Comparison of Activity in Scapular Stabilizing Muscles during Knee Push-Up Plus and Modified Vojta's 3-Point Support Exercises.

Selective serratus anterior (SA) strengthening without compensatory movement of the shoulder stabilizers is essential for shoulder stability and functional movement without causing shoulder injury and dysfunction. The purpose of this study was to compare electromyographic (EMG) activity between the SA, upper trapezius (UT), lower trapezius (LT), and pectoralis major (PM) during the knee push-up plus (KPUP) and modified Vojta's 3-point support (MV3PS) exercises. Scapular stabilizer muscle activity (UT, LT, SA, and PM) was investigated during the KPUP and MV3PS exercises in 40 healthy adults (19 males, 21 females) using surface EMG. Muscle activity of the SA was significantly higher during the MV3PS exercise than during the KPUP (p < 0.05). However, muscle activity in the PM was significantly lower during the MV3PS exercise (p < 0.05). In addition, the LT and UT showed less muscle activity during the MV3PS exercise, although the difference was not statistically significant (p > 0.05). These findings suggest that the MV3PS exercise better activates the SA than KPUP.

The effect of leg angle during push-up plus exercise on shoulder stabilization muscle activity.

[Purpose] This study investigated the effect of different leg angles during push-up plus exercise on shoulder stabilization muscle activity. [Participants and Methods] Fifteen healthy adult males participated in this study. The smart phone application Clinometer was used to measure leg angles of 70°, 90°, and 110° during push-up plus exercise. The muscle activities of the serratus anterior, upper trapezius fibers, and pectoralis major muscles involved in shoulder stabilization were analyzed using surface electromyogram. [Results] Leg angle significantly affected serratus anterior muscle activity, but it did not affect activities of the upper trapezius fibers or pectoralis major muscles. Post-hoc analysis revealed that serratus anterior muscle activity at the leg angle of 110° was significantly higher than at leg angles of 70° and 90°. [Conclusion] A higher leg angle during push-up plus exercise is a more effective intervention for the serratus anterior muscle activity.

Examining upper extremity muscle demand during selected push-up variants.

Push-ups are regularly adapted for specific muscular demands. The push-up plus (PUP) has been used to emphasize serratus anterior activation. Alterations in body posture have been suggested for targeted activation of muscles surrounding the shoulder and rotator cuff, but little data exists to inform these changes. The purpose of this research was to examine upper extremity muscle activity changes when varying aspects of the PUP. Healthy male participants (n = 20) performed PUP trials using combinations of hand contact area (knuckles/palms), humeral rotation (neutral/60° internal/60° external) and hand location (shoulder height/±30% arm length superior/inferior) at a fixed cadence. Electromyographic (EMG) activation from 14 muscles of the right upper extremity during each trial were examined, as well as ratios of activation for 7 muscle pairs. Palm contact and a superior hand location increased serratus activation, but absolute EMG changes between these effects were marginal (standard error = 3.8). Each independent variable altered mean EMG for most muscles as a main effect, with the largest changes in infraspinatus, upper and lower trapezius, and anterior deltoid. Altering the standard PUP does not seem to enhance serratus activation, but diverse responses in other muscles have training implications. These changes in muscle strategies can tailor the use of modified PUP exercises to target individual muscles or groups.

Different weight bearing push-up plus exercises with and without isometric horizontal abduction in subjects with scapular winging: A randomized trial.

The aim of the present study was to determine whether the application of isometric horizontal abduction (IHA) differentially affected two weight-bearing push-up plus exercises by examining activation of the scapulothoracic muscles in subjects with scapular winging. Fifteen male subjects performed standard push-up plus (SPP) and wall push-up plus (WPP), with and without IHA. Two-way analyses of variance using two within-subject factors were used to determine the statistical significance of observed differences in upper trapezius (UT), pectoralis major (PM), and serratus anterior (SA) muscle activities and UT/SA and PM/SA muscle activity ratios. UT and SA muscle activities were greater during SPP than WPP. PM muscle activity was lower with IHA application. The UT/SA and PM/SA muscle activity ratios were lower during SPP than WPP. The PM/SA muscle activity ratio was lower with IHA application. The results suggest that IHA application using a Thera-Band can effectively reduce PM muscle activity during SPP and WPP exercises. Moreover, the SPP exercise can be used to increase UT and SA muscle activity and reduce the UT/SA and PM/SA muscle activity ratios in subjects with scapular winging.

