EFFECT OF THREE DIFFERENT SCAPU- LAR POSITIONS ON ISOMETRIC STRENGTH AND MUSCLE ACTIVITY RA- TIO OF SERRATUS ANTERIOR IN SUB- JECTS WITH SCAPULAR WINGING
DOI:
https://doi.org/10.61841/sefp0e13Keywords:
Electromyography, Scapular winging, Serratus anterior, strengthening exerciseAbstract
The purpose of this study was to compare the isometric strength of serratus anterior at three different scapular positions (retracted, neutral and protracted) and electromyography activity ratio of upper tra- pezius to serratus anterior and upper trapezius to lower trapezius during isometric arm elevation between the subjects with and without scapular winging. Thirty-three subjects with scapular winging and thirty-three subjects without scapular winging were recruited for this study. This study showed that isometric strength of serratus ante- rior was significant decreased in subjects with scapular winging group than without scapular winging group (p<.05). In both of subjects with and without scapular winging groups, isometric strength of serratus anterior showed significant difference at scapular positions (p<.05). Isometric strength of serratus anterior was strongest in retracted scapular position (p<.05). Electromyography activity ratio of upper trapezius / serratus anterior was significantly higher in subjects with scapular winging than subjects without scapular winging (p<.05). Based on these findings in this study, the isometric strength of serratus anterior in retracted scapular position was strongest in both of subjects with and without scapular winging group. The higher upper trapezius/serratus anterior of elec- tromyography activity ratio in subjects with scapular winging than in subjects without scapular winging implies that upper trapezius muscle is used more dominantly among scapular upward rotators during shoulder elevation in subjects with scapular winging
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1. Bech KT, Larsen CM, Sjogaard G, Holtermann A, Taylor JL, Sogaard K. Voluntary activation of the trapezius muscle in cases with neck/shoulder pain compared to healthy controls. J Electromyogr Kinesiol. 2017;36:56- 64.
2. Borstad JD, Ludewig PM. Comparison of scapular kinematics between elevation and lowering of the arm in the scapular plane. Clin Biomech (Bristol, Avon). 2002;17(9-10):650-659.
3. Contemori S, Panichi R, Biscarini A. Effects of scapular retraction/protraction position and scapular elevation on shoulder girdle muscle activity during glenohumeral abduction. Hum Mov Sci. 2019;64:55-66.
4. Cools A, Declercq G, Cambier D, Mahieu N, Witvrouw E. Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms. Scand J Med Sci Sports. 2007;17(1):25-33.
5. Cools AM, Witvrouw EE, De Clercq GA, Danneels LA, Willems TM, Cambier DC, et al. Scapular muscle recruitment pattern: electromyographic response of the trapezius muscle to sudden shoulder movement before and after a fatiguing exercise. J Orthop Sports Phys Ther. 2002;32(5):221-229.
6. Cools AM, Witvrouw EE, Declercq GA, Danneels LA, Cambier DC. Scapular muscle recruitment patterns: trapezius muscle latency with and without impingement symptoms. Am J Sports Med. 2003;31(4):542-549.
7. Cools J, Mentens N, Furet P, Fabbro D, Clark JJ, Griffin JD, et al. Prediction of resistance to small molecule FLT3 inhibitors: implications for molecularly targeted therapy of acute leukemia. Cancer Res. 2004;64(18):6385-6389.
8. Cram JR. Introduction to surface electromyography: Aspen publishers; 1998.
9. Decker MJ, Hintermeister RA, Faber KJ, Hawkins RJ. Serratus anterior muscle activity during selected rehabilitation exercises. Am J Sports Med. 1999;27(6):784-791.
10. Ekstrom RA, Soderberg GL, Donatelli RA. Normalization procedures using maximum voluntary isometric contractions for the serratus anterior and trapezius muscles during surface EMG analysis. J Electromyogr Kinesiol. 2005;15(4):418-428.
11. Ellenbecker TS, Sueyoshi T, Bailie DS. Muscular activation during plyometric exercises in 90 degrees of glenohumeral joint abduction. Sports Health. 2015;7(1):75-79.
12. Garner BA, Shim J. Isometric shoulder girdle strength of healthy young adults. Clin Biomech (Bristol, Avon).
2008;23(1):30-37.
13. Hall Carrie M, Thein Brody L. Therapeutic exercise, Moving toward Function. A Wolters Kluwer Company Lippincott Williams & Wilkim. 2005;31:255-263.
14. Hamano T, Mutoh T, Hirayama M, Uematsu H, Higuchi I, Koga H, et al. Winged scapula in patients with myotonic dystrophy type 1. Neuromuscul Disord. 2012;22(8):755-758.
