1, 1, * The Effect of Push-Up Plus Exercise With Respiration On Muscle Activation of Around Shoulder Abstract Chan-Hyun Park 1, Tae-Gyu Lee 1, H

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1 1, 1, * The Effect of Push-Up Plus Exercise With Respiration On Muscle Activation of Around Shoulder Abstract Chan-Hyun Park 1, Tae-Gyu Lee 1, Ho-Hee Son *2 1 Catholic University of Pusan, College of Health Sciences, Department of Physical Therapy 2 Catholic University of Pusan, College of Health Sciences, Department of Physical Therapy Purpose The purpose of this study was to investigate the effect of the push-up plus(pup) exercise with respiration on the activity of the muscles around the shoulders. Methods Twenty subjects were performed three types of respiration that forced inspiration(fi), forced expiration(fe), general respiration(gr) in the each posture of wall PUP and knee PUP. Prior to the initiation of the study, subjects were clearly informed of the posture of PUP exercise and three types of respiration. The six types of exercise were randomly selected by numbering card. Each type of exercise was performed three times, and after the exercise, the subjects had a rest of 5minutes. Surface EMG of serratus anterior(sa), upper trapezius(ut), middle trapezius(mt), deltoid(dt) muscles were recorded. Results There was no statistically significant difference in each types of exercise, but in the wall PUP exercise, SA and UT muscle showed highest activity at the FE, and the FI higher than GR. MT showed highest muscle activity at the FI, and the DT showed the highest muscle activity in GR. In the knee PUP exercise, SA, UT, MT and DT showed highest muscle activity in FE. In addition, there was no interaction between the posture of the PUP exercise and the respiration types. Conclusion This study showed there was no statistically significant difference in the activity of the muscles around the shoulders when PUP exercise with respiration. However, higher muscle activity was shown when FE in the measured muscles. Therefore, it is suggested to control respiration for more efficient exercise. Key words : push-up plus, respiration, shoulder muscle, EMG, Corresponding author Son hohee address: sonhh@cup.ac.kr I. 1).,,,, 2),3).., Wilk 4),,,, -.

2 5-7) 8).,, 5).,, 8), 9).,, 10). 11), 12), 13), 8), 14),. Uhl 15). Ludewig 8),., 8), 10) 16). - 8), 17), 18), 19), 20). 21), 22), 23), 24),, 16), 25-27).,. 43). 28).,, 29), 30). 31). 50), 32), 33), 34) 35).. 1,,,,,,,,,,,,,, 51). 51)., Moreno 36)

3 (Proprioceptive Neuromuscular Facilitation, PNF), Areas 37)... II ~ ,,. 6,. 2. QEMG-4(LXM3204, LAXTHA Inc., Korea). Telescan Ver. 2.0, 3 (Figure 1). Figure 1. Surface EMG Device QEMG , 5 RMS(root mean square), 1 3, 3. (maximal voluntary isometric contraction; MVIC), 5 RMS 1 3, MVIC

4 . 80~480 Hz, 60 Hz. 4. 1),,,., 4~6, 7 1/2, 1/2, 38) (Figure 2). Figure 2. Attaching electrodes A: Serratus Anterior B: Upper Trapezius C: Middle Trapezius D: Deltoid 2) 20,,,.,. 6, 3, 5. (1) (wall push-up plus) 90 (Figure 3).

5 Figure 3. Wall push-up plus (2) (knee push-up plus) (Figure 4). Figure 4. Knee push-up plus. (1), (2) 5,,.. (1), (2) 5,,.. (1), (2) 5,.

6 5. MVIC %MVIC 3. (two-way analysis of variance). (α) 0.05, (one-way analysis of variance). SPSS ver III , 29.30±2.72 (20 11, 30 9 ), ±6.01cm, 71.75±10.18kg <Table 1>. Table 1. General characteristics of subjects (N=20) Variable Total Gender(male/female) 20/0 Age(year) 29.30±2.72 Height(cm) ±6.01 Weigh(kg) 71.75±10.18 Mean±standard deviation; *:p.05 2.,,, (Figure 5).

7 A B C D Figure 5. Interaction among of position and respiration A: Serratus Anterior B: Upper Trapezius C: Middle Trapezius D: Deltoid FEG; Forced Expiration Group(push-up plus with forced expiration), FIG; Forced Inspiration Group(push-up plus with forced inspiration), CG; Control Group(push-up plus with discretionary breathing control), WP; wall push-up plus, KP; knee push-up plus, 3. (p>.05),,., <Table 2>. Table 2. Comparison of muscle activation on wall push-up plus with variable respiration (Unit: %MVIC) FEG (n=20) FIG (n=20) CG (n=20) F p SA 66.30± ± ± UT 8.34± ± ±

