Scapular Stabilization Research Articles

Effects of Passive Scapular Stabilization on Upper Extremity Muscle Strength in Patients With Rotator Cuff Repair

Effects of Passive Scapular Stabilization on Upper Extremity Muscle Strength in Patients With Rotator Cuff Repair

Scapular Dyskinesis in the Athletic Patient: A Sport-Specific Review.

Scapular dyskinesis is an alteration of normal scapular kinematics. It is essential that each patient be evaluated holistically and that sport-related factors be taken into account. The presentation of scapular dyskinesis may be highly variable depending on the underlying etiology or associated pathology, but the onset of symptoms is often gradual. Sport-specific literature on scapular dyskinesis is most commonly reported in the context of baseball, swimming, and tennis. Treatment is most often conservative and involves physical therapy directed at the scapular stabilizers.

Effect of Functional Scapular Stabilization Training on Function and Pain in Frozen Shoulder Syndrome: A Randomized Controlled Trial

ObjectiveThe purpose of this study was to determine the effect of functional scapular stabilization training compared with the standard physical therapy on function and pain in people with frozen shoulder syndrome (FSS). MethodsIn a single-blind randomized controlled trial, 86 people with FSS were randomly allocated into the intervention group (functional stabilization training [n = 43]) and control group (standard physical therapy [n = 43]) using block randomization for 12 weeks. The primary outcome measures were the Shoulder Pain and Disability Index and the numeric pain rating scale. The secondary outcome measures were range of motion (ROM), range of passive abduction, and coracoid pain test. All the outcome measures were carried out by an independent blind outcome assessor at baseline and at the end of 12 weeks. ResultsA significant group × time interaction effect was observed for the Shoulder Pain and Disability Index (95% CI, 2.95-16.74; P < .01) and the numeric pain rating scale (95% CI, 0.67-2.07; P < .01) at the end of 12 weeks. The external rotation ROM showed a statistical significance with a mean change of 7.8° and P value of <.01. ConclusionThe present findings show that scapular functional stabilization training resulted in improvement of function, reduction in pain, and greater improvement in external rotation ROM in patients with FSS. Also, our study findings suggest the involvement of rotator interval and inferior soft-tissue structures as indicated by the coracoid pain test and range of passive abduction.

The Effects of Scapular Stabilization Exercises Accompanied by Spine Stabilization Exercises Using An Unstable Surface on Muscle Activities for Subjects with Scapular Winging

This study was intended to inspect the influence of scapular stabilization exercises accompanied by spine stabilization exercises using an unstable surface on muscle activity in subjects with scapular winging. Thirty subjects with scapular winging participated in the experiment. The subjects were randomly divided into two groups. One group performed scapular stabilization exercises accompanied by spine stabilization exercises on an unstable surface, whereas the other group performed only scapular stabilization exercises. In order to study the influence of the intervention, the muscle activity around the shoulder was measured. According to the experimental results, the activation of the lower trapezius muscle and serratus anterior muscle increased significantly in both groups after intervention. The muscle activities of the lower trapezius and serratus anterior in the control group were not as high as those in the experimental group. Moreover, the muscle activities of upper trapezius and pectoralis major decreased significantly in both groups after the exercise interventions, but no significant difference was observed between the two groups. As a result, the scapular stabilization exercises that are widely used in clinical practice were shown to increase lower trapezius and serratus anterior activities. Moreover, a combination of such exercises with spine stabilization exercises on an unstable surface was shown to confer greater benefits than scapular stabilization exercises alone and is thus recommended.

Clinical, Kinematic and Muscle Assessment of Bilateral Coordinated Upper-Limb Movements Following Cervical Spinal Cord Injury.

