[ RESEARCH REPORT ]

DAVID M. SELKOWITZ, PT, PhD, OCS, DAAPM1 CASEY CHANEY, PT, PhD, OCS, CSCS2
SANDRA J. STUCKEY, PT, PhD2 GEORGEANNE VLAD, PT, MA2

The Effects of Scapular Taping on the Surface

Electromyographic Signal Amplitude of Shoulder Girdle
Muscles During Upper Extremity Elevation in Individuals
With Suspected Shoulder Impingement Syndrome

N
ormal muscular control of the scapula is important for Ludewig and Cook23 found that EMG
activities involving upper extremity (UE) elevation. The signal amplitude of the upper trapezius is
increased, while that of the lower trape-
upper and lower trapezius and the serratus anterior
zius is decreased, in patients with shoulder
muscles have important and specific roles in upward impingement. This has been suggested to
rotation of the scapula during UE elevation.2,3,18,28 Muscular result in an imbalance between the upper
dysfunction, including weakness of scapulothoracic muscles,9 trapezius and serratus anterior in produc-
has been implicated in disorders such as shoulder (subacromial) ing upward scapular rotation, resulting in
impingement and rotator cuff strain. Shoulder pain due to these a shoulder shrug when attempting UE
elevation.22,24 Ludewig and Cook23 also
disorders has been associated with significantly reduced health.30
found that there is decreased scapular
upward rotation during UE elevation
T STUDY DESIGN: Multifactorial, repeated-mea- assessed for each muscle. in patients with shoulder impingement.
T RESULTS: Upper trapezius activity was signifi-
sures, within-subjects design. Decreased serratus anterior activity has
T OBJECTIVES: To investigate the immediate ef- cantly lower with tape during shelf task elevation also been found in patients with shoulder
fects of scapular taping on surface electromyograph-
ic (EMG) signal amplitude of shoulder girdle muscles
during upper extremity elevation in individuals with
suspected shoulder impingement syndrome.
T BACKGROUND: Individuals with shoulder im-
pingement syndrome may present with increased
activity of the upper trapezius and inhibition
of other shoulder muscles active during upper
extremity elevation. Scapular taping is theorized to
normalize shoulder girdle function during scapular
upward rotation by decreasing upper trapezius
activity and increasing the activity of the lower
trapezius and other muscles.
T METHODS AND MEASURES: Twenty-one
volunteers with suspected shoulder impingement
syndrome performed shoulder abduction in the
scapular plane and a functional overhead-reaching
(shelf) task, both with and without tape. Surface
electrodes were applied over the upper trapezius,
lower trapezius, serratus anterior, and infraspina-
tus muscles. Mean root-mean-square of the EMG
signal, normalized to maximum contraction, was
1
Professor, Western University of Health Sciences, Pomona, CA. 2 Associate Professor, Western University of Health Sciences, Pomona, CA. Partial funding for this study was
provided through a grant from the California Physical Therapy Fund, Inc. This study was approved by the Institutional Review Board of Western University of Health Sciences.
Address correspondence to David M. Selkowitz, 365 Lincoln Ave, Pomona, CA 91767-3929. E-mail: dselkowitz@westernu.edu
694 | november 2007 | volume 37 | number 11 | journal of orthopaedic & sports physical therapy
(P = .002), especially above 90 (P.002). Lower
trapezius activity was significantly higher with tape
(P = .043). No significant differences were found
between the tape and no tape for other muscles
for the shelf task. During shoulder abduction in the
scapular plane, the main effect for upper trapezius
showed a significant decrease of EMG signal
amplitude (P = .047) for tape versus no tape, but
no significant interactions were found among
components of this activity, or for other muscles.
T CONCLUSION: Scapular taping decreased upper
trapezius and increased lower trapezius activity in
people with suspected shoulder impingement during
a functional overhead-reaching task, and decreased
upper trapezius activity during shoulder abduction
in the scapular plane. Taping did not affect the other
muscles under the loads tested, but it is possible
that the activity of these muscles was not deficient
uninjured side in the injured subjects.8
at the time of testing. J Orthop Sports Phys Ther
2007;37(11):694-702. doi:10.2519/jospt.2007.2467
T KEY WORDS: biomechanics/upper extremity,
electromyographic activity, EMG, pain, scapula
impingement.34
Several authors agree that anterior tip-
ping of the scapula during UE elevation
was present in subjects with shoulder im-
pingement.4,23,25 These findings also sug-
gest diminished lower trapezius action
during upward rotation of the scapula.
Cools et al8 found significant delays in
lower and middle trapezius activation
in overhead (ie, overhead-throwing/-
functioning) athletes with impingement
syndrome compared to overhead athletes
who were uninjured. They also found sig-
nificant delays in lower trapezius activa-
tion on the injured side compared to the
In addition, Cools et al9 found decreased
lower trapezius surface EMG signal am-
plitude during isokinetic shoulder retrac-
tion in overhead athletes with shoulder
impingement compared to those without
impingement.
People with shoulder impingement
have been found, using fine-wire EMG,
to demonstrate decreased rotator cuff
activity, particularly of the infraspinatus
