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The Effects of Scapular Taping on the Surface

Electromyographic Signal Amplitude of Shoulder Girdle
Muscles During Upper Extremity Elevation in Individuals
With Suspected Shoulder Impingement Syndrome

ormal muscular control of the scapula is important for Ludewig and Cook23 found that EMG
activities involving upper extremity (UE) elevation. The signal amplitude of the upper trapezius is
increased, while that of the lower trape-
upper and lower trapezius and the serratus anterior
zius is decreased, in patients with shoulder
muscles have important and specific roles in upward impingement. This has been suggested to
rotation of the scapula during UE elevation.2,3,18,28 Muscular result in an imbalance between the upper
dysfunction, including weakness of scapulothoracic muscles,9 trapezius and serratus anterior in produc-
has been implicated in disorders such as shoulder (subacromial) ing upward scapular rotation, resulting in
impingement and rotator cuff strain. Shoulder pain due to these a shoulder shrug when attempting UE
elevation.22,24 Ludewig and Cook23 also
disorders has been associated with significantly reduced health.30
found that there is decreased scapular
upward rotation during UE elevation
T STUDY DESIGN: Multifactorial, repeated-mea- assessed for each muscle. in patients with shoulder impingement.
T RESULTS: Upper trapezius activity was signifi-
sures, within-subjects design. Decreased serratus anterior activity has
T OBJECTIVES: To investigate the immediate ef- cantly lower with tape during shelf task elevation also been found in patients with shoulder
fects of scapular taping on surface electromyograph- (P = .002), especially above 90 (P .002). Lower impingement.34
ic (EMG) signal amplitude of shoulder girdle muscles trapezius activity was significantly higher with tape Several authors agree that anterior tip-
during upper extremity elevation in individuals with (P = .043). No significant differences were found ping of the scapula during UE elevation
suspected shoulder impingement syndrome. between the tape and no tape for other muscles
was present in subjects with shoulder im-
T BACKGROUND: Individuals with shoulder im-
for the shelf task. During shoulder abduction in the
scapular plane, the main effect for upper trapezius pingement.4,23,25 These findings also sug-
pingement syndrome may present with increased
showed a significant decrease of EMG signal gest diminished lower trapezius action
activity of the upper trapezius and inhibition
of other shoulder muscles active during upper
amplitude (P = .047) for tape versus no tape, but during upward rotation of the scapula.
no significant interactions were found among Cools et al8 found significant delays in
extremity elevation. Scapular taping is theorized to
components of this activity, or for other muscles.
normalize shoulder girdle function during scapular lower and middle trapezius activation
upward rotation by decreasing upper trapezius T CONCLUSION: Scapular taping decreased upper in overhead (ie, overhead-throwing/-
activity and increasing the activity of the lower trapezius and increased lower trapezius activity in
functioning) athletes with impingement
trapezius and other muscles. people with suspected shoulder impingement during
syndrome compared to overhead athletes
T METHODS AND MEASURES: Twenty-one a functional overhead-reaching task, and decreased
who were uninjured. They also found sig-
upper trapezius activity during shoulder abduction
volunteers with suspected shoulder impingement
syndrome performed shoulder abduction in the
in the scapular plane. Taping did not affect the other nificant delays in lower trapezius activa-
muscles under the loads tested, but it is possible tion on the injured side compared to the
scapular plane and a functional overhead-reaching
that the activity of these muscles was not deficient
(shelf) task, both with and without tape. Surface uninjured side in the injured subjects.8
at the time of testing. J Orthop Sports Phys Ther
electrodes were applied over the upper trapezius, In addition, Cools et al9 found decreased
2007;37(11):694-702. doi:10.2519/jospt.2007.2467
lower trapezius, serratus anterior, and infraspina-
lower trapezius surface EMG signal am-
tus muscles. Mean root-mean-square of the EMG T KEY WORDS: biomechanics/upper extremity,
signal, normalized to maximum contraction, was electromyographic activity, EMG, pain, scapula plitude during isokinetic shoulder retrac-
tion in overhead athletes with shoulder

Professor, Western University of Health Sciences, Pomona, CA. 2 Associate Professor, Western University of Health Sciences, Pomona, CA. Partial funding for this study was
provided through a grant from the California Physical Therapy Fund, Inc. This study was approved by the Institutional Review Board of Western University of Health Sciences.
Address correspondence to David M. Selkowitz, 365 Lincoln Ave, Pomona, CA 91767-3929. E-mail:

