Lower-Trap Shipley PDF
Lower-Trap Shipley PDF
Lower-Trap Shipley PDF
• Treatment considerations
Anatomy - Trapezius
• Origin
– Medial one third of nuchal line
– External occipital protuberance
– Ligamentum nuchae
– Spinous processes of C7-T12
– Supraspinous ligament
• Insertion
– Lateral one third of the clavicle
– Medial aspect of the acromion
– Scapular spine
– Tubercle just lateral to medial
border of scapular spine
• Innervation
– Spinal accessory nerve, C3, C4 Thieme Atlas of Anatomy
• Indirect connection to
axial skeleton via
clavicular articulations
Dutton, 2004
Scapulothoracic Motion
• Scapulothoracic motion
– Frontal plane
• Upward and downward
rotation (U/DROT)
– Sagittal plane
• Anterior and posterior
tilting
– Transverse plane
• Internal and external
rotation (I/EROT)
• Generally accepted
– Posterior tilting
– EROT
• Scaption from
supported sitting
– Raising and lowering
– Kinematics and EMG
Kibler, 1998
Trapezius - Function
• Upper fibers (UT) • Not so straightforward
– UROT – Complex interaction
– Elevation between different fibers,
other musculature
• Middle fibers (MT)
– Different roles
– Adduction (Retraction) depending upon position
• Lower fibers (LT) – Mobility and stability
– UROT function
– Depression
Function – Force Couple for Upward
Rotation
• Coordinated
contraction
– Synergistic UROT
– Antagonistic
elevation/depression
– Results in dynamically
fixed axis for UROT
• Do not forget
– MT
– Posterior rotator cuff
– Pectoralis minor…
Borsa et al, 2008.
Function - Throwing
• Significant findings
– Lower peak protraction force at high velocity
– Lower protraction/retraction force ratio at low velocity
– Lower LT EMG activity during retraction at high velocity
Dysfunctional Muscle Activity
• Cools et al 2007
– 39 overhead athletes with impingement and 30
healthy controls
– EMG activity and intramuscular trapezius ratios during
isokinetic abduction, isokinetic EROT
• Significant findings
– Higher UT EMG activity both motions
– Lower LT EMG activity abduction
– Lower MT EMG activity EROT
– Altered UT/MT, UT/LT ratios
Dysfunctional Muscle Activity
• Huang et al, 2015
– 82 subjects with shoulder pain
– Classified dyskinesis
observationally into three
categories
– EMG activity and kinematics
during scaption
• Significant results
– Lower LT activity in those with
inferior angle and medial
border prominence during
lowering
– Higher UT activity in those with
inferior angle and medial
border prominence throughout
• Questions remain
– Factors in etiology of pathology?
– Compensatory mechanisms secondary to pathology?
– Representative of pain inhibition?
– What to do about it?
Treatment - Lower Trapezius
• Increasing % MVIC
– Low row
– Robbery
– D1 flexion
– Unilateral row
– Scaption <80
– Scaption > 120
– Prone horizontal abduction with EROT (T)
– Prone EROT at 90 abduction
– Prone flexion at 135 abduction (Y)
Uhl, 2009
Treatment – Lower Trapezius
• Significant findings
– Modified prone cobra and
prone row most favorable
when considering
amplitude and isolation
• Borsa PA, Laudner KG, Sauers EL. Mobility and stability adaptations in the shoulder of the
overhead athlete: A theoretical and evidence-based perspective. Sports Med. 2008;38:17-36.
• Cools AM, Declercq GA, Cambier DC, Mahieu NN, Witvrouw EE. Trapezius activity and
intramuscular balance during isokinetic exercise in overhead athletes with impingement
symptoms. Scand J Med Sci Sports. 2007;17:25-33.
• Cools AM, Witvrouw EE, Declercq GA, Vanderstraeten GG, Cambier DC. Evaluation of
isokinetic force production and associated muscle activity in the scapular rotators during a
protraction-retraction movement in overhead athletes with impingement symptoms. Br J
Sports Med. 2004;38:64-68.
• De Mey K, Cagnie B, Van De Velde A, Danneels L, Cools AM. Trapezius muscle timing during
selected shoulder rehabilitation exercises. J Orthop Sports Phys Ther. 2009;39(10)743-752.
References
• DiGiovine NM, Jobe FW, Pink M. EMG of upper extremity in pitching. J Shoulder Elbow Surg.
1992;1:15-25.
• Escamilla RF, Andrews JR. Shoulder muscle recruitment patterns and related biomechanics
during upper extremity sports. Sports Med. 2009;39(7):569-590.
• Gilroy AM, MacPherson BR, Ross LM. Thieme Atlas of Anatomy. New York, NY: Thieme
Medical Publishers, 2008.
• Hobart DJ, Anderson DA, Conroy VM. A Dissector of Human Anatomy Emphasizing the
Musculoskeletal System. University of Maryland School of Medicine Department of Physical
Therapy and Rehabilitation Science, 2008.
• Huang TS, Ou HS, Huang CY, Lin JJ. Specific kinematics and associated muscle activation in
individuals with scapular dyskinesis. J Shoulder Elbow Surg. 2015;24:1227-1234.
References
• Kao JT, Pink M, Jobe FW. Electromyographic analysis of the scapular muscles during a golf
swing. Am J Sports Med. 1995;23(1):19-23.
• Kennedy DJ, Viso DJ, Press J. Current concepts for shoulder training in the overhead athlete.
Curr Sports Med Rep. 2009;8(3):154-160.
• Kibler, WB. Current concepts the role of the scapula in athletic shoulder function. Am J Sports
Med. 1998;26:325-337.
• Kibler WB, Kuhn JE, Wilk K, Sciascia A, Moore S, Laudner K, Ellenbecker T, Thigpen C, Uhl T.
The disabled throwing shoulder: Spectrum of pathology – 10 year update. Arthroscopy.
2013;29:141-161.
• Lintner D, Noonan TJ, Kibler WB. Injury patterns and biomechanics of the athlete’s shoulder.
Clin Sports Med. 2008;27:527-551.
References
• Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint
pathologies. J Orthop Sports Phys Ther. 2009;39(2):90-104.
• Uhl T. Scientific basis and implementation of exercises for scapular rehabilitation. Continuing
education course – Baseball team medicine conference: Injury prevention and treatment
techniques. 2009.
Phases of Pitching