[논문]Changes in Muscle Activity of the Serratus Anterior According to Surface Tilt Angle During Push-up Plus Exercise in Subjects With Winged Scapula

Gu, Qian; Kim, Tae-ho; Chun, Jung-genn

doi:10.12674/ptk.2019.26.4.029

Changes in Muscle Activity of the Serratus Anterior According to Surface Tilt Angle During Push-up Plus Exercise in Subjects With Winged Scapula 원문보기

한국전문물리치료학회지 = Physical Therapy Korea, v.26 no.4, 2019년, pp.29 - 34

Gu, Qian (Dept. of Rehabilitation Medicine, Affiliated Hospital of Nantong University) , Kim, Tae-ho (Dept. of Physical Therapy, Daegu University) , Chun, Jung-genn (Dept. of Physical Therapy, Daegu University)

Abstract ▼ AI-Helper

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.

주제어

AI 본문요약
AI-Helper

* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.

문제 정의

The pectoralis major acts as a synergist muscle, compensating for a weak serratus anterior (Park et al, 2014). In this study, subjects with winged scapula were asked to avoid excessive exercise while participating to familiarized themselves according to surface tilt angles. As a result, although activity of the pectoralis major increased as the surface angle decreased, this was not significant, and since the serratus anterior activity increased substantially at the same time, the ratio of serratus anterior to pectoralis major was significantly different.
The purpose of this study was, therefore, to examine differences in activity of these three muscles as well as the ratio of serratus anterior to upper trapezius and serratus anterior to pectoralis major during push-up plus exercises on variously angled surfaces. This study aims to suggest an appropriate surface tilt angle that does not overload patients with shoulder joint dysfunction that require selective activation of serratus anterior.

제안 방법

The subjects performed push-up plus exercises on four different tilt angles, namely 0˚, 30˚, 60˚, and 90˚. As a starting position, the subjects placed their hands and feet shoulder width apart, placed their head, trunk, and hips in a straight line, pushed their hands toward the surface, and maintained this position for five seconds (Figure 1). The examiner instructed with verbal command that “push your hands in push-up posture as for as possible from the ground, hold for 5 seconds.
Repeated measures one-way analysis of variance was used to compare differences in the muscle activity of the upper trapezius, pectoralis major, and serratus anterior muscles during the push-up plus exercises on the four different tilt angles. Post-hoc analysis was performed by Bonferroni test, and all statistical analyses were conducted using SPSS ver.
Muscle activity was measured using wireless EMG, and electrodes were attached to the muscle belly of the serratus anterior (on the midaxillary line of the right fifth rib) and upper trapezius (in the region of trapezius insertion at the midpoint between the C7 spinous process and the right acromioclavicular joint) and approximately 2 ㎝ out from the axillary fold of the pectoralis major (Cram et al, 1998). The average of a root-mean-square (moving window 250 ㎳) values in the EMG data were calculated to quantify the amplitude of the signals using middle three of the five seconds recorded for each of the three muscles, excluding the initial and final seconds during push-up plus exercises. MyoResearch XP Master (version 1.
The purpose of this study was to examine differences in activity of the upper trapezius, pectoralis major, and serratus anterior muscles during push-up plus exercises with changes to the surface angle. Piraua and colleagues (2014) recommended that if the goal of an exercise program is to strengthen the serratus anterior, push-up exercise have been suggested on a flat surface.
However, changes to serratus anteior, upper trapezius, and pectoralis major activity during push-up plus exercise because of different surface tilt angles are unclear. The purpose of this study was, therefore, to examine differences in activity of these three muscles as well as the ratio of serratus anterior to upper trapezius and serratus anterior to pectoralis major during push-up plus exercises on variously angled surfaces. This study aims to suggest an appropriate surface tilt angle that does not overload patients with shoulder joint dysfunction that require selective activation of serratus anterior.
The subjects performed push-up plus exercises on four different tilt angles, namely 0˚, 30˚, 60˚, and 90˚. As a starting position, the subjects placed their hands and feet shoulder width apart, placed their head, trunk, and hips in a straight line, pushed their hands toward the surface, and maintained this position for five seconds (Figure 1).
Therefore, the results of the present study could be explained by weight bearing and gravity. This study demonstrated high activation of the serratus anterior muscle at a 0˚ surface tilt angle during push-up plus exercises, and this result agrees with those of previous studies recommending this exercise for winged scapula (Lear and Gross, 1998).

대상 데이터

This study was conducted with 16 subjects who have winged scapula attending university students in Gyeongsan, Korea. The mean characteristics of the participants were age of 23.

데이터처리

Repeated measures one-way analysis of variance was used to compare differences in the muscle activity of the upper trapezius, pectoralis major, and serratus anterior muscles during the push-up plus exercises on the four different tilt angles. Post-hoc analysis was performed by Bonferroni test, and all statistical analyses were conducted using SPSS ver. 22.0 for Windows (IBM corp., Armonk, NY, USA). Statistical significance was set at p＜.

성능/효과

The muscle activity of the serratus anterior in this study was significantly increased according to a decline of the surface tilt; at 0˚ and 30˚, muscle activity was higher than at 60˚ and 90˚ tilt angles. Ludewig and colleagues (2004) explain that serratus anterior activity increases by more than 20%MVIC because upward rotation of the scapula should be maintained during exercise against gravity (Ludewig et al, 2004).
This study found that performing push-up plus exercises on a flat surface with 0˚ and 30˚ tilt angle achieves high activation of the serratus anterior muscle for selective strengthening. It is therefore recommended that push-up plus exercises on such surfaces are regarded as the best choice for addressing weakness of the serratus anterior muscle and winged scapula.