694 | november 2007 | volume 37 | number 11 | journal of orthopaedic & sports physical therapy
impingement compared to those without 3-week follow-up after the end of therapy, and 10 females) from the University com-
impingement. the patient reported that he no longer had munity and selected affiliated physical
People with shoulder impingement pain and that he had resumed all his lei- therapy clinics. Subjects were offered a
have been found, using fine-wire EMG, sure time activities, including playing ten- $5 stipend for participation in the study
to demonstrate decreased rotator cuff nis several times a week. However, muscle to defray transportation costs. The sub-
activity, particularly of the infraspinatus activity was not examined in that patient. jects were at least 18 years of age (mean,
muscle, during isotonic shoulder abduc- Further research, such as experimental 42.8 years), with a mean body mass of
tion in the scapular plane. 32 This may studies and clinical trials, is necessary to 72.1 kg and a mean height of 167.9 cm.
result in insufficient humeral head de- elucidate the effects and effectiveness of They reported having shoulder pain for
pression during UE elevation leading to scapular taping. varying duration, ranging from 1 week
shoulder impingement. 32 Infraspinatus The purpose of this study was to deter- to several years. Inclusion criteria were
is considered to have an important role mine if scapular taping has an influence a positive Neer29 and/or Hawkins-Ken-
in depression of the humeral head and on surface EMG signal amplitude of the nedy16 test, history of pain in the proximal
in providing glenohumeral joint stability upper trapezius, lower trapezius, serratus portion of the C5-6 dermatome with UE
during UE elevation.14 anterior, and infraspinatus muscles dur- elevation,25 and no prior scapular taping,
McConnell (unpublished course ing UE elevation in subjects with signs no history of shoulder or cervical spine
notes, 1994) has proposed a method of and symptoms suggestive of shoulder surgery, no cervical spine pathology, and
scapular taping for treatment of shoul- impingement. no neurological conditions. The subjects
der impingement and other pathologies Based on the previously described im- also needed to be able to elevate their
thought to occur due to imbalances of pairments associated with shoulder im- involved UE to at least 100 of shoul-
the shoulder musculature. McConnells pingement, a beneficial effect of scapular der flexion and 100 of abduction in the
method of scapular taping and her theo- taping would be a decrease in activity of scapular plane.
ries regarding scapulothoracic region the upper trapezius and an increase in the
pathomechanics and rehabilitation have activity of the lower trapezius, serratus Instrumentation
not been adequately tested. anterior, and infraspinatus muscles. The Strips of 2-in (5.08-cm) CoverRoll tape
In a study involving uninjured sub- effects on the upper trapezius could be as and Leukotape were used for the scapular
jects, Cools et al7 found that, both with a result of the location of the tape, while taping procedure, which is based on the
and without lifting a load, there were no the effects on the other muscles could be McConnell method.
significant differences in surface EMG of considered indirect and related to chang- The EMG data acquisition and pro-
the upper and lower trapezius and ser- es in activation of the upper trapezius. cessing were performed with Noraxon
ratus anterior muscles between scapular Based on prior research and a pilot study (Noraxon USA, Inc, Scottsdale, AZ)
taping and no-taping conditions, during on the immediate effects of scapular tap- equipment. This included the Myosys-
UE elevation and lowering. Alexander et ing, we hypothesized that, in subjects tem 1200 4-channel surface EMG unit,
al1 found that a scapular taping technique with signs and symptoms of shoulder and MyoResearch software to process
used on healthy individuals decreased the impingement syndrome, scapular tap- the EMG signal. Characteristics of the
amplitude of the lower trapezius H-reflex ing would significantly decrease upper Noraxon signal detection and processing
until the tape was removed, indicating an trapezius surface EMG signal amplitude system were eighth-order Butterworth
inhibitory influence of taping. In contrast, compared to no taping. Additionally, we low-pass filter of 500 Hz (1%), first-or-
Morin et al27 found a significant decrease hypothesized that in these subjects there der high-pass filter of 10 Hz (10%), a
in upper trapezius EMG signal amplitude would be no significant difference in sampling frequency of 1000 Hz, a base-
and a concomitant significant increase in surface EMG signal amplitude between line noise of less than 1-V root-mean-
middle/lower trapezius EMG signal am- scapular taping and no-taping conditions square (RMS), an input impedance of
plitude with scapular taping compared to for the lower trapezius, serratus anterior, greater than 100 M7, a common-mode
no taping, in uninjured subjects. and infraspinatus muscles. rejection ratio of greater than 100 dB,
A case report by Host17 investigated the and a gain of 1000. The software was
use of scapular taping on a patient with a METHOD programmed to perform rectification and
diagnosis of shoulder impingement. The smoothing of the signal by calculating the

patient required 8 treatment sessions that his study was approved by the RMS using a 50-ms moving window. The
included the application of scapular tape Institutional Review Board of West- mean RMS of each muscle was normal-
combined with therapeutic exercise be- ern University of Health Sciences. ized to a maximum voluntary isometric
fore being able to perform full shoulder Informed consent was obtained, and data contraction (MVIC). Normalization was
flexion and abduction without pain. At the were collected on 21 volunteers (11 males performed using a 1-second moving win-

