Effects of Verbal Cue for Scapular Depression During Scapular Posterior Tilt Exercise on Scapular Muscle Activities and Clavicular Tilt Angle in Subjects With Rounded Shoulder Posture and Upper Trapezius Myofascial Pain원문보기
Background: Scapular posterior tilt (SPT) is important in the prevention of abnormal scapular movement and pain during elevation of the arm. However, previous studies have overlooked increased upper trapezius (UT) muscle activity interrupting the normal force couple of scapular motion and compensati...
Background: Scapular posterior tilt (SPT) is important in the prevention of abnormal scapular movement and pain during elevation of the arm. However, previous studies have overlooked increased upper trapezius (UT) muscle activity interrupting the normal force couple of scapular motion and compensation of levator scapulae (LS) muscle activated simultaneously with UT during SPT exercise. Objects: The purpose of this study was to compare the effects of modified SPT with depression exercise versus SPT exercise on serratus anterior (SA), lower trapezius (LT), UT, and LS muscle activities and the clavicular tilt angle, in subjects with rounded shoulder posture (RSP) and myofascial pain in the UT muscle region. Methods: Eighteen subjects with RSP were recruited and randomly allocated to 2 groups; 9 in the SPT group and 9 in the SPT with depression group. All subjects met the specific RSP criteria and had myofascial pain of UT region. Depending on the allocated group, subjects performed the assigned SPT exercise and EMG data were recorded during the each exercise. Clavicular tilt angle was defined as the angle between the line joining the medial and lateral end of the clavicle and a horizontal line. Results: The SA muscle activity was significantly greater in SPT with depression than with SPT exercise (p<.05). The UT, LS muscle activity and the clavicular tilt angle was significantly lower in SPT with depression than with SPT exercise (p<.05). Conclusion: These findings were insightful because the potential risk of pain from overactivation of the UT and LS was considered, in contrast with SPT exercise. SPT with depression exercise can be implemented as an effective method to facilitate scapular muscle activity for stability and to prevent myofascial pain in the neck and shoulder.
Background: Scapular posterior tilt (SPT) is important in the prevention of abnormal scapular movement and pain during elevation of the arm. However, previous studies have overlooked increased upper trapezius (UT) muscle activity interrupting the normal force couple of scapular motion and compensation of levator scapulae (LS) muscle activated simultaneously with UT during SPT exercise. Objects: The purpose of this study was to compare the effects of modified SPT with depression exercise versus SPT exercise on serratus anterior (SA), lower trapezius (LT), UT, and LS muscle activities and the clavicular tilt angle, in subjects with rounded shoulder posture (RSP) and myofascial pain in the UT muscle region. Methods: Eighteen subjects with RSP were recruited and randomly allocated to 2 groups; 9 in the SPT group and 9 in the SPT with depression group. All subjects met the specific RSP criteria and had myofascial pain of UT region. Depending on the allocated group, subjects performed the assigned SPT exercise and EMG data were recorded during the each exercise. Clavicular tilt angle was defined as the angle between the line joining the medial and lateral end of the clavicle and a horizontal line. Results: The SA muscle activity was significantly greater in SPT with depression than with SPT exercise (p<.05). The UT, LS muscle activity and the clavicular tilt angle was significantly lower in SPT with depression than with SPT exercise (p<.05). Conclusion: These findings were insightful because the potential risk of pain from overactivation of the UT and LS was considered, in contrast with SPT exercise. SPT with depression exercise can be implemented as an effective method to facilitate scapular muscle activity for stability and to prevent myofascial pain in the neck and shoulder.
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문제 정의
For these reasons, the present study introduced a modified SPT with depression exercise to relieve myofascial pain of the UT muscle region. Thus, the purpose of this study was to compare the effects of modified SPT with depression exercise versus SPT exercise on SA, LT, UT, and LS muscle activities and the clavicular tilt angle, in subjects with RSP and myofascial pain in the UT muscle region. It was hypothesized that SPT with depression exercise would increase the SA and LT muscle activity, and decrease the UT and LS muscle activity and clavicular tilt angle, compared with the effect of SPT exercise, in subjects with RSP and myofascial pain in the UT muscle region.
