Journal Pre-proofs

Kinesiotaping for scapular dyskinesis : the influence on scapular kinematics

and on the activity of scapular stabilizing muscles

Camille Tooth, Cédric Schwartz, David Colman, Jean-Louis Croisier, Stephen

Bornheim, Olivier Brüls, Vincent Denoël, Bénédicte Forthomme

PII: S1050-6411(20)30015-8
DOI: https://doi.org/10.1016/j.jelekin.2020.102400
Reference: JJEK 102400

To appear in: Journal of Electromyography and Kinesiology

Received Date: 3 May 2019

Revised Date: 12 December 2019
Accepted Date: 31 January 2020

Please cite this article as: C. Tooth, C. Schwartz, D. Colman, J-L. Croisier, S. Bornheim, O. Brüls, V. Denoël, B.
Forthomme, Kinesiotaping for scapular dyskinesis : the influence on scapular kinematics and on the activity of
scapular stabilizing muscles, Journal of Electromyography and Kinesiology (2020), doi: https://doi.org/10.1016/
j.jelekin.2020.102400

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 Kinesiotaping for scapular dyskinesis : the influence on scapular
kinematics and on the activity of scapular stabilizing muscles

Camille Tooth (PT) a,b, Cédric Schwartz (PhD)a , David Colman (PT)b, Jean-Louis
Croisier (PT, PhD) a,b, Stephen Bornheim b, Olivier Brüls a,c(PhD) , Vincent Denoël
(PhD)a,d, Bénédicte Forthomme a,b(PT,PhD)i
a Laboratory of Human Motion Analysis, University of Liège, Liège, Belgium
b Department of Physical Medicine and Rehabilitation, University of Liège, Liège, Belgium
c Department of Aerospace and Mechanical Engineering, University of Liège, Liège,
Belgium
d Department of Architecture, Geology, Environment and Constructions, University of Liège,
Liège, Belgium
File number Ethics Committee: B707201732302
Email address of the corresponding author:
ctooth@uliege.be

Key words: Electromyographic, scapular dyskinesis, kinesiotaping, scapular kinematics,

rehabilitation

Kinesiotaping for normalizing scapular dyskinesis : the influence on

scapular kinematics and on the activity of scapular stabilizing muscles

Conflict of interest
The authors, their immediate families, and any research foundation with which they are
affiliated did not receive any financial payments or other benefits from any commercial entity
related to the subject of this article.
Acknowledgements
The authors wish to thank the Wallonia-Brussels Federation (Belgium) for its support. The
Wallonia-Brussels Federation was not involved in data collection, data analysis or the
preparation of or editing of the manuscript. The authors also thank all the volunteers who
agreed to participate to this study.
 Abstract (199 words)
Scapular dyskinesis is observed in 61% of overhead athletes [3]. For most of them, it

remains asymptomatic. However, scapular dyskinesis is considered a risk factor for

shoulder injury by some authors [4]. The aim of this study is to explore the effectiveness

of kinesiotaping in modifying scapular kinematics and peri-scapular muscle activity in

dyskinetic athletes. The 3-dimensional position and orientation of the scapula as well as

the activation of upper trapezius, lower trapezius and serratus anterior were recorded in

twenty asymptomatic athletes during shoulder movements (flexion and abduction), in

loaded and unloaded conditions and in three circumstances (standard, kinesiotaping 1,

kinesiotaping 2). A significant decrease between 9 and 12% in upper trapezius activity

was observed with kinesiotaping 1 and 2. Lower trapezius activity was slightly increased

with kinesiotaping 1 while it was significantly decreased about 15-20% with

kinesiotaping 2. No change was observed in serratus anterior activity, for either

kinesiotaping 1 or 2. Considering scapular kinematics, both kinesiotaping 1 and 2

significantly increased posterior tilt and upward rotation. External rotation was decreased

with kinesiotaping 2, in comparison to standard condition. Kinesiotaping, and especially

taping 1, seems to be an effective method for changing periscapular muscle activity and

scapular kinematics.
 Introduction
Overhead sports like volleyball, handball, baseball, javelin throwing, swimming may
induce glenohumeral modifications and scapulo-thoracic alterations like scapular
dyskinesis. These alterations may occur after an active season or after a few years of
practice but can also be present just after a training session [3][54]. Indeed, Madsen et al.
observed 37% scapular dyskinesis in swimmers before and 82% after a one-hour training
session [32]. In a 12-weeks follow-up period, Hibberd et al. [13] found an increase in
forward shoulder posture, measured during overhead squats, in regular swimmers.
Postseason, in baseball players, Thomas et al. [54] noted an increase at 0° as well as a
decrease at 90° and 120° of upward rotation during arm abduction in comparison to
preseason tests.
The relationship between scapular dyskinesis and shoulder injuries has been studied at
great lengths and has been discussed for many years but there is still no consensus about
this issue [6][22][30] . Considering shoulder girdle biomechanics [25] and the roles of
scapula described by Kibler et al. [23], there are reasons to believe that abnormal scapular
motion can lead to a decrease of subacromial space and to impingement syndrome. Data
from litterature still tends to show an association between scapular dysfunction and
shoulder pain [4][14][50]. McKenna et al. [36], in a prospective study, found an
association between scapular position at rest and the occurrence of shoulder injuries in
swimmers. Indeed, these authors observed that swimmers with a shorter distance between
the inferior border of the scapula and the spine and between the anterior part of the
glenohumeral head and the acromion were more likely to sustain a injury. Struyf et al.
[50] remarked a decrease of upward rotation at 45° and 90° at the beginning of the season
in injured overhead athletes. Clarsen et al. [4] demonstrated that obvious dyskinesis was
considered as a risk factor of shoulder pain in handball players. Respectively in rugby
and in volleyball, Kawasaki et al. [21] and Merolla et al. [37] found a decrease in rotator
cuff muscles strength, specifically of the infraspinatus, and a shoulder discomfort in
athletes with scapular dyskinesis. Likewie, Su et al. [51] found a decrease in external and
in upward rotation at 45°, 90° and 135° in swimmers suffering from a subacromial
impingement. Johansson et al. [19] observed that a large proportion of kayakers with
shoulder pain presented scapular dyskinesis. In a recent systematic review, Hickey et al.
[14] proclaimed that scapular dyskinesis increased the risk of shoulder pain by 43% yet.
Möller et al. [38] went a little bit further, saying that scapular dyskinesis would be a risk
factor of shoulder pain if there were an increase between 20% and 60% of the training
load. This shows the multifactorial nature, including both intrinsic (muscle stiffness,
muscle weakness etc….) and extrinsic factors (training load for example), of
musculoskeletal injuries. However, other researchers like Myers et al.[40], Forthomme et
al. [10] or Hjelm et al. [15] found no significant relationship between scapular dyskinesis
and shoulder injuries in overhead athletes during the subsequent season.