muscle, during isotonic shoulder abduc-
tion in the scapular plane. 32 This may
result in insufficient humeral head de-
pression during UE elevation leading to
shoulder impingement. 32 Infraspinatus
is considered to have an important role
in depression of the humeral head and
in providing glenohumeral joint stability
during UE elevation.14
McConnell (unpublished course
notes, 1994) has proposed a method of
scapular taping for treatment of shoul-
der impingement and other pathologies
thought to occur due to imbalances of
the shoulder musculature. McConnells
method of scapular taping and her theo-
ries regarding scapulothoracic region
pathomechanics and rehabilitation have
not been adequately tested.
In a study involving uninjured sub-
jects, Cools et al7 found that, both with
and without lifting a load, there were no
significant differences in surface EMG of
the upper and lower trapezius and ser-
ratus anterior muscles between scapular
taping and no-taping conditions, during
UE elevation and lowering. Alexander et
al1 found that a scapular taping technique
used on healthy individuals decreased the
amplitude of the lower trapezius H-reflex
until the tape was removed, indicating an
inhibitory influence of taping. In contrast,
Morin et al27 found a significant decrease
in upper trapezius EMG signal amplitude
and a concomitant significant increase in
middle/lower trapezius EMG signal am-
plitude with scapular taping compared to
no taping, in uninjured subjects.
A case report by Host17 investigated the
use of scapular taping on a patient with a
diagnosis of shoulder impingement. The
patient required 8 treatment sessions that
included the application of scapular tape
combined with therapeutic exercise be-
fore being able to perform full shoulder
flexion and abduction without pain. At the
journal of orthopaedic & sports physical therapy | volume 37 | number 11 | november 2007 | 695
3-week follow-up after the end of therapy,
the patient reported that he no longer had
pain and that he had resumed all his lei-
sure time activities, including playing ten-
nis several times a week. However, muscle
activity was not examined in that patient.
Further research, such as experimental
studies and clinical trials, is necessary to
elucidate the effects and effectiveness of
scapular taping.
The purpose of this study was to deter-
mine if scapular taping has an influence
on surface EMG signal amplitude of the
upper trapezius, lower trapezius, serratus
anterior, and infraspinatus muscles dur-
ing UE elevation in subjects with signs
and symptoms suggestive of shoulder
impingement.
Based on the previously described im-
pairments associated with shoulder im-
pingement, a beneficial effect of scapular
taping would be a decrease in activity of
the upper trapezius and an increase in the
activity of the lower trapezius, serratus
anterior, and infraspinatus muscles. The
effects on the upper trapezius could be as
a result of the location of the tape, while
the effects on the other muscles could be
considered indirect and related to chang-
es in activation of the upper trapezius.
Based on prior research and a pilot study
on the immediate effects of scapular tap-
ing, we hypothesized that, in subjects
with signs and symptoms of shoulder
impingement syndrome, scapular tap-
ing would significantly decrease upper
trapezius surface EMG signal amplitude
compared to no taping. Additionally, we
hypothesized that in these subjects there
would be no significant difference in
surface EMG signal amplitude between
scapular taping and no-taping conditions
for the lower trapezius, serratus anterior,
and infraspinatus muscles.
METHOD
T
his study was approved by the
Institutional Review Board of West-
ern University of Health Sciences.
Informed consent was obtained, and data
were collected on 21 volunteers (11 males
and 10 females) from the University com-
munity and selected affiliated physical
therapy clinics. Subjects were offered a
$5 stipend for participation in the study
to defray transportation costs. The sub-
jects were at least 18 years of age (mean,
42.8 years), with a mean body mass of
72.1 kg and a mean height of 167.9 cm.
They reported having shoulder pain for
varying duration, ranging from 1 week
to several years. Inclusion criteria were
a positive Neer29 and/or Hawkins-Ken-
nedy16 test, history of pain in the proximal
portion of the C5-6 dermatome with UE
elevation,25 and no prior scapular taping,
no history of shoulder or cervical spine
surgery, no cervical spine pathology, and
no neurological conditions. The subjects
also needed to be able to elevate their
involved UE to at least 100 of shoul-
der flexion and 100 of abduction in the
scapular plane.
Instrumentation
Strips of 2-in (5.08-cm) CoverRoll tape
and Leukotape were used for the scapular
taping procedure, which is based on the
McConnell method.
The EMG data acquisition and pro-
cessing were performed with Noraxon
(Noraxon USA, Inc, Scottsdale, AZ)
equipment. This included the Myosys-
tem 1200 4-channel surface EMG unit,
and MyoResearch software to process
the EMG signal. Characteristics of the
Noraxon signal detection and processing
system were eighth-order Butterworth
low-pass filter of 500 Hz (1%), first-or-
der high-pass filter of 10 Hz (10%), a
sampling frequency of 1000 Hz, a base-
line noise of less than 1-V root-mean-
square (RMS), an input impedance of
greater than 100 M7, a common-mode
