Anterior Oblique Subsystem (AOS)

This course describes the anterior oblique subsystem (AOS), a concept originally proposed by Vleeming et al. (1). However, similar concepts have also been proposed, such as the anterior oblique sling, anterior oblique myofascial synergy, myofascial lines, anatomy trains, myofascial meridians, superficial front line, functional line, spiral line, and the serape effect.

The Anterior Oblique Subsystem (AOS) is comprised of:

• Rectus abdominis and pyramidalis
• Abdominal Fascia (Anterior layer)
• External Obliques
• Anterior Adductors
  • Potentially
    • Pectoralis Major
    • Serratus Anterior

Function (Brief):

• Concentric Function: Pushing, rotation "inward," and multi-segmental flexion
• Isometric Function: Transfer of force between lower and upper extremities and stabilization of the hips, sacroiliac joint, pubic symphysis, lumbar spine, and thoracic spine.
• Eccentric Function: Decelerate pushing, rotation "outward," and multi-segmental extension.

Practical Application

• Core
  • Static Chop and Progression
  • Planks and Progressions
• Integrated Exercise
  • Legs with Push

Common Maladaptive Behavior

• Over-active

The concepts and techniques described in this course may be particularly beneficial for neuromuscular re-education, coordination, motor pattern integration, whole-body strength, functional strength, and sports performance. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) should consider adding these exercises to their repertoire to improve the outcomes of their integrated exercise programs, sports performance programs, and therapeutic (rehabilitation) interventions.

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Group Exercise Instructors
• Massage Therapists
• Occupational Therapists - Intermediate
• Personal Trainers
• Physical Therapists
• Physical Therapy Assistants
• Yoga Instructors

This Course Includes:

• AI Tutor
• Study Guide
• Text and Illustrations
• Research Review
• Technique Videos
• Sample Routine
• Practice Exam
• Pre-approved Final Exam

Additional Subsystem Courses

• Intrinsic Stabilization Subsystem (ISS)
• Posterior Oblique Subsystem (POS)
• Deep Longitudinal Subsystem (DLS)

Caption: Anterior oblique subsystem (AOS): rectus abdominis, abdominal fascia (anterior layer), external obliques, and anterior adductors. Illustration from Vleeming et al. (2007) (1).

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1. Sanchez ER, Sanchez R, Moliver C. (2014). Anatomic relationship of pectoralis major and minor muscles: a cadaveric study. Aesthet. Surg. J. 34(2): 258-263.

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   • Rectus Abdominis

1. Levine, D., & Whittle, M. W. (1996). The effects of pelvic movement on lumbar lordosis in the standing position. Journal of Orthopaedic & Sports Physical Therapy , 24 (3), 130-135.

1. Kim, H. J., Chung, S., Kim, S., Shin, H., Lee, J., Kim, S., & Song, M. Y. (2006). Influences of trunk muscles on lumbar lordosis and sacral angle. European Spine Journal, 15(4), 409-414.

1. Snijders, C. J., Hermans, P. F., Niesing, R., Spoor, C. W., & Stoeckart, R. (2004). The influence of slouching and lumbar support on iliolumbar ligaments, intervertebral discs and sacroiliac joints. Clinical Biomechanics , 19 (4), 323-329.

1. Andersson, E. A., Grundström, H., & Thorstensson, A. (2002). Diverging intramuscular activity patterns in back and abdominal muscles during trunk rotation. Spine , 27 (6), E152-E160.

1. Cholewicki, J., Panjabi, M. M., & Khachatryan, A. (1997). Stabilizing function of trunk flexor‐extensor muscles around a neutral spine posture. Spine , 22 (19), 2207-2212.

1. Hodges, P. W., & Richardson, C. A. (1997). Contraction of the abdominal muscles associated with movement of the lower limb. Physical therapy , 77 (2), 132-142.

1. O’sullivan, P. B., Grahamslaw, K. M., Kendell, M., Lapenskie, S. C., Möller, N. E., & Richards, K. V. (2002). The effect of different standing and sitting postures on trunk muscle activity in a pain-free population. Spine , 27 (11), 1238-1244.