journal of orthopaedic & sports physical therapy | volume 37 | number 11 | november 2007 | 695
After informed consent, a brief history
of injury, demographic data, and anthro-
pometric data were obtained. Electrodes
were applied on the involved UE as previ-
ously described after cleaning and abrad-
ing the skin at the points of contact.
Each subject then performed a MVIC
for each muscle, with manual resistance
Figure 2. SCAPTION movement experimental setup.
applied by 1 of the examiners. The up-
per trapezius was resisted, first using a
rior to the border of the latissimus dorsi shrug of the shoulders, followed by the
muscle and the midaxillary line. The lower trapezius, with force applied to ex-
electrodes for the infraspinatus muscle tend the UE when it was held at 90 of
were placed approximately 4 cm inferior shoulder flexion (elbow fully extended).
to the spine of the scapula over the in- Then the infraspinatus was resisted with
fraspinatus fossa on the lateral aspect of a force applied toward shoulder internal
the muscle. All electrodes were oriented rotation, with the upper extremities held
Figure 1. Posterior and oblique views of scapular
taping (A) and electrode placements for the upper
parallel to the direction of the respective at 0 of shoulder flexion and abduction
trapezius (B), infraspinatus (C), lower trapezius (D), muscle fibers. and 90 of elbow flexion. The serratus an-
and serratus anterior (E). Two large wooden boards were placed terior was resisted last in a push-up-plus
at a 120 angle to each other for the sub- position against the wall.24
dow for the peak (highest average) of the jects to use as a guide for performing el- Following the normalization phase,
MVIC. evation and return from elevation in the each subject performed the SCAPTION
A Noraxon single electrode placed scapular plane (SCAPTION; 30 ante- and SHELF activities, both with and
over the proximal sternum was used as rior to the coronal plane). Subjects were without scapular tape. Both the order of
the reference electrode. Noraxon blue instructed to elevate as high as tolerable, application of tape and the order of activ-
sensor dual (bipolar, single differential) at least to 100. For the other activity ity performance were randomized for 8
electrodes, 1 cm in diameter, with an in- (SHELF), a shelf was mounted on a possible combinations using a balanced
terelectrode distance of 2 cm, were used wall for a functional task in which sub- Latin-square design.
to collect the EMG signal from the target jects raised and lowered their involved The same scapular taping procedure
muscles on the side of impairment. UE to place and remove a 0.5-kg bottle was applied to each subject. First, the Cov-
Electrode placement (FIGURE 1) was of water. The shelf height was adjusted erRoll tape was applied to the skin over
based on the work of Cram and Kas- according to each individuals capability the upper trapezius on the involved side,
man10 and Jensen et al.19 The electrodes and tolerance, so that the angle of shoul- starting from the clavicle anteriorly and
for the upper trapezius muscle were der flexion when reaching the shelf was at extending posteriorly, caudally, and medi-
placed approximately 2 cm lateral to least 100, as measured with a plastic go- ally to the paraspinal area proximal to the
the midpoint of an imaginary line con- niometer. A metronome, set at 40 beats lower trapezius electrode, so that the tape
necting the spinous process of the sev- per minute, was used to pace the subjects was approximately perpendicular to the
enth cervical vertebra and the acromion UE movements in both activities. course of this portion of the upper trape-
( just lateral to where the scapular tape A Sony video camera was used to film zius. The Leukotape was applied next on
was placed). Electrode placement for the subjects while they performed shoul- top of the CoverRoll tape, with compres-
the lower trapezius muscle was approxi- der elevation and lowering activities. The sion over the upper trapezius (FIGURE 1).
mately 10.5 cm inferomedial to the me- location of the camera relative to the sub- SCAPTION was performed with the
dial border of the spine of the scapula, ject was the same for all subjects within subjects standing at, and facing, the area
at a 55 oblique angle to the horizontal each of the 2 activities. Myovideo soft- where the 2 wooden boards intersected
plane, but not below T12. The serratus ware was used to process the video signal. (FIGURE 2). The subjects were instructed
anterior muscle was monitored along The video signal was used to identify the to use the wooden boards to guide them
its lower fibers, with electrodes placed beginning and end of the elevation and as they elevated both UEs simultane-
inferior to the axillary region (following lowering phases of both SCAPTION and ously in the scapular plane, but to not
the midaxillary line) at the level of the SHELF, to assist in defining the time pe- touch the boards. The subjects practiced
inferior angle of the scapula, just ante- riod used to derive the RMS. this activity for a few repetitions using