rejection ratio of greater than 100 dB,
and a gain of 1000. The software was
programmed to perform rectification and
smoothing of the signal by calculating the
RMS using a 50-ms moving window. The
mean RMS of each muscle was normal-
ized to a maximum voluntary isometric
contraction (MVIC). Normalization was
performed using a 1-second moving win-
 [ RESEARCH REPORT
Figure 1. Posterior and oblique views of scapular
taping (A) and electrode placements for the upper
trapezius (B), infraspinatus (C), lower trapezius (D),
and serratus anterior (E).
dow for the peak (highest average) of the
MVIC.
A Noraxon single electrode placed
over the proximal sternum was used as
the reference electrode. Noraxon blue
sensor dual (bipolar, single differential)
electrodes, 1 cm in diameter, with an in-
terelectrode distance of 2 cm, were used
to collect the EMG signal from the target
muscles on the side of impairment.
Electrode placement (FIGURE 1) was
based on the work of Cram and Kas-
man10 and Jensen et al.19 The electrodes
for the upper trapezius muscle were
placed approximately 2 cm lateral to
the midpoint of an imaginary line con-
necting the spinous process of the sev-
enth cervical vertebra and the acromion
( just lateral to where the scapular tape
was placed). Electrode placement for
the lower trapezius muscle was approxi-
mately 10.5 cm inferomedial to the me-
dial border of the spine of the scapula,
at a 55 oblique angle to the horizontal
plane, but not below T12. The serratus
anterior muscle was monitored along
its lower fibers, with electrodes placed
inferior to the axillary region (following
the midaxillary line) at the level of the
inferior angle of the scapula, just ante-
696 | november 2007 | volume 37 | number 11 | journal of orthopaedic & sports physical therapy
Figure 2. SCAPTION movement experimental setup.
rior to the border of the latissimus dorsi
muscle and the midaxillary line. The
electrodes for the infraspinatus muscle
were placed approximately 4 cm inferior
to the spine of the scapula over the in-
fraspinatus fossa on the lateral aspect of
the muscle. All electrodes were oriented
parallel to the direction of the respective
muscle fibers.
Two large wooden boards were placed
at a 120 angle to each other for the sub-
jects to use as a guide for performing el-
evation and return from elevation in the
scapular plane (SCAPTION; 30 ante-
rior to the coronal plane). Subjects were
instructed to elevate as high as tolerable,
at least to 100. For the other activity
(SHELF), a shelf was mounted on a
wall for a functional task in which sub-
jects raised and lowered their involved
UE to place and remove a 0.5-kg bottle
of water. The shelf height was adjusted
according to each individuals capability
and tolerance, so that the angle of shoul-
der flexion when reaching the shelf was at
least 100, as measured with a plastic go-
niometer. A metronome, set at 40 beats
per minute, was used to pace the subjects
UE movements in both activities.
A Sony video camera was used to film
the subjects while they performed shoul-
der elevation and lowering activities. The
location of the camera relative to the sub-
ject was the same for all subjects within
each of the 2 activities. Myovideo soft-
ware was used to process the video signal.
The video signal was used to identify the
beginning and end of the elevation and
lowering phases of both SCAPTION and
SHELF, to assist in defining the time pe-
riod used to derive the RMS.
]
Procedure
After informed consent, a brief history
of injury, demographic data, and anthro-
pometric data were obtained. Electrodes
were applied on the involved UE as previ-
ously described after cleaning and abrad-
ing the skin at the points of contact.
Each subject then performed a MVIC
for each muscle, with manual resistance
applied by 1 of the examiners. The up-
per trapezius was resisted, first using a
shrug of the shoulders, followed by the
lower trapezius, with force applied to ex-
tend the UE when it was held at 90 of
shoulder flexion (elbow fully extended).
Then the infraspinatus was resisted with
a force applied toward shoulder internal
rotation, with the upper extremities held
at 0 of shoulder flexion and abduction
and 90 of elbow flexion. The serratus an-
terior was resisted last in a push-up-plus
position against the wall.24
Following the normalization phase,
each subject performed the SCAPTION
and SHELF activities, both with and
without scapular tape. Both the order of
application of tape and the order of activ-
ity performance were randomized for 8
possible combinations using a balanced
Latin-square design.
The same scapular taping procedure
was applied to each subject. First, the Cov-
erRoll tape was applied to the skin over
the upper trapezius on the involved side,
starting from the clavicle anteriorly and
extending posteriorly, caudally, and medi-
ally to the paraspinal area proximal to the
lower trapezius electrode, so that the tape
was approximately perpendicular to the
course of this portion of the upper trape-
zius. The Leukotape was applied next on
top of the CoverRoll tape, with compres-
sion over the upper trapezius (FIGURE 1).
SCAPTION was performed with the
subjects standing at, and facing, the area
where the 2 wooden boards intersected
(FIGURE 2). The subjects were instructed
to use the wooden boards to guide them
as they elevated both UEs simultane-
ously in the scapular plane, but to not