1. Fujitani, R., Jiromaru, T., Kida, N., & Nomura, T. (2017). Effect of standing postural deviations on trunk and hip muscle activity. Journal of physical therapy science , 29 (7), 1212-1215.

1. Ng, J. K. F., Richardson, C. A., Parnianpour, M., & Kippers, V. (2002). EMG activity of trunk muscles and torque output during isometric axial rotation exertion: a comparison between back pain patients and matched controls. Journal of Orthopaedic Research , 20 (1), 112-121.

1. Ng, J. K. F., Richardson, C. A., Parnianpour, M., & Kippers, V. (2002). Fatigue-related changes in torque output and electromyographic parameters of trunk muscles during isometric axial rotation exertion: an investigation in patients with back pain and in healthy subjects. Spine , 27 (6), 637-646

1. Cholewicki, J., Silfies, S., Shah, R., Greene, H., Reeves, N. Alvi, K., Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 30(23), 2614-2620

1. Larsen, L. H., Hirata, R. P., & Graven-Nielsen, T. (2016). Effects of unilateral and bilateral experimental low-back pain on trunk muscle activity during stair walking in healthy and recurrent low-back pain patients. In 16th World Congress on Pain .

1. O'Sullivan, P., Twomey, L., Allison, G., Sinclair, J., Miller, K., & Knox, J. (1997). Altered patterns of abdominal muscle activation in patients with chronic low back pain. Australian journal of physiotherapy , 43 (2), 91-98.

1. David G. Simons, Janet Travell, Lois S. Simons, Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition ,© 1999 Williams and Wilkens
   • External Obliques

1. Rizk, N. N. (1980). A new description of the anterior abdominal wall in man and mammals. Journal of anatomy , 131 (Pt 3), 373.

1. McGill, S. M. (1991). Kinetic potential of the lumbar trunk musculature about three orthogonal orthopaedic axes in extreme postures. Spine , 16 (7), 809-815.

1. McGill, S. M. (1991). Electromyographic activity of the abdominal and low back musculature during the generation of isometric and dynamic axial trunk torque: implications for lumbar mechanics. Journal of Orthopaedic Research , 9 (1), 91-103.

1. McGill, S. M. (1992). A myoelectrically based dynamic three-dimensional model to predict loads on lumbar spine tissues during lateral bending. Journal of biomechanics , 25 (4), 395-414.

1. McGill, S. M. (1996). A revised anatomical model of the abdominal musculature for torso flexion efforts. Journal of biomechanics , 29 (7), 973-977.

1. De Troyer, A., & Estenne, M. (1988). Functional anatomy of the respiratory muscles. Clinics in chest medicine , 9 (2), 175-193.

1. Danneels, L. A., Vanderstraeten, G. G., Cambier, D. C., Witvrouw, E. E., Stevens, V. K., & De Cuyper, H. J. (2001). A functional subdivision of hip, abdominal, and back muscles during asymmetric lifting. Spine , 26 (6), E114-E121.

1. Hodges, P., Cresswell, A., & Thorstensson, A. (1999). Preparatory trunk motion accompanies rapid upper limb movement. Experimental Brain Research , 124 (1), 69-79.

1. Drysdale, C. L., Earl, J. E., & Hertel, J. (2004). Surface electromyographic activity of the abdominal muscles during pelvic-tilt and abdominal-hollowing exercises. Journal of athletic training , 39 (1), 32.

1. Cresswell, A. G., & Thorstensson, A. (1989). The role of the abdominal musculature in the elevation of the intra-abdominal pressure during specified tasks. Ergonomics , 32 (10), 1237-1246.

1. Bogduk, N., & Macintosh, J. E. (1984). The applied anatomy of the thoracolumbar fascia. Spine , 9 (2), 164-170.

1. Richardson C, Jull G, Hodges P, Hides J. Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain: Scientific Basis and Clinical Approach. Edinburgh: Churchill Livingstone: 1999.