696 | november 2007 | volume 37 | number 11 | journal of orthopaedic & sports physical therapy
the metronome (40 beats per minute) to (UP, DOWN) and the SHELF movements
pace the movements. Each elevation was (UP-NB, DOWN-B, UP-B, DOWN-NB)
completed in 1 beat and each lowering in order of performance, for the 2 parts
was completed in 1 beat, successively. Af- of the ROM, for each of the 4 muscles.
ter the subjects appeared to be familiar- A 3-factor (2-by-2-by-2) repeated-mea-
ized with the movement, they performed sures analysis of variance (ANOVA) was
5 repetitions of elevation and lowering performed for SCAPTION, for each of
the UEs in the scapular plane while data the 4 muscles. The factors (and their cor-
were collected. Although EMG data were responding levels) were taping condition
collected only from the involved UE, both (TAPE, NO TAPE), direction of move-
UEs were elevated and lowered simulta- ment (UP, DOWN), and ROM (90,
neously, to better control for unwanted 90). For SHELF, a 4-factor (2-by-2-
compensatory movements and because by-2-by-2) repeated-measures ANOVA
this method is commonly used in clinical was performed with the same factors (and
practice for evaluation. levels) as for SCAPTION, except for the
The SHELF task (FIGURE 3) was per- addition of the load factor and levels (B,
formed beginning with the bottle on the NB). If there were significant interaction
shelf. The activity was performed with effects involving the tape condition, these
only the involved UE moving, in the sag- were explored further with paired com-
Figure 3. SHELF task experimental setup.
ittal plane, paced by the metronome. A parison tests, comparing TAPE versus NO
practice period was conducted as with TAPE for the multifactor variables. The
SCAPTION. Subjects began the activity tive MVIC RMS. The 5-repetition mean alpha level for all tests was .05, except for
with the involved UE down at the side of of the normalized mean RMS values was the paired comparisons, in which this al-
the trunk without the bottle, and raised used as the EMG signal amplitude de- pha was divided by the number of paired
their involved UE to reach for and grasp pendent variable. comparisons (Bonferroni correction).
the bottle on the shelf. Then they lowered The 2 activities, SCAPTION and In addition, paired comparisons of
the UE to the starting position while hold- SHELF, were analyzed separately. For interest (determined a priori) were as-
ing the bottle. The activity continued with both activities, taping (TAPE) was com- sessed for the multicomponent factors of
the subjects raising the UE to the shelf pared to no taping (NO TAPE) for EMG the SCAPTION and SHELF activities for
again, this time holding the bottle and signal amplitude of the same 4 muscles. each muscle using dependent t tests, with
placing it on the shelf, and they completed It was considered possible that muscle the alpha level of .05 divided by the num-
the activity by lowering the UE to the start- function and activity might be affected ber of paired comparisons (4 for SCAP-
ing position without the bottle. This com- differently in impingement conditions, TION and 8 for SHELF).
pleted cycle was considered 1 repetition, depending on the direction in which the Subjects reported no pain immediately
and 5 repetitions were performed in total. UE was moving and where in the range prior to beginning each task. The immedi-
As with SCAPTION, each elevation in the of motion (ROM) the shoulder move- ate posttask pain VAS for each of the tasks
SHELF task was 1 beat and each lowering ment was occurring. Therefore, these (SCAPTION, SHELF) was compared for
was 1 beat (with or without the bottle). were factored into the analysis such that TAPE and NO TAPE, using dependent t
Reported pain was assessed as a sec- the direction of movement was dichoto- tests, with an alpha level of .05.
ondary variable, immediately prior to, mized into elevation (UP) and lowering
and after, both SCAPTION and SHELF (DOWN), and the ROM into greater than RESULTS
tasks, using a 10-cm visual analog scale 90 (90) and less than 90 ( 90), for

(VAS), with anchors of no pain and both SHELF and SCAPTION. In addi- uring the SCAPTION activity,
worst pain imaginable. tion, since the SHELF activity included subjects elevated their UE to a
periods in which the subject was raising mean (SD) of 140  16 when
Data Analysis and lowering the UE while holding a bot- taped and to 143  16 when not taped.
Noraxon MyoResearch software com- tle, the analysis dichotomized this factor This difference was not statistically sig-
puted the mean RMS of the EMG signal into bottle (B) and no bottle (NB). nificant (P = .136; dependent t test). Dur-
for each of the 4 muscles, for each rep- Statistical analysis was performed us- ing the SHELF task, subjects elevated
etition. The MyoResearch software nor- ing SPSS software (SPSS Inc, Chicago, IL) their UE to a mean of 130  9 flexion in
malized the mean RMS of each muscles to compare the TAPE and NO TAPE con- both conditions, as shelf height was kept
signal, for each repetition, to its respec- ditions for the SCAPTION movements constant between taping conditions.