8 MT 6.97± ± ± DT 17.30± ± ± FEG; Forced Expiration Group(push-up plus with forced expiration), FIG; Forced Inspiration Group(pushup plus with forced inspiration), CG; Control Group(push-up plus with discretionary breathing control), SA; Serratus Anterior, UT; Upper Trapezius, MT; Middle Trapezius, DT; Deltoid 4. (p>.05),,,,,, <Table 3>. Table 3. Comparison of muscle activation on knee push-up plus with variable respiration (Unit: %MVIC) FEG (n=20) FIG (n=20) CG (n=20) F p SA 64.69± ± ± UT 7.24± ± ± MT 7.87± ± ± DT 60.81± ± ± FEG; Forced Expiration Group(push-up plus with forced expiration), FIG; Forced Inspiration Group(pushup plus with forced inspiration), CG; Control Group(push-up plus with discretionary breathing control), SA; Serratus Anterior, UT; Upper Trapezius, MT; Middle Trapezius, DT; Deltoid Ⅳ. 39). 40)..,,,.,,.,.. Moreno 36) PNF 4., PNF, PNF,. Areas 37) PNF 4,,

9 ,.. 40),,., McGill 41), 42),. 31)...,, Hodges Richardson 43). 44),..,., 45), 46),. 47) 45, 90,, 1, 1. 48) EMG,

10 ., Park Lee 49)..,.,.. Ⅴ..,. References 1. Hess S. Functional stability of the glenohumeral joint. Manual therapy. 2000;5(2): Magee DJ. Orthopedic physical assessment. 3rd ed, Philadelphia, WB Saunders; p de Oliveira AS, de Morais Carvalho M, de Brum DPC. Activation of the shoulder and arm muscles during axial load exercises on a stable base of support and on a medicine ball. Journal of Electromyography and Kinesiology. 2008;18(3): Wilk KE, Arrigo CA, Andrews JR. Current concepts: the stabilizing structures of the glenohumeral joint. Journal of Orthopaedic & Sports Physical Therapy. 1997;25(6): Cools A, Declercq G, Cambier D, et al. Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms. Scandinavian journal of medicine & science in sports. 2007;17(1): Ekstrom RA, Donatelli RA, Soderberg GL. Surface electromyographic analysis of exercises for the trapezius and serratus anterior muscles. Journal of Orthopaedic & Sports Physical Therapy. 2003;33(5): Lin JJ, Wu YT, Wang SF, et al. Trapezius muscle imbalance in individuals suffering from frozen shoulder syndrome. Clinical rheumatology. 2005;24(6): Ludewig PM, Hoff MS, Osowski EE, et al. Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises. The American journal of sports medicine. 2004;32(2): Blackard DO, Jensen RL, Ebben WP. Use of EMG analysis in challenging kinetic chain terminology. Medicine and science in sports and exercise. 1999;31(3): Ellenbecker TS, Davies GJ. Closed kinetic chain exercise: a comprehensive guide to multiple joint exercise. Human Kinetics: Leeds; 2001.

11 11. Hardwick DH, Beebe JA, McDonnell M, et al. A comparison of serratus anterior muscle activation during a wall slide exercise and other traditional exercises. Journal of Orthopaedic & Sports Physical Therapy. 2006;36(12): Lehman GJ, MacMillan B, MacIntyre I, et al. Shoulder muscle EMG activity during push up variations on and off a Swiss ball. Dynamic Medicine. 2006;5(1): Smith J, Kotajarvi BR, Padgett DJ, et al. Effect of scapular protraction and retraction on isometric shoulder elevation strength. Archives of physical medicine and rehabilitation. 2002;83(3): Liebenson C. Self-management of shoulder disorders Part 1. Journal of Bodywork and Movement Therapies. 2005;9(3): Uhl TL, Carver TJ, Mattacola CG, et al. Shoulder musculature activation during upper extremity weight-bearing exercise. Journal of Orthopaedic & Sports Physical Therapy. 2003;33(3): Lehman GJ, Gilas D, Patel U. An unstable support surface does not increase scapulothoracic stabilizing muscle activity during push up and push up plus exercises. Manual Therapy. 2008;13(6): Maenhout A, Van Praet K, Pizzi L, et al. Electromyographic analysis of knee push up plus variations: what s the influence of the kinetic chain on scapular muscle activity? British J Sports Med Decker MJ, Hintermeister RA, Faber KJ. Serratus anterior muscle activity during selected rehabilitation exercises. The American journal of sports medicine. 1999;27(6): Gouvali MK, Boudolos K. Dynamic and electromyographical analysis in variants of push-up exercise. The Journal of Strength & Conditioning Research. 2005;19(1): Lunden JB, Braman JP, LaPrade RF, et al. Shoulder kinematics during the wall push-up plus exercise. Journal of Shoulder and Elbow Surgery. 2010;19(2): Cho SH, Baek IH, Cheon JY, et al. Effect of the Push-up Plus (PUP) Exercise at Different Shoulder Rotation Angles on Shoulder Muscle Activities. Journal of Physical Therapy Science. 2014;26(11): San Juan JG, Suprak DN, Roach SM, et al. The effects of exercise type and elbow angle on vertical ground reaction force and muscle activity during a push-up plus exercise. BMC musculoskeletal disorders. 2015;16(1): Lee SY, Han JT, Park MC, et al. Comparison of Shoulder Stabilizer Muscle Activations during Push Up Plus Exercise by with Cervical Flexion and Extension. Journal of Physical Therapy Science. 2011;23(1): Vaseghi B, Jaberzadeh S, Kalantari KK, et al. The impact of load and base of support on electromyographic onset in the shoulder muscle during push-up exercises. Journal of Bodywork and Movement Therapies. 2013;17(2): Martins J, Tucci HT, Andrade R, et al. Electromyographic amplitude ratio of serratus anterior and upper trapezius muscles during modified push-ups and bench press exercises. The Journal of Strength & Conditioning Research. 2008;22(2): Kim ER, Oh JS, Yoo WG. Effect of vibration frequency on serratus anterior muscle activity during performance of the push-up plus with a redcord sling. Journal of physical therapy science. 2014;26(8): Kim SH, Kwon OY, Kim SJ, et al. Serratus anterior muscle activation during knee push-up plus exercise performed on static stable, static unstable, and oscillating unstable surfaces in healthy subjects. Physical Therapy in Sport. 2014;15(1): Oliver GD, Keeley DW. Pelvis and torso kinematics and their relationship to shoulder kinematics in high-school baseball pitchers. The Journal of Strength & Conditioning Research. 2010;24(12): Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Physical therapy. 2000;80(3): Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. journal of