touch the boards. The subjects practiced
this activity for a few repetitions using
the metronome (40 beats per minute) to (UP, DOWN) and the SHELF movements
pace the movements. Each elevation was (UP-NB, DOWN-B, UP-B, DOWN-NB)
completed in 1 beat and each lowering in order of performance, for the 2 parts
was completed in 1 beat, successively. Af- of the ROM, for each of the 4 muscles.
ter the subjects appeared to be familiar- A 3-factor (2-by-2-by-2) repeated-mea-
ized with the movement, they performed sures analysis of variance (ANOVA) was
5 repetitions of elevation and lowering performed for SCAPTION, for each of
the UEs in the scapular plane while data the 4 muscles. The factors (and their cor-
were collected. Although EMG data were responding levels) were taping condition
collected only from the involved UE, both (TAPE, NO TAPE), direction of move-
UEs were elevated and lowered simulta- ment (UP, DOWN), and ROM (90,
neously, to better control for unwanted
compensatory movements and because
this method is commonly used in clinical
practice for evaluation.
The SHELF task (FIGURE 3) was per-
formed beginning with the bottle on the
shelf. The activity was performed with
only the involved UE moving, in the sag-
ittal plane, paced by the metronome. A
practice period was conducted as with
SCAPTION. Subjects began the activity
with the involved UE down at the side of
the trunk without the bottle, and raised
their involved UE to reach for and grasp
the bottle on the shelf. Then they lowered
the UE to the starting position while hold-
ing the bottle. The activity continued with
the subjects raising the UE to the shelf
again, this time holding the bottle and
placing it on the shelf, and they completed
the activity by lowering the UE to the start-
ing position without the bottle. This com-
pleted cycle was considered 1 repetition,
and 5 repetitions were performed in total.
As with SCAPTION, each elevation in the
SHELF task was 1 beat and each lowering
was 1 beat (with or without the bottle).
Reported pain was assessed as a sec-
ondary variable, immediately prior to,
and after, both SCAPTION and SHELF
Figure 3. SHELF task experimental setup.
tive MVIC RMS. The 5-repetition mean
of the normalized mean RMS values was
used as the EMG signal amplitude de-
pendent variable.
The 2 activities, SCAPTION and
SHELF, were analyzed separately. For
both activities, taping (TAPE) was com-
pared to no taping (NO TAPE) for EMG
signal amplitude of the same 4 muscles.
It was considered possible that muscle
function and activity might be affected
differently in impingement conditions,
depending on the direction in which the
UE was moving and where in the range
of motion (ROM) the shoulder move-
ment was occurring. Therefore, these
were factored into the analysis such that
the direction of movement was dichoto-
mized into elevation (UP) and lowering
(DOWN), and the ROM into greater than
90). For SHELF, a 4-factor (2-by-2-
by-2-by-2) repeated-measures ANOVA
was performed with the same factors (and
levels) as for SCAPTION, except for the
addition of the load factor and levels (B,
NB). If there were significant interaction
effects involving the tape condition, these
were explored further with paired com-
parison tests, comparing TAPE versus NO
TAPE for the multifactor variables. The
alpha level for all tests was .05, except for
the paired comparisons, in which this al-
pha was divided by the number of paired
comparisons (Bonferroni correction).
In addition, paired comparisons of
interest (determined a priori) were as-
sessed for the multicomponent factors of
the SCAPTION and SHELF activities for
each muscle using dependent t tests, with
the alpha level of .05 divided by the num-
ber of paired comparisons (4 for SCAP-
TION and 8 for SHELF).
Subjects reported no pain immediately
prior to beginning each task. The immedi-
ate posttask pain VAS for each of the tasks
(SCAPTION, SHELF) was compared for
TAPE and NO TAPE, using dependent t
tests, with an alpha level of .05.
RESULTS
tasks, using a 10-cm visual analog scale
(VAS), with anchors of no pain and
worst pain imaginable.
Data Analysis
Noraxon MyoResearch software com-
puted the mean RMS of the EMG signal
for each of the 4 muscles, for each rep-
etition. The MyoResearch software nor-
malized the mean RMS of each muscles
signal, for each repetition, to its respec-
journal of orthopaedic & sports physical therapy | volume 37 | number 11 | november 2007 | 697
90 (90) and less than 90 (90), for
both SHELF and SCAPTION. In addi-
tion, since the SHELF activity included
periods in which the subject was raising
and lowering the UE while holding a bot-
tle, the analysis dichotomized this factor
into bottle (B) and no bottle (NB). nificant (P = .136; dependent t test). Dur-
Statistical analysis was performed us-
ing SPSS software (SPSS Inc, Chicago, IL)
to compare the TAPE and NO TAPE con-
ditions for the SCAPTION movements
D
uring the SCAPTION activity,
subjects elevated their UE to a
mean (SD) of 140  16 when
taped and to 143  16 when not taped.
This difference was not statistically sig-
ing the SHELF task, subjects elevated
their UE to a mean of 130  9 flexion in
both conditions, as shelf height was kept
constant between taping conditions.
 [ RESEARCH REPORT ]
EMG* Comparisons Between TAPE and NO TAPE for SCAPTION Component
TABLE 1 Movements (Multifactor Variables), for the Upper Trapezius and Lower
Trapezius Muscles

