Trapezius muscle activation levels and ratios during scapular retraction exercises: A comparative study between patients with subacromial impingement syndrome and healthy controls


      • Patients have normal trapezius activity compared to healthy group during retraction exercises.
      • Retraction exercises do not cause abnormal compensatory trapezius muscle activity.
      • Retraction exercises can be safely used in shoulder impingement exercise programs.



      Little is known about trapezius muscle activities during scapular retraction exercises in patients with subacromial impingement syndrome. The aim of this study was to compare upper trapezius, middle trapezius and lower trapezius muscle activity and upper/middle and upper/lower trapezius ratios between patients with subacromial impingement syndrome and healthy individuals during six scapular retraction exercises.


      Twenty-two patients with subacromial impingement syndrome and 22 healthy individuals participated. Upper, middle, and lower trapezius activities were measured by surface electromyography, while the participants performed six scapular retraction exercises at different shoulder abduction angles in a standing position. Upper/middle and upper/lower trapezius ratios were also calculated. Repeated-measures analyses of variance were performed to determine whether muscle activation levels and ratios differed between groups during exercises.


      There was no significant exercise × group interactions for upper, middle, and lower trapezius activation levels and upper/middle and upper/lower trapezius ratios (P > .05). A main effect for the exercise was observed for the upper/middle and upper/lower trapezius ratios (P < .05).