후속연구

The limitations of this study should be noted. First, only four measuring angles were used and this could be increased for future research. Second, muscles other than the upper trapezius, pectoralis major, and serratus anterior also contribute to the control of the scapula, but they were not considered in this study.
Second, muscles other than the upper trapezius, pectoralis major, and serratus anterior also contribute to the control of the scapula, but they were not considered in this study. Future studies may wish to consider additional muscle groups, larger subject samples with a larger age range, and a broader sample of clinical patients.

참고문헌 (17)

Choi WJ, Yoon TL, Choi SA, et al. Different weight bearing push-up plus exercises with and without isometric horizontal abduction in subjects with scapular winging: A randomized trial. J BodyW Mov Ther. 2017;21(3):582-588. http://doi.org/10.1016/j.jbmt.2016.08.018

상세보기
Cram JR, Kasman GS, Holtz J. Introduction to surface electromyography. NY, USA, Aspen Publishers, 1998.
Decker MJ, Hintermeister RA, Faber KJ, et al. Serratus anterior muscle activity during selected rehabilitation exercises. Am J Sports Med. 1999;27(6):784-791

상세보기
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. http://doi.org/10.1016/j.clinbiomech.2005.03.008

상세보기
Kim BG, Gong, WT, Lee SY. The effect of push-up plus exercise with visual biofeedback on the activity of shoulder stabilizer muscles for winged scapula. J Phys Ther Sci. 2010:22(4):355-358. http://doi.org/10.1589/jpts.22.355

상세보기
Kim TH, Park HK. The comparison for serratus anterior muscle activity during protraction in open chain and closed chain exercises in healthy adults. J KEMA. 2018;2(1):1-5.
Labriola JE, Lee TQ, Debski RE, et al. Stability and instability of the glenohumeral joint: the role of shoulder muscles. J Shoulder Elbow Surg. 2005;14(1 Suppl S):32S-38S.

상세보기
Lawrence RL, Braman JP, Laprade RF, et al. Comparison of 3-dimensional shoulder complexkinematics in individuals with and without shoulder pain, part 1: Sternoclavicular, acromioclavicular, and scapulothoracic joint. J Orthop Sports Phys Ther. 2014;44(9):636-645. http://doi.org/10.2519/jospt.2014.5339

상세보기
Lear LJ, Gross MT. An electromyographical analysis of the scapular stabilizing synergists during a push-up progression. J Orthop Sports Phys Ther. 1998;28(3):146-157. http://doi.org/10.2519.jospt.1998.28.3.146

상세보기
Ludewig PM, Hoff MS, Osowski EE, et al. Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises. Am J Sports Med. 2004:32(2):484-493. http://doi.org/10.1177/0363546503258911

상세보기
Ludewig PM, Phadke V, Braman JP, et al. Motion of the shoulder complex during multiplanar humeral elevation. J Bone Joint Surg Am. 2009;91(2):378-389. http://doi.org/10.2106/JBJS.G.01483

상세보기
McClure PW, Michener LA, Sennett BJ, et al. Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elbow Surg. 2001;10(3):269-277. http://doi.org/10.1067/mse.2001.112954

상세보기
Madeleine P, Mathiassen SE, Arendt-Nielsen L. Changes in the degree of motor variability associated with experimental and chronic neck-shoulder pain during a standardised repetitive arm movement. Exp Brain Res. 2008;185(4):689-698. http://doi.org/10.1007/s00221-007-1199-2

상세보기
Park KM, Cynn HS, Kwon OY, et al. Comparison of pectoralis major and serratus anterior muscle activities during different push-up plus exercises in subjects with and without scapular winging. J Strength Cond Res. 2014;28(9):2546-2551. http://doi.org/10.1519/JSC.0000000000000443

상세보기
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. http://doi.org/10.1016/j.jelekin.2012.11.013

상세보기
Piraua AL, Pitangui AC, Silva JP, 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. http://doi.org/10.1016/j.jelekin.2014.05.009

상세보기
Weon JH, Kwon OY, Cynn HS, et al. 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. http://doi.org/10.1016/S1836-9553(11)70020-0

상세보기

표제어: PCR

동의어: Packet Collision Rate

용어 설명 출처 목록 (6)

용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

내보내기 구분	파일저장 인쇄 메일전송
구성항목	기본정보 상세정보 관리번호, 논문명, 저널/프로시딩명, 저자 , 발행년, 권, 호, 시작페이지, 끝페이지, 발행기관 관리번호, 논문명, 대등논문명, 저자 , 저널/프로시딩명, 발행기관, 발행년, 발행언어, 권, 호, 시작페이지, 끝페이지, ISBN, ISSN, 주제분야, 키워드, 초록(한글), 초록(영문), 저자(소속기관)
저장형식	Text(ASCII format) Excel format RefWorks Direct Export RIS format (for Reference Manager, ProCite, EndNote), Scholar's Aids, Mendeley
메일정보	받는사람 (필수) @ 보내는사람 (선택) @ 제목 내용 KISTI 검색결과 이메일 서비스
안내	총 건의 자료가 검색되었습니다. 다운받으실 자료의 인덱스를 입력하세요. (1-10,000) 검색결과의 순서대로 최대 10,000건 까지 다운로드가 가능합니다. 데이타가 많을 경우 속도가 느려질 수 있습니다.(최대 2~3분 소요) 다운로드 파일은 UTF-8 형태로 저장됩니다. 파일의 내용이 제대로 보이지 않을실 때는 웹브라우저 상단의 보기 -> 인코딩 -> 자동선택 여부를 확인하십시오. ~ Text(ASCII format) Excel format

연합인증