SHOULDER SERIES PART 1: Compilation of Evidence Based Scapulo-Thoracic Stabilization Exercises

   

     There is much controversy in shoulder exercises. As a fitness and/or health care professional, you are faced with so many challenges in what to do to start a patient to "fire" the right muscles. But do we explain these exercises simply because they are our favorite exercises? Or do we back them up with an evidence-based approach? I decided to compile a few of the research out there that exist about shoulder stabilization as well as Scapulo-thoracic strengthening exercises.

SCAPULO-THORACIC EXERCISES: Which ones do we use if we only have so much time with a patient in one session?

Kibler, et al analyzed specific exercises for scapular control in the early phases of shoulder rehabilitation (Kibler WB, Sciascia AD, Uhl TL, Tambay N, Cunningham T.

Am J Sports Med. 2008 Sep;36(9):1789-98. doi: 10.1177/0363546508316281. Epub 2008 May 9.)

RESULTS SHOWED: 

• There were no significant differences in muscle activation amplitude between groups. Muscle activation was moderate across all of the exercises and varied slightly with the specific exercise. 
• The serratus anterior and lower trapezius were activated between 15% and 30% in all exercises.
• Upper trapezius activation was high (21%-36%) in the dynamic exercises (lawnmower and robbery). 
• Serratus anterior was activated first in the low row and last in the lawnmower and robbery. 
• The upper trapezius and lower trapezius were activated first in the lawnmower and robbery.

CLINICAL RELEVANCE:

• Inferior glide and low row can be performed early in rehabilitation because of their limited range of motion, while lawnmower and robbery, which require larger movements, can be instituted later in the sequence.

Moseley, Jobe, et al analyzed the scapular muscles during a Shoulder Rehabilitation Program (Moseley JB Jr, Jobe FW, Pink M, Perry J, Tibone J. Am J Sports Med. 1992 Mar-Apr;20(2):128-34.)

- They evaluated 16 exercises, and 8 muscles (The 8 muscles studied were the upper, middle, and lower trapezius; levator scapula; rhomboids; pectoralis minor; and the middle and lower serratus anterior.)

RESULTS:

• Twelve of the exercises qualified as top exercises for all of the muscles. On further analysis, a group of 4 exercises was shown to make up the core of a scapular muscle strengthening program. Those 4 exercises include 
• scaption (scapular plane elevation)

       Rows....

• push-up with a plus

        

• press-up (and press downs) 

Decker, et al studied the Serratus Anterior muscle activity during selected rehabilitation exercises

(Decker MJ, Hintermeister RA, Faber KJ, Hawkins RJ. Am J Sports Med. 1999 Nov-Dec;27(6):784-91.)

• The purpose of this study was to document the electromyographic activity and applied resistance associated with eight scapulohumeral exercises performed below shoulder height.
• RESULTS: PUSH UPS with a PLUS and DYNAMIC HUG - both maintained Upward Rotation of the Scapula and have the greatest activation of the Serratus anterior muscles.

Ekstrom and Donatelli on Surface electromyographic analysis of exercises for the trapezius and serratus anterior muscles (Ekstrom RA, Donatelli RA, Soderberg GL.

J Orthop Sports Phys Ther. 2003 May;33(5):247-58.) 

RESULTS:

• The unilateral shoulder shrug exercise was found to produce the greatest EMG activity in the upper trapezius. 
• For the middle trapezius, the greatest EMG amplitudes were generated with 2 exercises: shoulder horizontal extension with external rotation and the overhead arm raise in line with the lower trapezius muscle in the prone position. 
• The arm raise overhead exercise in the prone position produced the maximum EMG activity in the lower trapezius. 
• The serratus anterior was activated maximally with exercises requiring a great amount of upward rotation of the scapula. The exercises were shoulder abduction in the plane of the scapula above 120 degrees and a diagonal exercise with a combination of shoulder flexion, horizontal flexion, and external rotation.
   

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