4
Electromyographic alterations have been associated with scapular dyskinesis too,
essentially in symptomatic people [7][31][49][57]. In fact, Smith et al. [49] found an
increase in the activation of upper trapezius and a decrease in the activation of lower
trapezius in dyskinetic symptomatic subjects. Thigpen et al. [53] observed a decrease in
the activation of serratus anterior in subjects with a forward head posture, which is
accompanied by an increase in scapular anterior tilt. As for Wadsworth et al. [57], these
authors noticed differences in the timing of scapular muscles activations in subjects with
soulder pain in comparison to healthy subjects. They found an increased variability of
timing of activation among the symptomatic population with a delayed activity of serratus
anterior during shoulder elevations in scapular plane.
Kinesiotaping, an original method developed by Kenso Kase in the 1970’s, has been
suggested by different authors as a potential solution to normalize scapular dysfunction
[17] without limiting range of motion. Differents functions were given to theses elastic
tape bands: improving recruitment motor pattern by stimulating mecanoreceptors
[16][52][58], improving blood and lymphatic flow [42], decreasing pain by using the gate
control principle [26][28][42], mechanical effects [16][56]. But the exact mechanism
associated with kinesiotaping effects remains unclear. In the treatment of scapular
dysfunction, Mc Connel taping (inhibitory upper trapezius tape) [34][35], which consist
in a rigid taping applied from the coracoïd process until the inferior border of the scapula,
is often used to correct scapulothoracic motion. This technique was based on Morrissey’s
principle [39], which sustained the hypothesis that a tape placed perpendicular to a
muscle tends to increase its activity and a tape placed parallele to a muscle tended to
decrease its activity. Moreover, Van Herzeele et al. [56] found a positive mechanical
effect of Mc Connel taping in asymptomatic handball players with a moderate increase of
upward rotation and posterior tilt after placement of the tape.
Scapular dyskinesis often consists of a lack of posterior tilt, upward and external rotation
of the scapula, as well as a decrease of sub-acromial space that can lead to shoulder
impingement if the shoulder is frequently solicited. Therefore, correction of scapular
dysfunction could help decrease sub-acromial compression and prevent shoulder
disorders. In view of the multidirectional pattern of the dysfunction, a single taping seems
to be insufficient to correct dysfunction in the three planes. The first aim of this study was
assess the effectiveness of kinesiotaping in the normalization of scapular kinematics and
peri-scapular muscle activity in dyskinetic asymptomatic athletes. The second aim was to
compare the two different techniques and to define which is most efficient.

Methods
1) Participants

5
Twenty volunteer athletes were enrolled in this study. They were aged 21.9 ± 1.8 years,
measuring 179.2 ± 4.8 centimeters and weighing 73.4 ± 8.2 kg. They practiced various
sports including overhead sports (tennis, volleyball, crossfit, football, swimming,
basketball, boxing) with an average time of 6.5 ± 2.5 hours/week for at least four years..
The recruitment consisted in a visual evaluation and clinical measures. Volunteers had to
present unilateral or bilateral scapular dyskinesis [55] visible at rest and during ten
repeated shoulder elevations (“yes/no” method) [55], in frontal and in sagittal planes. The
characteristics of scapular dyskinesis were assessed by two different experienced
physiotherapists in blind condition. The reproducibility between the two assessors,
assessed with kappa correlation, was good (0.83). Scapular dysfunction was also
evaluated with the “Lateral Scapular Slide Test”[8][27][41], described by Kibler et
al.[23] and widely used in clinical practice. A minimum difference of 1.5 centimeters
between the dominant and the non-dominant sides had to be found in at least two of the
three positions of the test. Then scapular upward/downward rotation was measured at rest,
with an inclinometer (with the same method as the one used by Johnson et al.)[20]. A
good reproductibility has been demonstrated on 20 non-overhead sportspeople (mean age
22.1±2.8) by the experimenter for this method (ICC= 0.653 (0.053-0.871)) (non-
published data). A downward rotation had to be observed in volunteers because
kinesiotaping aimed to act on its. Exclusion criteria were asymmetry of length of lower
limbs, scoliosis or dorsal hyperkyphosis, shoulder surgical history, shoulder pain,
shoulder injury (muscular, osseous, ligamentary, tendinous) or positive tendinous and
impingement tests (Jobe, Patte 0°, Patte 90°, Lift off Test, Palm-up Test). Moreover, it
has been checked, by a visual evaluation, that all the subjects were able to attain full
range of motion (without pain) in flexion and in abduction, to confirm that they were
“healthy”.
The protocol has been validated by the Medical Ethics Committee of the University of
Liege. All the participants were informed about the nature of the tests and the progress of
the experimentations before the beginning of the tests.
2) EMG acquisitions

The electromyographic (EMG) signals were collected with Trigno Standard and Trigno
Mini wireless sensors (Delsys, Boston, MA, USA) using silver-contact bipolar bar
electrodes with fixed 10 mm inter-electrode spacing [45]. Three of the main scapular
stabilizing muscles of the shoulder were investigated: upper trapezius, lower trapezius
and serratus anterior. Electrodes were placed following Barbero et al. [1]
recommandations. They were placed on the dyskinetic side. In case of bilateral scapular
dyskinesis, electrodes were placed on the side where the most important dysfunction was
observed, following Mc Clure et al. criteria (normal motion, subtle abnormality and
obvious abdnormality) [33]. Data was acquired at a sample frequency of 1000 Hz.
As a warm up, the volunteers were asked to perform two series of 10 shoulder internal
rotations and two series of 10 shoulder external rotations at 0° of abduction with a
resistive elastic band.
Volunteers then performed maximum voluntary isometric contractions (MVIC) in order
to determine the peak electromyographic signal for each muscle. These contractions were