Cervical spinal cord injury (cSCI) often results in bilateral impairment of the arms, leading to difficulties in performing daily activities. However, little is known about the neuromotor alterations that affect the ability of individuals with cSCI to perform coordinated movements with both arms. To address this issue, we developed and tested a functional assessment that integrates clinical, kinematic, and muscle activity measures, including the evaluation of bilateral arm movements. Twelve subjects with a C5-C7 spinal lesion and six unimpaired subjects underwent an evaluation that included three tests: the Manual Muscle Test, Range Of Motion test and Arm stabilisation test, a subsection of the "Van Lieshout arm/hand function test". During the latter, we recorded kinematic and muscle activity data from the upper-body during the execution of a set of movements that required participants to stabilize both arms against gravity at different configurations. Analytical methods, including muscle synergies, spinal maps, and Principal Component Analysis, were used to analyse the data. Clinical tests detected limitations in shoulder abduction-flexion of cSCI participants and alterations in elbows-wrists motor function. The instrumented assessment provided insight into how these limitations impacted the ability of cSCI participants to perform bilateral movements. They exhibited severe difficulty in performing movements involving over-the-shoulder motion and shoulder internal rotation due to altered patterns of activity of the scapular stabilizer muscles, latissimus dorsi, pectoralis, and triceps. Our findings shed light on the bilateral neuromotor changes that occur post-cSCI addressing not only motor deficits, but also the underlying abnormal, weak, or silent muscle activations.

The Effects of Scapular Stabilization Training using the Different Exercise Prop for Impingement Syndrome of Factory Workers

The Effects of Scapular Stabilization Training using the Different Exercise Prop for Impingement Syndrome of Factory Workers

Effects of Cervical Stabilization and Scapular Stabilization Exercise on the Proprioception and Craniovertebral Angle and Upper Trapezius Muscle Tone of People with Forward Head Posture

Seung-Hwan LeeㆍByoung-Ha YooㆍHyun-Seo PyoㆍDongyeop Lee, PT, PhDㆍJi-Heon Hong, PT, PhDㆍ Jae-Ho Yu, PT, PhDㆍJin-Seop Kim, PT, PhDㆍSeong-Gil Kim, PT, PhD. KSPM 2022;17:1-13. https://doi.org/10.13066/kspm.2022.17.4.1

Nonoperative treatment of shoulder pain

Background: The shoulder joint has a wide range of motion and is extensively used. Damage in its components may cause functional deficits and pain. In particular, shoulder joint pain is associated with discomfort due to the involvement of the joint’s movement in basic tasks of daily life, such as washing one’s hair, dressing, and eating.Current Concepts: Diseases that cause shoulder joint pain include shoulder impingement syndrome, rotator cuff tear and tendinopathy, lesion of superior labrum anterior to posterior, biceps tendinitis, adhesive capsulitis, calcific tendinitis, and shoulder instability. Nonoperative treatment of shoulder joint pain includes: (1) reducing pain and preventing structural damage through rest, lifestyle modification, and physical therapy; (2) reducing pain through drug and injection treatment; (3) strengthening the rotator cuff muscles, around the scapula; and (4) performing scapular stabilization treatment through muscle strengthening. These treatments maintain the biomechanics of the shoulder joint, prevent disease progression, and enable pain-free daily life and exercise through symptom relief.Discussion and Conclusion: It is necessary to have an accurate understanding of the structures that cause shoulder joint pain. Understanding the cause of the pain can prevent the disease from progressing. Nonoperative management for shoulder pain consists of preventing a decrease in the range of motion of the shoulder joint with reduction of pain relief, preventing inflammation through drug treatment, injection treatment, lifestyle modifications, and improving muscle strength of the muscles around the rotator cuff and periscapular muscle joint through rehabilitation exercise. Nonoperative treatment modalities are valuable and cost-effective management options for shoulder pain.

Effects of scapulothoracic exercises on chest mobility, respiratory muscle strength, and pulmonary function in male COPD patients with forward shoulder posture: a randomized control trial

Background The postural abnormality, forward shoulder posture (FSP), is the most common cause of respiratory impairment in older individuals with chronic obstructive pulmonary disease (COPD). A recent study found that performing pectoral stretching and scapular strengthening exercises for eight weeks could reduce FSP in healthy participants. We aimed to determine the effects of pectoral stretching and scapular stabilizer strengthening exercises on FSP, chest wall mobility, respiratory muscle strength, and pulmonary function in male patients with COPD. Methods This study was randomized clinical trial. Forty male COPD patients with FSP aged 60–90 years were included and randomly allocated to control (n=20) and exercise (n=20) groups. Following completion of the scapulothoracic exercises (three days/week, for eight weeks), respiratory functions were assessed by measuring the magnitude of FSP, chest mobility, respiratory muscle strength, and pulmonary functions. Results FSP and thoracic kyphosis angle significantly decreased compared to controls (p&lt;0.001, p&lt;0.001). Middle and lower chest mobility markedly increased (p&lt;0.001, p&lt;0.001) and the pectoralis minor index significantly improved (p&lt;0.001). The strength of the lower trapezius and serratus anterior muscles significantly increased at week eight of the exercise training (p&lt;0.003, p&lt;0.001). There was a marked increase in maximum inspiratory pressure and maximum expiratory pressure (p&lt;0.001, p&lt;0.001). Conclusions The eight-week combined pectoral muscles self-stretching and serratus anterior and lower trapezius strengthening exercises could be an effective treatment and/or prevention strategy for FSP reduction, leading to improved respiratory function in male COPD patients.