1. Granata, K. P., Slota, G. P., & Wilson, S. E. (2004). Influence of fatigue in neuromuscular control of spinal stability. Human factors , 46 (1), 81-91.

1. Lehman, G. J., Hoda, W., & Oliver, S. (2005). Trunk muscle activity during bridging exercises on and off a swissball. Chiropractic & osteopathy , 13 (1), 14.

1. Adductors

1. Hungerford, B., Gilleard, W., Hodges, P. (2003) Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine 28(14), 1593-1600

1. Pool-Goudzwaard, A. L., Vleeming, A., Stoeckart, R., Snijders, C. J., & Mens, J. M. A. (1998). Insufficient lumbopelvic stability: a clinical, anatomical and biomechanical approach to ‘a-specific’ low back pain. Manual Therapy , 3 (1), 12-20.

1. Snijders, C. J., Vleeming, A., & Stoeckart, R. (1993). Transfer of lumbosacral load to iliac bones and legs: Part 1: Biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clinical biomechanics , 8 (6), 285-294.

1. Snijders, C. J., Slagter, A. H., van Strik, R., Vleeming, A., Stoeckart, R., & Stam, H. J. (1995). Why Leg Crossing?: The Influence of Common Postures on Abdominal Muscle Activity. Spine , 20 (18), 1989-1993.

1. Padua, D. A., Bell, D. R., & Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. Journal of athletic training , 47 (5), 525.

1. Mauntel, T., Begalle, R., Cram, T., Frank, B., Hirth, C., Blackburn, T., & Padua, D. (2013). The effects of lower extremity muscle activation and passive range of motion on single leg squat performance. Journal Of Strength And Conditioning Research / National Strength & Conditioning Association , 27 (7), 1813-1823

1. Bell, D. R., Vesci, B. J., DiStefano, L. J., Guskiewicz, K. M., Hirth, C. J., & Padua, D. A. (2012). Muscle activity and flexibility in individuals with medial knee displacement during the overhead squat. Athletic Training and Sports Health Care , 4 (3), 117-125.

1. Hungerford, B., Gilleard, W., Hodges, P. (2003) Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine 28(14), 1593-1600

1. Hägglund M, Waldén M, Ekstrand J. Risk factors for lower extremity muscle injury in professional soccer: the UEFA Injury Study. The American Journal Of Sports Medicine . February 2013;41(2):327-335. Available from: MEDLINE Complete, Ipswich, MA. Accessed May 4, 2016.

1. Ekstrand J, Hägglund M, Waldén M. Epidemiology of muscle injuries in professional football (soccer). The American Journal Of Sports Medicine . June 2011;39(6):1226-1232. Available from: MEDLINE Complete, Ipswich, MA. Accessed May 4, 2016.

1. Naal F, Dalla Riva F, Wuerz T, Dubs B, Leunig M. Sonographic prevalence of groin hernias and adductor tendinopathy in patients with femoroacetabular impingement. The American Journal Of Sports Medicine . September 2015;43(9):2146-2151. Available from: MEDLINE Complete, Ipswich, MA. Accessed May 4, 2016.

1. Robinson, P., Barron, D. A., Parsons, W., Grainger, A. J., Schilders, E. M. G., & O’Connor, P. J. (2004). Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings. Skeletal radiology , 33 (8), 451-457.
   • Pectoralis Major

1. Sanchez ER, Sanchez R, Moliver C. (2014). Anatomic relationship of pectoralis major and minor muscles: a cadaveric study. Aesthet. Surg. J. 34(2): 258-263.

1. Harms-Ringdahl, K. (1986). On assessment of shoulder exercise and load-elicited pain in the cervical spine. Biomechanical analysis of load--EMG--methodological studies of pain provoked by extreme position. Scandinavian journal of rehabilitation medicine. Supplement , 14 , 1-40.

