[논문]Comparison of the Effects of Closed Kinetic Chain Exercise and Open Kinetic Chain Exercise According to the Shoulder Flexion Angle on Muscle Activation of Serratus Anterior and Upper Trapezius Muscles During Scapular Protraction

Park, Ju-jung; Chon, Seung-chul

doi:10.12674/ptk.2017.24.4.011

Comparison of the Effects of Closed Kinetic Chain Exercise and Open Kinetic Chain Exercise According to the Shoulder Flexion Angle on Muscle Activation of Serratus Anterior and Upper Trapezius Muscles During Scapular Protraction 원문보기

한국전문물리치료학회지 = Physical Therapy Korea, v.24 no.4, 2017년, pp.11 - 19

Park, Ju-jung (Dept. of Physical Therapy, Jaseng Korean Medicine Hospital) , Chon, Seung-chul (Dept. of Physical Therapy, College of Medical Science, Konyang University)

Abstract ▼ AI-Helper

Background: Methods for exercising serratus anterior (SA) and upper trapezius (UT) muscles are important for the recovery of patients with various shoulder disorders, yet the efficacy of closed or open kinetic chain exercises have not yet been evaluated. Objects: The purpose of this study was to compare the activation of the SA and UT muscles during scapular protraction considering both closed and open kinetic chain exercises. Methods: Thirty subjects were randomly divided into experimental groups (closed kinetic chain exercise) and control groups (open kinetic chain exercise) in which scapular protraction was performed at $90^{\circ}$ or $125^{\circ}$ shoulder flexion. Electromyographic activity data were collected from the SA and UT muscles per position and exercise method. Results: Separate mixed 2-way analysis of variance showed significant differences in the activation of the SA (F1,28=6.447, p=.017) and the UT (F1,28=35.450, p=.001) muscles between the groups at $90^{\circ}$ and $125^{\circ}$ shoulder flexion. Also, the SA/UT ratio measures at $90^{\circ}$ and $125^{\circ}$ shoulder flexion significantly differed between the groups (F1,28=15.457, p=.001). That is, the closed chain exercise was more effective than open chain exercise for strengthening the SA muscle and controlling the UT muscle, $125^{\circ}$ of shoulder joint was more effective than $90^{\circ}$. Conclusion: The findings suggest that scapular protraction with shoulder $125^{\circ}$ flexion at the closed kinetic chain exercise may be more effective in increasing SA muscle activation and decreasing UT muscle activation as well as increasing the SA/UT ratio than open kinetic chain exercise.

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문제 정의

The purpose of this study was to investigate effective exercise methods for selective strengthening of the shoulder and surrounding scapular muscles in musculoskeletal disorders, which are often encountered during rehabilitation for patients with shoulder joint problems. This study was not a pushing condition in weight bearing of prone position, but a pushing against the wall in standing position, and also, the closed chain exercise was more effective than open chain exercise for strengthening the SA muscle and controlling the UT muscle, 125° of shoulder joint was more effective than 90°.
Although there is a question about selective SA strengthening exercises that can solve the problem of the simultaneous increase in muscle activity of the SA and the antagonistic muscles, studies on the difference between closed kinetic chain exercise and open kinetic chain exercise seem to be insufficient. The purpose of this study was to investigate the difference between closed kinetic chain exercise and open kinetic chain exercise methods and the effect of the shoulder joint flexion angle on the muscle activity of the SA and UT in scapular protraction exercises.