The effect of the push-up plus on shoulder muscle activation while using a sling with a pulley.

[Purpose] This study was conducted to investigate the effects of the push-up plus while using a balance ball, a sling, and a sling with a pulley in a creeping position on an unstable floor. [Subjects and Methods] The subjects were divided into three groups of 15 members each who performed the different three type methods of push-up plus (with scapulae protruding) in a random order while in a creeping posture. The muscle activity of each group in the push-up plus posture was measured using electromyography, and the measurement values were compared among the groups using one-way analysis of variance (ANOVA). [Results] The intergroup comparison revealed that the activation of the pectoralis major muscle of the balance ball exercise group was significantly decreased. In this comparison, the activity ratio for the pectoralis major muscles of the balance ball exercise group significantly decreased, and the activity ratio of their serratus anterior muscles significantly increased. From the post analysis, the differences in the activity ratios of the pectoralis major and serratus anterior muscles for the balance ball exercise group were significant when compared with those of the other groups. [Conclusion] Among the three different exercise methods in unstable situations presented in this study, the push-up plus exercise in a creeping posture using the balance ball can be recommended for the selective strengthening of the serratus anterior muscle.

A comparison of the shoulder and trunk muscle activity according to the various resistance condition during push up plus in four point kneeling.

[Purpose] This study was to compare the shoulder and trunk muscle activity according to the various resistance condition during knee push-up-plus. [Subjects and Methods] Twenty healthy adults participated in this study (9 males and 11 females). The subjects performed dominant-leg-extended knee push-up-plus apply to resistance in the direction of abduction, adduction, extension and the flexion. The surface Electromyography activities of the upper trapezius, serratus anterior, homolateral external oblique and the heterolateral internal oblique were measured. The Electromyography activities of each muscle were compared using a one-way repeated analysis of variance. [Results] The Electromyography activities of serratus anterior and external oblique muscles between the resistance directions were significantly increased extension. The Electromyography activities of heterolateral internal oblique muscle between the resistance directions were significantly increased adduction. [Conclusion] To suggest use of the decision exercise tolerance orientation when muscle strengthening exercises for shoulder and trunk according to variation resistance in lower extremity during Push-up-plus.

Effect of the push-up plus guide and resistance device (PPGRD) on the serratus anterior during push-up plus.

[Purpose] This study developed a push-up plus guide and resistance device and investigated the effectiveness of the device. [Subject and Methods] A 39-year-old man presented with moderate pain with left scapular dyskinesis. A newly designed assistance device was used as a push-up plus guide and resistance device (PPGRD). The subject performed the push-up plus exercise without and then with the PPGRD for 2 weeks each. [Results] After performing the push-up plus exercise with the PPGRD for 2 weeks, the serratus anterior muscle power was increased, the pain score was decreased, and the absence of scapular dyskinesis was confirmed. [Conclusion] The PPGRD provided appropriate guidance and prevented excessive trunk flexion during the push-up plus exercise.

EMG activity of the serratus anterior and trapezius muscles during the different phases of the push-up plus exercise on different support surfaces and different hand positions.

[Purpose] The appropriate exercise prescription is crucial for achieving scapular stability and providing successful rehabilitation, and the Push-up Plus (PuP) exercise has an important role in shoulder rehabilitation. Consequently, this study examined the effect of support surface stability, hand positioning, and phase of exercise, on the trapezius and serratus anterior muscle contractions as well as on the EMG ratio of the upper/lower trapezius. [Subjects and Methods] Thirteen healthy male volunteers participated in this study. The subjects performed the PuP exercise on stable and unstable supporting surfaces with three different hand orientations. During the PuP exercise, the muscle activities of the upper (UT) and lower (LT) trapezius, as well as the serratus anterior (SA) were measured and expressed as percentages of maximum voluntary isometric contraction (%MVIC). [Results] The EMG activities of UT and LT were statistically greater during the push-up phase compared to the plus phase of the exercise. The contrary was recorded for the activity of the SA. SA was affected by the support surface as well as by the hand positioning. [Conclusion] The results suggest that different phases of the PuP exercise require different muscle stability actions with corresponding activations of appropriate muscle fibers. A detailed prescription of the required phase of the exercise can more effectively activate the scapula-thoracic musculature.

Effect of various hand position widths on scapular stabilizing muscles during the push-up plus exercise in healthy people.

