Associations between cervical and scapular posture and the spatial distribution of trapezius muscle activity

The first aim of this investigation was to quantify the distribution of trapezius muscle activity with different scapular postures while seated. The second aim of this investigation was to examine the association between changes in cervical and scapular posture when attempting to recruit different subdivisions of the trapezius muscle. Cervical posture, scapular posture, and trapezius muscle activity were recorded from 20 healthy participants during three directed shoulder postures. Planar angles formed by reflective markers placed on the acromion process, C7, and tragus were used to quantify cervical and scapular posture. Distribution of trapezius muscle activity was recorded using two high-density surface electromyography (HDsEMG) electrodes positioned over the upper, middle, and lower trapezius. Results validated the assumption that directed scapular postures preferentially activate different subdivisions of the trapezius muscle. In particular, scapular depression was associated with a more inferior location of trapezius muscle activity (r = 0.53). Scapular elevation was coupled with scapular abduction (r = 0.52). Scapular adduction was coupled with cervical extension (r = 0.35); all other changes in cervical posture were independent of changes in scapular posture. This investigation provides empirical support for reductions in static loading of the upper trapezius and improvements in neck posture through verbal cueing of scapular posture.     

Interfering effects of multitasking on muscle activity in the upper extremity.

Multitasking, where workers are required to perform multiple physical tasks with various levels of cognitive load is common in today's workplace. Simultaneous physical and mental demands are thought to cause task interference and likely increase muscle activity. To test the interfering effects of multitasking, 16 healthy participants performed hand and shoulder exertions with combinations of four grip conditions (no grip, 30% grip with low precision, 30% grip with high precision, and maximal grip) and three shoulder conditions at 90 degrees abduction (maintaining posture, 40% force-controlled moment, 40% posture-controlled moment), with and without the Stroop test while surface EMG was recorded from eight upper extremity muscles. Both 40% MVC shoulder moments increased extrinsic forearm muscle activity by 2-4% MVE (p<0.01). Grip exertion at 30% MVC reduced anterior and middle deltoid activity by 2% MVE (p<0.01). Exerting a constant force against the transducer (force-controlled) required 3-4% MVE greater middle and posterior deltoid activity (p<0.001) compared to supporting an equivalent inertial load at the same shoulder angle (posture-controlled). Performing the mental task (Stroop test) concurrently with either 40% MVC shoulder moments significantly increased trapezius activity by nearly 2% MVE (p<0.05). Interestingly, the Stroop test also reduced all deltoid activity by 1% MVE (p<0.05). The addition of both the Stroop test and force-control shoulder exertion independently reduced maximal grip force by 7% and 10% MVC, respectively. These results suggest that more complex workplace tasks may act to increase muscle load or interfere with task performance. These small but significant findings may play a role in the development of long-term musculoskeletal disorders in the workplace.     

Muscle pain induces task-dependent changes in cervical agonist/antagonist activity.

This study examined the effect of experimental neck muscle pain on the EMG-force relationship of cervical agonist and antagonist muscles. Surface EMG signals were detected from the sternomastoid, splenius capitis, and upper trapezius muscles bilaterally from 14 healthy subjects during cervical flexion and extension contractions of linearly increasing force from 0 to 60% of the maximum voluntary contraction (MVC). Measurements were performed before and after injection of 0.5 ml hypertonic and isotonic saline into either the sternomastoid or splenius capitis in two experimental sessions. EMG average rectified value (ARV) of the sternomastoid, splenius capitis, and upper trapezius muscles and the muscle fiber conduction velocity (CV) of the sternomastoid muscle were estimated at 5% MVC force increments. During cervical flexion with injection of hypertonic saline in sternomastoid, ARV of sternomastoid was lower on the side of pain in the force range 25-60% MVC (P < 0.05) and was associated with a bilateral reduction of splenius capitis and upper trapezius ARV (P < 0.01). During cervical extension, injection of hypertonic saline in splenius capitis resulted in lower estimates of splenius capitis ARV on the painful side from 45 to 60% MVC (P < 0.05), which was associated with a bilateral increase in upper trapezius ARV estimates from 50 to 60% MVC (P < 0.001). However, no significant change was identified for estimates of sternomastoid ARV. Experimentally induced neck muscle pain resulted in task-dependent changes in cervical agonist/antagonist activity without modifications in muscle fiber CV.     