6
performed in 6 differents positions (illustrated in Figure 1) as recommended by Schwartz
et al.[45]. To limit a possible influence of the investigator, the MVIC positions were
maintained using a steel structure rather than manual pressure. This structure could adapt
to both the test positions and the specific size of the volunteers. Prior to each test position,
the volunteers were asked to perform 3 increasing sub-maximal trials of 6 seconds to get
used to the exercice and the effort. Subsenquently, they performed 3 trials of 6 seconds in
each test position. During the trials, the volunteers were given verbal encouragement. To
avoid fatigue, a minimum of 30 seconds rest intervals was provided between each trial
and each MVIC test position respectively. This timing was chosen based on the article by
Schwartz et al. [45]. The order of the position’s tests has been randomized with the
function “random sort” in Excel 2016 (Microsoft, USA).
All these tests were carried out bilaterally because Fischer et al. [9] observed a 14%
increase of the force of the upper trapezius in the bilateral « empty can position »
compared to unilaterally testing. Another reason justifying this decision was the limitation
of thoracic compensations.
3) Three-dimensionnal assessment

Scapular kinematics was assessed using a three-dimensional motion analysis system, an

optoelectronic system based on active markers (Codamotion, Charnwood Dynamic, UK)
[43]. For that purpose, four Codamotion CX1 units were used, at a sampling of 100 Hz.
The validity, the precision and the reproducibility of the laboratory and the system has
been proved in previous study [43][44] (peak-to-peak values = 0.4 mm in the x-axis, 2.5
mm in the y-axis and 3mm in the y-axis). Fifteen active markers were placed on the skin
of the subject on the same side as the EMG electrodes: 4 on the thorax, 6 on the scapula, 4
on the arm and 1 on the acromio-clavicular joint.

Reference position of the body and of the scapula was defined with the volunteer standing
upright, arms by their sides and looking forward. The center of the gleno-humeral head
was estimated using abductions, flexions and circumductions, with the same method as
suggested by Gamage et al.[11].

4) Movements

After MVIC and three-dimensional marker placement, participants were asked to perform
10 active shoulder flexions (sagittal plane) and 10 active shoulder abductions (frontal
plane) both with and without loading. The forearm was placed in a neutral pro-supination
position for flexion movement and in shoulder external rotation position for abduction
movement (the thumb in the direction of the movement). The movements were guided by
a wood apparatus. In order to standardize the speed of movement, a metronome at 30
beats per minute was used. At each beat, the arm had to be alternately at maximal
elevation and by their side.

7
The load used in flexion and abduction corresponded to 25% of the strength (maximal
value out of the three repetitions) developped in Seated U 90° position (Figure 1),
measured by means of a manual dynamometer (MicroFet 2, Hoggan Scientific LLC,
USA).

During flexion and abduction, electromyographic activity of scapular stabilizing muscles

(upper trapezius, lower trapezius and serratus anterior) and scapular kinematics was
recorded in three different conditions : without kinesiotaping (standard condition), with
Taping 1 (KT1) and with Taping 2 (KT2). The order of the different conditions was
randomized.
5) Kinesiotaping method

Kinesiotaping was applied in two different ways. KT1 was inspired by McConnell taping

and KT2 was imagined by our research team. For applying KT1, the volunteer sat on a

stool, shoulder placed at 60° of flexion in sagittal plane and supported. Taping was

applied from the coracoid process, then firmly on the upper trapezius and finally on the

inferior angle of the scapula. The strip was full stretched between the spine and the

inferior border of the scapula. Applying KT2 began with the same method as for KT1.

The first strip was exactly the same as McConnell taping. The second strip was applied

from the thoracic spine and to the inferior border of scapula. Full tension was applied

from the inferior border of the scapula to the lateral side in order to enhance scapular

upward rotation (Figure 2).

To standardize the placement and to be as reproducible as possible, all the strips were

applied by the same investigator. For the same reasons, the placement of the strips was

not individualised according to the characteristics of the dysfunction observed in each

subject.

6) Data reduction

8
The EMG signals were first band pass filtered (20–500 Hz, zero-phase 4th order
Butterworth filter) and then processed using a root-mean-square filter (100 ms moving
window). The EMG signals were then normalized with respect to the values obtained
during the MVIC tests in order to obtain a percentage of the maximal voluntary activity
(MVA) for each of the muscles considered. The level of activation of each muscle (upper
trapezius, lower trapezius and serratus anterior) was then defined as the average value of
the processed signal among the five last repetitions [45].
The last five movements out of the ten repetitions were considered for scapular
kinematics to better appreciate scapular dysfunction. Scapular kinematics results were
expressed only up to 120° because the accuracy of the measurements of scapular motion
is hugely disrupted by skin movements and soft tissue artefacts after this range of motion.
Scapular orientation was expressed relative to the thorax by use of YXZ Cardan
decomposition [59]. The orientation of the humerus, for flexion and abduction, was
expressed relative to the thorax by use of YXZ Cardan decomposition [47] to avoid
Gimbal lock. The scapular orientation was then expressed relative to the humeral
elevation. The two phases of movement (upward and downward) were processed
independently as Borstad et al. measured significant differences between concentric and
eccentric phases of arm elevations. [2][43]. Values measured in the reference position
(straight, arms to the sides and looking ahead) were subtracted from the values measured
during movements in order to only consider changes during movements and to limit inter-
individual adaptations. Upward rotation, external rotation and posterior tilt are expressed
with negative values while downward rotation, internal rotation and anterior tilt are
represented with positive values.
Both for EMG and scapular kinematics, 4 angles of movement were retained for the
analysis (30°, 60°, 90°, 120°). Activity and kinematics at 30° were estimated based on the
average of the values measured between 25° and 35°. The same method was used for the
other angles in order to limit biais.

7) Statistical analysis

Statistical analysis was performed using the MiniTab software (MiniTab Inc., State
College, Pennsylvania, USA). Descriptive statistics were calculated at 30°, 60°, 90 and
120° of elevation in sagittal and frontal planes. A Shapiro-Wilk test was done to assess
the normality of the variables. Since all the variables were normally distributed,
comparisons between the three different conditions were made using repeated measures
ANOVA, both for EMG and kinematics analysis. The level of significance was set at p <
0.05 for all the tests done.