15. Huang H-Y, Lin J-J, Guo YL, Wang WT-J, Chen Y-J. EMG biofeedback effectiveness to alter muscle activity pattern and scapular kinematics in subjects with and without shoulder impingement. J Electromyogr Kinesiol. 2013;23(1):267-274.
16. Johnson G, Bogduk N, Nowitzke A, House D. Anatomy and actions of the trapezius muscle. Clin Biomech
(Bristol, Avon). 1994;9(1):44-50.
17. Jonkers I, Stewart C, Desloovere K, Molenaers G, De Borre L, Spaepen A, editors. Relating knee kinematics, muscle lengthening profiles and spasticity level of the rectus femoris in children with cerebral palsy. International meeting of the European Society for Movement Analysis in Adults and Children, Date: 2003/09/11-2003/09/13, Location: Marseille; 2003.
18. Kang FJ, Ou HL, Lin KY, Lin JJ. Serratus Anterior and Upper Trapezius Electromyographic Analysis of the Push-Up Plus Exercise: A Systematic Review and Meta-Analysis. J Athl Train. 2019;54(11):1156-1164.
19. Kibler WB, Wilkes T, Sciascia A. Mechanics and pathomechanics in the overhead athlete. Clin Sports Med.
2013;32(4):637-651.
20. Kisner C, Colby LA, Borstad J. Therapeutic exercise: foundations and techniques: Fa Davis; 2017.
21. Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther. 2000;80(3):276-291.
22. Ludewig PM, Hoff MS, Osowski EE, Meschke SA, Rundquist PJ. Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises. Am J Sports Med. 2004;32(2):484-493.
23. Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther. 2009;39(2):90-104.
24. Martin RM, Fish DE. Scapular winging: anatomical review, diagnosis, and treatments. Curr Rev Musculoskelet Med. 2008;1(1):1-11.
25. Martins J, Tucci HT, Andrade R, Araujo RC, Bevilaqua-Grossi D, Oliveira AS. Electromyographic amplitude ratio of serratus anterior and upper trapezius muscles during modified push-ups and bench press exercises. J Strength Cond Res. 2008;22(2):477-484.
26. Moon S-J, Kim T-H, Roh J-S. A comparison of the serratus anterior muscle activity according to the shoulder flexion angles in a closed kinetic chain exercise and an open kinetic chain exercise. J the Kor Soc Phys Med. 2013;8(3):369-378.
27. Mottram SL. Dynamic stability of the scapula. Man Ther. 1997;2(3):123-131.
28. Mueller AM, Entezari V, Rosso C, McKenzie B, Hasebrock A, Cereatti A, et al. The effect of simulated scapular winging on glenohumeral joint translations. J Shoulder Elbow Surg. 2013;22(7):986-992.
29. Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM. Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med.
2006;34(3):385-391.
30. Page P, Frank C, Lardner R. Assessment and treatment of muscle imbalance: the Janda approach. J Orthop Sports Phys Ther. 2011;41(10):799-800.
31. Pirauá ALT, Pitangui ACR, Silva JP, dos Passos MHP, de Oliveira VMA, Batista LdSP, et al.
Electromyographic analysis of the serratus anterior and trapezius muscles during push-ups on stable and unstable bases in subjects with scapular dyskinesis. J Electromyogr Kinesiol. 2014;24(5):675-681.
32. Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: mosby; 2002.
33. Smith J, Kotajarvi BR, Padgett DJ, Eischen JJ. Effect of scapular protraction and retraction on isometric shoulder elevation strength. Arch Phys Med Rehabil. 2002;83(3):367-370.
34. Wang SS, Normile SO, Lawshe BT. Reliability and smallest detectable change determination for serratus anterior muscle strength and endurance tests. Physiother Theory Pract. 2006;22(1):33-42.
35. Weon J-H, Kwon O-Y, Cynn H-S, Lee W-H, Kim T-H, Yi C-H. Real-time visual feedback can be used to activate scapular upward rotators in people with scapular winging: an experimental study. J Physiother. 2011;57(2):101-107.
36. Wiater JM, Flatow EL. Long thoracic nerve injury. Clin Orthop Relat Res. 1999(368):17-27.
37. Wilk KE, Meister K, Andrews JR. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports Med. 2002;30(1):136-151.
38. Yano Y, Hamada J, Tamai K, Yoshizaki K, Sahara R, Fujiwara T, et al. Different scapular kinematics in healthy subjects during arm elevation and lowering: glenohumeral and scapulothoracic patterns. J Shoulder Elbow Surg. 2010;19(2):209-215.
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