Evaluation of Novel EMG Biofeedback for Postural Correction During Computer Use

Postural correction is an effective rehabilitation technique used to treat chronic neck and shoulder pain, and is aimed toward reducing the load on the surrounding muscles by adopting a neutral posture. The objective of this investigation was to evaluate the effectiveness of real-time high-density surface EMG (HDsEMG) biofeedback for postural correction during typing. Twenty healthy participants performed a typing task with two forms of postural feedback: (1) verbal postural coaching and (2) verbal postural coaching plus HDsEMG biofeedback. The interface used activity from two HDsEMG arrays placed over the trapezius designed to shift trapezius muscle activity inferiorly. The center of gravity across both arrays was used to quantify the spatial distribution of trapezius activity. Planar angles taken from upper extremity reflective markers quantified cervicoscapular posture. During the biofeedback condition, trapezius muscle activity was located 12.74 ± 3.73 mm more inferior, the scapula was 2.58 ± 1.18° more adducted and 0.23 ± 0.24° more depressed in comparison to verbal postural coaching alone. The results demonstrate the short-term effectiveness of a real-time HDsEMG biofeedback intervention to achieve postural correction, and may be more effective at creating an inferior shift in trapezius muscle activity in comparison to verbal postural coaching alone.     

The effect of postural correction on muscle activation amplitudes recorded from the cervicobrachial region

In clinical practice, postural correction is a common treatment approach for individuals with neck and shoulder pain. As chronic static muscle use is thought to be associated with the onset of some neck and shoulder pain syndromes, it is important to understand the impact a postural correction program might have on muscle activation amplitudes in the neck and shoulder regions. Normalized surface electromyographic data were recorded from the levator scapulae, upper trapezius, supraspinatus, posterior deltoid, masseter, rhomboid major, cervical erector spinae, and sternocleidomastoid muscles of the dominant side of each of eighteen healthy subjects. Subjects performed five repetitions of each of four seated typing postures (habitual, corrected, head-forward and slouched) and four standing postures (habitual, corrected, and head-forward and slouched). Repeated-measures analysis of variance models (α = 0.05) revealed that in sitting postural correction tended to decreased the level of muscle activation required in all muscles studied during seated computer work, however this finding was not statistically significant. Corrected posture in sitting did, however produce a statistically significant reduction in muscle activity compared to forward head posture. Corrected posture in standing required more muscle activity than habitual or forward head posture in the majority of cervicobrachial and jaw muscles, suggesting that a graduated approach to postural correction exercises might be required in order to train the muscles to appropriately withstand the requirements of the task. A surprising finding was that muscle activity levels and postural changes had the largest impact on the masseter muscle, which demonstrated activation levels in the order of 20% maximum voluntary electrical activation.     

Altered activity of the serratus anterior during unilateral arm elevation in patients with cervical disorders

Altered activity in the axioscapular muscles is considered to be an important feature in patients with neck pain. The activity of the serratus anterior (SA) and trapezius muscles during arm elevation has not been investigated in these patients. The objectives of this study was to investigate whether there is a pattern of altered activity in the SA and trapezius in patients with insidious onset neck pain (IONP) (n = 22) and whiplash associated disorders (WAD) (n = 27). An asymptomatic group was selected for baseline measurements (n = 23).Surface electromyography was used to measure the onset of muscle activation and duration of muscle activity of the SA as well as the upper, middle, and lower trapezius during unilateral arm elevation in the three subject groups. Both arms were tested.With no interaction, the main effect for the onset of muscle activation and duration of muscle activity for serratus anterior was statistically significant among the groups. Post hoc comparison revealed a significantly delayed onset of muscle activation and less duration of muscle activity in the IONP group, and in the WAD group compared to the asymptomatic group. There were no group main effects or interaction effects for upper, middle and lower trapezius.This finding may have implications for scapular stability in these patients because the altered activity in the SA may reflect inconsistent or poorly coordinated muscle activation that may reduce the quality of neuromuscular performance and induce an increased load on the cervical and the thoracic spine.     

