Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation

Background: Restoration of control of dynamic scapular motion by specific activation of the serratus anterior and lower trapezius muscles is an important part of functional rehabilitation. This study evaluated activation of those muscles in specific exercises. Hypothesis: Specific exercises will activate key scapular-stabilizing muscles in clinically significant amplitudes and patterns. Study Design: Controlled laboratory study. Methods: Muscle activation amplitudes and patterns were evaluated in the serratus anterior, upper trapezius, lower trapezius, anterior deltoid, and posterior deltoid muscles with electromyography in symptomatic (n = 18) and asymptomatic (n = 21) subjects as they executed the low row, inferior glide, lawnmower, and robbery exercises. Results: 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. Conclusion: These specific exercises activate key scapular-stabilizing muscles at amplitudes that are known to increase muscle strength. Clinical Relevance: These exercises can be used as part of a comprehensive rehabilitation program for restoration of shoulder function. They activate the serratus anterior and lower trapezius - key muscles in dynamic shoulder control - while variably activating the upper trapezius. Activation patterns depended on scapular position resulting in variability of amplitude and activation sequencing between exercises. 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.