Manual Therapy 15 (2010) 562e566

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Manual Therapy
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Original article

The effect of a scapular postural correction strategy on trapezius activity in

patients with neck pain
Sally Wegner*, Gwendolen Jull, Shaun OLeary, Venerina Johnston
Division of Physiotherapy, School of Health and Rehabilitation Sciences, Level 7, Therapies Building 84A, The University of Queensland, St Lucia, QLD 4072, Australia

a r t i c l e i n f o

a b s t r a c t

Article history:
Received 16 November 2009
Received in revised form
16 June 2010
Accepted 21 June 2010

Extensive computer use amongst ofce workers has lead to an increase in work-related neck pain.
Aberrant activity within the three portions of the trapezius muscle and associated changes in scapular
posture have been identied as potential contributing factors. This study compared the activity (surface
electromyography) of the three portions of the trapezius in healthy controls (n 20) to a neck pain group
with poor scapular posture (n 18) during the performance of a functional typing task. A scapular
postural correction strategy was used to correct scapular orientation in the neck pain group and electromyographic recordings were repeated. During the typing task, the neck pain group generated greater
activity in the middle trapezius (MT) (p 0.02) and less activity in the lower trapezius (LT) (p 0.03)
than the control group. Following correction of the scapula, activity recorded by the neck pain group was
similar to the control group for the middle and lower portions (p 0.09; p 0.91). These ndings
indicate that a scapular postural correction exercise may be effective in altering the distribution of
activity in the trapezius to better reect that displayed by healthy individuals.
2010 Elsevier Ltd. All rights reserved.

Keywords:
Postural correction
Trapezius muscle
Neck pain

1. Introduction
Complaints of work-related neck pain are becoming increasingly
prevalent, especially amongst intensive computer users (Cook et al.,
2000; Korhonen et al., 2003; Silanpaa et al., 2003; Cagnie et al.,
2007). A recent study conducted by Cagnie et al. (2007) found
that over a twelve-month period, 45.5% of 512 ofce workers
reported neck pain. Studies investigating neck pain associated with
static sitting postures have identied altered posture and muscle
recruitment patterns in the cervicobrachial region as potential
contributing factors (Nederhand et al., 2000; Falla et al., 2004;
Szeto et al., 2005).
Individuals with neck pain may display altered postural
behaviours when performing prolonged sitting tasks, such as
during computer use. Szeto et al. (2002) found that ofce workers
with neck pain tended to drift in and out of scapular protraction
more than asymptomatic ofce workers. These changes were
associated with altered behaviour in the upper trapezius (UT)
muscle and were linked to the severity of neck pain experienced.
That is, those with higher levels of discomfort displayed a more
aberrant pattern of trapezius muscle behaviour compared to those
with mild/no symptoms (Szeto et al., 2005). These ndings are

* Corresponding author.
E-mail address: sallywegner@hotmail.com (S. Wegner).
1356-689X/$ e see front matter 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.math.2010.06.006

consistent with other observations of altered trapezius muscle

behaviour in patients with neck pain disorders (Nederhand et al.,
2000; Falla et al., 2004; Thorn et al., 2007).
Clinical theory contends that aberrant scapular posture and any
associated changes in axioscapular muscle activity may contribute
to, or exacerbate painful neck disorders by adversely affecting
mechanical stresses on pain sensitive cervicobrachial structures
(Behrsin and Maguire, 1986). Consequently, scapular postural
correction strategies have been advocated as part of the intervention for patients with neck pain who display an alteration in
scapular orientation (Jull et al., 2008; Mottram et al., 2009). It is
hypothesised that correcting scapular orientation will positively
inuence the activity of the axioscapular muscles such as the
trapezius muscles. Certainly it has been shown that scapular
posture can be accurately trained in healthy controls and that all
three portions of the trapezius muscle are active in maintaining
scapular orientation (Mottram et al., 2009). However, the effect of
scapular correction exercises on trapezius muscle behaviour in the
neck pain population remains unknown. In particular it is unknown
if a scapular postural correction exercise would normalise the
myoelectric activity in the different portions of the trapezius in
individuals with neck pain.
The aims of the study were twofold. Firstly, to establish if there
was a difference in trapezius muscle behaviour in people with neck
pain who display aberrant scapular posture compared to healthy
controls during a functional typing task. The second aim was to

S. Wegner et al. / Manual Therapy 15 (2010) 562e566

563

evaluate the effect of a scapular postural correction strategy on

trapezius muscle behaviour in the neck pain participants when the
typing task was repeated. Specically we aimed to determine
whether correcting the scapular orientation in the people with
neck pain would alter the activity levels in the three portions of the
trapezius muscle to better reect those displayed by the healthy
controls.