journal of orthopaedic & sports physical therapy | volume 37 | number 11 | november 2007 | 697
EMG* Comparisons Between TAPE and NO TAPE for SCAPTION Component
TABLE 1 Movements (Multifactor Variables), for the Upper Trapezius and Lower
Trapezius Muscles

Upper Trapezius Lower Trapezius


UP 90 80.6 (47.2) 90.8 (48.3) .015 30.0 (24.7) 29.7 (21.5) .842
UP 90 111.5 (56.8) 124.5 (81.9) .082 81.0 (64.6) 70.7 (58.7) .152
DOWN 90 65.6 (29.6) 68.5 (33.8) .243 56.0 (46.7) 48.9 (47.9) .197
DOWN 90 37.4 (21.4) 43.3 (25.9) .033 23.0 (21.3) 21.6 (22.4) .357
Abbreviations: <90, shoulder movement below 90 elevation in the sagittal plane; >90, shoulder movement above 90 in the sagittal plane; DOWN, lowering
direction of movement; NO TAPE, condition with no scapular taping; SCAPTION, task of elevation and return from elevation in the scapular plane; TAPE,
condition with scapular taping; UP, elevation direction of movement.
* Values expressed in mean (SD) normalized to percent maximum voluntary isometric contraction (%MVIC). No statistically significant differences using
paired t tests with Bonferroni correction (alpha = .05/4 = .0125).

EMG* Comparisons Between TAPE and NO TAPE for SCAPTION Component

TABLE 2 Movements (Multifactor Variables), for the Serratus Anterior and
Infraspinatus Muscles

Serratus Anterior Infraspinatus


UP 90 50.2 (34.3) 50.6 (35.9) .904 30.6 (30.3) 27.4 (21.1) .487
UP 90 103.2 (51.8) 101.0 (57.0) .673 38.1 (34.1) 35.8 (30.3) .624
DOWN 90 67.3 (38.5) 63.2 (36.6) .388 28.6 (29.3) 24.7 (17.0) .363
DOWN 90 32.2 (27.7) 33.7 (29.0) .707 23.7 (28.3) 20.7 (18.9) .527
Abbreviations: <90, shoulder movement below 90 elevation in the sagittal plane; >90, shoulder movement above 90 in the sagittal plane; DOWN, lowering
direction of movement; NO TAPE, condition with no scapular taping; SCAPTION, task of elevation and return from elevation in the scapular plane; TAPE,
condition with scapular taping; UP, elevation direction of movement.
* Values expressed in mean (SD) normalized to percent maximum voluntary isometric contraction (%MVIC). No statistically significant differences using
paired t tests with Bonferroni correction (alpha = 0.05/4 = 0.0125).

The 3-factor repeated-measures (df = 1, F = 5.214, P = .033). Paired com- no significant 2-, 3-, or 4-way interac-
ANOVA for EMG signal amplitude of parison testing (paired t tests with Bonfer- tions among taping condition and the
the upper trapezius during SCAPTION roni correction: alpha w 2 = 0.025 for the 2 other factors (P.05). However, there
showed that there were no significant 2- paired comparisons) showed that the up- was a significant main effect (P = .047)
way or 3-way interactions among taping per trapezius had significantly less EMG for the taping condition. The lower tra-
condition and the other factors (P.05). signal amplitude during the elevation pezius had significantly greater EMG
However, there was a significant main ef- phase of movement with TAPE compared signal amplitude with TAPE compared
fect (P = .047) for the taping condition. to NO TAPE (df = 20, t = 3.222, P = .004). to NO TAPE (df = 1, F = 4.649, P = .043).
Upper trapezius EMG signal amplitude The magnitude of the mean decrease was The magnitude of the mean increase was
was significantly less with TAPE than 9.6% (97.7%-88.3% MVIC: [9.4 w 97.7]  13.5% (61.3%-69.6% MVIC).
with NO TAPE. 100]. The other relevant paired compari- There were no significant differences
There were no significant differences son for this interactioncomparing TAPE between TAPE and NO TAPE (main or
between TAPE and NO TAPE (main or to NO TAPE during the lowering phase of interaction effects) during the SHELF
interaction effects) for any of the other movementwas not statistically signifi- task for the serratus anterior and infra-
muscles (P.05). cant (P = .224). There were no significant spinatus muscles (P.05).
The 4-factor repeated-measures interactions among taping condition and TABLES 1 through 4 display descrip-
ANOVA for the upper trapezius during the other 2 factors (P.05). tive statistics for all components of the
the SHELF task showed a significant The 4-factor repeated-measures SCAPTION and SHELF activities, re-
interaction between the factors of tape ANOVA for the lower trapezius during spectively, for each muscle. The paired
condition and direction of movement the SHELF task showed that there were comparisons of interest (determined a

