Rehabilitation of Scapular Muscle Balance: Which Exercises to Prescribe?

Ann M. Cools , Vincent Dewitte, Frederick Lanszweert, Dries Notebaert, Arne Roets, Barbara Soetens, Barbara Cagnie and Erik E. Witvrouw

The objective of this study was to determine whether a  selection of the commonly used trapezius strengthening exercisescan be performed for muscle balance rehabilitation, based on a low upper trapezius (UT)/ower trapezius (LT), UT/middle trapezius (MT), or UT/serratus anterior (SA) muscle ratio.  Electromyographic activity of the 3 trapezius parts and the SA was measured in 45 healthy subjects performing 12 commonly described scapular exercises, using surface electromyography.  The exercises side-lying external rotation, side-lying forward flexion, prone horizontal abduction with external rotation, and prone extension were found to be the most appropriate for intramuscular trapezius muscle balance rehabilitation. For the UT/SA ratio, none of the exercises met the criteria for optimal intermuscular balance restoration.

In the selection of rehabilitation exercises, the clinician should have a preference for exercises with high activation of the LT and MT and low activity of the UT and in cases of trapezius muscle imbalance, some exercises are preferable over others because of their low UT/LT and UT/MT ratios.

The American Journal of Sports Medicine, 35, 1744-1751

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