Conscious Correction of Scapular Orientation in Overhead Athletes Performing Selected Shoulder Rehabilitation Exercises: The Effect on Trapezius Muscle Activation Measured by Surface Electromyography

STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To assess the effect of conscious correction of scapular orientation on the activation of the 3 sections of the trapezius muscle during shoulder exercises in overhead athletes with scapular dyskinesis. BACKGROUND: Previous research has led to the recommendation of 4 exercises for training of the trapezius muscle: prone extension, sidelying external rotation, sidelying forward flexion, and prone horizontal abduction with external rotation. However, the extent to which conscious correction of scapular orientation impacts trapezius muscle activation levels during these exercises is unknown. METHODS: Absolute (upper trapezius [UT], middle trapezius [MT], lower trapezius [LT]) and relative (UT/MT and UT/LT) muscle activation levels were determined with surface electromyography in 30 asymptomatic overhead athletes with scapular dyskinesis, during 4 selected exercises performed with and without conscious correction of scapular orientation. Repeated-measures analyses of variance were used to determine if a voluntary scapular orientation correction strategy influenced the activation levels of the different sections of the trapezius during each exercise. RESULTS: With conscious correction of scapular orientation, activation levels of the 3 sections of the trapezius muscle significantly increased during prone extension (mean +/- SD difference: UT, 5.9% +/- 8.6% maximal voluntary isometric contraction [MVIC]; MT 13.8% +/- 11.0% MVIC; LT 9.8% +/- 10.8% MVIC; P<.05) and sidelying external rotation (UT, 2,2% +/- 4.4% MVIC; MT 6.7% +/- 10.6% MVIC; LT, 13.3% +/- 24.4% MVIC; P<.05). There was no difference between conditions for sidelying forward flexion and prone horizontal abduction with external rotation. The UT/MT and UT/LT ratios were similar between conditions for all 4 exercises. CONCLUSION: Conscious correction of scapular orientation during the prone extension and sidelying external rotation exercises can be used to increase the activation level in the 3 sections of the trapezius in overhead athletes with scapular dyskinesis. Although lack of kinematic data limits the interpretation of the results, this study suggests that conscious correction of scapular orientation can be performed without altering the favorable UT/MT and UT/LT ratios that have been previously reported for these exercises. J Orthop Sports Phys Ther 2013;43(1):3-10. Epub 16 November 2012. doi:10.2519/jospt.2013.4283