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Examples of angle and rectified EMG traces during a single trial of scapular plane shoulder elevation (A), the wall slide exercise (B), and the push-up plus exercise (C). Y-axis units for muscle activity are volts. Abbreviations: Hum Elev, humeral elevation angle; LAT, latissimus dorsi; LT, lower trapezius; SA, serratus anterior; UT, upper trapezius.
Source publication
Single-group repeated-measures design.
To investigate the ability of the wall slide exercise to activate the serratus anterior muscle (SA) at and above 90 degrees of humeral elevation.
Strengthening of the SA is a critical component of rehabilitation for patients with shoulder impingement syndromes. Traditional SA exercises have included scapular p...
Contexts in source publication
Context 1
... example of how a typical subject activated the muscles in each movement is shown in Figure 2. For scapular plane shoulder elevation (Figure 2A), this subject activated the serratus anterior and the upper trapezius initially, with the lower trapezius activated later. The amount of serratus anterior activation increased as the humeral elevation angle increased. For the wall slide ( Figure 2B), this subject activated the serratus anterior, as well as the upper and lower trapezius muscles. Similar to scapular plane shoulder elevation, the serratus anterior activation increased with increasing humeral elevation. For the push-up plus against the wall (Figure 2C), the serratus ante- rior was activated to a similar degree as in the other 2 movements in this subject. The upper trapezius was activated only early in the movement and the lower trapezius was not activated much above resting levels. For all 3 movements, the latissimus dorsi was rela- tively ...
Context 2
... example of how a typical subject activated the muscles in each movement is shown in Figure 2. For scapular plane shoulder elevation (Figure 2A), this subject activated the serratus anterior and the upper trapezius initially, with the lower trapezius activated later. The amount of serratus anterior activation increased as the humeral elevation angle increased. For the wall slide ( Figure 2B), this subject activated the serratus anterior, as well as the upper and lower trapezius muscles. Similar to scapular plane shoulder elevation, the serratus anterior activation increased with increasing humeral elevation. For the push-up plus against the wall (Figure 2C), the serratus ante- rior was activated to a similar degree as in the other 2 movements in this subject. The upper trapezius was activated only early in the movement and the lower trapezius was not activated much above resting levels. For all 3 movements, the latissimus dorsi was rela- tively ...
Context 3
... example of how a typical subject activated the muscles in each movement is shown in Figure 2. For scapular plane shoulder elevation (Figure 2A), this subject activated the serratus anterior and the upper trapezius initially, with the lower trapezius activated later. The amount of serratus anterior activation increased as the humeral elevation angle increased. For the wall slide ( Figure 2B), this subject activated the serratus anterior, as well as the upper and lower trapezius muscles. Similar to scapular plane shoulder elevation, the serratus anterior activation increased with increasing humeral elevation. For the push-up plus against the wall (Figure 2C), the serratus ante- rior was activated to a similar degree as in the other 2 movements in this subject. The upper trapezius was activated only early in the movement and the lower trapezius was not activated much above resting levels. For all 3 movements, the latissimus dorsi was rela- tively ...
Context 4
... example of how a typical subject activated the muscles in each movement is shown in Figure 2. For scapular plane shoulder elevation (Figure 2A), this subject activated the serratus anterior and the upper trapezius initially, with the lower trapezius activated later. The amount of serratus anterior activation increased as the humeral elevation angle increased. For the wall slide ( Figure 2B), this subject activated the serratus anterior, as well as the upper and lower trapezius muscles. Similar to scapular plane shoulder elevation, the serratus anterior activation increased with increasing humeral elevation. For the push-up plus against the wall (Figure 2C), the serratus ante- rior was activated to a similar degree as in the other 2 movements in this subject. The upper trapezius was activated only early in the movement and the lower trapezius was not activated much above resting levels. For all 3 movements, the latissimus dorsi was rela- tively ...
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Citations
... Push-up and push-up plus exercises are examples of closed kinetic chain training protocols that are widely utilized in shoulder injury rehabilitation (4). The plus phase of push-up plus exercise involves full protraction of the scapular resulting from posterior thorax translation, which can be performed either independently or as a continuation of the concentric phase of traditional push-up (5). Many individuals in the initial phases of fitness or rehabilitation programs are not be able to perform push-up plus exercises with full range of motion, therefore modified push-up plus exercises, such as knee push-up plus, elbow push-up plus, and wall push-up plus, are recommended as effective and safe alternatives (6,7). ...