Upper Trapezius Lower Trapezius

Movement TAPE NO TAPE P TAPE NO TAPE P

UP 90 80.6 (47.2) 90.8 (48.3) .015 30.0 (24.7) 29.7 (21.5) .842
UP 90 111.5 (56.8) 124.5 (81.9) .082 81.0 (64.6) 70.7 (58.7) .152
DOWN 90 65.6 (29.6) 68.5 (33.8) .243 56.0 (46.7) 48.9 (47.9) .197
DOWN 90 37.4 (21.4) 43.3 (25.9) .033 23.0 (21.3) 21.6 (22.4) .357
Abbreviations: <90, shoulder movement below 90 elevation in the sagittal plane; >90, shoulder movement above 90 in the sagittal plane; DOWN, lowering
direction of movement; NO TAPE, condition with no scapular taping; SCAPTION, task of elevation and return from elevation in the scapular plane; TAPE,
condition with scapular taping; UP, elevation direction of movement.
* Values expressed in mean (SD) normalized to percent maximum voluntary isometric contraction (%MVIC). No statistically significant differences using
paired t tests with Bonferroni correction (alpha = .05/4 = .0125).

EMG* Comparisons Between TAPE and NO TAPE for SCAPTION Component

TABLE 2 Movements (Multifactor Variables), for the Serratus Anterior and
Infraspinatus Muscles

Serratus Anterior Infraspinatus

Movement TAPE NO TAPE P TAPE NO TAPE P

UP 90 50.2 (34.3) 50.6 (35.9) .904 30.6 (30.3) 27.4 (21.1) .487
UP 90 103.2 (51.8) 101.0 (57.0) .673 38.1 (34.1) 35.8 (30.3) .624
DOWN 90 67.3 (38.5) 63.2 (36.6) .388 28.6 (29.3) 24.7 (17.0) .363
DOWN 90 32.2 (27.7) 33.7 (29.0) .707 23.7 (28.3) 20.7 (18.9) .527
Abbreviations: <90, shoulder movement below 90 elevation in the sagittal plane; >90, shoulder movement above 90 in the sagittal plane; DOWN, lowering
direction of movement; NO TAPE, condition with no scapular taping; SCAPTION, task of elevation and return from elevation in the scapular plane; TAPE,
condition with scapular taping; UP, elevation direction of movement.
* Values expressed in mean (SD) normalized to percent maximum voluntary isometric contraction (%MVIC). No statistically significant differences using
paired t tests with Bonferroni correction (alpha = 0.05/4 = 0.0125).

The 3-factor repeated-measures
ANOVA for EMG signal amplitude of
the upper trapezius during SCAPTION
showed that there were no significant 2-
way or 3-way interactions among taping
condition and the other factors (P.05).
However, there was a significant main ef-
fect (P = .047) for the taping condition.
Upper trapezius EMG signal amplitude
was significantly less with TAPE than
with NO TAPE.
There were no significant differences
between TAPE and NO TAPE (main or
interaction effects) for any of the other
muscles (P.05).
The 4-factor repeated-measures
ANOVA for the upper trapezius during
the SHELF task showed a significant
interaction between the factors of tape
condition and direction of movement
(df = 1, F = 5.214, P = .033). Paired com-
parison testing (paired t tests with Bonfer-
roni correction: alpha w 2 = 0.025 for the 2
paired comparisons) showed that the up-
per trapezius had significantly less EMG
signal amplitude during the elevation
phase of movement with TAPE compared
to NO TAPE (df = 20, t = 3.222, P = .004).
The magnitude of the mean decrease was
9.6% (97.7%-88.3% MVIC: [9.4 w 97.7] 
100]. The other relevant paired compari-
son for this interactioncomparing TAPE
to NO TAPE during the lowering phase of
movementwas not statistically signifi-
cant (P = .224). There were no significant
interactions among taping condition and
the other 2 factors (P.05).
The 4-factor repeated-measures
ANOVA for the lower trapezius during
the SHELF task showed that there were
no significant 2-, 3-, or 4-way interac-
tions among taping condition and the
other factors (P.05). However, there
was a significant main effect (P = .047)
for the taping condition. The lower tra-
pezius had significantly greater EMG
signal amplitude with TAPE compared
to NO TAPE (df = 1, F = 4.649, P = .043).
The magnitude of the mean increase was
13.5% (61.3%-69.6% MVIC).
There were no significant differences
between TAPE and NO TAPE (main or
interaction effects) during the SHELF
task for the serratus anterior and infra-
spinatus muscles (P.05).
TABLES 1 through 4 display descrip-
tive statistics for all components of the
SCAPTION and SHELF activities, re-
spectively, for each muscle. The paired
comparisons of interest (determined a

698 | november 2007 | volume 37 | number 11 | journal of orthopaedic & sports physical therapy
 EMG* Comparisons Between TAPE and NO TAPE
TABLE 3 for SHELF Component Movements (Multifactor Variables),
for Upper Trapezius and Lower Trapezius