698 | november 2007 | volume 37 | number 11 | journal of orthopaedic & sports physical therapy
EMG* Comparisons Between TAPE and NO TAPE
TABLE 3 for SHELF Component Movements (Multifactor Variables),
for Upper Trapezius and Lower Trapezius

Upper Trapezius Lower Trapezius


UP NB 90 71.0 (40.7) 80.2 (47.5) .012 28.3 (32.0) 27.6 (33.0) .647
UP NB 90 96.8 (45.4) 106.7 (46.4) .003 41.0 (37.2) 35.4 (33.0) .077
DOWN B 90 63.5 (28.0) 70.1 (31.2) .013 48.7 (36.9) 42.3 (35.1) .031
DOWN B 90 34.1 (19.2) 35.9 (19.6) .183 22.2 (24.8) 20.8 (25.0) .240
UP B 90 77.5 (45.0) 84.2 (42.8) .083 33.0 (32.4) 31.3 (30.0) .407
UP B 90 111.5 (56.8) 119.6 (81.9) .001 51.7 (53.8) 43.0 (38.7) .173
DOWN NB 90 50.9 (23.8) 54.2 (22.2) .101 36.9 (28.3) 29.3 (26.2) .011
DOWN NB 90 33.7 (20.8) 32.3 (20.0) .260 16.9 (25.3) 15.4 (25.4) .185
Abbreviations: <90, shoulder movement below 90 elevation in the sagittal plane; >90, shoulder movement above 90 in the sagittal plane; B, holding bottle;
DOWN, lowering direction of movement; NB, without holding bottle; NO TAPE, condition with no scapular taping; SHELF, functional task in which subjects
raised and lowered their involved upper extremity; TAPE, condition with scapular taping; UP, elevation direction of movement.
* Values expressed in mean (SD) normalized to percent maximum voluntary isometric contraction (%MVIC).

Statistically significant difference using paired t tests with Bonferroni correction (alpha = .050/8 = .00625).

EMG* Comparisons Between TAPE and NO TAPE

TABLE 4 for SHELF Component Movements (Multifactor Variables),
for Serratus Anterior and Infraspinatus

Serratus Anterior Infraspinatus


UP NB 90 45.9 (38.2) 47.0 (34.1) .702 26.4 (18.6) 25.1 (18.6) .271
UP NB 90 99.9 (57.1) 98.5 (57.9) .735 32.1 (21.7) 32.0 (19.7) .924
DOWN B 90 79.5 (46.4) 79.1 (47.0) .893 28.6 (17.0) 30.2 (18.2) .257
DOWN B 90 35.4 (35.8) 35.6 (46.2) .957 21.8 (18.8) 20.5 (16.6) .210
UP B 90 49.0 (36.4) 49.2 (40.3) .932 28.3 (19.5) 27.2 (19.7) .300
UP B 90 114.4 (72.7) 114.2 (67.2) .964 37.4 (24.1) 39.2 (26.4) .194
DOWN NB 90 62.1 (42.8) 58.1 (38.7) .354 23.9 (13.3) 23.6 (11.4) .843
DOWN NB 90 36.6 (36.5) 36.4 (47.6) .959 19.5 (17.0) 17.8 (14.1) .171
Abbreviations: <90, shoulder movement below 90 elevation in the sagittal plane; >90, shoulder movement above 90 in the sagittal plane; B, holding bottle;
DOWN, lowering direction of movement; NB, without holding bottle; NO TAPE, condition with no scapular taping; SHELF, functional task in which subjects
raised and lowered their involved upper extremity; TAPE, condition with scapular taping; UP, elevation direction of movement.
* Values expressed in mean (SD) normalized percent maximum voluntary isometric contraction (%MVIC). No statistically significant differences using paired
t tests with Bonferroni correction (alpha = .050/8 = .00625).

priori) were analyzed for the difference NO TAPE for SCAPTION and SHELF conditions for SHELF and SCAPTION
between TAPE and NO TAPE during for the upper trapezius and the 3 other (0.5 cm and 0.2 cm, respectively) were
the SHELF task for each component of muscles were significant (P.00625). also too small to be clinically relevant.
the 2 activities using paired t tests. The There were no significant differences
comparisons between TAPE and NO in mean pain scores between TAPE and DISCUSSION
TAPE during the SHELF task for the NO TAPE during SHELF (TAPE, 1.1 cm;