Introduction: Unstable surfaces are commonly utilized to enhance the flexibility of the musculoskeletal system for achieving training or rehabilitation goals. However, their effects on shoulder muscle activation during various push-up (PU) exercises have not been thoroughly investigated. Therefore, the purpose of this study was to synthesize electromyography (EMG) data of shoulder muscles in individuals without scapular dyskinesis performing different PU exercises on both stable and unstable surfaces. Methods: A systematic online search was conducted in electronic databases, including Web of Science, PubMed, Scopus, and Google Scholar, up to January 16, 2024, using predefined sets of keywords. Out of the 1,971 titles and abstracts screened, 80 articles were reviewed in detail by two independent researchers to check the eligibility, of which 28 eligible studies were ultimately included. Following assessment of the quality and risk of bias, the studies were categorized based on exercises and muscle groups, and a meta-analysis using a random-effects model was performed to estimate the overall effect size. Results: The use of unstable surfaces led to a decrease in anterior deltoid activity during PU [P = 0.032; I 2 = 91.34%; SMD = −0.630 (95% CI −1.205, −0.055)], an increase in pectoralis major activity during PU [P = 0.006; I 2 = 63.72%; SMD = 0.282 (95% CI 0.079, 0.484)], as well as during knee PU [P = 0.018; I 2 = 32.29%; SMD = 0.309 (95% CI 0.052, 0.565)], and an increase in triceps brachii activity during PU [P = 0.000; I 2 = 85.05%; SMD = 0.813 (95% CI 0.457, 1.168)], knee PU [P = 0.000; I 2 = 0.00%; SMD = 0.589 (95% CI 0.288, 0.891)], as well as during push-up plus [P = 0.006; I 2 = 13.16%; SMD = 0.563 (95% CI 0.161, 0.965)]. However, the use of unstable surfaces did not show a significant effect on the EMG activity of the pectoralis major during push-up plus [P = 0.312; I 2 = 22.82%; SMD = 0.207 (95% CI −0.194, 0.609)]. Conclusions: Unstable surfaces can modulate muscle activity in different PU exercises, while the effects on the targeted muscles depend on the type of exercise. The findings of this review provide a framework based on the level of activity of each shoulder muscle during different PU exercises, which can help coaches, trainers, and sports therapists select the most suitable type of PU for designing training or rehabilitation programs. Particularly, the most suitable exercise for increasing anterior deltoid activity is PU on a stable surface. To concurrently increase activity of the pectoralis major and triceps brachii, adding unstable surfaces under hands during knee PU and standard PU is recommended. Systematic Review Registration: PROSPERO, identifier CRD42021268465.
... 2-Strength of middle trapezius: Patient was in prone position with head and feet supported on the plinth, shoulder joint was externally rotated and abducted 90ₒ and elbow joint was flexed 90ₒ and the patient was asked to retract the scapulae (Fig. 2) (12). 3-Strength of serratus anterior: Patient was in standing position with the trunk in neutral position and patient was asked to raise the arm in sliding manner against the wall in the plane of scapula end with scapular protraction (Fig. 3) (18). The patient held positions 6 seconds and perform 3 sets of 10 repetitions and 3times per week for 6 weeks. ...
... 9,13 On the other hand, the exercises wall slide (WS) and wall push-up plus (WPUP) are widely used in clinical practice because they supposedly generate a high SA activity and possibly an excellent UT/SA activation ratio. 14 Scapular neuromuscular control has also been assessed, to a lesser extent, through the onset latency of the scapular muscles, that is, the time it takes a target muscle to activate relative to the primary motor muscle recorded by sEMG. [15][16][17] Stabilizing scapular muscles present an earlier-onset latency than UT and other prime mover muscles (e.g., posterior deltoid [PD] and anterior deltoid [AD]), showing an optimal muscle recruitment pattern for shoulder movements that require an adequate scapular position and movement. ...
... The exercises were selected based on previous studies where a significant effect of the exercises on onset latency or sEMG amplitude was observed. 8,9,13,14,17 The participant performed the exercises three times without resistance for familiarization purposes, receiving corrective tactile feedback as needed. The sEMG signals of the scapular muscles (UT, MT, LT, and SA) and deltoideus (AD and PD) were recorded, while each participant performed three repetitions of five exercises (randomized by computer random number generator). ...