Myofascial trigger point development from visual and postural stressors during computer work.

The mechanism of musculoskeletal pain underlying low level static exertions, such as those experienced during computer work, is poorly understood. It was hypothesized that static postural and visual stress experienced during computer work might contribute to trigger point development in the trapezius muscles, resulting in myofascial pain. A study was conducted to observe the development of myofascial trigger points while 16 female subjects used a computer under conditions of high and low postural and visual stress. Trigger point development was monitored via expert opinion, subject self-report, and electromyographic activity. Only the high visual stress conditions resulted in greater trigger point sensitivity as reported by subjects and the myofascial specialist. Cyclic trends in median frequency of the EMG signal were assessed for the trapezius muscle. When high visual stress was combined with low postural stress condition there were significantly fewer cycles (1.6 cycles) as compared to the condition of low visual and low postural stress (2.8 cycles), and the condition of high visual and high postural stress (3.5 cycles). These significant differences between conditions were found for the right trapezius but not for the left. The findings suggest that high visual stress may be involved in the development of the myofascial pain response.     

Functional subdivision of the upper trapezius muscle during maximal isometric contractions

The electromyographic (EMG) activity pattern across the upper trapezius of 22 healthy subjects was investigated during maximal isometric contractions. Eight bipolar surface electrodes with 10 mm distance between adjacent electrode pairs were placed on a line from the clavicle to the scapula. At the region near the clavicle the highest EMG amplitudes were recorded during 90 ° arm abduction. At the more posterior parts the highest amplitudes were found both during arm abduction and shoulder elevation. A double differential recording technique which reduced the EMG cross-talk contribution supported the finding that the upper trapezius was differently activated when the arm posture was changed. The normalized EMG amplitude-force relationship during the shoulder elevation showed a curvilinear relationship on the anterior part of the upper trapezius with a slower increase in EMG amplitude than force at low force. The slope of the curve, at low force, increased gradually in the posterior direction on the upper trapezius. The EMG activity patterns across the upper trapezius indicate a flexibility in motor activation which maybe reflects a functional optimization of the contractions performed by this muscle.     

Temporal Co-Variation between Eye Lens Accommodation and Trapezius Muscle Activity during a Dynamic Near-Far Visual Task

Near work is associated with increased activity in the neck and shoulder muscles, but the underlying mechanism is still unknown. This study was designed to determine whether a dynamic change in focus, alternating between a nearby and a more distant visual target, produces a direct parallel change in trapezius muscle activity. Fourteen healthy controls and 12 patients with a history of visual and neck/shoulder symptoms performed a Near-Far visual task under three different viewing conditions; one neutral condition with no trial lenses, one condition with negative trial lenses to create increased accommodation, and one condition with positive trial lenses to create decreased accommodation. Eye lens accommodation and trapezius muscle activity were continuously recorded. The trapezius muscle activity was significantly higher during Near than during Far focusing periods for both groups within the neutral viewing condition, and there was a significant co-variation in time between accommodation and trapezius muscle activity within the neutral and positive viewing conditions for the control group. In conclusion, these results reveal a connection between Near focusing and increased muscle activity during dynamic changes in focus between a nearby and a far target. A direct link, from the accommodation/vergence system to the trapezius muscles cannot be ruled out, but the connection may also be explained by an increased need for eye-neck (head) stabilization when focusing on a nearby target as compared to a more distant target.     

Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks

Forward head and rounded shoulder posture (FHRSP) is theorized to contribute to alterations in scapular kinematics and muscle activity leading to the development of shoulder pain. However, reported differences in scapular kinematics and muscle activity in those with forward head and rounded shoulder posture are confounded by the presence of shoulder pain. Therefore, the purpose of this study was to compare scapular kinematics and muscle activity in individuals free from shoulder pain, with and without FHRSP. Eighty volunteers were classified as having FHRSP or ideal posture. Scapular kinematics were collected concurrently with muscle activity from the upper and lower trapezius as well as the serratus anterior muscles during a loaded flexion and overhead reaching task using an electromagnetic tracking system and surface electromyography. Separate mixed model analyses of variance were used to compare three-dimensional scapular kinematics and muscle activity during the ascending phases of both tasks. Individuals with FHRSP displayed significantly greater scapular internal rotation with less serratus anterior activity, during both tasks as well as greater scapular upward rotation, anterior tilting during the flexion task when compared with the ideal posture group. These results provide support for the clinical hypothesis that FHRSP impacts shoulder mechanics independent of shoulder pain.     

Trapezius muscle rest time during standardised computer work--a comparison of female computer users with and without self-reported neck/shoulder complaints.

Work related musculoskeletal disorders (WMSDs) in the shoulder/neck area are a common and increasing problem among European computer workers, especially women. Long-term low-level workloads with low degree of muscle rest are a potential risk factor for developing WMSDs. The purpose of the present study of female computer users (age 45-65 years) in Denmark and Sweden was to investigate if subjects with self-reported neck/shoulder complaints (cases, N=35) show less trapezius muscle relative rest time (RRT) than controls (N=44) when performing standardised short-term computer work tasks in controlled laboratory conditions. Surface electromyography (EMG) signals were recorded bilaterally from the upper trapezius muscles during a type, edit, precision and colour word stress task. Besides RRT, 10th percentile RMS values were calculated. On the average, 15 of the cases and 18 of the controls showed analysable EMG files per task. For the colour word stress task, the results showed lower RRT values and higher 10th percentile RMS amplitude levels among cases compared to controls. No such signs could be found for the other tasks performed. The present results indicate an increased motor response to a psychological stressor among subjects with self-reported neck/shoulder complaints.     

The influence of initial posture on the sit-to-stand movement

Head movements, ground reaction forces and electromyographic activity of selected muscles were recorded simultaneously from two subjects as they performed the sit-to-stand manouevre under a variety of conditions. The influence of initial leg posture on the magnitude of the various parameters under investigation was examined first. A preferred initial leg posture resulted in smaller magnitudes of head movement and ground reaction forces. EMG activity in some muscles, trapezius and erector spinae, decreased, while in others, quadriceps and hamstrings, it increased in the preferred leg posture. The decreases seen correlate with reductions in head movement observed. The effect of inhibiting habitual postural adjustments of the head and neck, by comparing "free" and "guided" movements was also examined. In guided movements there are significant reductions in head movement, ground reaction forces and EMG activity in trapezius, sternomastoid and erector spinae. It would appear that both initial leg posture and the abolition of habitual postural adjustment have a profound influence on the efficiency of the sit-to-stand manouevre. This preliminary study high-lights the practical importance of head posture in the diagnosis and treatment of movement disorders, as well as in movement education.     

Surface EMG amplitude and frequency dependence on exerted force for the upper trapezius muscle: a comparison between right and left sides

Surface electromyographic (EMG) amplitude and mean power frequency (MPF) were used to study the isometric muscular activity of the right versus the left upper trapezius muscles in 14 healthy right-handed women. The EMG activity was recorded simultaneously with force signals during a 10-15 s gradually increasing exertion of force, up to maximal force. Only one side at a time was tested. On both sides there was a significant increase in EMG amplitude (microV) during the gradually increasing force from 0% to 100% maximal voluntary contraction (MVC). The right trapezius muscle showed significantly less steep slopes for regression of EMG amplitude versus force at low force levels (0%-40% MVC) compared intra-individually with high force levels (60%-100% MVC). This was not found for the left trapezius muscle. At 40% MVC a significantly lower MPF value was found for the right trapezius muscle intra-individually compared with the left. An increase in MPF between 5% and 40% MVC was statistically significant when both sides were included in the test. The differences in EMG activity between the two sides at low force levels could be due to more slow-twitch (type I fibres) motor unit activity in the right trapezius muscles. It is suggested that this is related to right-handed activity.     

