Background: The functioning of the serratus anterior (SA) muscle is essential to normal scapulohumeral rhythm during forward flexion (FF) of the shoulder. Also, SA weakness and overuse of the upper trapezius (UT) is observed in patients with shoulder dysfunction and trapezius myalgia. We designed a combination exercise involving FF and scapular protraction with resistance (CFFSP) to activate the SA muscle and to deactivate the UT muscle.
Objects: The purpose of this study was to determine whether or not CFFSP would be more effective in activating the SA muscle than FF alone and FF with scapular protraction (FFP).
Methods: Nineteen subjects (12 men and 7 women) participated in this study and performed FF, FFP, and CFFSP at 120°. Surface electromyography was applied to the SA, UT, and pectoralis major (PM) muscles, as was one-way analysis of variance (ANOVA) with repeated measures. Statistical significance was set at .05. Bonferroni adjustment was used to counteract the problem of multiple comparisons, with a statistical level of significance of .017 (.05/3).
Results: A statistically significant difference was found in relation to the three positions for the SA muscle (p<.001) and the SA/UT ratio (p=.005) using ANOVA. Significantly different results, depending on the position, were also demonstrated using the Bonferroni post-hoc test for the SA muscle (FF=28.27±16.20, FFP=45.66±15.81, and CFFSP=62.4±27.21) and for the SA/UT ratio (FF=3.04±2.14, FFP=3.61±2.38, and CFFSP=5.95±3.01). Significant differences between the three positions was not found regarding the average amplitude of SA/PM muscle ratio (SA/PM: p=.060).
Conclusion: We recommend the use of CFFSP to strengthen the SA muscle at 120°.

• Sung-hoon Jung(Kinetic Ergocise Based on Movement Analysis Laboratory, Dept. of Physical Therapy, The Graduate School, Yonsei University)
• In-cheol Jeon(Kinetic Ergocise Based on Movement Analysis Laboratory, Dept. of Physical Therapy, The Graduate School, Yonsei University)
• Ui-jae Hwang(Kinetic Ergocise Based on Movement Analysis Laboratory, Dept. of Physical Therapy, The Graduate School, Yonsei University)
• Jun-hee Kim(Kinetic Ergocise Based on Movement Analysis Laboratory, Dept. of Physical Therapy, The Graduate School, Yonsei University)
• Oh-yun Kwon(Kinetic Ergocise Based on Movement Analysis Laboratory, Dept. of Physical Therapy, College of Health Science, Yonsei University, Dept. of Ergonomic Therapy, The Graduate School of Health and Environment, Yonsei University) Corresponding author