In SPT with depression exercise, SA muscle activity significantly increased, and UT and LS muscle activity and clavicular tilt angle significantly decreased. To our knowledge, this is the first study to compare scapular muscle activities and clavicular tilt angle using modified SPT with depression exercise versus SPT exercise.
가설 설정
Thus, the purpose of this study was to compare the effects of modified SPT with depression exercise versus SPT exercise on SA, LT, UT, and LS muscle activities and the clavicular tilt angle, in subjects with RSP and myofascial pain in the UT muscle region. It was hypothesized that SPT with depression exercise would increase the SA and LT muscle activity, and decrease the UT and LS muscle activity and clavicular tilt angle, compared with the effect of SPT exercise, in subjects with RSP and myofascial pain in the UT muscle region.
제안 방법
, superficial palpation). All measurements were performed on the dominant side used by subjects when eating and writing, and were performed by a physical therapist with 3 years of clinical experience in musculoskeletal treatment.
The purpose of this study was to compare the effects of SPT with depression exercise with SPT exercise on SA, LT, UT, and LS muscle activities and clavicular tilt angle, in subjects with RSP and myofascial pain in the UT region. In SPT with depression exercise, SA muscle activity significantly increased, and UT and LS muscle activity and clavicular tilt angle significantly decreased.
Three inertial measurement sensors were placed on the posterior head, upper thorax, and lumbar spine and calibrated for a value of 0° with the head, trunk, and pelvis in a straight line in the quadruped position. The subjects were then instructed to move the hips backward slowly while keeping the head, trunk, and pelvis in a straight line and looking downward at this time. The sensors provided 3D angular orientation; the examiner continuously monitored whether the subjects maintained a value of 0° (within ±5° error tolerance), and advised the subjects of incorrect position to prevent compensation by thoracolumbar flexion or pelvic posterior tilt.
9° in subjects without scapular abnormality and 4° in subjects with shoulder impingement respectively. These data are different from the present study because this study used 2D photographic analysis and recruited the subjects with RSP. On the other hand, Ha et al.
This study compared the effect of SPT with depression exercise with that of SPT exercise, on SA, LT, UT, and LS muscle activities and clavicular tilt angle, in subjects with RSP and myofascial pain in the UT muscle region. In SPT with depression exercise, SA muscle activity significantly increased, and UT and LS muscle activity and clavicular tilt angle significantly decreased.
대상 데이터
82. This provided the necessary sample size of 12 subjects for this study. From the initial 25 subjects, 7 were eliminated from the study (4 did not met the RSP criteria and 3 had no taut band in UT region).
데이터처리
The Kolmogorov-Smirnov Z-test was used to assess normal distribution. An independent t-test was used to identify the homogeneity of demographic characteristics and to compare SA, LT, UT, and LS muscle activities and clavicular tilt angle between the two groups. Statistical significance was set at .
이론/모형
The Kolmogorov-Smirnov Z-test was used to assess normal distribution. An independent t-test was used to identify the homogeneity of demographic characteristics and to compare SA, LT, UT, and LS muscle activities and clavicular tilt angle between the two groups.
성능/효과
(2002) reported that excessive stiffness of the LS contributes to an increased compressive and shear force on the cervical spine during active neck movement. In this study, addition of a scapular depression phase to scapular upward rotation facilitated scapular depressors and reciprocally inhibited scapular elevators during SPT with depression (significantly increased SA activity versus significantly reduced UT and LS activity). Although variety of SPT exercises were performed in many previous studies (Ebaugh et al, 2005; Ha et al, 2012; Hardwick et al, 2006; Lee et al, 2015), the results only examined the primary muscle of scapular stability such as SA and LT and did not confirm UT and LS so it could not suggest the best method for scapular dyskinesis because the unexpected risk or side-effect of neck and shoulder pain occur.
Future longitudinal studies are necessary to determine the long-term effects of SPT with depression on scapular muscle activities and clavicular position in subjects with RSP and myofascial pain of the UT region. Second, the results could not be generalized to the patient population because healthy young subjects with only one specific RSP criteria, an average grade 2 tenderness score, and an average VAS score of 4 participated. Therefore, a sample population with a broad age range and moderate to severe symptoms should be investigated in future studies.