1. Ekholm, J., Arborelius, U. P., Hillered, L., & Ortqvist, A. (1978). Shoulder muscle EMG and resisting moment during diagonal exercise movements resisted by weight-and-pulley-circuit. Scandinavian journal of rehabilitation medicine , 10 (4), 179-185.

1. Marchetti, P. H., & Uchida, M. C. (2011). Effects of the pullover exercise on the pectoralis major and latissimus dorsi muscles as evaluated by EMG. Journal of applied biomechanics , 27 (4), 380-384.

1. Pearl, M. L., Perry, J., Torburn, L. M. S. P. T., & Gordon, L. H. (1992). An electromyographic analysis of the shoulder during cones and planes of arm motion. Clinical orthopaedics and related research , (284), 116-127.

1. Pink, M., Jobe, F. W., & Perry, J. (1990). Electromyographic analysis of the shoulder during the golf swing. The American journal of sports medicine , 18 (2), 137-140.

1. Jobe, F. W., Moynes, D. R., & Antonelli, D. J. (1986). Rotator cuff function during a golf swing. The American journal of sports medicine , 14 (5), 388-392.

1. Gowan, I. D., Jobe, F. W., Tibone, J. E., Perry, J., & Moynes, D. R. (1987). A comparative electromyographic analysis of the shoulder during pitching: professional versus amateur pitchers. The American journal of sports medicine , 15 (6), 586-590.

1. Ryu, R. K., McCormick, J., Jobe, F. W., Moynes, D. R., & Antonelli, D. J. (1988). An electromyographic analysis of shoulder function in tennis players. The American journal of sports medicine , 16 (5), 481-485.

1. Rokito, A. S., Jobe, F. W., Pink, M. M., Perry, J., & Brault, J. (1998). Electromyographic analysis of shoulder function during the volleyball serve and spike. Journal of Shoulder and Elbow Surgery , 7 (3), 256-263.

1. Scovazzo, M.L., Browne, A., Pink, M., Jobe, F.W., and Kerrigan, J. (1991). The painful shoulder during freestyle swimming: An electromyographic cinematographic analysis of twelve muscles. The American Journal of Sports Medicine. 577-582.

1. Paton, M. E., & Brown, J. M. M. (1994). An electromyographic analysis of functional differentiation in human pectoralis major muscle. Journal of Electromyography and Kinesiology , 4 (3), 161-169.

1. Glass, S. C., & Armstrong, T. (1997). Electromyographical Activity of the Pectoralis Muscle During Incline and Decline Bench Presses. The Journal of Strength & Conditioning Research , 11 (3), 163-167.

1. Harms-Ringdahl, K. (1986). On assessment of shoulder exercise and load-elicited pain in the cervical spine. Biomechanical analysis of load--EMG--methodological studies of pain provoked by extreme position. Scandinavian journal of rehabilitation medicine. Supplement , 14 , 1-40.

1. Welsch, E. A., Bird, M., & Mayhew, J. L. (2005). Electromyographic activity of the pectoralis major and anterior deltoid muscles during three upper-body lifts. Journal of Strength and Conditioning Research , 19 (2), 449.

1. Lehman, G. J., MacMillan, B., MacIntyre, I., Chivers, M., & Fluter, M. (2006). Shoulder muscle EMG activity during push up variations on and off a Swiss ball. Dynamic Medicine , 5 (1), 7.

1. Steenbrink, F., De Groot, J. H., Veeger, H. E. J., Meskers, C. G. M., van de Sande, M. A. J., & Rozing, P. M. (2006). Pathological muscle activation patterns in patients with massive rotator cuff tears, with and without subacromial anaesthetics. Manual therapy , 11 (3), 231-237.

1. Santana, J. C., Vera-Garcia, F. J., & McGill, S. M. (2007). A kinetic and electromyographic comparison of the standing cable press and bench press. Journal of Strength and Conditioning Research , 21 (4), 1271.