This scale was anchored as 0 no pain and 10 the worst pain

imaginable. Age and body mass index (BMI) were also recorded for
each participant to ensure that any confounding could be
controlled. Table 1 provides the participant demographics for both
the neck pain and control groups.

2. Methods

Surface electromyography (EMG) was used to obtain myoelectric signals from the three portions of the trapezius muscle. Pairs of
electrodes were placed unilaterally at the mid-position between
the C6 spinous process and the lateral acromion, on the anterior
border of the muscle bulk, for the UT muscle (Mercer, 2002).
Electrodes for the middle portion of the trapezius (MT) were placed
adjacent to the spinous process of T2. For the LT, electrodes were
positioned along the line between T5 and the acromion (Johnson
and Pandyan, 2005). The electrodes used were 10 mm adhesive
Ag/AgCl (Myotronics-Noromed, Inc.) surface electrodes (MT and LT)
and 20 mm surface electrodes (Myotronics-Noromed, Inc.) (UT). A
centre-to-centre inter-electrode distance of 20 mm was employed.
The reference electrode was placed over the upper thoracic spine.
Prior to attachment of the electrodes, the participants skin was
prepared by cleaning the area with an abrasive gel and alcohol
(Hermens et al., 2000). The area was shaved if necessary. A 6channel EMG was used (NeuroLog, Digitimer Ltd., England). EMG
signals were amplied (gain, 1000), passed through a 10e500 Hz
band-width lter and sampled at 1000 Hz. Data were sampled with
Spike software (Cambridge Electronics Design, UK) and converted
into a format suitable for signal processing with Matlab 7 software
(The Math Works, Inc).

2.1. Participants
Thirty-eight volunteers participated in the study including 20
pain free controls and 18 individuals with neck pain. Participants
included both males and females in an age range of 18e48 years
and were recruited from the university and general community.
Sample size was based on our previous study utilizing similar data
collection methodology and patient populations to identify differences in trapezius muscle activity between control and neck pain
populations (alpha 0.05, power 0.92) (Johnston et al., 2008b).
Participants were included into the control group if they were
asymptomatic and were without a history of neck pain or neck
trauma. The control participants were also required to display
good scapular posture and control to allow comparison with the
neck pain group who were selected on the basis of an aberrant
scapular posture. It was hypothesised that controls who displayed
good posture would ultimately display ideal trapezius muscle
behaviour. Good scapular posture was dened as the mid-position
between all available ranges of scapular motion e upward/downward rotation, medial/lateral rotation, anterior/posterior tipping
and protraction/retraction (Ludewig et al., 2009; Mottram et al.,
2009). This was assessed by the primary investigator who visually analysed the position of the acromion in the sagittal plane both
at rest and during upper limb active movement. The side that most
accurately displayed scapular mid-position was chosen as the test
side.
Participants were included into the neck pain group if they
scored 15% or greater on the Neck Disability Index (NDI) e
a minimal score to reect the presence of at least a mild neck pain
disorder (Vernon, 2008), had a history of neck pain of greater than
three months duration over a 12-month period and demonstrated
poor scapular posture on the symptomatic side of their neck in
a relaxed standing posture. The resting position was visually
assessed by the primary investigator with a poor posture being
considered a deviation from the mid-position between all available
ranges of scapular motion e upward/downward rotation, medial/
lateral rotation, anterior/posterior tipping and protraction/retraction. Poor scapular posture was included as a criterion to ensure
that there was clinical justication to perform a scapula correction
strategy in the second part of the study. If both sides displayed poor
scapular posture, the most symptomatic side was chosen as the test
side. Participants were excluded if they had a history of neck
surgery; chronic neck pain resulting from a traumatic incident (for
example: motor vehicle crash); a medical diagnosis of bromyalgia,
cervical radiculopathy, carpal tunnel syndrome, systemic illness or
a connective tissue disorder, any neurological signs or shoulder
pathology.
Written informed consent was obtained from all participants.
The Institutional Medical Research Ethics Committee granted
ethical approval for this study.
2.2. Baseline measures
The participants with neck pain completed theNDI (Vernon and
Mior, 1991) and completed a visual analogue scale (VAS) for pain.