Upper Trapezius Lower Trapezius

Movement TAPE NO TAPE P TAPE NO TAPE P

UP NB 90 71.0 (40.7) 80.2 (47.5) .012 28.3 (32.0) 27.6 (33.0) .647
UP NB 90 96.8 (45.4) 106.7 (46.4) .003 41.0 (37.2) 35.4 (33.0) .077
DOWN B 90 63.5 (28.0) 70.1 (31.2) .013 48.7 (36.9) 42.3 (35.1) .031
DOWN B 90 34.1 (19.2) 35.9 (19.6) .183 22.2 (24.8) 20.8 (25.0) .240
UP B 90 77.5 (45.0) 84.2 (42.8) .083 33.0 (32.4) 31.3 (30.0) .407
UP B 90 111.5 (56.8) 119.6 (81.9) .001 51.7 (53.8) 43.0 (38.7) .173
DOWN NB 90 50.9 (23.8) 54.2 (22.2) .101 36.9 (28.3) 29.3 (26.2) .011
DOWN NB 90 33.7 (20.8) 32.3 (20.0) .260 16.9 (25.3) 15.4 (25.4) .185
Abbreviations: <90, shoulder movement below 90 elevation in the sagittal plane; >90, shoulder movement above 90 in the sagittal plane; B, holding bottle;
DOWN, lowering direction of movement; NB, without holding bottle; NO TAPE, condition with no scapular taping; SHELF, functional task in which subjects
raised and lowered their involved upper extremity; TAPE, condition with scapular taping; UP, elevation direction of movement.
* Values expressed in mean (SD) normalized to percent maximum voluntary isometric contraction (%MVIC).

Statistically significant difference using paired t tests with Bonferroni correction (alpha = .050/8 = .00625).

EMG* Comparisons Between TAPE and NO TAPE

TABLE 4 for SHELF Component Movements (Multifactor Variables),
for Serratus Anterior and Infraspinatus

Serratus Anterior Infraspinatus

Movement TAPE NO TAPE P TAPE NO TAPE P

UP NB 90 45.9 (38.2) 47.0 (34.1) .702 26.4 (18.6) 25.1 (18.6) .271
UP NB 90 99.9 (57.1) 98.5 (57.9) .735 32.1 (21.7) 32.0 (19.7) .924
DOWN B 90 79.5 (46.4) 79.1 (47.0) .893 28.6 (17.0) 30.2 (18.2) .257
DOWN B 90 35.4 (35.8) 35.6 (46.2) .957 21.8 (18.8) 20.5 (16.6) .210
UP B 90 49.0 (36.4) 49.2 (40.3) .932 28.3 (19.5) 27.2 (19.7) .300
UP B 90 114.4 (72.7) 114.2 (67.2) .964 37.4 (24.1) 39.2 (26.4) .194
DOWN NB 90 62.1 (42.8) 58.1 (38.7) .354 23.9 (13.3) 23.6 (11.4) .843
DOWN NB 90 36.6 (36.5) 36.4 (47.6) .959 19.5 (17.0) 17.8 (14.1) .171
Abbreviations: <90, shoulder movement below 90 elevation in the sagittal plane; >90, shoulder movement above 90 in the sagittal plane; B, holding bottle;
DOWN, lowering direction of movement; NB, without holding bottle; NO TAPE, condition with no scapular taping; SHELF, functional task in which subjects
raised and lowered their involved upper extremity; TAPE, condition with scapular taping; UP, elevation direction of movement.
* Values expressed in mean (SD) normalized percent maximum voluntary isometric contraction (%MVIC). No statistically significant differences using paired
t tests with Bonferroni correction (alpha = .050/8 = .00625).

priori) were analyzed for the difference
between TAPE and NO TAPE during
the SHELF task for each component of
the 2 activities using paired t tests. The
comparisons between TAPE and NO
TAPE during the SHELF task for the
NO TAPE for SCAPTION and SHELF
for the upper trapezius and the 3 other
muscles were significant (P.00625).
There were no significant differences
in mean pain scores between TAPE and
NO TAPE during SHELF (TAPE, 1.1 cm;
conditions for SHELF and SCAPTION
(0.5 cm and 0.2 cm, respectively) were
also too small to be clinically relevant.
DISCUSSION

T
upper trapezius, for UP B 90 and for NO TAPE, 1.6 cm; P = .057) or SCAP- his study investigated the imme-
UP NB 90, were statistically signifi- TION (TAPE, 1.4 cm; NO TAPE, 1.6 cm; diate effects of a particular scapular
cant (P.001 and P.002, respectively), P = .267) on the VAS. Considering the low taping method on activation of the
based on the Bonferroni-corrected alpha mean pain scores, and based on studies shoulder musculature in individuals who
(.05/8 = .00625). None of the other com- of other musculoskeletal conditions,6,11,35 had signs and symptoms of shoulder im-
parisons of interest between TAPE and these VAS differences between taping pingement. The scapular taping method

