Sports Medicine Research: In the Lab & In the Field: Scapular Rehabilitation: Inside Info to Help Choose the Right Exercises (Sports Med Res)


Monday, March 21, 2016

Scapular Rehabilitation: Inside Info to Help Choose the Right Exercises

Superficial and Deep Scapulothoracic Muscle EMG Activity During Different Types of Elevation Exercises in the Scapular Plane

Castelein B, Cools A, Bostyn E, Delemarre J, Lemahieu T, Cagnie B. J Orthop Sports Phys Ther. 2016 Mar;46(3):184-93

Take Home Message: Different humeral elevation exercises result in different levels of scapulothoracic muscle activity.  Knowledge of muscle activity levels for different exercises could help clinicians optimize rehabilitation protocols.

The scapulothoracic joint has minimal bony stabilization and is primarily dynamically stabilized by multiple muscle attachments.  It plays an important role in shoulder function by providing a stable base for glenohumeral motion. Glenohumeral elevation exercises are commonly used in scapular rehabilitation training.  However, the level of activation in the scapulothoracic muscles between different types of elevation exercises has not been fully defined.  Knowledge of muscle activity levels for different exercises could help clinicians develop appropriate rehabilitation programs.  Therefore, the objective of this study was to evaluate scapulothoracic muscle activity during different types of elevation exercise in the scapular plane.  For this study, a total of 21 healthy participants (10 female, 11 male, mean age of 32 years) performed three 3 different elevation tasks in the scapular plane: scaption (elevation in the scapular plane), towel wall slide, and elevation with external rotation (using a Theraband).  The exercises were repeated with additional load added.  Fine-wire and surface electromyography (EMG) was used to measure muscle activity in the deep scapulothoracic muscles (levator scapulae, pectoralis minor, and rhomboid major) and superficial scapulothoracic muscles (upper, middle and lower trapezius and serratus anterior), respectively.  The researchers found that the middle and lower trapezius had the highest activity during elevation with external rotation, the upper trapezius had the highest activity during scaption, and the pectoralis minor had the highest activity during the towel wall side.  The addition of load to the exercises resulted in higher activity of all muscles and some differences in activation patterns.  Specifically, the middle and lower trapezius and the levator scapulae had significantly higher activity in both scaption and elevation with external rotation compared to the wall slide with additional load.

Results from this study show that scapulothoracic muscle activity during various humeral elevation exercises differs and that adding load results in higher muscle activity and some different activation patterns.  The authors make several suggestions for clinicians: 1) if the main goal is to activate the middle and lower trapezius, elevation with external rotation is the most appropriate exercise 2) if the main goal is to activate the upper trapezius, scaption is optimal and 3) if the main goal is to activate the pectoralis minor, the towel wall slide is the best option.  A limitation of this study was that the measurements were taken on healthy people and it is not clear if an injured patient population would have similar muscle activity during these exercises.  In addition, without baseline measurements in patients with deficits, it is not clear how clinicians will use this data to optimize treatment protocols.  Taken together, this study provides a map of the activity of scapulothoracic muscles, including the deep muscles that have not been previously evaluated and are important in scapular control, during different elevation exercises that could potentially be used by clinicians to make specific rehabilitation choices.  This study necessitates further clinical studies to investigate the role of scapulothoracic muscles in abnormal scapular movement and its relation to shoulder pain and injury.

Questions for Discussion: How would you use this data to optimize scapular rehabilitation protocols? What other exercises do you use to target specific scapulothoracic muscles?

Written by: Katie Reuther
Reviewed by: Stephen Thomas

Related Posts:

Castelein B, Cagnie B, Parlevliet T, & Cools A (2016). Superficial and Deep Scapulothoracic Muscle Electromyographic Activity During Elevation Exercises in the Scapular Plane. The Journal of Orthopaedic and Sports Physical Therapy, 46 (3), 184-93 PMID: 26868896


Kelly Martin said...

I think this article provides insight into the necessity to choose rehabilitation exercises with intent. Sometimes there is a “more exercise is better exercise” approach to treating various injuries, and this article did a nice job of focusing in on a few exercises that may be beneficial when evaluating a scapulothoracic related injury. As an athletic trainer with softball, I have used each of these exercises at one point in time or another – especially with the nature of the sport being unilateral. A few other exercises that I have used include T’s and Y’s, body blade in external rotation, and low rows. I think that the exercises presented in this article must augment other forms of therapy. It is so important to focus on deficits in an athlete’s presentation, and to address those deficits. In the same light, an understanding of the root of the injury or problem is essential for treating scapulothoracic injuries. With this understanding, the exercises presented in this article are an excellent resource for health care professionals when creating a rehabilitation protocol. As far as limitations, I agree with the fact that future research is needed in order to see the effects that these exercises may have on various types of scapulothoracic injuries. I think that EMG studies on pathological patients will be necessary, but I also think that PRO’s and functional assessments will be beneficial information moving forward.

Katie Reuther said...

Thanks for your comment Kelly. I do think this article is a great resource for optimizing rehab protocols. This group recently followed up with an article looking at the same muscles and activities in patients with subacromial impingement syndrome (SIS)( They found that patients with SIS had significantly higher pectoralis minor activity during elevation tasks in comparison with healthy controls. Another important finding was that there was no significant differences between SIS and healthy controls for the other muscles during these activities. Hopefully, this group will expand their work to other injuries and include additional exercises so that clinicians can develop personalized and effective rehabilitation plans.

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