9
 Results
All participants completed the study. No complaints or shoulder pain were reported either
during or after the assessment. Four subjects were excluded from the three-dimensional
analysis because of technical problems but data from the 16 others were retained for
analysis. As for EMG analysis, the data from the 20 volunteers was used and analysed.
1) EMG activity of scapular stabilizing muscles

In the standard condition, during shoulder movements (flexion and abduction), muscular
activity of the 3 muscles considered tended to increase from 30° till 120°, except for the
upper trapezius during loaded flexion (sagittal plane) where the activity only increases
until 90° (Table 1).
During the concentric phase of shoulder flexion in the loaded condition, in comparison
with the standard condition, the activity of the upper trapezius decreased between 9 and
12%, at 90° and 120° (p=0.001) after kinesiotaping placement, without significant
difference between KT1 and KT2. In the eccentric phase of this movement, if we
compare kinesiotaping to standard condition, a decrease about 10-11% is observed at
120° (KT1 and KT2) and 60° (KT1) (p=0.022-0.044) in the unloaded condition and at
120° with KT2 (p=0.030) in the loaded condition. In the concentric phase of abduction
(frontal plane), a decrease between 9 and 11% of the activity of upper trapezius is still
observed after kinesiotaping placement, in comparison to standard condition. This was
measured at 90° (KT2) and 120° (KT2) (p=0.0001-0.027) in the loaded condition. In the
eccentric phase of abduction, no difference is found between standard and kinesiotaping
conditions (Table 1).
During flexion (sagittal plane) and abduction (frontal plane), essentially in the concentric
phase, when compared to standard condition, the activity of lower trapezius tends to
increase with KT1 while the opposite effect is observed with KT2, where the activity is
decreased by about 15-20% in comparison to the standard condtion and to the KT1
condition. This decrease reaches significance at 60° and 120° (p=0.031-0.032) of the
upward phase of flexion, in the unloaded condition. No significant difference is noted in
the other conditions (Table 1).
Considering the serratus anterior, no change is observed, either for KT1 or KT2, in
comparison to standard condition.
2) Scapular kinematics

Scapular kinematics was characterised in three different planes of scapular rotation:

upward/downward rotation, internal/external rotation and anterior/posterior tilt.

10
In standard condition, external rotation reaches lower values in the unloaded compared
to the loaded condition, both in the sagittal plane (8.11-8.25° loaded vs 4.54-6.57°
unloaded) and in the frontal plane (17.32-18.22° loaded vs 14.90-15.45° unloaded), but
this difference is not statistically significant (p>0.05). No differences in upward rotation
and posterior tilt are found between loaded and unloaded elevations (sagittal and frontal
plane). The upward rotation range is between 33.70° and 34.25° when doing elevations in
the sagittal plane and between 32.59° and 32.36° when the frontal plane is considered. As
for posterior tilt range of motion, it reaches values between 11.91° and 12.09° in the
sagittal plane and between 11.75° and 12.76° in the frontal plane (Table 2).
Regarding the effects of kinesiotaping, some statistical differences can be highlighted
when compared to standard condition. These differences appear mainly in the first
degrees of the movements (30°, 60°), i.e. approximately at the range of motion where the
kinesiotape was placed on the skin of the subjects.
Considering upward rotation, kinesiotaping tends to significantly increase the range of
motion. Even if KT2 seems to further increase upward rotation, no significant differences
is found when compared with KT1. In the concentric phase of flexion (sagittal plane),
significant effects of kinesiotape are found at 30°, 60° and 90° in the unloaded condition
(p=0.0001-0.016) and in 30° and 60° in the loaded condition (p=0.0001-0.027), in
comparison with the standard condition. In the eccentric phase, differences reach
significance at 90°, 60° and 30° in the unloaded condition (p=0.0001-0.002) and at 90°
and 30° in the loaded condition (p=0.014-0.015). In the concentric phase of abduction
(frontal plane), significant differences are found at 30° and 60° both in the loaded
(p=0.005-009) and unloaded (p=0.0001-0.003) conditions when compared to the standard
condition. In the eccentric phase of abduction, significant effects of kinesiotaping are
observed at 30° and 60° in the unloaded condition (p= 0.0001-0.039) and at all
amplitudes (30°,60°,90°,120°) in the loaded condition (p=0.0001-0.011) (Table 2).
Concerning external/internal rotation, during flexion (sagittal plane), in the concentric
phase of the movement, kinesiotaping tends to increase internal rotation in the first
degrees of the movement (30°,60°) in the loaded (p=0.0001-0.038) and unloaded
(p=0.0001-0.032) conditions. Considering the eccentric phase of flexion, internal rotation
was significantly increased at 90° and at 30° without distinction between loaded
(p=0.0001-0.013) and unloaded (p=0.001-0.011) conditions. Considering abduction
(frontal plane), in the concentric phase of the movement, kinesiotaping decreases external
rotation at 30° and 60° in the unloaded condition (p=0.0001-0.001) and at 30° in the
loaded condition (p=0.009). In the eccentric phase of the abduction movement, external
rotation is decreased at 60° in the unloaded condition (p=0.007) while it is decreased at
60° and 30° in the loaded condition (p= 0.009). In all of these conditions, no significant
differences are observed between KT1 and KT2, except for the upward phase of
abduction, in the unloaded condition, where the effect of KT2 in decreasing internal
rotation are more pronounced than the ones observed with KT1 (p=0.0001) (Table 2).
Posterior tilt is also highly influenced by kinesiotaping. In the concentric phase of
flexion (sagittal plane), posterior tilt is increased after the placement of the strips. It
reaches significance at 60° and 90° in the unloaded condition (0.002-0.011) and at
30°,60° and 90° in the loaded condition (p=0.004-0.031). In the eccentric phase of

11
flexion, significant differences are observed at 30°, 60° and 90° in the unloaded condition
(p=0.001-0.013) and at 30° and 60° in the loaded condition (p=0.001-0.037) in
comparison to the standard condition. In abduction (frontal plane), the analysis failed to
find significant effects in the upward phase of the movement but in the eccentric phase,
kinesiotaping significantly increases posterior tilt at 30° in the unloaded condition
(p=0.015). Once more, no significant differences are found between KT1 and KT2, even
if KT2 tends to further increase posterior tilt (Table 2).