Objective
To compare the surface electromyographic (sEMG) amplitude, activation ratio, and onset latency of the main scapular stabilizing muscles between five typical rehabilitative exercises.
Design
Twenty-seven healthy participants performed five scapular exercises [wall-slide (WS), wall push-up plus, prone horizontal abduction with external rotation (PHABER), external rotation in side-lying (ERSL), and low row] while simultaneously recording sEMG of serratus anterior (SA), middle trapezius (MT), lower trapezius (LT), and upper trapezius (UT). sEMG amplitudes, onset latencies, and activation ratios were calculated.
Results
PHABER showed an excellent UT/MT (0.43) and UT/LT (0.30) muscle balance with high (> 50% MVIC) MT and LT amplitudes, a low (< 20% MVIC) UT amplitude, and an early activation of the scapular stabilizing muscles (-474.7 to 89.9 ms) relative to UT. ERSL showed excellent UT/SA (0.26), UT/MT (0.32), and UT/LT (0.21) activation ratios; and along with LR and WS, showed early activation of the scapular stabilizing muscles (-378.1 to -26.6 ms).
Conclusions
PHABER presented optimal scapular neuromuscular control. Although ERSL, low row, and WS did not meet all the criteria associated with optimal scapular neuromuscular control, these exercises could be used in early stages of shoulder rehabilitation because they favor early activation of the scapular stabilizing muscles.
... 7,8 Specifically, scapular stability exercises have been reported to be effective in reducing pain and functional impairment in subjects with subacromial impingement syndrome in several studies, including that of Ravichandran et al. 8 The serratus anterior muscle is closely related to scapular stability, and previous studies have introduced various serratus anterior exercises aimed at promoting scapular stability in the context of interventions for subacromial impingement syndrome. 9,10 Decreased scapular upward rotation during shoulder elevation can reduce the subacromial space, impede tissue healing, and contribute to an increase in symptomatic impingement. 11,12 In addition, upward rotation of the scapula by the serratus anterior is a critical movement during shoulder elevation, achieved with the force-couple of the upper trapezius. ...
... Various exercises involving adduction and upward rotation of the serratus anterior, such as push-up plus, serratus anterior punch, dynamic hug, and wall slide, have been introduced for the prevention and rehabilitation of shoulder impingement syndrome. 10,13 The serratus punch and wall slide exercises have gained attention for specific reasons. The serratus punch exercise activates the serratus anterior muscle through scapular protraction, providing stability during the plus-phase, and exhibits higher serratus anterior activity compared to other exercises involving the plus-phase. ...
... The wall slide exercise effectively increases upward rotation of the serratus anterior muscle by elevating the shoulder from 90 degrees to 180 degrees. Notably, in Hardwick et al. 10 , the wall slide exercise was found to be beneficial for early shoulder rehabilitation as it allows for reduced load by partially supporting the weight of the arms against the wall during execution. The wall slide exercise can serve as an early and suitable exercise for activating the serratus anterior in CrossFit practitioners with impingement syndrome by reducing the load and promoting scapular stability during overhead movements. ...
... 1) Modified prone cobra 12 2) Wall slide exercise 11,15,20 : The participant stood facing a wall with the wall from nose to knees with feet shoulderwidth apart. Then, the ulnar border of the forearms contacted the wall with shoulder 90° abduction and elbow 90° flexion. ...
... The push-up plus (PP) exercise generated the highest SA muscle activation as compared with other scapular stabilization exercises and was recommended for high activate the SA muscles [5][6][7]. However, it is necessary to control exercise intensity because PP is difficult to perform repetitively in patients with weakened SA muscles. ...
... We cluster skeletal muscles into 20 major muscle groups with binary activation as shown in the checkboxes in Figure 1. As sources from sport experts have been successfully used as annotation source in similar problems [95], the pairing of muscle group activations to physical activities is obtained from >400 health care and fitness resources reported by well-established fitness and sport experts and comprehensive scientific research of physical activity, e.g., [34,40,55,131,88,16,18,130]. These resources label a set of primary activated muscle. ...
