The Activation of Serratus Anterior Muscle During the Plank Exercise

January 4, 2025 updated by: Berivan Beril Kılıç

Serratus Anterior Activation and Its Relationship with Shoulder Rotators in Adolescent Volleyball Players with Scapular Dyskinesia During Plank Exercise

Scapular dyskinesia is a condition characterized by changes in the resting position or movement of the scapula, which can impair shoulder function. Issues such as increased glenohumeral angle, reduced rotator cuff strength, and decreased subacromial space are commonly observed in athletes and sedentary individuals. Scapular muscle imbalances, particularly in the serratus anterior and lower trapezius muscles, are key contributors to dyskinesia. Studies show decreased EMG activity in these muscles among sedentary individuals, while increased activity is noted in overhead athletes. The relationship between serratus anterior activity and shoulder external rotation strength varies, highlighting the importance of strengthening scapular muscles to prevent injury in athletes.

The core, including the spine, hips, pelvis, and abdomen, provides stability and transfers forces throughout the body. Core and scapular stability are interrelated, and impairment in scapular stability can weaken core strength, increasing the risk of injury. Therefore, exercises targeting both the core and scapular muscles are vital in athletic training programs. The plank exercise, which minimizes spinal load and promotes strength, is preferred for enhancing both core and scapular endurance. However, improper form, especially due to weak stabilizer muscles, can lead to compensations that increase injury risk, such as long thoracic nerve injury. Although studies exist on serratus anterior activity during plank exercises, there is limited research on its activation in athletes with scapular dyskinesia.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Scapular dyskinesia is defined as changes in the resting position of the scapula or in scapular movement. This condition can lead to negative changes in optimal shoulder function in individuals (Huang, Chen, Du, & Lin, 2020; Jildeh, Ference, Abbas, Jiang, & Okoroha, 2021). Changes such as an increase in the glenohumeral angle during horizontal abduction with scapular dyskinesia, a decrease in the maximal strength of the rotator cuff muscles responsible for compression stability, and a decrease in the subacromial space during overhead functions have been reported (Kibler & Sciascia, 2019). These resulting functional impairments and imbalances are observed in 67-100% of athletes, as well as sedentary individuals, sometimes without symptoms and sometimes accompanied by shoulder pathology (Silva et al., 2022). While many factors contributing to the development of scapular dyskinesia have been identified, one key factor is scapular muscle imbalances. The scapulothoracic muscle groups frequently emphasized in relation to scapular dyskinesia are the lower trapezius and serratus anterior. The serratus anterior muscle is responsible for upward rotation, external rotation, and posterior tilt of the scapula. This muscle is crucial for maintaining normal alignment and the continuity of functional scapular movement (Ludewig, Cook, & Nawoczenski, 1996; Ludewig & Reynolds, 2009). In a study conducted with sedentary individuals, it was reported that the EMG activity of the lower trapezius and serratus anterior muscles decreased in the presence of scapular dyskinesia (Ann MJ Cools et al., 2014). In contrast to this study, the EMG activity of the serratus anterior muscle in overhead athletes with scapular dyskinesia was examined during various movement patterns and functions such as shoulder elevation, push-up exercises, and tennis serves. It was suggested that muscle activity increased compared to sedentary individuals, and this increase should be further investigated in the future (de Paula Marques & Dionisio, 2024). Another point emphasized is the relationship between serratus anterior muscle activation and shoulder external rotation force in individuals with dyskinesia. While it has been stated that serratus anterior muscle activity decreases in the presence of scapular dyskinesia, external rotation muscle strength varies depending on the evaluated position. The importance of scapular muscles for shoulder external rotation strength has also been highlighted (Uga, Nakazawa, & Sakamoto, 2016). Strengthening the muscles responsible for external rotation in overhead athletes and restoring normal scapular movement are key points that should be emphasized as a whole in injury prevention programs (Ann M. Cools, Johansson, Borms, & Maenhout, 2015; Tooth et al., 2020).

The core region of the body includes the spine, hips, pelvis, proximal lower extremities, and abdomen (Kibler, Press, & Sciascia, 2006). The strength of these muscles allows for the transfer of compressive, translational, and shear forces, which serve to mechanically stabilize the spine and distribute forces to the rest of the body (Akuthota, Ferreiro, Moore, & Fredericson, 2008; Fredericson & Moore, 2005). Core stability is defined as the ability to control the position and movement of the trunk over the pelvis during integrated kinetic chain activities. It allows for the optimal transfer and control of force and movement to the terminal segment. Similar to the core muscles, the scapula plays an important role in transferring the force produced to the distal segments. Impairment in scapular stability can lead to a decrease in core strength, thereby increasing the risk of injury and reducing athletic performance. For this reason, exercises aimed at increasing scapular muscle and core endurance should be incorporated into athletes' exercise programs to prevent injury and enhance performance (Cobanoglu, Keklik, Zorlular, Polat, & Akaras, 2019). One of the exercises frequently included in Korean strength training programs for athletes is the plank exercise. Unlike sit-up exercises, the plank exercise is widely preferred to increase strength and endurance because it does not place a load on the lumbar spine and only minimally loads the spine when performed using body weight (Topçu et al., 2022). It is very important to perform plank exercises with correct segment alignment. The correct plank position is achieved in a push-up stance, with body weight supported by the forearms, elbows, and toes. The arms should be placed directly under the shoulder joints, and the entire body should maintain a straight alignment (Neporent, Schlosberg, & Archer, 2011; Zhang, Dong, & El Saddik, 2016). A lack of strength in the core or scapular stabilizer muscles during the plank may cause the person to adopt an incorrect posture by compensating with the thoracic spine or lower hips. In fact, a case report indicated that incorrect and excessive scapular activity during plank exercises may lead to long thoracic nerve injury (Güzel, Ozen, & Sözay, 2023). There are studies in the literature examining the activity of the serratus anterior muscle, which is responsible for scapular stabilization, in athletes during plank exercises (Can, Harput, & Turgut, 2024). However, no research has been found that evaluates serratus anterior EMG activity during plank exercises in athletes with scapular dyskinesia."