1. Schick, E. E., Coburn, J. W., Brown, L. E., Judelson, D. A., Khamoui, A. V., Tran, T. T., & Uribe, B. P. (2010). A comparison of muscle activation between a Smith machine and free weight bench press. The Journal of Strength & Conditioning Research , 24 (3), 779-784.

1. McCaw, S. T., & Friday, J. J. (1994). A comparison of muscle activity between a free weight and machine bench press. J Strength Cond Res , 8 (4), 259-64.

1. Uribe, B. P., Coburn, J. W., Brown, L. E., Judelson, D. A., Khamoui, A. V., & Nguyen, D. (2010). Muscle activation when performing the chest press and shoulder press on a stable bench vs. a Swiss ball. The Journal of Strength & Conditioning Research , 24 (4), 1028-1033.

1. David, G., Magarey, M. E., Jones, M. A., Dvir, Z., Türker, K. S., & Sharpe, M. (2000). EMG and strength correlates of selected shoulder muscles during rotations of the glenohumeral joint. Clinical Biomechanics , 15 (2), 95-102.

1. Saeterbakken, A. H., van den Tillaar, R., & Fimland, M. S. (2011). A comparison of muscle activity and 1-RM strength of three chest-press exercises with different stability requirements. Journal of sports sciences , 29 (5), 533-538.

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1. Kronberg, M., NÉmeth, G., & Broström, L. A. (1990). Muscle activity and coordination in the normal shoulder. An electromyographic study. Clinical orthopaedics and related research , (257), 76-85.

1. Hirashima, M., Kadota, H., Sakurai, S., Kudo, K., & Ohtsuki, T. (2002). Sequential muscle activity and its functional role in the upper extremity and trunk during overarm throwing. Journal of sports sciences , 20 (4), 301-310.

1. Glousman R, Jobe F, Tibone J, Moynes D, Antonelli D, Perry J. Dynamic Electromyographic analysis of the throwing shoulder with glenohumeral instability. J Bone Joint Surg 70A(2):220-226, 1988.

1. Park, K. M., Cynn, H. S., Kwon, O. Y., Yi, C. H., Yoon, T. L., & Lee, J. H. (2014). Comparison of pectoralis major and serratus anterior muscle activities during different push-up plus exercises in subjects with and without scapular winging. The Journal of Strength & Conditioning Research , 28 (9), 2546-2551.

1. Park, K. M., Cynn, H. S., Yi, C. H., & Kwon, O. Y. (2013). Effect of isometric horizontal abduction on pectoralis major and serratus anterior EMG activity during three exercises in subjects with scapular winging. Journal of Electromyography and Kinesiology , 23 (2), 462-468.
   • Serratus Anterior

1. Kao, J. T., Pink, M., Jobe, F. W., & Perry, J. (1995). Electromyographic analysis of the scapular muscles during a golf swing. The American journal of sports medicine , 23 (1), 19-23.

1. McHardy, A., & Pollard, H. (2005). Muscle activity during the golf swing. British journal of sports medicine , 39 (11), 799-804.

1. Maffet, M. W., Jobe, F. W., Pink, M. M., Brault, J., & Mathiyakom, W. (1997). Shoulder muscle firing patterns during the windmill softball pitch. The American journal of sports medicine , 25 (3), 369-374.

1. Seo, S. H., Jeon, I. H., Cho, Y. H., Lee, H. G., Hwang, Y. T., & Jang, J. H. (2013). Surface EMG during the push-up plus exercise on a stable support or Swiss ball: scapular stabilizer muscle exercise. Journal of physical therapy science , 25 (7), 833-837.

1. Park, Se-yeon, and Won-gyu Yoo. “Differential activation of parts of the serratus anterior muscle during push-up variations on stable and unstable bases of support.” Journal of Electromyography and Kinesiology 21.5 (2011): 861-867.

1. Kibler, W. B., Chandler, T. J., Shapiro, R., & Conuel, M. (2007). Muscle activation in coupled scapulohumeral motions in the high performance tennis serve. British journal of sports medicine , 41 (11), 745-749.