In this paper, we tackle the new task of video-based Activated Muscle Group Estimation (AMGE) aiming at identifying currently activated muscular regions of humans performing a specific activity. Video-based AMGE is an important yet overlooked problem. To this intent, we provide the MuscleMap136 featuring >15K video clips with 136 different activities and 20 labeled muscle groups. This dataset opens the vistas to multiple video-based applications in sports and rehabilitation medicine. We further complement the main MuscleMap136 dataset, which specifically targets physical exercise, with Muscle-UCF90 and Muscle-HMDB41, which are new variants of the well-known activity recognition benchmarks extended with AMGE annotations. With MuscleMap136, we discover limitations of state-of-the-art architectures for human activity recognition when dealing with multi-label muscle annotations and good generalization to unseen activities is required. To address this, we propose a new multimodal transformer-based model, TransM3E, which surpasses current activity recognition models for AMGE, especially as it comes to dealing with previously unseen activities. The datasets and code will be publicly available at https://github.com/KPeng9510/MuscleMap.
... [2][3][4][5][6][7] Previous studies reported that the UT is frequently hyperactive, and the LT and SA are weakening muscles. [8][9][10] In the shoulder with impingement, the ratios of the SA to UT activities and the LT to UT activities are lower than those of normal subjects. [11][12][13][14] In previous studies aimed to strengthen the SA and LT, prone arm lift exercise has been reported as a way to significantly increase the activities of the SA and LT. ...
... Using push-up variations, researchers showed that SA activity was more significant during push-up plus exercises than during regular push-ups (19,24). ...
Background: The serratus anterior (SA) muscle is an important scapular stabilizer and has a profound role in retaining the scapulohumeral rhythm. Therefore, modified push-up plus (MPUP) has been advised to strengthen this muscle as a closed chain workout. However, few previous studies have reported the possibility of a reparative motion from pectoralis major (PM) that could replace and amend SA's function during push-up plus. Objectives: The current study examined MPUP's effect using biofeedback EMG on some of the selected scapular stabilizers. Methods: Sixteen healthy young subjects voluntarily participated in this study. Each subject performed push-ups, from the quadruped position, under two conditions (i.e., with or without visual and auditory biofeedback). Surface EMG measured pectoralis major, serratus anterior, and upper trapezius activity. A paired t-test was used to determine any statistically significant difference between the two conditions. Additionally, the effect size was calculated to quantify the magnitude of EMG biofeedback in each muscle. Results: MPUP training using biofeedback significantly increased SA muscle activity and decreased PM muscle activity, but there was no significant change in UT activity. Conclusions: Excessive PM activity was repressed because of biofeedback, and the workout was done with the enhancement of SA muscular activity. Thus, including biofeedback while doing MPUPs helps limit PM's supplementary action and enhance SA muscle activity.
... Adhesive capsulitis is a condition that results in acute pain and restriction of joint mobility in all planes of the shoulder joint during active and passive motions [12]. Shoulder joint range of motion (ROM) limits associated with essential breast cancer treatment have a detrimental effect on the patient's quality of life by impairing functionality. ...
Background: The purpose of this study was to determine the impact of complex decongestive therapy applications on upper extremity function in breast cancer patients who developed adhesive capsulitis after lymphedema. Methods: Thirty patients who developed adhesive capsulitis due to lymphedema were divided into two groups as study (n=15) and control (n=15) groups. Both groups received 20 minutes of exercise five days a week for three weeks by Biodex isokinetic dynamometer, as well as a hot pack and TENS treatment to the shoulder joint. Along with the adhesive capsulitis treatment, the study group received 45 minutes of intensive decongestive therapy. The Visual Analogue Scale (VAS) was used to assess pain, circumference, and volumetric measurements were used to assess edema, and the Arm, Shoulder, and Hand Problems Questionnaire (DASH: Disabilities of the Arm, Shoulder, and Hand) was used to assess upper extremity functionality. Shoulder range of motion was evaluated. Results: Both groups had improvements in pain (P < 0.05), shoulder joint range of motion (P < 0.05), and upper extremity functionality (P < 0.001) after the treatment. There was a significant decrease in circumference and volumetric measurements in the study group (P < 0.05). However, no differences were seen in measurements in the control group (P > 0.05). Conclusion: The results were shown that complex decongestive therapy was beneficial in reducing lymphedema in breast cancer patients who acquired adhesive capsulitis due to lymphedema. As a consequence, we believe that supplementing conventional physiotherapy with complex decongestive therapy will benefit patients.
