Br J Sports Med doi:10.1136/bjsm.2009.062810
  • Original article

Electromyographic analysis of knee push up plus variations: what is the influence of the kinetic chain on scapular muscle activity?

  1. A Cools1
  1. 1Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
  2. 2Private practice, Antwerp, Belgium
  3. 3Private practice, Deurne, Belgium
  1. Correspondence to Dr Annelies Maenhout, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185, B9000 Ghent, Belgium; annelies.maenhout{at}
  • Accepted 1 August 2009
  • Published Online First 14 September 2009


Objective First, to look for appropriate closed kinetic chain exercises to restore intramuscular imbalance between upper trapezius (UT) and serratus anterior (SA) in overhead athletes. Second, to determine the influence of using diagonal pattern muscle recruitment during knee push up plus (KPP) exercises on scapular electromyographic activity.

Design Single group repeated-measures design.

Setting Controlled laboratory study.

Participants Thirty-two physically active individuals in good general health who did not have a history of neck and/or shoulder injury or surgery nor participated in high-level overhead sports or performed upper limb strength training for more than 5 h/week.

Interventions Subjects performed the standard KPP and six variations.

Main outcome measurements Electromyographic activity of the three trapezius parts and the SA.

Results Four exercises with a low UT/SA can be selected for rehabilitation of intramuscular balance: standard KPP, KPP with homolateral leg extension, KPP with a wobble board and homolateral leg extension and one-handed KPP. The use of a wobble board during KPP exercises and performance on one hand has no influence on SA electromyographic activity.

Heterolateral leg extension during KPP stimulates lower trapezius activity, whereas homolateral leg extension stimulates SA activity.

Conclusions In case of intramuscular scapular imbalance, some exercises are preferable over others because of their low UT/SA ratio. The use of a kinetic chain approach during KPP exercises influences scapular muscle activity.


  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Ethical Committee, Ghent University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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