This result was supported by UT and LS muscle activities in the present study. This study showed that SPT group had greater UT and LS muscle activities and clavicular tilt angle than SPT with depression group. It could mean that the higher UT and LS muscle activities are, the greater clavicular tilt angle occurs.
UT and LS muscle activity was significantly lower during SPT with depression than with SPT exercise (by 31.62% and 41.17%, respectively), supporting the research hypothesis. These findings have clinical implications because during SPT exercise, individuals with RSP would just focus on shoulder elevation without controlling UT and LS muscle activity, resulting in myofascial shoulder pain (Azevedo et al, 2008; Kannan et al, 2012; Olson et al, 2000).
후속연구
Second, the results could not be generalized to the patient population because healthy young subjects with only one specific RSP criteria, an average grade 2 tenderness score, and an average VAS score of 4 participated. Therefore, a sample population with a broad age range and moderate to severe symptoms should be investigated in future studies. Third, this study had relatively low statistical power because it designed experiment of independent two groups so future studies need repeated-measurement design to further differentiate between the two exercise protocols.
Therefore, a sample population with a broad age range and moderate to severe symptoms should be investigated in future studies. Third, this study had relatively low statistical power because it designed experiment of independent two groups so future studies need repeated-measurement design to further differentiate between the two exercise protocols. Finally, the more precise measurement devices such as 3D or real-time measuring system, digital pressure algometry, or ultrasonography will be need to improve measurement errors in future studies.
참고문헌 (45)
Akel I, Pekmezci M, Hayran M, et al. Evaluation of shoulder balance in the normal adolescent population and its correlation with radiological parameters. Eur Spine J. 2008;17(3):348-354.
Arlotta M, LoVasco G, McLean L. Selective recruitment of the lower fibers of the trapezius muscle. J Electromyogr Kinesiol. 2011;21(3):403-410. https://doi.org/10.1016/j.jelekin.2010.11.006
Azevedo DC, de Lima Pires T, de Souza Andrade F, et al. Influence of scapular position on the pressure pain threshold of the upper trapezius muscle region. Eur J Pain. 2008;12(2):226-232.
Cole AK, McGrath ML, Harrington SE, et al. Scapular bracing and alteration of posture and muscle activity in overhead athletes with poor posture. J Athl Train 2013;48(1):12-24. https://doi.org/10.4085/1062-6050-48.1.13
Criswell E. Cram's introduction to surface electromyography. 2nd ed. Sudbury, MA, Jones and Bartlett Publishers. 2010:268-297.
Duyur Cakit B, Genc H, Altuntas V, et al. Disability and related factors in patients with chronic cervical myofascial pain. Clin Rheumatol. 2009;28(6):647-654. https://doi.org/10.1007/s10067-009-1116-0
Dziedzig K, Hill J, Lewis M, et al. Effectiveness of manual therapy or pulsed shortwave diathermy in addition to advice and exercise for neck disorders: a pragmatic randomised controlled trail in physical therapy clinics. Arthritis Rheum 2005;53:214-222.
Ebaugh DD, McClure PW, Karduna AR. Three-dimensional scapulothoracic motion during active and passive arm elevation. Clin Biomech (Bristol, Avon). 2005:20(7):700-709.
Ettinger L, Weiss J, Shapiro M, et al. Normalization to Maximal Voluntary Contraction is Influenced by Subacromial Pain. J Appl Biomech. 2016;32(5):433-440.
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.
Fernandez de las Penas C, Alonso-Blanco C, Miangolarra JC. Myofascial trigger points in subjects presenting with mechanical neck pain: A blinded, controlled study. Man Ther 2006;12:29-33.
Gemmell H, Miller P, Nordstrom H. Immediate effect of ischaemic compression and trigger point pressure release on neck pain and upper trapezius trigger points: A randomised controlled trial. Clin Chiropr. 2008;11(1):30-36.
Ha SM, Kwon OY, Cynn HS, et al. Comparison of electromyographic activity of the lower trapezius and serratus anterior muscle in different arm-lifting scapular posterior tilt exercises. Phys Ther Sport. 2012;13(4):227-232. https://doi.org/10.1016/j.ptsp.2011.11.002
Ha SM, Kwon OY, Weon JH, et al. Reliability and validity of goniometric and photographic measurements of clavicular tilt angle. Man Ther. 2013;18(5):367-371. https://doi.org/10.1016/j.math.2012.12.006
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.