[Purpose] The purpose of this study was to determine the effect of various hand position widths during the push-up plus (PUP) exercise on the activity of the scapular stabilizing muscles and other upper-extremity muscles involved in the exercise. [Subjects and Methods] Nine healthy men participated in our study. The PUP exercise was performed on a stable surface in seven different hand positions, namely shoulder width (SW), and narrower SW (NSW) and wider SW (WSW) at 10%, 20%, and 30%. Surface electromyography was used to measure the muscle activities and muscle ratio of the upper trapezius (UT), middle trapezius, lower trapezius (LT), serratus anterior (SA), pectoralis major, deltoid anterior, latissimus dorsi (LD), and triceps muscles. [Results] The SA and LD muscle activities significantly decreased in the 30% NSW and 20% WSW hand positions, respectively. The UT/LT muscle ratio significantly increased in the 30% WSW hand position. [Conclusion] The results of this study suggest that during the PUP exercise, the SW hand position should be used. In the 30% NSW hand position, the SA muscle activity decreased, and the UT/ LT ratio increased in the 30% WSW hand position.

Effect of the Shoulder Flexion Angle in the Sagittal Plane on the Muscle Activities of the Upper Extremities when Performing Push-up plus Exercises on an Unstable Surface.

[Purpose] The purpose of this study was to investigate the effect of the shoulder flexion angle on the muscle activities of the upper extremities when performing the push-up plus exercise (PUPE) on an unstable surface with the forearm in the external rotation position. [Subjects] The subjects were conducted on 15 normal male adults. [Methods] A sling device was used for the unstable surface, and PUPE was performed with the forearm in the external rotation position. The shoulder flexion angles measured in the sagittal plane were 110°, 90°, and 70°. Electromyography was used for a comparitive analysis of the muscle activities of the serratus anterior (SA), the pectoralis major (PM), and the upper trapezius (UT). [Results] In the intra-group comparison, the muscle activity of SA was statistically the highest when the shoulder-flexion angle was 110°. [Conclusion] performing PUPE on an unstable surface, the muscle activity of the SA is activated the most when the shoulder flexion angle is 110° and the forearm is in the external rotation position.

Effect of Vibration Frequency on Serratus Anterior Muscle Activity during Performance of the Push-up Plus with a Redcord Sling.

[Purpose] We investigated the effect of vibration at various frequencies on serratus anterior (SA) muscle activity. [Subjects] Ten male subjects were recruited. [Methods] The subjects performed the push-up plus exercise supported by straps above the surface and vertical ropes in the Redcord sling. During the push-up plus, vibrations of 0, 30, 50, or 90 Hz were applied to the Redcord sling using a mechanical vibration apparatus attached to the rope. SA muscle activity was recorded using electromyography. [Results] SA muscle activity at the 50 Hz vibration frequency was significantly higher than that of no vibration. [Conclusion] Performing the push-up plus using a Redcord sling with mechanical vibration of 50 Hz effectively increased SA muscle activity.

Comparison of Upper Trapezius, Anterior Deltoid, and Serratus Anterior Muscle Activity during Push-up plus Exercise on Slings and a Stable Surface.

[Purpose] The purpose of this study was to identify effects of push-up plus exercise on different support surfaces on upper extremity muscular activity. [Subjects] The subjects were 28 students (10 males, 18 females) at B University. [Methods] The subjects performed push-up plus exercises either on slings or on a fixed support. [Results] Push-up plus exercises on slings showed significant increases in the muscle activity of the trapezius (upper fiber), deltoid (anterior fiber), and serratus anterior muscles compared with stabilization exercises on a fixed support. [Conclusion] Based on these results, it is considered that performance of the push-up plus exercise on slings will increase scapular muscle activity.

Serratus anterior muscle activation during knee push-up plus exercise performed on static stable, static unstable, and oscillating unstable surfaces in healthy subjects.

OBJECTIVES: To compare electromyographic (EMG) activity of the serratus anterior (SA) during knee push-up plus exercises according to various surfaces (static stable, static unstable, and oscillating unstable surfaces). STUDY DESIGN: Comparative study by repeated measures. SETTING: Yonsei University laboratory. PARTICIPANTS: In total, 15 healthy male subjects participated. MAIN OUTCOME MEASURES: The subjects performed knee push-up plus exercises on three different surfaces: static stable, static unstable, and oscillating unstable surfaces. Surface EMG activity of the SA for the peak and average amplitudes were collected from the dominant arm and presented as a percentage of the maximal voluntary contraction. A one-way repeated-measures ANOVA with a Bonferroni post hoc test was performed to compare differences in SA EMG activity according to the surface. RESULTS: The peak and average amplitudes of SA activity were significantly greater during knee push-up plus on the oscillating unstable surface than on the static stable or static unstable surfaces (p < 0.01). Additionally, there was no significant difference between the stable and static unstable surfaces (p > 0.05). CONCLUSIONS: Knee push-up plus exercise on an oscillating unstable surface activates the SA more than the same exercise on static stable and static unstable surfaces.