      Compared to healthy individuals, patients with subacromial impingement syndrome did not exhibit different upper, middle, and lower trapezius activity and had similar upper/middle and upper/lower trapezius ratios during the various scapular retraction exercises. Therefore, scapular retraction exercises with various shoulder abduction could be safely offered for the patients with subacromial impingement syndrome since it does not lead to abnormal compensatory trapezius muscle activity. If the goal is to minimize upper/middle and upper/lower trapezius ratios, the scapular retraction exercises at 0° shoulder abduction may be used in early stage of shoulder rehabilitation.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ayatollahi K.
        • Okhovatian F.
        • Kalantari K.
        • Baghban A.A.
        A comparison of scapulothoracic muscle electromyographic activity in subjects with and without subacromial impingement syndrome during a functional task.
        J. Bodyw. Mov. Ther. 2017; 21: 719-724
        • Bandholm T.
        • Rasmussen L.
        • Aagaard P.
        • Jensen B.R.
        • Diederichsen L.
        Force steadiness, muscle activity, and maximal muscle strength in subjects with subacromial impingement syndrome.
        Muscle Nerve. 2006; 34: 631-639
        • Breckenridge J.D.
        • McAuley J.H.
        Shoulder pain and disability index (SPADI).
        J. Phys. 2011; 57: 197
        • Castelein B.
        • Cagnie B.
        • Parlevliet T.
        • Danneels L.
        • Cools A.
        Optimal normalization tests for muscle activation of the levator scapulae, pectoralis minor, and rhomboid major: an electromyography study using maximum voluntary isometric contractions.
        Arch. Phys. Med. Rehabil. 2015; 96: 1820-1827
        • Castelein B.
        • Cagnie B.
        • Parlevliet T.
        • Cools A.
        Scapulothoracic muscle activity during elevation exercises measured with surface and fine wire EMG: a comparative study between patients with subacromial impingement syndrome and healthy controls.
        Man. Ther. 2016; 23: 33-39
        • Castelein B.
        • Cools A.
        • Parlevliet T.
        • Cagnie B.
        Modifying the shoulder joint position during shrugging and retraction exercises alters the activation of the medial scapular muscles.
        Man. Ther. 2016; 21: 250-255
        • Chester R.
        • Smith T.O.
        • Hooper L.
        • Dixon J.
        The impact of subacromial impingement syndrome on muscle activity patterns of the shoulder complex: a systematic review of electromyographic studies.
        BMC Musculoskelet. Disord. 2010; 11: 45
        • Cid M.M.
        • Januario L.B.
        • Zanca G.G.
        • Mattiello S.M.
        • Oliveira A.B.
        Normalization of the trapezius sEMG signal–a reliability study on women with and without neck-shoulder pain.
        Braz. J. Phys. Ther. 2018; 22: 110-119
        • Colado J.C.
        • Garcia-Masso X.
        • Triplett N.T.
        • Calatayud J.
        • Flandez J.
        • Behm D.
        • Rogers M.E.
        Construct and concurrent validation of a new resistance intensity scale for exercise with Thera-Band® elastic bands.
        J. Sports Sci. Med. 2014; 13: 758
        • Cools A.
        • Declercq G.
        • Cambier D.
        • Mahieu N.
        • Witvrouw E.
        Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms.
        Scand. J. Med. Sci. Sports. 2007; 17: 25-33
        • Cools A.M.
        • Dewitte V.
        • Lanszweert F.
        • Notebaert D.
        • Roets A.
        • Soetens B.
        • Cagnie B.
        • Witvrouw E.E.
        Rehabilitation of scapular muscle balance which exercises to prescribe?.
        Am. J. Sports Med. 2007; 35: 1744-1751
        • Cools A.M.
        • Cambier D.
        • Witvrouw E.E.
        Screening the athlete's shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology.
        Br. J. Sports Med. 2008; 42: 628-635
        • De Mey K.
        • Danneels L.
        • Cagnie B.
        • Huyghe L.
        • Seyns E.
        • Cools A.M.
        Conscious correction of scapular orientation in overhead athletes performing selected shoulder rehabilitation exercises: the effect on trapezius muscle activation measured by surface electromyography.
        J. Orthop. Sports Phys. Ther. 2013; 43: 3-10
        • De Mey K.
        • Danneels L.
        • Cagnie B.
        • Van den Bosch L.
        • Flier J.
        • Cools A.M.
        Kinetic chain influences on upper and lower trapezius muscle activation during eight variations of a scapular retraction exercise in overhead athletes.
        J. Sci. Med. Sport. 2013; 16: 65-70
        • de Morais Faria C.D.C.
        • Teixeira-Salmela L.F.
        • de Paula Goulart F.R.
        • de Souza Moraes G.F.
        Scapular muscular activity with shoulder impingement syndrome during lowering of the arms.
        Clin. J. Sport Med. 2008; 18: 130-136
        • Ekstrom R.A.
        • Donatelli R.A.
        • Soderberg G.L.
        Surface electromyographic analysis of exercises for the trapezius and serratus anterior muscles.
        J. Orthop. Sports Phys. Ther. 2003; 33: 247-258
        • Graichen H.
        • Hinterwimmer S.
        • von Eisenhart-Rothe R.
        • Vogl T.