Discussion
Scapular dyskinesis is observed in 61% of overhead athletes [3] and for most of them, it
remains asymptomatic. Kibler et al. [23] described the different roles of the scapula: the
stable point of the glenohumeral articulation, retraction-protraction on the thoracic wall,
elevation of the acromion, to be the base for muscle attachment and to be a link of an
important kinetic chain. All of these roles lead us to believe that scapular dysfunction may
lead to an increased risk of shoulder injuries by limiting acromion elevation and inducing
instability [6][24]. Different authors confirmed this link [4][14][50], some of them
affirming that scapular dyskinesis increase the risk of future shoulder injuries by 46%
[14]. According to the roles described by Kibler et al. [23], scapular dysfunction is
suggested to also decrease shoulder performance, by disrupting the kinetic chain and thus
the energy transfer. All of this suggests that normalizing scapular dyskinesis is interesting
in asymptomatic subjects, with two main objectives: preventing shoulder injuries and
optimizing performance. That’s why the purpose of this study was to assess the
effectiveness of 2 different kinesiotaping techniques on changing scapular kinematics and
the activity of scapular stabilizing muscles.
Considering EMG activity, the results showed a decrease of 8-13% of the activity of the
upper trapezius after kinesiotaping placement, both in flexion and abduction, in
comparison to the standard condition, without significant difference between KT1 and
KT2. This decrease was mostly present at 120° but sometimes at 90° and 60° too. As for
the lower trapezius activity, a significant decrease about 15-20% was observed with KT2,
at 60° and 120°, both in flexion and abduction while serratus anterior activity was not
influenced by kinesiotaping. All of these results, with the exception of those observed in

12
the serratus anterior, are clinically interesting, as Smith et al. [49] demonstrated an
increase in upper trapezius activity and a decrease in lower trapezius activity in dyskinetic
symptomatic subjects. If we compare our results to the literature, with the same
kinesiotaping method as used for KT1 in this study, Lin et al. [29] found a decrease in
upper trapezius activity too but also observed an increase in serratus anterior activity,
which was not demonstrated in our study. Using another kinesiotaping technique, Hsu et
al. [16] confirmed the hypothesis that strips placed parallel to muscle length tend to
increase activity. When compared to the results observed with McConnell rigid taping,
Selkowitz et al.[46] found an increase in lower trapezius activity combined with a
decrease in upper trapezius activity in shelf task elevations while Cools et al. [5] and
Intelangelo et al. [18] found no interaction between kinesiotaping and muscular activity.
One hypothesis explaining the effects observed may be that cutaneous mechanoreceptors
are stimulated following strips stretching, which influence the information’s sent the
central nervous system and to the muscles (by myotatic reflex) and have an impact on
muscle activity [16][58]. Moreover, kinesiotaping may, by its mechanical effects modify
muscle length at some part and modify muscle activity in consequence.
Concerning scapular kinematics, the most important effects were observed at 30° and 60°,
which corresponds to approximately the range of motion where the kinesiotaping was
placed on the skin of the subjects. An increase in upward rotation was observed in flexion
and abduction with kinesiotaping and was most important in the unloaded condition and
with KT2. Considering external/internal rotation, an increase in internal rotation was
observed in flexion while a decrease in external rotation was found in abduction. This
effect was more pronounced with KT2 than with KT1, which had a rather negative
impact. Finally, posterior tilt was also increased after kinesiotaping placement, without
significant differences between KT1 and KT2. Our results confirm those of Van Herzeele
et al. [56], who analyzed scapular kinematics with the same technique as used for KT1 in
the current study. This reiterated the mechanical effects of kinesiotaping previously
described by other authors [16][17][48][58]. If we consider posterior tilt improvement, we
can consider that kinesiotaping helps correcting forward shoulder posture. The same
mechanical effects on posture were demonstrated by Hajibashi et al.[12].
From a clinical point of view, different points should be retained. Kinesiotaping seems to
be effective in modifying scapular-stabilizing muscles’ activity and scapular kinematics.
Considering that the effects are mostly observed at the range of motion where the strips
were placed, we recommend that the importance of the dysfunction and the amplitude at
which it predominates should be considered during strip placement. The effects
depending on the amplitude show that kinesiotaping is not a “miracle technique” but may
be helpful for its mechanical (passive correction), proprioceptive (neuromotor stimulation
and conscious correction) and reassuring effects for patients (feeling of being supported).
When comparing the two different kinesiotaping techniques, the results seems to show
that the second one (KT2) should not be used in case of decreased upper trapezius/lower
trapezius ratio because this technique tends to decrease lower trapezius activity (which
increase scapular dysfunction) and tends to have negative effects on scapular external
rotation. Knowing that the lower trapezius plays a role in scapular external rotation and in
posterior tilt, a decrease in lower trapezius activity may have a negative impact on
scapular kinematics in those kind of people. However, cocking position requires the

13
scapula to be in posterior tilt, upward rotation and external rotation. So, KT1 seems to
favor this cocking position and strength transfer from the lower limbs and the trunk to the
upper limb. The positive effects of KT1 on upward rotation would also reduce rotator cuff
compression while increasing sub-acromial space in subjects with downward rotation at
rest and therefore limiting the occurrence of injuries. These hypotheses should be further
explored by assessing performance with and without kinesiotape or by making
ultrasonographic measurements of sub-acromial space. Moreover, it would also be
interesting to assess the effects of KT1 on shoulder injury prevention through a
prospective study. In any cases, given the controversial effects reported in literature,
kinesiotaping must be considered as an additional/complementary technique and must not
replace muscular and articular rehabilitation. However, kinesiotaping could perhaps be
useful, simultaneous to rehabilitation, to increase the effects of a specific scapular
stabilizing muscles strengthening and to help people with poor motor control to activate
specific muscles (proprioceptive effect). Nevertheless, dyskinetic pattern can change from
one patient to another, some patients having a lack of serratus anterior activity for
example. In this case, another technique will have to be found.
This study has some limitations. The first limitation is the large variability of the scapular
dyskinesis observed (type 1 vs type 2, obvious vs subtle). Scapular dyskinesis may be
better normalized in some subjects rather than others depending on the characteristics of
the dysfunction observed. The second limitation is the important variability of the sports
practiced by the volunteers which may influence the dysfunction observed (football,
volleyball, tennis, swimming, boxing, etc.) as some sports frequently solicit the upper-
limb while others do not. The dysfunction observed may also have been highly influenced
by an incorrect posture in some of the subjects included. The last limitation was the lack
of a control group, which does not allow us to know if a real normalization is observed
following kinesiotaping placement.