2.3. Electromyography

2.4. Procedure
Participants sat in a comfortable position at a standard ofce
workstation in an adjustable chair without arm supports. They
were instructed to make individual changes for their comfort
(McLean, 2005). Resting EMG was recorded for 10 s prior to
commencement of the task with the participant sitting in a relaxed
position with their hands resting on the keyboard. They were then
asked to type continuously at their normal pace for 5 min. A copytyping program, Bruces Typing Tutor was used to display the text.
Errors could be corrected using the backspace key.
The participants with neck pain undertook the second stage of
the study. These participants were instructed in a postural correction exercise. The primary investigator taught the participant to
assume a neutral lumbar spine and to correct the scapular position
using the necessary cues to position the scapula on the chest wall in
the mid-position between all directions of scapular motion specic
for that participant. This involved various instructions as pertinent
to the scapular orientation of the individual subject e for example
for downwardly rotated scapula instructions included gently lift
Table 1
Descriptive statistics for the neck pain and control groups.
Neck pain (n 18) [mean (S.D)] Control (n 20) [mean (S.D)]
Age (years)
Gender Male
Female
BMI (kg/m2)
NDI (0e100)
VAS (0e10) on
testing day
Duration of
neck pain
(yrs)

27.2 (6.9)
7
11
22.4 (3.7)
20.2 (5.5)
2.0 (2.0)

24.8 (6.6)
7
14
23.3 (2.4)
e
e

5.5 (4.8)

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S. Wegner et al. / Manual Therapy 15 (2010) 562e566

the tip of the shoulder or for predominantly protracted scapulae

gently spread the front of your shoulders apart to draw your
shoulder blades across your chest wall. The participant then
practiced the posture exercise until satisfactory correction as
judged by the investigator was achieved (approximately 5e10 min).
All participants could correct scapular posture satisfactorily
following the intervention.
A plumb line was positioned alongside the participants whilst
sitting with the corrected scapular position. It was centred on
a mark bisecting the lateral acromion to permit the investigator to
monitor the maintenance of the participants corrected scapular
posture during the second 5-min typing task. In the case of
a participant losing the corrected scapular orientation during the
repeated typing task appropriate verbal cues were provided in
order to re-establish the corrected scapular position.

Table 2
RMS EMG activity of the three portions of the trapezius muscle in the neck pain and
control groups during the resting condition.
Muscle
(1sRMS [V])

Control group
(mean [S.D.])

Neck pain group

(mean [S.D.])

F-statistic

UT
MT
LT

1.49 [0.28]
1.18 [0.46]
1.26 [0.35]

1.47 [0.25]
1.30 [0.38]
1.22 [0.33]

F(1,36) 0.03, p 0.86

F(1,36) 0.86, p 0.36
F(1,36) 0.10 p 0.75

UT e upper trapezius.
MT e middle trapezius.
LT e lower trapezius.

group generated signicantly greater activity in the MT muscle

(p 0.02) and signicantly less activity in the LT muscle (p 0.03)
than the control group during the typing condition (Table 3).
3.3. Typing condition 2 e corrected posture

2.5. Data analysis and statistics

To establish a measure of myoelectric activity during the typing
tasks, the mean 1s root mean square (1sRMS) was calculated for
each muscle using a 1s sliding window over 5 s epochs sampled at
baseline (prior to task), 60, 120, 180, 240 and 290 s into the task
(Matlab7 software, Math Works, Inc.) (Johnston et al., 2008a).
Between-group comparisons of RMS data were used for analysis to
avoid issues concerning the use of maximal voluntary contraction
(MVC) reference contractions for data normalisation purposes in
patients with painful disorders (Graven-Nielsen et al., 1997; Marras
and Davis, 2001; van Dien et al., 2003). Additionally, both groups
were similar with respect to age, height, and weight characteristics,
thus it was assumed that factors such as impedance of EMG signal
would be similar between groups, permitting the comparison of
the RMS data. The raw RMS EMG data were skewed and therefore
they were logarithmically transformed to normalise the distribution. All analyses were performed with the transformed data and
the results displayed in table form. As there were no differences
between the neck pain and control groups at each epoch, the mean
of the ve epochs was calculated and used in the analysis.
Preliminary analysis indicated that there were no betweengroup differences for the variables age, gender or BMI (all p > 0.3).
Thus, they were not considered in subsequent analyses. MANOVA
was used to determine differences between the groups at baseline,
during the rst typing task and following postural correction for
each portion of the trapezius. Bonferroni correction was used to
control for Type 1 error. A paired t-test was conducted for a withingroup comparison of RMS data recorded during the typing and
corrected typing conditions in the neck pain group. SPSS v.15 (SPSS,
Chicago, IL) was used to perform the analysis. Signicance was set
up at p < 0.05, with 95% condence limits.
3. Results
3.1. Rest condition
At baseline in the resting position, there were no differences
between the neck pain and control groups [F(3,34) 1.78, p 0.17].
Table 2 displays the transformed raw 1sRMS (V) recorded from both
the neck pain and control groups at rest, with no differences found
in activity for any of the three portions of the trapezius.
3.2. Typing condition 1
There was a signicant difference across groups during the rst
typing task [F(3,34) 3.7, p 0.02]. Activity in the three portions of
the trapezius increased during the typing task for both participant
groups. Between-group comparisons revealed that the neck pain