journal of orthopaedic & sports physical therapy | volume 37 | number 11 | november 2007 | 699
 [ RESEARCH REPORT
used in this study resulted in a small but
significant decrease in EMG signal am-
plitude of the upper trapezius compared
to no taping, during a functional task
requiring shoulder elevation. Scapular
taping also produced a significant overall
decrease in upper trapezius activity dur-
ing shoulder abduction in the scapular
plane. There was also a significant over-
all increase in lower trapezius EMG sig-
nal amplitude during the functional task
when scapular taping was used.
The upper trapezius was more af-
fected during elevation than lowering.
Because this subject sample did not have
high pain levels, it is possible that the ef-
fect was greater above 90 because that
is where there is greater impingement
and, therefore, it was more provocative.
In addition, if the upper trapezius is more
biomechanically and physiologically
(length-tension) challenged above 90,
this could also have been a factor.
The serratus anterior and infraspi-
natus were not significantly affected by
scapular taping. It is possible that this
method of taping provides an insufficient
indirect influence (via alteration of upper
trapezius activation), and these muscles
require exercise training to increase their
activity in the presence of impingement.
It is also possible that there were no defi-
cits in activation of these muscles.
Comparison to the Literature
The results for the upper and lower tra-
pezius muscles are in agreement with the
findings of Morin et al,27 who found sig-
nificant decreases in upper trapezius and
increases in lower trapezius activity with
scapular taping compared to no taping in
uninjured subjects. Morin et al27 differed
in their experimental method from the
current study and those previously men-
tioned. They placed the lower trapezius
electrode between the medial scapular
border and the thoracic spine, halfway
between the superior and inferior angles
of the scapula. This may have been more
representative of the middle trapezius or
a combination of lower and middle trape-
zius. In addition, the activity measured by
700 | november 2007 | volume 37 | number 11 | journal of orthopaedic & sports physical therapy
Morin et al27 was a type of isometric, seat-
ed, inclined row (approaching a shrug).
Alexander et al1 found that a scapu-
lar taping technique inhibited the lower
trapezius. However, they applied the tape
onto the skin overlying the lower trape-
zius and parallel to the direction of its fi-
bers, rather than over and perpendicular
to the upper trapezius as was done in the
current study.
Cools et al7 found no significant dif-
ferences in uninjured subjects between
scapular taping and no taping for the
upper, middle, and lower trapezius, and
serratus anterior. The results of the cur-
rent study were similar to those of Cools
et al7 for serratus anterior, but differed in
its finding of a decrease in upper trape-
zius activation and an increase in lower
trapezius activation.
Cools et al7 divided the movement
directions and ROM into 0 to 90, 90 tests. This is also similar to other stud-
to 180, 180 to 90, and 90 to 0, as in ies.8,9,25 In addition, this study did not re-
the current study. However, Cools et al7
investigated shoulder flexion and abduc-
tion, which were slightly different than
the movement tasks in the current study.
In addition, the location of the upper
trapezius electrode was midway between
the C7 spinous process and the acromion
in the Cools et al7 study, which has been
reported to depress the signal amplitude
of the upper trapezius.19 They applied the
tape lateral to the electrodes and later-
ally over the upper trapezius. Perhaps the
most important difference between the 2
studies involves the subject populations:
the current study used injured individu-
als rather than noninjured subjects.
Possible Study Limitations
The small significant differences for the up-
per and lower trapezius, as well as the lack
of significant differences between taping
and no taping for EMG signal amplitude
of the serratus anterior and infraspinatus
might represent the true phenomenon,
or might be due to characteristics of this
studys subject population. The duration of
shoulder problems varied among these sub-
jects. However, such variation is consistent
with other reports in the literature investi-
]
gating people with shoulder impingement
problems, including greater than 1 week,20
up to 12 weeks,36 and some studies having
indicated no time period at all.8,9,31 The sub-
jects in the current study were not in acute
pain, which is also consistent with this
literature, but might explain the low mag-
nitudes or lack of differences seen with tap-
ing. It is also important to note that there is
no evidence that any of the muscles studied
were deficient at the time this study was
conducted. However, Cools et al9 also found
that there were no deficits in surface EMG
signal amplitude of the serratus anterior in
injured compared to uninjured overhead
throwers, despite finding deficits in shoul-
der protraction torque at high speeds.
While the subjects in this study had
subjective and objective findings con-
sistent with shoulder impingement, this
was not verified with diagnostic imaging
quire that the subjects be symptomatic in
other clinical physical examination tests
besides the Neer or Hawkins-Kennedy
tests.21,31 Although there is much varia-
tion in the literature, the physical and
subjective examination tests used in this
study have been used in combination as
sufficient criteria for labeling subjects
with shoulder impingement syndrome in
the literature.8,25,26 Several diagnoses and
pathologies have been included in the
literature as being indicative of shoulder
impingement syndrome (eg, partial ro-
tator cuff tear, full-thickness rotator cuff
tear, subacromial bursitis, supraspinatus,
infraspinatus, subscapularis, and biceps
tendinitis), and various methods of mak-