The Effect of Modified Push-up Exercise Using Electromyography Biofeedback on Selection of Scapular Stabilizing Muscles

Background: The serratus anterior (SA) muscle is an important scapular stabilizer and has a profound role in retaining the scapulohumeral rhythm. Therefore, modified push-up plus (MPUP) has been advised to strengthen this muscle as a closed chain workout. However, few previous studies have reported the possibility of a reparative motion from pectoralis major (PM) that could replace and amend SA's function during push-up plus. Objectives: The current study examined MPUP's effect using biofeedback EMG on some of the selected scapular stabilizers. Methods: Sixteen healthy young subjects voluntarily participated in this study. Each subject performed push-ups, from the quadruped position, under two conditions (i.e., with or without visual and auditory biofeedback). Surface EMG measured pectoralis major, serratus anterior, and upper trapezius activity. A paired t-test was used to determine any statistically significant difference between the two conditions. Additionally, the effect size was calculated to quantify the magnitude of EMG biofeedback in each muscle. Results: MPUP training using biofeedback significantly increased SA muscle activity and decreased PM muscle activity, but there was no significant change in UT activity. Conclusions: Excessive PM activity was repressed because of biofeedback, and the workout was done with the enhancement of SA muscular activity. Thus, including biofeedback while doing MPUPs helps limit PM's supplementary action and enhance SA muscle activity.

Effect of Manual Pressure Release and Scapular Stabilization Exercises on Myofascial Pain Syndrome Following Neck Dissection Surgery

Effect of Manual Pressure Release and Scapular Stabilization Exercises on Myofascial Pain Syndrome Following Neck Dissection Surgery

Cervical Stabilization Exercises Versus Scapular Stabilization Exercises in Treatment of Chronic Mechanical Neck Pain

Cervical Stabilization Exercises Versus Scapular Stabilization Exercises in Treatment of Chronic Mechanical Neck Pain

Subacromial Impingement Syndrome: A Systematic Review of Existing Treatment Modalities to Newer Proprioceptive-Based Strategies.

Musculoskeletal pain is a common reason for primary care visits, with many visits for shoulder pain due to subacromial impingement syndrome (SIS). Current treatments lack evidence for effective management, showing only temporary outcomes. This systematic review evaluates existing modalities in comparison to the use of more permanent proprioceptive-based strategies. Specifically, this meta-analysis compared the use of kinesiology tape, myofascial trigger point release (MPTR), scapular stabilization exercises (SSE), and resistance training. PubMed, BioMedCentral, and ScienceDirect databases were queried for studies evaluating proprioceptive-based exercises in the last nine years. In total, 48 studies met the inclusion and exclusion criteria. After removing duplicates, a total of 14 level 1 studies were left. Kinesiology tape use demonstrated a statistically significant reduction in pain-free range of motion. MPTR improved in all pain scores and the disability scores index. SSE also reduced pain; however, mixed results were seen for range of motion. Finally, resistance training not only reduced pain but improved proprioception and joint position sense. Even though all techniques showed some promise in treating SIS, further large-scale studies exploring related outcomes are needed.