제안 방법

The limitations of this study are as follows. First, there is a small problem that this study did not resolve uncontrolled scapular movement such as arm sway and different speed for the scapular protraction, and anthropometric part of subjects for the more precise measurement. Second, we did not control the motion by using a quantitative motion analyzer.
In this study, based on the universality and availability of shoulder forward flexion angle, 90° and 125° of shoulder flexion were respectively selected for performing scapular protraction in standing posture.
In this study, we measured the muscle activity of the SA and UT using surface electromyography (EMG) (Telemyo 2400T, Noraxon Inc., Scottsdale, AZ, USA). Before adhering the surface electrodes, hair was removed with a razor and disinfected with alcohol.
The subject was placed in a standing posture with a shoulder flexion of 90°, and the palm was placed on the wall with the elbow joint fully extended. The subject was instructed to push the wall with the hand, leaning back to avoid flexion of the elbow joint, and scapular protraction was carried out with the scapula facing forward. The subject faced the wall and flexed the shoulder by 125° in a standing posture, and the elbow joint was fully extended so that the palm was leaned against the wall.
The subject faced the wall and flexed the shoulder by 125° in a standing posture, and the elbow joint was fully extended so that the palm was leaned against the wall. The subject was instructed to push with the palm and lean to avoid flexion of the elbow joint, and scapular protraction was carried out with the scapula facing forward (Figure 1).
The subjects actively flexed the shoulder joint at the end of the 90° and 125° ranges of motion, and they were verbally instructed so that they could assume the correct postures.
Consent form was obtained and the subjects voluntarily participated in the experiment, the University Institutional Review Board approved the study (approval number: 2017-053). The subjects were randomly divided into two groups, the experimental group and the control group. Subjects were included if they had (1) no pain in the shoulder and neck, (2) no restrictions in the range of motion of both shoulder joints, (3) less than 6 hours of upper limb muscle movement in the last week, (4) no abnormality in upper extremity sensation, (5) and no open wounds that would interfere with electrode attachment.
In the standing posture involving partial compression and resistance seem to be highly realistic. Therefore, measures in standing position were selected and applied for the scapular protraction exercise in this study.
This study was conducted with 30 adults who agreed to the experiment with a sufficient explanation about the purpose and methods of the study. Consent form was obtained and the subjects voluntarily participated in the experiment, the University Institutional Review Board approved the study (approval number: 2017-053).

대상 데이터

The subject was placed in a standing posture with a shoulder flexion of 90°, and the palm was placed on the wall with the elbow joint fully extended.

데이터처리

The age, height, and body weight of the subjects were independent-t tests. In order to compare the muscle activity of the SA and UT in the closed kinetic chain exercise (experimental group) and the open kinetic chain exercise (control group) with the shoulder at 90° and 125° angles, two-way analysis of variance was used, and a Bonferroni test was performed in a post-analysis when the individual effect was significant.

이론/모형

Kim et al (2008) measured the position of electrodes on the SA and UT muscles using data from Criswell (2010). Therefore, in this study, the positions of the electrodes for surface EMG were determined by referring to the measurement methods of Criswell (2010) and Moseley et al (1992). In previous studies similar to this study, surface EMG was used to measure muscle activity in the SA and UT.

성능/효과

It was found that 125° increases activity more than 90° in closed kinetic chain exercise. And also, it was confirmed that the SA muscle was relatively increased with decreasing UT muscle at the scapular protraction from the ratio of SA/UT results.
As a result of this study, it was found that the closed kinetic chain exercise method increased the muscle activity of the SA and decreased the muscle activity of the UT in comparison to the open kinetic chain exercise method. When the shoulder flexion angles were 90° and 125°, the muscle activity of the SA was increased by 19% and 20%, respectively, and the muscle activity of the UT was decreased by 37% and 69%, respectively.
As a result, it has been discovered that the closed chain movement method is more effective than the open chain method, and the muscular activity of the SA increases at 125° (an angle greater than 90°).
The results of this study show that in the shoulder joint at 90° and 125° of flexion, the ratio of SA to UT activity in closed kinetic chain exercise was significantly higher than that of the open chain method (Table 3).
This study was not a pushing condition in weight bearing of prone position, but a pushing against the wall in standing position, and also, the closed chain exercise was more effective than open chain exercise for strengthening the SA muscle and controlling the UT muscle, 125° of shoulder joint was more effective than 90°.

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