Conclusion
KT1 and KT2 induce modifications of both scapular kinematics and the EMG activity of
two of the muscles concerned (upper and lower trapezius). However, beside these positive
effects, KT2 induces a decrease in lower trapezius activity and highly limits external
rotation of the scapula. So, KT1 can be considered as the most effective technique in the
case of scapular dyskinesis characterized by upper trapezius/lower trapezius imbalance.
The mechanical and proprioceptive effects of KT1 could be useful in limiting shoulder
injuries in overhead athletes with downward rotation at rest or forward shoulder posture
by increasing subacromial space. Further studies will be necessary to assess the

14
effectiveness of this prevention technique, potentially combined with scapular muscle
rehabilitation.

References

[1] Barbero, M., Merletti, R., & Rainoldi, A. Atlas of muscle innervation zones :
understanding surface electromyography and its applications. Springer, 2012
[2] Borstad, J. D., & Ludewig, P. M. Comparison of scapular kinematics between
elevation and lowering of the arm in the scapular plane. Clinical Biomechanics 2002;
17(9-10): 650–659.
[3] Burn, M. B., McCulloch, P. C., Lintner, D. M., Liberman, S. R., & Harris, J. D.
Prevalence of Scapular Dyskinesis in Overhead and Nonoverhead Athletes: A
Systematic Review. Orthopaedic Journal of Sports Medicine 2016; 4(2):
2325967115627608.
[4] Clarsen, B., Bahr, R., Andersson, S. H., & Munk, R. Reduced glenohumeral
rotation, external rotation weakness and scapular dyskinesis are risk factors for
shoulder injuries among elite male handball players: a prospective cohort study. Br J
Sports Med 2014; 48: 1327–1333.
[5] Cools, A. ., Witvrouw, E. ., Danneels, L. ., & Cambier, D. Does taping influence
electromyographic muscle activity in the scapular rotators in healthy shoulders?
Manual Therapy 2002; 7(3): 154–162.
[6] Cools, A. M. J., Struyf, F., De Mey, K., Maenhout, A., Castelein, B., & Cagnie, B.
Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead
athlete. British Journal of Sports Medicine 2014; 48(8): 692–697.

15
[7] Cools, A. M., Witvrouw, E. E., Declercq, G. A., Danneels, L. A., & Cambier, D. C.
Scapular Muscle Recruitment Patterns: Trapezius Muscle Latency with and without
Impingement Symptoms. American Journal of Sports Medecine 2003; 31(4):542-
549.
[8] Curtis, T., & Roush, J. R. The Lateral Scapular Slide Test: A Reliability Study of
Males with and without Shoulder Pathology. North American Journal of Sports
Physical Therapy  2006; 1(3): 140–146.
[9] Fischer, S. L., Grewal, T.-J., Wells, R., & Dickerson, C. R. Effect of bilateral versus
unilateral exertion tests on maximum voluntary activity and within-participant
reproducibility in the shoulder. Journal of Electromyography and Kinesiology 2011;
21(2): 311–317.
[10] Forthomme, B., Wieczorek, V., Frisch, A., Crielaard, J.-M. & Croisier, J.-L.
Shoulder Pain among High-Level Volleyball Players and Preseason Features.
Medicine & Science in Sports & Exercise 2013; 45(10): 1852–1860.
[11] Gamage, S. S. H. U., & Lasenby, J. New least squares solutions for estimating the
average centre of rotation and the axis of rotation. Journal of Biomechanics 2002;
35(1) : 87–93.
[12] Hajibashi, A., Amiri, A., Sarrafzadeh, J., Maroufi, N., & Jalaei, S. Effect of
Kinesiotaping and Stretching Exercise on Forward Shoulder Angle in Females with
Rounded Shoulder Posture. Journal of Rehabilitation Sciences and Research 2014; 1:
78–83.
[13] Hibberd, E. E., Laudner, K. G., Kucera, K. L., Berkoff, D. J., Yu, B., & Myers, J.
B. Effect of Swim Training on the Physical Characteristics of Competitive
Adolescent Swimmers. American Journal of Sports Medicine 2016; 44(11):2813-
2819.
[14] Hickey, D., Solvig, V., Cavalheri, V., Harrold, M., & Mckenna, L. Scapular
dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic
athletes: a systematic review and meta-analysis. British Journal of Sports Medicine
2018; 52(2), 102–110.
[15] Hjelm, N., Werner, S., & Renstrom, P. Injury risk factors in junior tennis players:
a prospective 2-year study. Scandinavian Journal of Medicine & Sciences in Sports
2012; 22: 40-48.
[16] Hsu, Y.-H., Chen, W.-Y., Lin, H.-C., Wang, W. T. J., & Shih, Y.-F. The effects of
taping on scapular kinematics and muscle performance in baseball players with
shoulder impingement syndrome. Journal of Electromyography and Kinesiology
2009; 19(6): 1092–1099.
[17] Huang, T.-S., Ou, H.-L., & Lin, J.-J. Effects of trapezius kinesio taping on
scapular kinematics and associated muscular activation in subjects with scapular
dyskinesis. Journal of Hand Therapy 2017: 1-7
[18] Intelangelo, L., Bordachar, D., & Barbosa, A. W. C. Effects of scapular taping in