Supporting and Stabilizing the Scapulohumeral Rhythm With a Body- or Robot-Powered Orthosis

The versatile functionality of the human upper limb is owed to the coordinated rotation of the scapula and humerus, a pattern called the scapulohumeral rhythm (SHR). Various medical conditions can alter the SHR, frequently leading to limitations in activities of daily living. However, to date, supporting the SHR in practice is often not feasible. We present a textile orthosis that assists the SHR both in stand-alone use and in combination with the ANYexo, a therapy exoskeleton, or the Myoshirt, an assistive exomuscle. The SHR Orthosis comprised a textile harness and a scapula interface that was coupled with the upper arm to promote scapular upward rotation. In a technical evaluation including four participants without impairments and one with a partial hemiparesis, the SHR Orthosis followed the desired scapular rotation with an average deviation of less than 5°, thus providing accurate support and guidance towards the physiological SHR. The SHR Orthosis substituted for ≤ 42.0 % of the normal forces, and ≤ 19.6 % of the tangential forces required for scapular stabilization and rotation, providing sufficient support for patients with remaining muscular function. At last, the SHR Orthosis provides practicable scapula support in daily life, during conventional therapy, and in combination with assistive and therapy robots.

Scapular force: Couple ratios in healthy shoulders – An observational study reflecting typical values

BackgroundScapular stability is primarily maintained through the action of the scapular stabilisers and not through bony stability. The values of the force couple ratios of the scapular stabilisers remain largely unknown.ObjectivesTo determine typical scapular force couple strength ratios in the pain-free shoulders of healthy female and male participants.MethodsThis was a quantitative cross-sectional study. The muscle strength of the serratus anterior upper and lower fibres, the upper, middle and lower trapezius and the rhomboids (in both shoulders) were determined in kilogram force (kgf) using a handheld dynamometer. The ratios of the force couples of the scapulae of both shoulders of the participants were calculated. Participants (both female and male) with healthy shoulders were recruited from the general public (a local university, schools, church groups and sport clubs). We mainly utilised descriptive analysis. Statistical significance was set at 5%.ResultsForce couple ratios were as follows (means, with SD). Dominant arm in women: upper trapezius:lower trapezius 3.63 (0.97); serratus anterior lower fibres:lower trapezius = 1.97 (0.27); middle trapezius:serratus anterior upper fibres = 0.40 (0.10); serratus anterior lower fibres:rhomboids = 1.41 (0.21); lower trapezius:rhomboids = 0.74 (0.17). Dominant arm in men: upper trapezius:lower trapezius = 2.70 (0.72); serratus anterior lower fibres:lower trapezius = 2.15 (0.45); middle trapezius:serratus anterior upper fibres = 0.47 (0.12); serratus anterior lower fibres:rhomboids = 1.40 (0.31) and lower trapezius:rhomboids = 0.17 (0.6).ConclusionSpecific force couple strength ratios were determined, between and within the nondominant and the dominant arms of the shoulders of healthy women and men.Clinical implicationsScapular stability is mainly maintained through the optimal force couple balance of the scapular stabilisers.

Reverse Total Shoulder Arthroplasty Alters Humerothoracic, Scapulothoracic, and Glenohumeral Motion During Weighted Scaption.

