-278
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• 2021

Purpose: This study aimed to investigate effective cueing methods for selective muscle activation of the serratus anterior. Methods: Based on the inclusion criteria, 26 healthy adults, both males and females, were recruited for the measurement of muscle activation of the upper trapezius and serratus anterior muscles while performing basic movements in knee push-up plus (KPP) and dynamic hug (DH) positions using five different cueing methods. An electromyogram was used to measure muscle activation, and both muscle activation and muscle ratio (serratus anterior/upper trapezius) were compared during the basic movements and different cueing methods. The cueing methods were trapezius verbal cueing, trapezius verbal cueing + trapezius tactile cueing, emphasis verbal cueing, serratus anterior tactile cueing, and trapezius verbal cueing + trapezius tactile cueing + serratus anterior tactile cueing. Results: The results of the study showed that there was a significant difference in the muscles for the two exercises (p < 0.05). There was also a significant difference between the cueing methods (p < 0.05). The correlative effect between the muscles and cueing methods was also significant (p < 0.05). The muscle ratio in trapezius verbal cueing + trapezius tactile cueing + serratus anterior tactile cueing during KPP and DH was higher than in basic movements and other cueing methods. This confirms that trapezius verbal cueing + trapezius tactile cueing + serratus anterior tactile cueing is an effective cueing method for selective activation of the serratus anterior during KPP and DH. This study also demonstrated that cueing by a therapist may both increase and decrease selective muscle activation. Conclusion: Through this study, an effective cueing method to selectively activate the serratus anterior may be suggested, and the results of this study may provide basic information regarding future studies and clinical practice.

• 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.

• Physical Therapy Korea
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• v.17 no.4
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• pp.8-15
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• 2010

This study was designed to investigate the effect of different hand positions on scapulothorcic muscle activities during push-up plus exercises. Fourteen healthy males performed push-up plus exercises under three conditions (neutral, $90^{\circ}$ internally rotated, and $90^{\circ}$ externally rotated hand positions), during which the activities of the serratus anterior, pectoralis major, and upper trapezius muscles were recorded using surface electromyography. The statistical significance at three different hand positions was tested by repeated one-way ANOVA. The mean activities of the serratus anterior increased and the mean activities of the pectoralis major decreased in the order of neutral hand position, internally rotated hand position, and externally rotated hand position. There was a significant difference during push-up plus between neutral and externally rotated hand positions as well as in the serratus anterior/pectoralis major activity ratio (p<.0.5). However, no significant differences were found in the activity of the upper trapezius muscle or the serratus anterior/upper trapezius activity ratio. We suggest that the push-up plus exercise performed in the externally rotated hand position could a beneficial strategy for selective strengthening of the serratus anterior muscle, while minimizing the activity of the pectoralis major muscle.

• Physical Therapy Korea
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• v.18 no.1
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• pp.1-8
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• 2011

Push-up plus has been advocated for increasing the activity of the serratus anterior muscle, the most critical scapular stabilizer. However, no previous study has reported the possibility of compensatory motion on the part of the pectoralis major, which could substitute for the action of the serratus anterior during push-up plus. The aim of the current study was to investigate the immediate effect of electromyography (EMG) biofeedback of the pectoralis major muscle on the pectoralis major, upper trapezius, and serratus anterior muscles during push-up plus. Fourteen healthy young subjects voluntarily participated in this study; each subject performed push-up plus from the quadruped position, in two conditions (i.e., with or without visual and auditory biofeedback). Surface EMG was used to measure pectoralis major, serratus anterior, and upper trapezius activity. A paired t-test was used to determine any statistically significant difference between the two conditions. Additionally, effect size was calculated to quantify the magnitude of EMG biofeedback in each muscle. Visual and auditory feedback reduced pectoralis major muscle activity significantly (p=.000) and increased the serratus anterior muscle activity significantly (p=.002), but did not induce a significant difference in upper trapezius muscle activity (p=.881). Thus, it is concluded that the visual and auditory feedback of pectoralis major muscle activity can be used to facilitate serratus anterior muscle activity during push-up plus.

• The Journal of Korean Physical Therapy
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• v.32 no.3
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• pp.157-162
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• 2020

Purpose: This study was to evaluate several tasks performed at a high intensity in terms of their ability to elicit EMG activity in the serratus anterior by comparing the EMG activities of the serratus anterior, upper trapezius, and lower trapezius muscles during six tasks combined shoulder flexion with rotation. Methods: Fifteen healthy males were recruited to this study. Each subject was instructed to assume a sitting position without back support and asked to flex (90° or 120°) the right shoulder and protract the scapula in the sagittal plane with maximal external rotation; to assume a neutral position; or to internally rotate the glenohumeral joint. The EMG data were collected from the serratus anterior (SA), upper trapezius (UT), and lower trapezius (LT) muscles were normalized to maximum voluntary isometric contraction. The UT/LT and UT/SA muscle activity ratios in each task were assessed by calculating the surface EMG. Data were analyzed by two-way repeated-measures analysis of variance, with the level of significance set at p<0.05. Results: The results of this study, shoulder flexion with external rotation resulted in low upper trapezius/serratus anterior and upper trapezius/lower trapezius ratios and a relatively high level of serratus anterior activation. Conclusion: Shoulder flexion with external rotation used herein may be considered as important for clinical interventions aimed at selectively increasing SA strengthen and clinical selection of exercises for improving glenohumeral joint and scapulothoracic control.