16
 young adults with shoulder pain and scapular dyskinesis. Journal of Bodywork and
Movement Therapies 2016; 20(3): 525–532.
[19] Johansson, A., Svantesson, U., Tannerstedt, J., & Alricsson, M. Prevalence of
shoulder pain in Swedish flatwater kayakers and its relation to range of motion and
scapula stability of the shoulder joint. Journal of Sports Sciences 2016; 34(10): 951–
958.
[20] Johnson, M. P., McClure, P. W., & Karduna, A. R. New Method to Assess
Scapular Upward Rotation in Subjects With Shoulder Pathology. Journal of
Orthopaedic & Sports Physical Therapy 2001; 31(2): 81–89.
[21] Kawasaki, T., Yamakawa, J., Kaketa, T., Kobayashi, H., & Kaneko, K. Does
scapular dyskinesis affect top rugby players during a game season? Journal of
Shoulder and Elbow Surgery 2012; 21(6): 709-714.
[22] Kibler, B. W., Sciascia, A., & Wilkes, T. Scapular Dyskinesis and Its Relation to
Shoulder Injury. Journal of the American Academy of Orthopaedic Surgeons 2012;
20(6): 364–372.
[23] Kibler, W. B. The Role of the Scapula in Athletic Shoulder Function. American
Journal of Sports Medicine 1998; 26(2): 325-337.
[24] Kibler, W. B. Scapular Dyskinesis and Its Relation to Shoulder Injury. Journal of
the American Academy of Orthopaedic Surgeons 2012; 20(6): 364–372.
[25] Kibler, W. B. Biomechanical analysis of the shoulder during tennis activities.
Clinics in Sports Medicine 1995; 14(1): 79–85.
[26] Kim, B.-J., & Lee, J.-H. Effects of scapula-upward taping using kinesiology tape
in a patient with shoulder pain caused by scapular downward rotation. Journal of
Physical Therapy Science 2015; 27(2): 547–548.
[27] Koslow, P. A., Prosser, L. A., Strony, G. A., Suchecki, S. L., & Mattingly, G. E.
Specificity of the Lateral Scapular Slide Test in Asymptomatic Competitive
Athletes. Journal of Orthopaedic & Sports Physical Therapy 2003; 33(6): 331-336.
[28] Lee, M. H., Lee, C. R., Park, J. S., Lee, S. Y., Jeong, T. G., Son, G. S., Kim, Y. K.
Influence of Kinesio Taping on the Motor Neuron Conduction Velocity. Journal of
Physical Therapy Science 2011; 23(2): 313–315.
[29] Lin, J. J., Hung, C. J., & Yang, P. L. The effects of scapular taping on
electromyographic muscle activity and proprioception feedback in healthy shoulders.
Journal of Orthopaedic Research 2011; 29(1): 53–57.
[30] Littlewood, C., & Cools, A. M. J. Scapular dyskinesis and shoulder pain: the devil
is in the detail. British Journal of Sports Medicine 2018; 52(2): 72–73.
[31] Ludewig, P. M., Hoff, M. S., Osowski, E. E., Meschke, S. A., & Rundquist, P. J.
Relative Balance of Serratus Anterior and Upper Trapezius Muscle Activity during
Push-Up Exercises. The American Journal of Sports Medicine 2004; 32(2): 484–
493.

17
[32] Madsen, P. H., Bak, K., Jensen, S., & Welter, U. Training Induces Scapular
Dyskinesis in Pain-Free Competitive Swimmers: A Reliability and Observational
Study. Clinical Journal of Sport Medicine 2011; 21(2): 109–113.
[33] McClure, P., Tate, A. R., Kareha, S., Irwin, D., & Zlupko, E. A clinical method
for identifying scapular dyskinesis, part 1: reliability. Journal of Athletic Training
2009; 44(2) : 160–164.
[34] McConnell, J., Donnelly, C., Hamner, S., Dunne, J., & Besier, T. Passive and
Dynamic Shoulder Rotation Range in Uninjured and Previously Injured Overhead
Throwing Athletes and the Effect of Shoulder Taping. PM & R 2012; 4(2): 111–116.
[35] McConnell, J., & McIntosh, B. The Effect of Tape on Glenohumeral Rotation
Range of Motion in Elite Junior Tennis Players. Clinical Journal of Sport Medicine
2009; 19(2): 90–94.
[35] McKenna, L., Straker, L., & Smith, A. Can scapular and humeral head position
predict shoulder pain in adolescent swimmers and non-swimmers? Journal of Sports
Sciences 2012; 30(16): 1767–1776.
[37] Merolla, G., De Santis, E., Sperling, J. W., Campi, F., Paladini, P., & Porcellini,
G. Infraspinatus strength assessment before and after scapular muscles rehabilitation
in professional volleyball players with scapular dyskinesis. Journal of Shoulder and
Elbow Surgery 2010; 19(8): 1256–1264.
[38] Møller, M., Nielsen, R. O., Attermann, J., Wedderkopp, N., Lind, M., Sørensen,
H., & Myklebust, G. Handball load and shoulder injury rate: a 31-week cohort study
of 679 elite youth handball players. British Journal of Sports Medicine 2017; 51(4):
231–237.
[39] Morrissey, D. Proprioceptive shoulder taping. Journal of Bodywork and
Movement Therapies 2000; 4(3): 189–194.
[40] Myers, J. B., Oyama, S., & Hibberd, E. E. Scapular dysfunction in high school
baseball players sustaining throwing-related upper extremity injury: a prospective
study. Journal of Shoulder and Elbow Surgery 2013; 22(9): 1154–1159.
[41] Odom, C. J., Taylor, A. B., Hurd, C. E., & Denegar, C. R. Measurement of
scapular asymetry and assessment of shoulder dysfunction using the Lateral Scapular
Slide Test: a reliability and validity study. Physical Therapy 2001; 81(2): 799–809.
[42] Pyšný, L., Pyšná, J., & Petrů, D. Kinesio Taping Use in Prevention of Sports
Injuries During Teaching of Physical Education and Sport. Procedia-Social and
Behavioral Sciences 2015; 186: 618–623.
[43] Schwartz, C., Croisier, J.-L., Rigaux, E., Denoël, V., Brüls, O., & Forthomme, B.
Dominance effect on scapula 3-dimensional posture and kinematics in healthy male
and female populations. Journal of Shoulder and Elbow Surgery 2014; 23(6): 873–
881.
[44] Schwartz, C., Denoël, V., Forthomme, B., Croisier, J. L., & Brüls, O. (2015).
Merging multi-camera data to reduce motion analysis instrumental errors using