The pattern of muscle activity displayed by the neck pain group

changed following the implementation of the scapular postural
correction exercise. Within-group calculations revealed signicant
increase in activity in the LT muscle (p 0.03) when compared to
the activity recorded during the rst typing task (Table 4).
There was no overall difference between groups following the
posture exercise [F(3,34) 1.9, p 0.14]. Between-group comparisons revealed similar activity levels of the three portions of trapezius recorded for the neck pain group during the corrected typing
task to that observed for the control group during the rst typing
task performed in their natural posture (UT: p 0.31, MT: p 0.09,
LT: p 0.91) (Table 5).
4. Discussion
This study demonstrated that during a typing task, there were
alterations in trapezius muscle behaviour in individuals with
mechanical neck pain who displayed poor scapular posture when
compared to a control group with good scapular posture. Moreover, the results of this study suggest that a simple scapular
postural correction strategy can address the alterations in trapezius
activity.
4.1. Muscle activation patterns
At baseline in the resting position, there were no signicant
differences between the neck pain and control groups in the activity
recorded for any of the three portions of the trapezius muscle. There
were trends for the MT activity to be relatively more and the LT to be
relatively less in the neck pain group compared to the control group.
During the 5 min typing task (TT 1) activity increased in all portions
of the trapezius muscle in both groups, likely reecting the role of
trapezius in scapular stability during upper limb function such as
typing. The trends evident in the resting position were now found to
be signicant differences between the two groups. That is, the

Table 3
Mean EMG activity recorded from the control and neck pain groups during typing
condition 1 (TT 1) with natural scapular posture.
Muscle
TT 1: control group TT 1: neck pain group F-statistic
(1sRMS [V]) (mean [S.D.])
(mean [S.D.])
UT
MT
LT

1.78 [0.28]
1.47 [0.10]
1.57 [0.13]

UT e upper trapezius.
MT e middle trapezius.
LT e lower trapezius.
a
p < 0.05.

1.74 [0.17]
1.59 [0.20]
1.45 [0.19]

F(1,36) 0.28, p 0.60

F(1,36) 6.5, p 0.02a
F(1,36) 4.8, p 0.03a

S. Wegner et al. / Manual Therapy 15 (2010) 562e566

Table 4
A comparison of EMG activity in the three portions of trapezius during the typing
task without scapular correction (TT 1) and with scapular correction (TT 2) in the
neck pain group.
Muscle
(1sRMS [V])

TT 1:
(mean [S.D.])

TT 2:
(mean [S.D.])

t-Test

UT
MT
LT

1.74 [0.17]
1.59 [0.20]
1.45 [0.19]

1.71 [0.09]
1.53 [0.12]
1.56 [0.24]

t(17) 0.84, p 0.41

t(17) 1.81, p 0.08
t(17) 2.26, p 0.03a

UT e upper trapezius.
MT e middle trapezius.
LT e lower trapezius.
a
p < 0.05.