Study Type

Observational

Enrollment (Actual)

29

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey
      • Istanbul, Turkey
        • Biruni University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult

Accepts Healthy Volunteers

Yes

Sampling Method

Probability Sample

Study Population

adolescent athlete

Description

Inclusion Criteria:

  • Female athletes aged 13-18 years.

Exclusion Criteria:

  • Shoulder pain severe enough to interfere with activity in the past 3 months.
  • History of shoulder surgery or fractures.
  • Recent acute orthopedic injuries to the lower extremities, upper extremities, or lower back.
  • History of any neurological or systemic diseases.
  • Significant spinal deformities, such as scoliosis.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Scapular Dyskinesis Group
adolescent volleyball players with scapular dyskinesis
Diagnostic test: scapular dyskinesis test
Scapular dyskinesia in athletes will be visually evaluated. It will be considered present if, during 3 out of 5 arm elevation attempts, any of the following are observed: prominence of the medial or upper scapular border, lower scapular angle, excessive clavicular elevation, or rapid downward rotation of the scapula. After the tester demonstrates the required movements, the athletes will practice the movement. The test will begin with the arms at the sides of the body, elbows straight, and shoulders in neutral rotation. Two testers will observe from behind and video record the movements. Participants will be instructed to raise their arms as high as possible simultaneously, using the 'thumbs up' position, and to maintain this position for 3 seconds before lowering their arms for another 3 seconds. Athletes will perform the arm elevation with a dumbbell weight calculated as 1.4% of their body weight (Kamonseki, Haik, Ribeiro, Almeida, & Camargo, 2023).
Control Group
adolescent volleyball players without scapular dyskinesis
Diagnostic test: scapular dyskinesis test
Scapular dyskinesia in athletes will be visually evaluated. It will be considered present if, during 3 out of 5 arm elevation attempts, any of the following are observed: prominence of the medial or upper scapular border, lower scapular angle, excessive clavicular elevation, or rapid downward rotation of the scapula. After the tester demonstrates the required movements, the athletes will practice the movement. The test will begin with the arms at the sides of the body, elbows straight, and shoulders in neutral rotation. Two testers will observe from behind and video record the movements. Participants will be instructed to raise their arms as high as possible simultaneously, using the 'thumbs up' position, and to maintain this position for 3 seconds before lowering their arms for another 3 seconds. Athletes will perform the arm elevation with a dumbbell weight calculated as 1.4% of their body weight (Kamonseki, Haik, Ribeiro, Almeida, & Camargo, 2023).

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Surface EMG
Time Frame: baseline
A NeuroTrac Myoplus Pro (Quintet, Bergen, Norway) EMG device will be used for surface electromyography analysis of the serratus anterior. Disposable 30 x 30 mm round adhesive electrodes will be placed on the dominant side at the 7th intercostal space and at the level of the xiphoid process, while the reference electrode will be positioned on the sternal notch of the sternum. To minimize the negative effects of possible skin movement during the plank exercises, electrodes will be applied while the participant is seated with the trunk in a neutral position and arms flexed at 90 degrees (Januario, Cid, Zanca, Mattiello, & Oliveira, 2022; Konrad, 2005). Participants will perform front plank, prone plank, and side plank exercises for 30 seconds each. Parameters related to muscle strength, total work, and resting tone will be displayed on the device in microvolts, and maximal voluntary contraction will recorded as a percentage.
baseline

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Core Strength
Time Frame: baseline
Core endurance in athletes will be assessed using McGill's core endurance tests (McGill, Childs, & Liebenson, 1999). Trunk Flexor Endurance Test, Trunk Extensor Endurance Test and Trunk Lateral Endurance Test will be used for assesment. The time the athlete can maintain this position will be recorded in seconds.
baseline
Shoulder rotator strength
Time Frame: baseline
The internal and external rotation muscle strength of athletes will be assessed using a hand dynamometer with demonstrated reliability (Chamorro, Arancibia, Trigo, Arias-Poblete, & Jerez-Mayorga, 2021). The assessment will be conducted with the athlete in a prone position, with the arm at 90 degrees of abduction and the shoulder in neutral, while the elbow is flexed at 90 degrees (Coinceicao et al., 2018). The dynamometer will be placed proximal to the ulnar styloid process, and the evaluator will stabilize the arm by holding the upper arm with their other hand. The athlete will perform an isometric contraction for 5 seconds. After a 30-second rest, the measurement will be repeated. Each measurement will be conducted three times, and the best score will be recorded. The external rotation/internal rotation (ER/IR) ratio will be calculated using the formula: (External rotation strength / Internal rotation strength) x 100.
baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Berivan Beril Kılıç

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

October 1, 2024

Primary Completion (Actual)

December 1, 2024

Study Completion (Actual)

January 4, 2025

Study Registration Dates

First Submitted

September 18, 2024

First Submitted That Met QC Criteria

September 18, 2024

First Posted (Actual)

September 23, 2024

Study Record Updates

Last Update Posted (Actual)

March 25, 2025

Last Update Submitted That Met QC Criteria

January 4, 2025

Last Verified

November 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 69869

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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