ing a diagnosis have been used, which
add to the confusion in clinical definition.
Therefore, the diagnostic label of impinge-
ment syndrome may vary depending on
the specific tissue pathology involved, as
well as the severity, which may result in
variations in diagnostic usefulness of the
various impingement syndrome tests. This
is also an issue among studies that have
investigated the diagnostic usefulness of
commonly used clinical tests. While some
tests not used in this study have been
shown to have high diagnostic value and
positive predictive value, both the Neer
and Hawkins-Kennedy tests have been
shown to have adequately high diagnostic
accuracy and positive predictive value and,
under certain conditions, even higher than
other tests with higher levels of specifici-
ty.5,31 Only in instances of complete rotator
cuff tears have the tests used in the cur-
rent study been found to have lower levels
of specificity compared to other tests.31
McClure et al,26 in their study of impinge-
ment, excluded people with acute inflam-
mation or complete rotator cuff tears. It is
likely that the subjects in the current study
did not have complete rotator cuff tears or
acute inflammation, based on their sub-
jective and objective findings and their
performance during the study.
In general, the subjects were activating
their muscles at higher percent of MVIC
in the UP and 90 phases of the SHELF
and SCAPTION tasks (TABLES 1-4). The
relative activation levels reached 100%
or more of MVIC for upper trapezius and
serratus anterior, for certain phases of the
tasks. However, it is likely that the manual
muscle test MVICs in the current studys
procedure underestimated the true maxi-
mum EMG signal amplitude capability of
these muscles, which would overestimate
the relative activation levels during these
tasks. The normalization contractions
used in the current study did not include
certain activities reported to produce
higher maximum contractions.15 The high
relative activation levels noted above are
also higher than those found by Cools et
al7; however, they did not report the activi-
ties used for maximum contractions, and
their subjects were uninjured, unlike the
subjects in the current study. The ability of
subjects in the current study to maximally
activate their muscles might have been im-
paired, which could also have resulted in
higher relative activation levels measured
during the tasks. Obtaining true maxi-
mum contractions in an injured popula-
tion, or comparing them to those obtained
in uninjured people, can be problematic.
The results of the comparisons found in
this study are nonetheless valid because
journal of orthopaedic & sports physical therapy | volume 37 | number 11 | november 2007 | 701
the design was within subjects, and sub-
maximal normalization contractions have
been reported to be appropriate for study-
ing surface EMG signal amplitude.12,38
Cross talk (electrical activity from a
nearby contracting muscle) is a phenom-
enon present in surface EMG studies that
can contaminate the signal detected from
a target muscle. However, surface EMG is
an appropriate method for detecting mus-
cle electrical activity and cross talk is lim-
ited when the target muscles are relatively
large and superficial,3,15,33 as in the current
study. The distance between the electrode
pairs of any 2 muscles in the current
study was more than 3 cm. This distance
has been shown to adequately limit cross
talk.37 The small interelectrode distance
(2 cm) within each electrode pair, used
in the current study, is also considered to
limit cross talk.13,15 In addition, the single-
differential (bipolar) electrode technique
is thought to limit cross talk and the ad-
dition of common mode noise from the
environment to the signal.3
The lack of significant change in pain
VAS scores and UE elevation ROM in
the scapular plane, between taping and
no taping, might also have been due to
the current stage of the problem in these
subjects. Another study investigating the
effects of taping on posture in subjects
with shoulder impingement syndrome
showed that posture and overhead ROM
were significantly improved while sub-
jects were taped, but there was no differ-
ence in pain complaint.21
Further study of the effectiveness of
the method of scapular taping used in
this study would be beneficial in patients
who are more symptomatic and for com-
parison of this taping method to other
interventions during rehabilitation for
long-term effects. In addition, the effect
of load requires further study.
CONCLUSION
A
particular method of scapular
taping used in individuals with signs
and symptoms of shoulder impinge-
ment resulted in significantly decreased
upper trapezius surface EMG signal am-
plitude, and significantly increased lower
trapezius amplitude, compared to no tap-
ing during a functional reaching task in-
volving UE elevation and lowering. The
predominant effects on the upper trape-
zius occurred during UE elevation above
90 of shoulder elevation. There was also
a significant decrease in upper trapezius
activity with taping compared to no taping
during shoulder abduction in the scapular
plane. No significant differences in EMG
signal amplitude between taping and no
taping were found for any of the UE eleva-
tion and lowering movements for the ser-
ratus anterior and infraspinatus muscles,
and no differences in pain complaint were
found between taping and no taping for
the SCAPTION and SHELF tasks. Fur-
ther study is necessary to determine if the
EMG changes found in the current study
are associated with functional improve-
ment in patients with these problems.
ACKNOWLEDGMENTS
T
he authors thank the follow-
ing people for their consultation on
data analysis and statistics: Dale
Berger, PhD; Gary Gugelchuk, PhD; Ste-
phen Allison, PT, PhD; Carolyn Ervin,
PhD; Robert Wiswell, PhD; and Paula
Ludewig, PT, PhD. The authors also
thank Jess Opatynski for his assistance
with photography. T
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