Surface EMG during the Push-up plus Exercise on a Stable Support or Swiss Ball: Scapular Stabilizer Muscle Exercise.

[Purpose] Scapular stabilizer strengthening exercise is crucial for shoulder rehabilitation. The purpose of this study was to compare two types of push-up plus exercises, on a stable and unstable bases of support, using surface electromyography (EMG), to suggest an effective shoulder rehabilitation program. [Subjects and Methods] Ten healthy men volunteered for this study. All volunteers performed two sets of push-up plus exercise (standard push up and knee push up) on stable and unstable bases of support. The muscle activities of five important scapular stabilizer muscles (upper trapezius, middle trapezius, lower trapezius, serratus anterior, latissimus dorsi) were recorded during the exercise. [Results] The upper trapezius showed greater mean electric activation amplitude in the scapular retraction posture than in the scapular protraction posture, and the serratus anterior showed greater mean electric activation amplitude in the scapular protraction posture than in the scapular retraction posture. The root-mean-square normalized EMG values of the muscles were greater during the exercise performed on the unstable support than those on the stable support. [Conclusion] The standard push-up plus exercise on an unstable base of support helps to increase muscle activity, especially those of the upper/middle trapezius and serratus anterior.

The Effect of Hand Position Changes on Electromyographic Activity of Shoulder Stabilizers during Push-up Plus Exercise on Stable and Unstable Surfaces.

[Purpose] The purpose of this study was to determine the effect of hand position changes on electromyographic activity of shoulder stabilizers during push-up plus exercise (PUPE) performed on both stable and unstable surfaces. [Subjects] This study was performed on a cohort of 20 normal adults divided into an unstable surface group (USG) (n=10) and a stable surface group (SSG) (n=10). [Methods] A sling device was used to provide an unstable surface, and a push-up bar was used to provide a stable surface. PUPEs were performed with hands in various positions: the neutral position (NP), the internal rotation position (IRP), or the external rotation position (ERP). Electromyography was used to determine and analyze the electromyographic activity of the upper trapezius muscle (UT), the lower trapezius muscle (LT), the serratus anterior muscle (SA), and the pectoralis major muscle (PM). [Results] Comparison of the results within the USG and SSG showed significant differences depending on the hand position used during the exercise. Comparison between the USG and SSG showed that the ERP hand posture resulted in significant differences in electromyographic activity of the SA in the USG. [Conclusion] The electromyographic activity of the SA indicated that performing PUPEs using the ERP on an unstable surface provided more effective intervention for shoulder stabilization than ERP on a stable surface.

Effects of Push-ups Plus Sling Exercise on Muscle Activation and Cross-sectional Area of the Multifidus Muscle in Patients with Low Back Pain.

[Purpose] The purpose of this study was to examine the effect of lumbar stability exercises on chronic low back pain by using sling exercise and push-ups. [Subjects] Thirty adult subjects with chronic back pain participated, with 10 adults being assigned to each of 3 exercise groups: general physical therapy (PT), lumbar stability using sling exercises (Sling Ex), and sling exercise plus push-ups (Sling Ex+PU). Each group trained for 30 minutes 3 times a week for 6 weeks. The Oswestry Disability Index (ODI), surface electromyographic (sEMG) activity of the lumbar muscles, and cross-sectional area of the multifidus muscle on computed tomography (CT) were evaluated before and at 2, 4, and 6 weeks of therapy. [Results] A significant decrease in ODI was seen in all therapy groups, and this change was greater in the Sling Ex and Sling Ex+PU groups than in the PT group. No changes in sEMG activity were noted in the PT group, whereas significant increases in the sEMG activities of all lumbar muscles were found in the other 2 groups. The increases in the sEMG activities of the rectus abdominis and internal and external oblique muscles of the abdomen were greater in the Sling Ex+PU group than in the other 2 groups. [Conclusion] These findings demonstrate that Sling Ex+PU, similar to normal lumbar stabilization exercise, is effective in activating and improving the function of the lumbar muscles. These results suggest that Sling Ex+PU has a positive impact on stabilization of the lumbar region.