18
 Kalman filters. Computer Methods in Biomechanics and Biomedical Engineering,
18(9), 952–960.
[45] Schwartz, C., Tubez, F., Wang, F., Croisier, J., Brüls, O., Denoël, V., & Forthomme,
B. Normalizing shoulder EMG : An optimal set of maximum isometric voluntary
contraction tests considering reproducibility. Journal of Electromyography and
Kinesiology 2017; 37, 1–8.
[46] Selkowitz, D. M., Chaney, C., Stuckey, S. J., & Vlad, G. 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. The Journal of Orthopaedic and Sports Physical Therapy
2007; 37(11): 694–702.
[47] Šenk, M., & Chèze, L. Rotation sequence as an important factor in shoulder
kinematics. Clinical Biomechanics 2006; 21: S3–S8.
[48] Shaheen, A. F., Villa, C., Lee, Y. N., Bull, A. M. J., & Alexander, C. M. Scapular
taping alters kinematics in asymptomatic subjects. Journal of Electromyography and
Kinesiology 2013; 23(2): 326–333.
[49] Smith, M., Sparkes, V., Busse, M., & Enright, S. Upper and lower trapezius
muscle activity in subjects with subacromial impingement symptoms: Is there
imbalance and can taping change it? Physical Therapy in Sport 2009; 10(2): 45–50.
[50] Struyf, F., Nijs, J., Meeus, M., Roussel, N., Mottram, S., Truijen, S., & Meeusen,
R. Does Scapular Positioning Predict Shoulder Pain in Recreational Overhead
Athletes? International Journal of Sports Medicine 2013; 35(1): 75–82.
[51] Su, K. P. E., Johnson, M. P., Gracely, E. J., & Karduna, A. R. Scapular rotation in
swimmers with and without impingement syndrome: practice effects. Medicine and
Science in Sports and Exercise 2004; 36(7): 1117–1123.
[52] Thelen, M. D., Dauber, J. A., & Stoneman, P. D. The Clinical Efficacy of Kinesio
Tape for Shoulder Pain: A Randomized, Double-Blinded, Clinical Trial. Journal of
Orthopaedic & Sports Physical Therapy 2008; 38(7): 389–395.
[53] Thigpen, C. A., Padua, D. A., Michener, L. A., Guskiewicz, K., Giuliani, C.,
Keener, J. D., & Stergiou, N. Head and shoulder posture affect scapular mechanics
and muscle activity in overhead tasks. Journal of Electromyography and Kinesiology
2010; 20(4): 701–709.
[54] Thomas, S. J., Thomas, S. J., Swanik, K. A., Swanik, C. B., Huxel, K. C., & Iv, J.
D. K. Change in Glenohumeral Rotation and Scapular Position After Competitive
High School Baseball. Journal of Sports Rehabilitation 2010; 19(2): 125-135.
[55] Uhl, T. L., Kibler, W. Ben, Gecewich, B., & Tripp, B. L. Evaluation of Clinical
Assessment Methods for Scapular Dyskinesis. Arthroscopy: The Journal of
Arthroscopic & Related Surgery 2009; 25(11): 1240–1248.
[56] Van Herzeele, M., van Cingel, R., Maenhout, A., De Mey, K., & Cools, A. Does
the Application of Kinesiotape Change Scapular Kinematics in Healthy Female

19
 Handball Players? International Journal of Sports Medicine 2013; 34(11), 950–955.
[57] Wadsworth, D., & Bullock-Saxton, J. Recruitment Patterns of the Scapular
Rotator Muscles in Freestyle Swimmers with Subacromial Impingement.
International Journal of Sports Medicine 1997; 18(8): 618–624.
[58] Williams, S., Whatman, C., Hume, P. A., & Sheerin, K. Kinesio Taping in
Treatment and Prevention of Sports Injuries. Sports Medicine 2012; 42(2): 153–164.
[59] Wu, G., van der Helm, F. C. T., Veeger, H. E. J. D., Makhsous, M., Van Roy, P.,
Anglin, C., & International Society of Biomechanics. ISB recommendation on
definitions of joint coordinate systems of various joints for the reporting of human
joint motion--Part II: shoulder, elbow, wrist and hand. Journal of Biomechanics
2005; 38(5): 981–992.

Figures and tables

Figure 1: Illustration of the Maximum Voluntary Isometric Contraction tests: (1) empty can, (2)
seated U 90°, (3) prone-v-thumbs up, (4) rotation 90°, (5) seated U 125°, (6) seated T.

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 Figure 2: Illustration of the two kinesiotaping techniques (KT1 and KT2)

Table 1: Muscle activity (in %Maximal Voluntary Activation) of upper trapezius (UT), lower
trapezius (LT) and serratus anterior (SA) during shoulder flexion (Flex) and shoulder abduction
(Abd) (30°, 60°, 90° and 120°) with load (W) and without load (UW) [median-value ± standard
deviation] UP=upward phase; DN= downward phase; T0= standard condition ; T1= KT1 ; T2= KT2
*= significant differences for the muscle in the movement considered
A,B,C = groups made by Tukey comparison if p reached significance (<0.05)

21
Table 2: Scapular kinematics (expressed in degrees) during shoulder flexion (Flex) and shoulder
abduction (Abd) (30°, 60°, 90° and 120°) with load (W) and without load (UW) [median-value ±
standard deviation] UP=upward phase; DN= downward phase ; U/D= upward/downward rotation;
I/ER= internal/external rotation; A/P= anterior/posterior tilt; T0= standard condition ; T1= KT1 ;
T2= KT2
*= significant differences for the movement considered
A,B,C = groups made by Tukey comparison if p reached significance (<0.05)

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Camille Tooth, PT, is a sports physiotherapist at Sports Medical Centre of the University Hospital in Liege
(Belgium), specialized in shoulder rehabilitation. Whether at preventive or curative levels, she manages
many athletes in her practice, including many overhead athletes. She is also an Assistant Professor at the
University of Liege where she teaches basic techniques of physiotherapy and courses about upperlimb
rehabilitation. Currently, she works on a PhD at the University of Liege on the topic of scapular dyskinesis
and scapular rehabilitation.

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