Shoulder Retractor Strengthening Exercise to Minimize Rhomboid Muscle Activity and Subacromial Impingement
Abstract
Abstract
Purpose: We investigated the best position for shoulder retractor strengthening exercise to maximize middle trapezius activity and minimize rhomboid major activity. Although both trapezius and rhomboids are scapular retractors, rhomboids also act as downward rotators of the scapula, which can worsen subacromial impingement. Methods: Twelve healthy participants (age 30 [SD 6] y) with no history of shoulder pain were recruited for this study, which used fine-wire electromyography to examine maximal muscle activation of the middle trapezius and rhomboid major muscle fibres in four different positions: with the shoulder in 90° abduction with elbow completely extended and (1) shoulder internal rotation, (2) shoulder neutral rotation, (3) shoulder external rotation, and (4) rowing (shoulder neutral rotation and elbow flexed 90°). The ratio of trapezius to rhomboid muscles was compared with Wilcoxon signed-rank tests. Results: Muscle activation ratio during shoulder retraction exercise was significantly lower by 22% (i.e., rhomboid was more active than middle trapezius) when performed with the shoulder in rowing position (elbow flexed) than with the shoulder in external rotation (elbow extended) position (p=0.031). All four positions produced coactivation of trapezius and rhomboids. Discussion: Rowing position may not be the best position for shoulder retractor strengthening in patients with impingement syndrome. The preferable position for maximizing middle trapezius activity and minimizing rhomboid activity may be shoulder external rotation with elbow extended.
Résumé
Objet: Chercher la meilleure position pour un exercice de renforcement du rétracteur de l'épaule afin de maximiser l'activité du trapèze moyen et de réduire celle du grand rhomboïde au minimum. Même si les deux sont des rétracteurs de l'omoplate, les rhomboïdes font aussi pivoter l'omoplate vers le bas, ce qui peut aggraver la compression subacromiale. Méthodes: On a recruté 12 participants en bonne santé (âgés de 30 [ET 6] ans) sans antécédent de douleur à l'épaule pour cette étude dans le cadre de laquelle on a utilisé l'électromyographie à fil fin pour étudier l'activité maximale des fibres musculaires du trapèze moyen et du grand rhomboïde dans différentes positions: épaule en abduction à 90° avec coude en extension complète et a) rotation de l'épaule vers l'intérieur, b) rotation neutre de l'épaule, c) rotation de l'épaule vers l'extérieur d) mouvement d'aviron (rotation neutre de l'épaule et coude en flexion à 90°). On a comparé le ratio des trapèzes par rapport aux rhomboïdes au moyen du test de Wilcoxon pour observations appariées. Résultats: Le ratio d'activation musculaire au cours de l'exercice de rétraction de l'épaule était beaucoup moins élevé de 22% (c.-à-d. que le rhomboïde était plus actif que le trapèze moyen) l'épaule en position d'aviron (coude en flexion) qu'en position de rotation vers l'extérieur (coude en extension) (p=0,031). Les quatre positions ont produit une coactivation du trapèze et des rhomboïdes. Discussion: La position d'aviron n'est peut-être pas la meilleure position pour renforcer le rétracteur de l'épaule chez les patients qui ont un syndrome de pincement. La position préférée pour maximiser l'activité du trapèze moyen et réduire celle des rhomboïdes au minimum peut être la rotation vers l'extérieur, le coude en extension.
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Physiotherapy Canada
Volume 68 • Number 1 • Winter 2016
Pages: 24 - 28
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© Canadian Physiotherapy Association, 2016. All rights reserved.
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Published online: 21 January 2016
Published in print: Winter 2016
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Physiotherapy Canada 2016 68:1, 24-28
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