Postural changes associated with public speech tests lead to mild and selective activation of stress hormone release.

We tested whether simulation of postural changes, which occur during public speech test procedures, activates cardiovascular system and stress hormone release that could interfere with the effect of psychosocial stress load. Young healthy male volunteers (n=8) underwent procedure imitating exactly all postural changes present in the psychosocial stress model based on public speech used in this laboratory (namely changes from sitting to standing and repeated sitting). Postural changes were associated with increases in heart rate, blood pressure, plasma concentrations of noradrenaline and aldosterone and elevation in plasma renin activity. In contrast to cardiovascular parameters, adrenocorticotropic hormone, cortisol and adrenaline, the main characteristics of hormonal response during mental stress, were not significantly influenced. The overall magnitude of all observed alterations was much smaller than that seen following mental stress procedures in our previous studies. This study provides evidence that changes in body posture during public speech test procedure influence hemodynamics and endocrine responses in a mild manner. Though this influence may represent a source of unspecific variance, substantial confounding effects on responses to the psychosocial component of the procedure are unlikely. In any case, models combining mental stressors and changes in body posture must be interpreted as complex stress stimuli.     

The influence of posture variation on electromyographic signals in females obtained during maximum voluntary isometric contractions: A shoulder example

Surface electromyography (sEMG) is commonly used to estimate muscle demands in occupational tasks. To allow for comparisons, sEMG amplitude is normalized to muscle specific maximum voluntary contractions (MVCs) performed in a standardized set of postures. However, maximal sEMG amplitude in shoulder muscles is highly dependent on arm posture and therefore, normalizing task related muscular activity to standard MVCs may lead to misinterpretation of task specific muscular demands. Therefore, the purpose of this study was to investigate differences in commonly monitored shoulder muscles using normalized sEMG amplitude between maximal exertions at different hand locations and across force exertion directions relative to standard MVCs. sEMG was recorded from the middle deltoid, pectoralis major sternal head, infraspinatus, latissimus dorsi, and upper trapezius. Participants completed standardized muscle-specific MVCs and two maximal exertions in 5 hand locations (low left, low right, high left, high right, and central) in each of the four force directions (push, pull, up, and down). Peak sEMG was analyzed in the direction(s) that elicited the highest signal for each muscle. All muscles differed by location (p < 0.05). Latissimus dorsi had the greatest activation during pulls (32–135% MVC); upper trapezius and middle deltoid while exerting upwards (73–103% and 42–78% MVC, respectively); infraspinatus while pushing (38–79% MVC); and pectoralis major activation was the highest during downwards exertions (48–84% MVC). Normalization of location specific maximal exertions to standard muscle specific MVCs underestimated maximal activity across 90% of the tasks in all shoulder muscles tested, except for latissimus dorsi where amplitudes were overestimated in low right hand location. Normalization of location specific muscle activity to standard muscle specific MVCs often underestimates muscle activity in task performance and is cautioned against if the goal is to accurately estimate muscle demands.     

The effects of upper limb posture and a sub-maximal gripping task on corticospinal excitability to muscles of the forearm

Variations in handgrip force influences shoulder muscle activity, and this effect is dependent upon upper limb position. Previous work suggests that neural coupling between proximal and distal muscles with changes in joint position is a possible mechanism but these studies tend to use artificially constrained postures that do not reflect activities of daily living. The purpose of this study was to examine the effects of upper limb posture on corticospinal excitability to the forearm muscles during workplace relevant arm positions. Motor evoked potentials (MEPs) were elicited in four forearm muscles via transcranial magnetic stimulation at six arm positions (45°, 90° and 120° of humeral elevation in both the flexion and abduction planes). MEPs were delivered as stimulus–response curves (SRCs) at rest and at constant intensity during two gripping tasks. Boltzmann plateau levels were smaller for the flexor carpi radialis in flexion at 45° versus 90° (p = 0.0008). Extensor carpi radialis had a greater plateau during flexion than abduction (p = 0.0042). Corticospinal excitability to the forearm muscles were influenced by upper limb posture during both the resting and gripping conditions. This provides further evidence that upper limb movements are controlled as a whole rather than segmentally and is relevant for workplace design considerations.     