        • Englmeier K.H.
        • Eckstein F.
        Effect of abducting and adducting muscle activity on glenohumeral translation, scapular kinematics and subacromial space width in vivo.
        J. Biomech. 2005; 38: 755-760
        • Harput G.
        • Guney-Deniz H.
        • Duzgun I.
        Upper to middle trapezius muscle activation ratio during scapular retraction exercise at different shoulder abduction angles.
        Turkish Journal of Physiotherapy and Rehabilitation. 2017; 28: 111-117
        • Harput G.
        • Guney-Deniz H.
        • Duzgun I.
        • Toprak U.
        • Michener L.A.
        • Powers C.
        The influence of active scapular retraction on acromio-humeral distance at various degrees of shoulder abduction.
        J. Athl. Train. 2018; 53: 584-589
        • Hermens H.J.
        • Freriks B.
        • Disselhorst-Klug C.
        • Rau G.
        Development of recommendations for SEMG sensors and sensor placement procedures.
        J. Electromyogr. Kinesiol. 2000; 10: 361-374
        • Kibler W.B.
        • McMullen J.
        Scapular dyskinesis and its relation to shoulder pain.
        J. Am. Acad. Orthop. Surg. 2003; 11: 142-151
        • Kibler W.B.
        • Ludewig P.M.
        • McClure P.W.
        • Michener L.A.
        • Bak K.
        • Sciascia A.D.
        Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘Scapular Summit’.
        Br. J. Sports Med. 2013; 47: 877-885
        • Larsen C.
        • Juul-Kristensen B.
        • Olsen H.
        • Holtermann A.
        • Søgaard K.
        Selective activation of intra-muscular compartments within the trapezius muscle in subjects with Subacromial Impingement Syndrome. A case-control study.
        J. Electromyogr. Kinesiol. 2014; 24: 58-64
        • Lopes A.D.
        • Timmons M.K.
        • Grover M.
        • Ciconelli R.M.
        • Michener L.A.
        Visual scapular dyskinesis: kinematics and muscle activity alterations in patients with subacromial impingement syndrome.
        Arch. Phys. Med. Rehabil. 2015; 96: 298-306
        • Ludewig P.M.
        • Cook T.M.
        Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement.
        Phys. Ther. 2000; 80: 276-291
        • McCabe Robert A.
        • et al.
        Surface electromygraphic analysis of the lower trapezius muscle during exercises performed below ninety degrees of shoulder elevation in healthy subjects.
        North American journal of sports physical therapy: NAJSPT. 2007; 2: 34
        • Michener L.A.
        • McClure P.W.
        • Karduna A.R.
        Anatomical and biomechanical mechanisms of subacromial impingement syndrome.
        Clin. Biomech. 2003; 18: 369-379
        • Moeller C.R.
        • Bliven K.C.H.
        • Valier A.R.S.
        Scapular muscle-activation ratios in patients with shoulder injuries during functional shoulder exercises.
        J. Athl. Train. 2014; 49: 345
        • Myers J.B.
        • Pasquale M.R.
        • Laudner K.G.
        • Sell T.C.
        On-the-field resistance-tubing exercises for throwers: an electromyographic analysis.
        J. Athl. Train. 2005; 40: 15
        • Nordander C.
        • Balogh I.
        • Mathiassen S.E.
        • Ohlsson K.
        • Unge J.
        • Skerfving S.
        • Hansson G.Å.
        Precision of measurements of physical workload during standardised manual handling. Part I: surface electromyography of m. trapezius, m. infraspinatus and the forearm extensors.
        J. Electromyogr. Kinesiol. 2004; 14: 443-454
        • Oyama S.
        • Myers J.B.
        • Wassinger C.A.
        • Lephart S.M.
        Three-dimensional scapular and clavicular kinematics and scapular muscle activity during retraction exercises.
        J. Orthop. Sports Phys. Ther. 2010; 40: 169-179
        • Phadke V.
        • Camargo P.
        • Ludewig P.
        Scapular and rotator cuff muscle activity during arm elevation: a review of normal function and alterations with shoulder impingement.
        Braz. J. Phys. Ther. 2009; 13: 1-9
        • Reinold M.M.
        • Escamilla R.
        • Wilk K.E.
        Current concepts in the scientific and clinical rationale behind exercises for glenohumeral and scapulothoracic musculature.
        J. Orthop. Sports Phys. Ther. 2009; 39: 105-117
        • Roy J.-S.
        • Moffet H.
        • McFadyen B.J.
        Upper limb motor strategies in persons with and without shoulder impingement syndrome across different speeds of movement.
        Clin. Biomech. 2008; 23: 1227-1236
        • Smith M.
        • Sparkes V.
        • Busse M.
        • Enright S.
        Upper and lower trapezius muscle activity in subjects with subacromial impingement symptoms: is there imbalance and can taping change it?.
        Phys. Ther. Sport. 2009; 10: 45-50
        • Solem-Bertoft E.
        • Thuomas K.A.
        • Westerberg C.E.
        The influence of scapular retraction and protraction on the width of the subacromial space. An MRI study.
        Clin. Orthop. Relat. Res. 1993; : 99-103
        • Tate A.R.
        • McClure P.W.
        • Kareha S.
        • Irwin D.
        Effect of the Scapula Reposition Test on shoulder impingement symptoms and elevation strength in overhead athletes.
        J. Orthop. Sports Phys. Ther. 2008; 38: 4-11