upper trapezius, for UP B 90 and for NO TAPE, 1.6 cm; P = .057) or SCAP- his study investigated the imme-
UP NB 90, were statistically signifi- TION (TAPE, 1.4 cm; NO TAPE, 1.6 cm; diate effects of a particular scapular
cant (P .001 and P .002, respectively), P = .267) on the VAS. Considering the low taping method on activation of the
based on the Bonferroni-corrected alpha mean pain scores, and based on studies shoulder musculature in individuals who
(.05/8 = .00625). None of the other com- of other musculoskeletal conditions,6,11,35 had signs and symptoms of shoulder im-
parisons of interest between TAPE and these VAS differences between taping pingement. The scapular taping method

journal of orthopaedic & sports physical therapy | volume 37 | number 11 | november 2007 | 699
used in this study resulted in a small but Morin et al27 was a type of isometric, seat- gating people with shoulder impingement
significant decrease in EMG signal am- ed, inclined row (approaching a shrug). problems, including greater than 1 week,20
plitude of the upper trapezius compared Alexander et al1 found that a scapu- up to 12 weeks,36 and some studies having
to no taping, during a functional task lar taping technique inhibited the lower indicated no time period at all.8,9,31 The sub-
requiring shoulder elevation. Scapular trapezius. However, they applied the tape jects in the current study were not in acute
taping also produced a significant overall onto the skin overlying the lower trape- pain, which is also consistent with this
decrease in upper trapezius activity dur- zius and parallel to the direction of its fi- literature, but might explain the low mag-
ing shoulder abduction in the scapular bers, rather than over and perpendicular nitudes or lack of differences seen with tap-
plane. There was also a significant over- to the upper trapezius as was done in the ing. It is also important to note that there is
all increase in lower trapezius EMG sig- current study. no evidence that any of the muscles studied
nal amplitude during the functional task Cools et al7 found no significant dif- were deficient at the time this study was
when scapular taping was used. ferences in uninjured subjects between conducted. However, Cools et al9 also found
The upper trapezius was more af- scapular taping and no taping for the that there were no deficits in surface EMG
fected during elevation than lowering. upper, middle, and lower trapezius, and signal amplitude of the serratus anterior in
Because this subject sample did not have serratus anterior. The results of the cur- injured compared to uninjured overhead
high pain levels, it is possible that the ef- rent study were similar to those of Cools throwers, despite finding deficits in shoul-
fect was greater above 90 because that et al7 for serratus anterior, but differed in der protraction torque at high speeds.
is where there is greater impingement its finding of a decrease in upper trape- While the subjects in this study had
and, therefore, it was more provocative. zius activation and an increase in lower subjective and objective findings con-
In addition, if the upper trapezius is more trapezius activation. sistent with shoulder impingement, this
biomechanically and physiologically Cools et al7 divided the movement was not verified with diagnostic imaging
(length-tension) challenged above 90, directions and ROM into 0 to 90, 90 tests. This is also similar to other stud-
this could also have been a factor. to 180, 180 to 90, and 90 to 0, as in ies.8,9,25 In addition, this study did not re-
The serratus anterior and infraspi- the current study. However, Cools et al7 quire that the subjects be symptomatic in
natus were not significantly affected by investigated shoulder flexion and abduc- other clinical physical examination tests
scapular taping. It is possible that this tion, which were slightly different than besides the Neer or Hawkins-Kennedy
method of taping provides an insufficient the movement tasks in the current study. tests.21,31 Although there is much varia-
indirect influence (via alteration of upper In addition, the location of the upper tion in the literature, the physical and
trapezius activation), and these muscles trapezius electrode was midway between subjective examination tests used in this
require exercise training to increase their the C7 spinous process and the acromion study have been used in combination as
activity in the presence of impingement. in the Cools et al7 study, which has been sufficient criteria for labeling subjects
It is also possible that there were no defi- reported to depress the signal amplitude with shoulder impingement syndrome in
cits in activation of these muscles. of the upper trapezius.19 They applied the the literature.8,25,26 Several diagnoses and
tape lateral to the electrodes and later- pathologies have been included in the
Comparison to the Literature ally over the upper trapezius. Perhaps the literature as being indicative of shoulder
The results for the upper and lower tra- most important difference between the 2 impingement syndrome (eg, partial ro-
pezius muscles are in agreement with the studies involves the subject populations: tator cuff tear, full-thickness rotator cuff
findings of Morin et al,27 who found sig- the current study used injured individu- tear, subacromial bursitis, supraspinatus,
nificant decreases in upper trapezius and als rather than noninjured subjects. infraspinatus, subscapularis, and biceps
increases in lower trapezius activity with tendinitis), and various methods of mak-
scapular taping compared to no taping in Possible Study Limitations ing a diagnosis have been used, which
uninjured subjects. Morin et al27 differed The small significant differences for the up- add to the confusion in clinical definition.
in their experimental method from the per and lower trapezius, as well as the lack Therefore, the diagnostic label of impinge-
current study and those previously men- of significant differences between taping ment syndrome may vary depending on
tioned. They placed the lower trapezius and no taping for EMG signal amplitude the specific tissue pathology involved, as
electrode between the medial scapular of the serratus anterior and infraspinatus well as the severity, which may result in
border and the thoracic spine, halfway might represent the true phenomenon, variations in diagnostic usefulness of the
between the superior and inferior angles or might be due to characteristics of this various impingement syndrome tests. This
of the scapula. This may have been more studys subject population. The duration of is also an issue among studies that have
representative of the middle trapezius or shoulder problems varied among these sub- investigated the diagnostic usefulness of
a combination of lower and middle trape- jects. However, such variation is consistent commonly used clinical tests. While some
zius. In addition, the activity measured by with other reports in the literature investi- tests not used in this study have been