Kannan P. Management of myofascial pain of upper trapezius: A three group comparison study. Glob J Health Sci. 2012;4(5):46-52. https://doi.org/10.5539/gjhs.v4n5p46
Kibler WB, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg. 2003;11(2):142-151.
Kofler M. Functional organization of exteroceptive inhibition following nociceptive electrical fingertip stimulation in humans. Clin Neurophys. 2003;114(6):973-980.
Lee JH, Cynn HS, Choi WJ, et al. Various shrug exercises can change scapular kinematics and scapular rotator muscle activities in subjects with scapular downward rotation syndrome. Hum Mov Sci. 2016;45:119-129. https://doi.org/10.1016/j.humov.2015.11.016
Lee JH, Cynn HS, Yoon TL, et al. The effect of scapular posterior tilt exercise, pectoralis minor stretching, and shoulder brace on scapular alignment and muscles activity in subjects with round-shoulder posture. J Electromyogr Kinesiol. 2015;25(1):107-114. https://doi.org/10.1016/j.jelekin.2014.10.010
Lewis JS, Wright C, Green A. Subacromial impingement syndrome: The effect of changing posture on shoulder range of movement. J Orthop Sports Phys Ther. 2005;35(2):72-87.
McCabe RA, Orishimo KF, McHugh MP, et al Surface electromygraphic analysis of the lower trapezius muscle during exercises performed below ninety degrees of shoulder elevation in healthy subjects. N Am J Sports Phys Ther. 2007;2(1):34-43.
McClure PW, Bialker J, Neff N, et al. Shoulder function and 3-dimensional kinematics in people with shoulder impingement syndrome before and after a 6-week exercise program. Phys Ther 2004;84(9):832-848.
Michener LA, Pidcoe PE, Frith AM. Reliability and validity of scapular muscle strength testing in patients with shoulder pain and functional loss. Med Sci Sport Exer. 2003;35(5):S242.
Moseley JB, 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.
Neumann DA. Kinesiology of the Musculoskeletal System: Foundations for physical rehabilitation. 1st ed. St Louis, Mosby, 2002:114-125.
Oliveira-Campelo NM, de Melo CA, Alburquerque-Sendin F, et al. Short-and medium-term effects of manual therapy on cervical active range of motion and pressure pain sensitivity in latent myofascial pain of the upper trapezius muscle: A randomized controlled trial. J Manipulative Physiol Ther. 2013;36(5):300-309.
Olson SL, O'Connor DP, Birmingham G, et al. Tender point sensitivity, range of motion, and perceived disability in subjects with neck pain. J Orthop Sports Phys Ther. 2000;30(1):13-20.
Page P, Frank CC, Lardner R. Assessment and Treatment of Muscle Imbalance: The janda approach. 1st ed. Champaign, IL, Human Kinetics. 2009:52-55.
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. https://doi.org/10.1016/j.jelekin.2012.11.013
Pontillo M, Orishimo KF, Kremenic IJ, et al. Shoulder musculature activity and stabilization during upper extremity weight-bearing activities. N Am J Sports Phys Ther. 2007;2(2):90-96.
Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndrome. 1st ed. St. Louis, Mosby, 2002:210-227.
Simons DG, Travell JG, Simons LS, et al. Myofascial Pain and Dysfunction: The trigger point manual. 2nd ed. Baltimore, Williams and Wilkins. 1999:285-288.
Smith J, Dahm DL, Kaufman KR, et al. Electromyographic activity in the immobilized shoulder girdle musculature during scapulothoracic exercises. Arch Phys Med Rehabil. 2006;87(7):923-927.
Solem-Bertoft E, Thuomas KA, Westerberg CE. The influence of scapular retraction and protraction on the width of the subacromial space: An MRI study. Clinical Orthopaedics and Related Research. 1993;296:99-103.
Szeto GP, Straker L, Raine S. A field comparison of neck and shoulder postures in symptomatic and asymptomatic office workers. Appl Ergon. 2002;33(1):75-84.
Thigpen CA, Padua DA, Michener LA, et al. Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks. J Electromyogr Kinesiol. 2010;20(4):701-709. https://doi.org/10.1016/j.jelekin.2009.12.003
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