activity in MT was higher and the LT was less in the neck pain group
compared to the control group. There was a trend towards lesser
activity in the UT in the neck pain group but activity was not
signicantly different to that recorded from the control group.
Previous studies have shown that individuals with neck pain
display altered trapezius activation patterns. Most have examined
the activity of the UT during typing or other similar upper limb
tasks. Results are mixed with both lesser (Falla et al., 2004) and
greater activity (Szeto et al., 2005; Johnston et al., 2008a, b) in the
UT being recorded in neck pain subjects compared to pain free
individuals. That is, the presence of pain can be associated with
either an inhibitory (Falla et al., 2007) or facilitory effect (Szeto
et al., 2005) on trapezius activation patterns. The average pain
(VAS) of subjects in the current study on the day of testing was
2.0  2.0 cm on a 10 cm scale, but pain during the typing task was
not monitored. Thus we are unable to determine if there was any
association between changes in pain and changes in the UT muscle
behaviour during the typing task in this study.
The relationship between the three portions of trapezius during
a functional activity has not been widely investigated. In one study,
Falla et al. (2007) produced experimental pain with hypertonic
saline injections into the upper portion of trapezius and found that
activity during a shoulder exion task was re-distributed across the
trapezius. In response to pain, activity reduced in the UT compared
to the pain free control condition which the authors considered was
in line with a pain adaptation model. Activity increased in the LT but
remained unchanged in the MT, which was reasoned to be a reorganisation of trapezius muscle activation to allow the subject to
complete the task. This present study also found differences in
muscle activity within the trapezius in the mechanical neck pain
group relative to the pain free control group. During the typing task,
our ndings were that the neck pain group had greater activity in
the MT and lesser activity in the LT relative to the control group.
Methodological differences between this present study and that of
Falla et al. (2007) may explain the discrepancies in the ndings. Falla
et al. used an experimental pain paradigm and recorded trapezius
muscle activity during a shoulder exion task in comparison to the
typing task used in this study. The different upper limb tasks would
impart different forces and excursions of motion to the shoulder

Table 5
A comparison of EMG activity in the three portions of trapezius between control
participants in TT 1 and the neck pain group during typing condition 2 (TT2) with
scapular correction.
Muscle
TT 1: control group TT 2: neck pain group F-statistic
(1sRMS [V]) (mean [S.D.])
(mean [S.D.])
UT
MT
LT

1.78 [0.28]
1.47 [0.10]
1.57 [0.13]

UT e upper trapezius.
MT e middle trapezius.
LT e lower trapezius.

1.71 [0.09]
1.53 [0.12]
1.56 [0.24]

F(1,36) 1.05, p 0.31

F(1,36) 2.98, p 0.09
F(1,36) 0.01, p 0.91

565

girdle that feasibly would impose different demands on scapular

motion (McClure et al., 2001) and the various portions of the
trapezius muscle. In this manner the observed behaviour of the
trapezius muscle in response to upper limb tasks could in part be
task dependent.
The second aim of this study was to investigate trapezius muscle
behaviour in the neck pain group during a repeat of the typing task
(TT 2), after they had been taught a scapular postural correction
exercise. When these subjects held their scapula in a corrected
position while typing, activity in the middle portion of trapezius
decreased (although not signicantly (p 0.08)) and the mean
activity levels for the LT increased relative to the activity recorded
during the rst typing task (TT 1). UT activity remained unchanged
between the two conditions, suggesting that the postural correction strategy mainly affected a reorganisation of activity in the
middle and lower portions of trapezius. When the activity of each
portion of trapezius was compared between the neck pain group
typing with a corrected scapular posture (TT 2) and the control
group (TT 1), no differences in activity were found suggesting that
activity was now becoming similar between the two groups.
This study only considered the immediate effects of the exercise.
Further studies are needed to determine whether a period of
training can inuence the pattern of trapezius activation in the long
term and to determine whether the training results in changes in
pain and improved work/typing capacity.
4.2. Limitations of the study
Limitations to the study must be noted. While the majority of
the neck pain participants were able to achieve the corrected
posture and maintain it during the 5-min typing task, some
participants constantly resumed their original posture and required
regular cueing and feedback from the researcher. The amount of
time used by the participants to practice the task, may not have
allowed for sufcient practice of a sustained contraction. The
resulting uctuation in myoelectric activity may have inuenced
the mean activity calculated for each portion of trapezius. The
control group only performed one typing task, as they were carefully selected on the basis of having good scapular posture not in
need of correction. Thus it is unknown whether task familiarisation
may have changed results if the control group had have undertaken
a second typing trial. Finally, scapular posture was only assessed
visually. Further research quantifying scapular position is required
to conrm whether the corrected scapular position is similar to the
posture displayed by pain free controls and whether the change in
posture was related to the change in trapezius activity.
5. Conclusion
Altered trapezius activity has been linked to neck pain and this
study has provided some preliminary evidence to suggest that
a scapular postural correction exercise may effectively alter the
pattern to better reect the pattern utilised by people without neck
pain. This nding provides some preliminary support for such an
exercise in the treatment programs of neck pain patients to reestablish the optimal muscle activity levels. Further research is
required to investigate the dosage of exercise required and to
determine the relationship between changes in scapular posture
and redistribution of activity in the trapezius muscle.
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