12 orthopaedic & sports physical therapy. 2009;39(2): Pryor JA, Prasad AS. Physiotherapy for respiratory and cardiac problems: adults and paediatrics. Elsevier Health Sciences; Sapsford R. Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Manual therapy. 2004;9(1): Perret C, Spengler CM, Egger G, et al. Influence of endurance exercise on respiratory muscle performance. Medicine and science in sports and exercise. 2000;32(12): Markov G, Spengler CM, KnoÈpfli-Lenzin C, et al. Respiratory muscle training increases cycling endurance without affecting cardiovascular responses to exercise. European journal of applied physiology. 2001;85(3-4): Kim JH. The Effect of Improved Pulmonary Function in the Stroke Patients after Respiratory Physical Therapy. Graduate School of Rehabilitation Science, Daegu University. Master s thesis Moreno MA, Silva Ed, Gonçalves M. O efeito das técnicas de facilitação neuromuscular proprioceptiva método Kabat nas pressões respiratórias máximas. Fisioter Mov. 2005;18(2): Areas GPT, Borghi-Silva A, Lobato AN, et al. Effect of upper extremity proprioceptive neuromuscular facilitation combined with elastic resistance bands on respiratory muscle strength: a randomized controlled trial. Brazilian Journal of Physical Therapy. 2013;17: Neumann DA. Kinesiology of the musculoskeletal system: foundations for rehabilitation. Elsevier Health Sciences; Couser Jr JI, Martinez FJ, Celli BR. Respiratory Response and Ventilatory Muscle Recruitment During Arm Elevation in Normal Subjects. Chest. 1992;101(2): Han JW. The Effect of Breathing Exercise with Dynamic Upper Extremity Exercise on Pulmonary Function and Respiratory Muscle Strength of Adults in Their 20 s. Graduate School of Rehabilitation Science, Daegu University. Master s thesis McGill SM, Grenier S, Kavcic N, et al. Coordination of muscle activity to assure stability of the lumbar spine. Journal of Electromyography and Kinesiology. 2003;13(4): Yoon JW. The effect of core stability execise for inspiratory competence in patient with stroke. Graduate school of Rehabilitation and Welfare, Yong-in University. Master s thesis Hodges PW, Richardson CA. Contraction of the abdominal muscles associated with movement of the lower limb. Physical therapy. 1997;77(2): Jeon YS. Effects of Scapular Stabilizers During the Push Up Plus Exercise and the Push Up Plus Exercise with Abdominal Bracing. Graduate School of Life Science, Catholic University of Pusan. Master s thesis Hodges PW, Richardson CA. Transversus abdominis and the superficial abdominal muscles are controlled independently in a postural task. Neuroscience letters. 1999;265(2): Tarnanen SP, Siekkinen KM, Häkkinen AH, et al. Core muscle activation during dynamic upper limb exercises in women. The Journal of Strength & Conditioning Research. 2012;26(12): Seo KC. The Effect of Pulmonary Function in the Stroke Patients after Feedback Breathing Exercise among position changes. Graduate School of Rehabilitation Science, Daegu University. Master s thesis Kim K, Park RJ, Bae SS et al. Effect of diaphragmatic breathing exercise on Activation of trunk muscle of patients with low back pain. The Journal of Korean Society of Physical Therapy. 2005;17(3): Park DJ, Lee HO. Activation of abdominal muscles during abdominal hollowing in four different positions. Journal of Physical Therapy Science. 2010;22(2): Vera-Garcia FJ, Elvira JL, Brown SH et al. Effects of abdominal stabilization maneuvers on the control of spine

13 motion and stability against sudden trunk perturbations. Journal of Electromyography and Kinesiology. 2007;17(5): Ki C. Effects of Forced Breathing Exercise on the Trunk Functions of Chronic Low Back Pain Patients. Graduate School of Rehabilitation Science, Daegu University. Master s thesis

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