Reverse total shoulder arthroplasty (rTSA) typically restores active arm elevation. Prior studies in patients with rTSA during tasks that load the arm had limitations that obscured underlying three-dimensional (3D) kinematic changes and the origins of motion restrictions. Understanding the scapulothoracic and glenohumeral contributions to loaded arm elevation will uncover where functional deficits arise and inform strategies to improve rTSA outcomes. In a cohort of patients who had undergone rTSA and a control cohort, we asked: (1) Is there a difference in maximum humerothoracic elevation when scapular plane elevation (scaption) is performed with and without a handheld weight? (2) Is maximum humerothoracic elevation related to factors like demographics, patient-reported outcome scores, isometric strength, and scapular notching (in the rTSA group only)? (3) Are there differences in underlying 3D scapulothoracic and glenohumeral motion during scaption with and without a handheld weight? Ten participants who underwent rTSA (six males, four females; age 73 ± 8 years) were recruited at follow-up visits if they were more than 1 year postoperative (24 ± 11 months), had a BMI less than 35 kg/m 2 (29 ± 4 kg/m 2 ), had a preoperative CT scan, and could perform pain-free scaption. Data from 10 participants with a nonpathologic shoulder, collected previously (five males, five females; age 58 ± 7 years; BMI 26 ± 3 kg/m 2 ), were a control group with the same high-resolution quantitative metrics available for comparison. Participants in both groups performed scaption with and without a 2.2-kg handheld weight while being imaged with biplane fluoroscopy. Maximum humerothoracic elevation and 3D scapulothoracic and glenohumeral kinematics across their achievable ROM were collected via dynamic imaging. In the same session the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST), and isometric strength were collected. Data were compared between weighted and unweighted scaption using paired t-tests and linear mixed-effects models. When compared with unweighted scaption, maximum humerothoracic elevation decreased during weighted scaption for patients who underwent rTSA (-25° ± 30°; p = 0.03) but not for the control group (-2° ± 5°; p = 0.35). In the rTSA group, maximum elevation correlated with the ASES score (r = 0.72; p = 0.02), and weighted scaption correlated with BMI (r = 0.72; p = 0.02) and the SST (r = 0.76; p = 0.01). Scapular notching was observed in three patients after rTSA (Grades 1 and 2). Four of 10 patients who underwent rTSA performed weighted scaption to less than 90° humerothoracic elevation using almost exclusively scapulothoracic motion, with little glenohumeral contribution. This manifested as changes in the estimated coefficient representing mean differences in slopes in the humerothoracic plane of elevation (-12° ± 2°; p < 0.001) and true axial rotation (-16° ± 2°; p < 0.001), scapulothoracic upward rotation (7° ± 1°; p < 0.001), and glenohumeral elevation (-12° ± 1°; p < 0.001), plane of elevation (-8° ± 3°; p = 0.002), and true axial rotation (-11° ± 2°; p < 0.001). The control group demonstrated small differences between scaption activities (< |2°|), but a 10° increase in humerothoracic and glenohumeral axial rotation (both p < 0.001). After rTSA surgery, maximum humerothoracic elevation decreased during weighted scaption by up to 88° compared with unweighted scaption, whereas 4 of 10 patients could not achieve more than 90° of elevation. These patients exhibited appreciable changes in nearly all scapulothoracic and glenohumeral degrees of freedom, most notably a near absence of glenohumeral elevation during weighted scaption. Patients with rTSA have unique strategies to elevate their arms, often with decreased glenohumeral motion and resultant compensation in scapulothoracic motion. In contrast, the control group showed few differences when lifting a handheld weight. Functional deficiency in activities that load the shoulder after rTSA surgery can affect patient independence, and they may be prevalent but not captured in clinical studies. Pre- or postoperative rehabilitation to strengthen scapular stabilizers and the deltoid should be evaluated against postoperative shoulder function. Further study is required to determine the etiology of deficient glenohumeral motion after rTSA, and the most effective surgical and/or rehabilitative strategies to restore deficient glenohumeral motion after rTSA.

Comparative Analysis of Upper Extremity Performance Variables in Elite and Novice Recurve Archers: A Cross-Sectional Observational Study

Scapular stability, grip strength, and fine motor skills are found to be the important variables to achieve the highest performance in precision tasks. Archery being one of the precision games, understanding these variables in archers is crucial as they can influence shooting performance. Therefore, the purpose of the present study was to compare the fine motor skill, hand grip strength and scapular stability in elite and novice recurve archers.50 Novice and 50 Elite recurve archers in the age group of 15-25 years were recruited. Scapular stability was assessed by Scapular dyskinesis test, hand grip strength by baseline hydraulic hand dynamometer for both upper limbs (bow arm and draw arm) &amp; fine motor skill was assessed by Purdue pegboard. The results were analysed using SPSS software, version 16.00. Independent T-test and Mann Whitney U test were performed for between-group comparisons. Elite archers [draw arm (27.02±7.08), bow arm (26.16±7.31) CI- 95%] showed statistically significant greater hand grip strength [draw arm (p=0.039), bow arm (p=0.008)] than novice archers [draw arm (23.92 ±7.73), bow arm (22.04 ± 7.86) CI-95%]. In assembly tasks for fine motor skill, elite archers [(34.44 ±3.92) CI-95%] showed significantly better coordination (p=0.011) than novice archers [(31.78±6.14) CI-95%]. For scapular stability, elite archers showed significant scapular dyskinesia on the draw arm (p=0.005) and bow arm (p=0.012)] than novice archers. Elite recurve archers had significantly better hand grip strength and fine motor skill than novice recurve archers. However, 52% subtle and 18% obvious scapular dyskinesia was observed in elite archers than novice archers who showed 38% subtle and 8% obvious scapular dyskinesis. The results of the study indicate that elite archers had statistically significant hand grip strength for both arms, fine motor skills, and a greater presence of obvious and subtle scapular dyskinesis than novice archers.