700 | november 2007 | volume 37 | number 11 | journal of orthopaedic & sports physical therapy
shown to have high diagnostic value and the design was within subjects, and sub- upper trapezius surface EMG signal am-
positive predictive value, both the Neer maximal normalization contractions have plitude, and significantly increased lower
and Hawkins-Kennedy tests have been been reported to be appropriate for study- trapezius amplitude, compared to no tap-
shown to have adequately high diagnostic ing surface EMG signal amplitude.12,38 ing during a functional reaching task in-
accuracy and positive predictive value and, Cross talk (electrical activity from a volving UE elevation and lowering. The
under certain conditions, even higher than nearby contracting muscle) is a phenom- predominant effects on the upper trape-
other tests with higher levels of specifici- enon present in surface EMG studies that zius occurred during UE elevation above
ty.5,31 Only in instances of complete rotator can contaminate the signal detected from 90 of shoulder elevation. There was also
cuff tears have the tests used in the cur- a target muscle. However, surface EMG is a significant decrease in upper trapezius
rent study been found to have lower levels an appropriate method for detecting mus- activity with taping compared to no taping
of specificity compared to other tests.31 cle electrical activity and cross talk is lim- during shoulder abduction in the scapular
McClure et al,26 in their study of impinge- ited when the target muscles are relatively plane. No significant differences in EMG
ment, excluded people with acute inflam- large and superficial,3,15,33 as in the current signal amplitude between taping and no
mation or complete rotator cuff tears. It is study. The distance between the electrode taping were found for any of the UE eleva-
likely that the subjects in the current study pairs of any 2 muscles in the current tion and lowering movements for the ser-
did not have complete rotator cuff tears or study was more than 3 cm. This distance ratus anterior and infraspinatus muscles,
acute inflammation, based on their sub- has been shown to adequately limit cross and no differences in pain complaint were
jective and objective findings and their talk.37 The small interelectrode distance found between taping and no taping for
performance during the study. (2 cm) within each electrode pair, used the SCAPTION and SHELF tasks. Fur-
In general, the subjects were activating in the current study, is also considered to ther study is necessary to determine if the
their muscles at higher percent of MVIC limit cross talk.13,15 In addition, the single- EMG changes found in the current study
in the UP and 90 phases of the SHELF differential (bipolar) electrode technique are associated with functional improve-
and SCAPTION tasks (TABLES 1-4). The is thought to limit cross talk and the ad- ment in patients with these problems.
relative activation levels reached 100% dition of common mode noise from the
or more of MVIC for upper trapezius and environment to the signal.3 ACKNOWLEDGMENTS
serratus anterior, for certain phases of the The lack of significant change in pain

tasks. However, it is likely that the manual VAS scores and UE elevation ROM in he authors thank the follow-
muscle test MVICs in the current studys the scapular plane, between taping and ing people for their consultation on
procedure underestimated the true maxi- no taping, might also have been due to data analysis and statistics: Dale
mum EMG signal amplitude capability of the current stage of the problem in these Berger, PhD; Gary Gugelchuk, PhD; Ste-
these muscles, which would overestimate subjects. Another study investigating the phen Allison, PT, PhD; Carolyn Ervin,
the relative activation levels during these effects of taping on posture in subjects PhD; Robert Wiswell, PhD; and Paula
tasks. The normalization contractions with shoulder impingement syndrome Ludewig, PT, PhD. The authors also
used in the current study did not include showed that posture and overhead ROM thank Jess Opatynski for his assistance
certain activities reported to produce were significantly improved while sub- with photography. T
higher maximum contractions.15 The high jects were taped, but there was no differ-
relative activation levels noted above are ence in pain complaint.21
also higher than those found by Cools et Further study of the effectiveness of REFERENCES
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702 | november 2007 | volume 37 | number 11 | journal of orthopaedic & sports physical therapy