Muscle Activation in Specific Regions of the Trapezius During Modified Kendall Manual Muscle Tests

Abstract

Context: Manual muscle tests (MMTs) are often used when assessing shoulder injuries. For the trapezius, individual MMTs are used to selectively test the upper trapezius region (UTR), middle trapezius region (MTR), and lower trapezius region (LTR). The MMTs for each region are assumed to preferentially recruit the corresponding muscle fibers and produce a maximal contraction; however, whether this is true is unknown.

Objective: To determine if maximal voluntary isometric contractions (MVICs) for the upper trapezius (UT-MVIC), middle trapezius (MT-MVIC), and lower trapezius (LT-MVIC), adapted from the Kendall MMTs, recruited the corresponding trapezius regions.

Design: Crossover study.

Setting: Laboratory.

Patients or other participants: A total of young, healthy individuals (10 men, 9 women, 1 not listed; age = 23.9 ± 1.7 years, height = 171.4 ± 9.6 cm, mass = 75.7 ± 11.6 kg).

Intervention(s): Participants performed 3 repetitions of each MVIC. High-density surface electromyography measurements were collected from the UTR, MTR, and LTR.

Main outcome measure(s): Root mean square (excitation) of the UTR, MTR, and LTR.

Results: We observed an increase in UTR excitation during the LT-MVIC compared with the UT-MVIC (P = .016) and MT-MVIC (P < .001). The MTR excitation increased during the MT-MVIC (P = .001) and the LT-MVIC (P < .001) compared with the UT-MVIC. We also noted an increase in MTR excitation during the LT-MVIC compared with the MT-MVIC (P < .001). The LTR excitation increased during the MT-MVIC and LT-MVIC (P values < .001) compared with the UT-MVIC.

Conclusions: The UT-MVIC and MT-MVIC did not necessarily recruit the corresponding trapezius regions more than the other MVICs did. Rather, the LT-MVIC appeared to produce the greatest excitation of all trapezius regions. Additional research is needed; however, clinicians should be aware that maximal contractions may not always recruit the desired muscle region.

Keywords: back assessment; high-density surface electromyography; muscle recruitment; musculoskeletal assessment; neck assessment; shoulder assessment.