Case Study

The deltoid muscle is often forgotten when it comes to the evaluation and planning of treatment in shoulder conditions. Shoulder dysfunction, rotator cuff tendinopathy, and frozen shoulder are the conditions that affect functioning in major cases. The study involved an exploration of possible causes of dysfunction, especially pain and overhead activities. The patient presented with chronic pain and decreased shoulder function. A suitable shoulder rehabilitation program was designed keeping the deltoid muscle denervation into consideration. The shoulder pain, range of motion, strength, and function were evaluated at the baseline and the end of 6 weeks. The results were correlated and explored to identify the involvement of the deltoid muscle. The study showed a positive test of deltoid muscle involvement, which was identified through the strength-duration curve. There was a clinically significant improvement observed in the patients' function. Hence, the study hypothesized that along with scapular stabilization, it is important to consider deltoid equally during the assessment and treatment plan in shoulder rehabilitation program.

Effects of A Progressive Rehabilitation Program on Shoulder Internal Rotation Range of Motion, Acromiohumeral Distance, And Pain in An Adolescent Female Swimmer with Subacromial Pain (Impingement) Syndrome

Shoulder injuries are common in competitive youth swimmers because of sport-specific changes in upper extremity physical characteristics and acromio-humeral distance (AHD). These physical alterations could cause abnormal scapular kinematics and positioning. Subacromial pain syndrome (SPS), scapular dyskinesis, and SLAP lesions require a multiphase approach. A 14-years-old female athlete who has been swimming for 7 years had SPS symptoms for 14 months. She also had scapular dyskinesis and suspected SLAP lesion. She received 15 treatment sessions. We conducted a progressive and comprehensive rehabilitation program consisting of electrotherapy, thermal agent, mobilization techniques, posterior shoulder stretching exercises, upper and lower extremity strengthening, proprioception, scapular stabilization, and core stabilization exercises, rhythmic stabilization exercises, plyometric exercises, and the advanced thrower’s 10 program. Internal rotation range of motion (IRROM) with bubble inclinometer, pain with Visual Analog Scale, and AHD with ultrasonographic imaging were assessed before treatment and at the end of the 9th and 15th treatment sessions. Before treatment, IRROM was 52°, AHD was 10.67 mm, and pain intensity at rest and during swimming was 0 and 3.1 cm, respectively. After 9 treatment sessions, IRROM was 55.6°, AHD was 11.62 mm, pain intensity at rest and during swimming was 3.7 cm and 5.1 cm, respectively. At the end of the treatment, IRROM was 58.33°, AHD was 12.02 mm, pain intensity at rest and during swimming was 0 cm. A progressive and challenging rehabilitation program may positively change the scapular and glenohumeral kinematic patterns leading to an increase in AHD and IRROM, therefore a decrease in pain.

Causal mechanisms of a scapular stabilization intervention for patients with subacromial pain syndrome: a secondary analysis of a randomized controlled trial

BackgroundCausal mediation analysis is one way to bridge this gap by exploring the causal pathways of a given intervention. The aim of this study was to assess whether scapular motion, position, and periscapular muscle strength are mediators for pain and shoulder disability outcomes following a scapular stabilization intervention for patients with subacromial pain syndrome.MethodsSixty patients were randomized into two groups: scapular stabilization or periscapular strengthening exercises. The intervention consisted of three sessions per week for 8 weeks. The primary outcome measures were pain and disability and the following outcome measures were considered as potential mediators: scapular motion, scapular position, periscapular muscle strength, age, duration of symptoms, and side of the complaint. A model-based inference approach with bootstrap simulations was used to estimate the average causal mediation effect, average direct effect, and the average total effect from the data of a randomized clinical trial that evaluated the effect of adding scapular stabilization exercises to a scapulothoracic strengthening program in people with subacromial pain syndrome.ResultsThe results demonstrated that none of the putative mediators were influenced by the intervention. However, muscle strength of serratus anterior, upper, middle, and lower trapezius muscles was associated with shoulder disability.ConclusionScapular kinematic and periscapular muscle strength did not mediate the effect of scapular stabilization exercises on shoulder pain or disability scores in subjects with subacromial pain syndrome. Muscle strength of serratus anterior, upper, middle and lower trapezius were associated with shoulder disability scores at 8-weeks follow-up.