Long-term electromyographic activity in upper trapezius and low back muscles of women with moderate physical activity.

The habitual activity patterns of trapezius and postural back muscles (multifidus, iliocostalis, longissimus) of 23 female subjects with moderate physical activity were studied. Bilateral surface electromyographic (sEMG) recordings from start of work until bedtime were analyzed. The activity level was calibrated as percentage of root mean square-detected muscle activity at maximal voluntary contraction (EMG(max)). Sixty-six previous trapezius recordings of women with moderate physical activity were included in some analyses to pursue the full range of variation in trapezius activity. Twenty-six of these were recorded twice, separated by 16-28 mo. Median activity level and duration of periods with sEMG activity of <0.5% EMG(max) ("rest time"; only trapezius) and exceeding 2 ("burst time"), 10, 30, and 50% EMG(max) was determined. The trapezius median activity level ranged from 0.6 to 8.8% EMG(max), burst time from 9 to 84%, and rest time from 2 to 84%. The activity patterns of the back muscles showed similar large interindividual variation. Repeated trapezius recordings of the same subject showed high consistency; intraclass correlation coefficients ranged from 0.62 to 0.79 for different sEMG variables. Periods with high sEMG amplitude were of short duration; 7% of the trapezius recordings did not present time intervals (0.2-s duration) above 50% EMG(max). The activity patterns of the postural muscles, despite large interindividual variability, were distinctly different from activity patterns of upper and lower limb muscles reported by others (e.g., mean burst time 40-50 vs. 10-20%). We conclude that postural trunk muscles show idiosyncratic activity patterns with large interindividual variation. High-threshold motor units are activated to a very minor extent.     

Effect of arm-shoulder fatigue on carpenters at work

The purpose of the study was to analyse the effect of arm-shoulder fatigue on manual performance. Ten experienced carpenters performed three standardized tasks (nailing, sawing and screwing). Electromyographic activity was recorded from six arm-shoulder muscles and the performances were video-filmed. After 45 min of standardized arm-cranking (arm-shoulder-fatiguing exercise of approximately 70%-80% maximal oxygen consumption), the tasks were repeated. The number of work movements and the time taken for each task were recorded and the quality of the work performed was compared. After the fatiguing exercise, only nailing was perceived as being harder and more mistakes were made during nailing and sawing. Movement performance was not influenced during nailing but was slightly slower during sawing and faster during screwing. However, there were increased mean EMG amplitudes in the upper trapezius and biceps muscles during nailing, in the upper trapezius, anterior deltoid and infraspinatus muscles during sawing and in the anterior deltoid muscle during screwing. Of the muscles studied the upper trapezius and anterior deltoid muscles increased their activity most after the arm-shoulder-fatiguing exercise.     

Normalization of surface EMG amplitude from the upper trapezius muscle in ergonomic studies — A review

Surface electromyographic (EMG) amplitude from the upper trapezius muscle is widely used as a measure of shoulder-neck load in ergonomic studies. A variety of methods for normalizing EMG amplitude from the upper trapezius (EMGamp_ut) have been presented in the literature. This impedes meta-analyses of, for instance, upper trapezius load in relation to development of shoulder-neck disorders. The review offers a thorough discussion of different normalization procedures for EMGamp_ut. The following main issues are focused: output variable, location of electrodes, posture and attempted movement during normalization, load and duration of reference contractions, signal processing and test-retest repeatability. It is concluded that translations of EMGamp_ut into biomechanical variables, for example relative force development in the shoulder or in the upper trapezius itself, suffer from low validity, especially if used in work tasks involving large and/ or fast arm movements. The review proposes a standard terminology relating to normalization of EMGamp_ut and concludes in a concrete suggestion for a normalization procedure generating bioelectrical variables which reflect upper trapezius activation.