1. Ryu, R. K., McCormick, J., Jobe, F. W., Moynes, D. R., & Antonelli, D. J. (1988). An electromyographic analysis of shoulder function in tennis players. The American journal of sports medicine , 16 (5), 481-485.

1. Pink, M., Perry, J., Browne, A., Scovazzo, M. L., & Kerrigan, J. (1991). The normal shoulder during freestyle swimming: an electromyographic and cinematographic analysis of twelve muscles. The American Journal of Sports Medicine , 19 (6), 569-576.

1. Nuber, G. W., Jobe, F. W., Perry, J., Moynes, D. R., & Antonelli, D. (1986). Fine wire electromyography analysis of muscles of the shoulder during swimming. The american journal of sports medicine , 14 (1), 7-11.

1. Witt, D., Talbott, N., & Kotowski, S. (2011). Electromyographic activity of scapular muscles during diagonal patterns using elastic resistance and free weights. International journal of sports physical therapy , 6 (4), 322.

1. Diederichsen, L. P., Nørregaard, J., Dyhre-Poulsen, P., Winther, A., Tufekovic, G., Bandholm, T., … & Krogsgaard, M. (2009). The activity pattern of shoulder muscles in subjects with and without subacromial impingement. Journal of Electromyography and kinesiology , 19 (5), 789-799.

1. de Morais Faria, C. D. C., Teixeira-Salmela, L. F., de Paula Goulart, F. R., & de Souza Moraes, G. F. (2008). Scapular muscular activity with shoulder impingement syndrome during lowering of the arms. Clinical Journal of Sport Medicine , 18 (2), 130-136.

1. Wadsworth, D. J. S., & Bullock-Saxton, J. E. (1997). Recruitment patterns of the scapular rotator muscles in freestyle swimmers with subacromial impingement. International journal of sports medicine , 18 (08), 618-624.

1. McMahon, P. J., Jobe, F. W., Pink, M. M., Brault, J. R., & Perry, J. (1996). Comparative electromyographic analysis of shoulder muscles during planar motions: anterior glenohumeral instability versus normal. Journal of shoulder and elbow surgery , 5 (2), 118-123.

1. Phadke, V., Camargo, P. R., & Ludewig, P. M. (2009). Scapular and rotator cuff muscle activity during arm elevation: a review of normal function and alterations with shoulder impingement. Brazilian Journal of Physical Therapy , 13 (1), 1-9.

1. Thigpen CA, Padua DA, Michener LA, Guskiewicz K, Giuliani C, Keener JD, Stergiou N. (2010). Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks. Journal of Electromyography and Kinesiology . 20: 701-709.

1. Kwon JW, Son SM, Lee NK. (2015). Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders. J Phys Ther Sci. 27: 1739-1742

1. Helgadottir, H., Kristjansson, E., Einarsson, E., Karduna, A., & Jonsson, H. (2011). Altered activity of the serratus anterior during unilateral arm elevation in patients with cervical disorders. Journal of electromyography and kinesiology,21(6), 947-953.

1. Weon, J. H., Oh, J. S., Cynn, H. S., Kim, Y. W., Kwon, O. Y., & Yi, C. H. (2010). Influence of forward head posture on scapular upward rotators during isometric shoulder flexion. Journal of Bodywork and movement therapies , 14 (4), 367-374.

1. Ludewig, P. M., & Cook, T. M. (1996). The effect of head position on scapular orientation and muscle activity during shoulder elevation. Journal of Occupational Rehabilitation , 6 (3), 147-158.

1. Cools, A. M., Witvrouw, E. E., Declercq, G. A., Vanderstraeten, G. G., & Cambier, D. C. (2004). Evaluation of isokinetic force production and associated muscle activity in the scapular rotators during a protraction-retraction movement in overhead athletes with impingement symptoms. British journal of sports medicine , 38 (1), 64-68.

1. McQuade, K. J., Dawson, J., & Smidt, G. L. (1998). Scapulothoracic muscle fatigue associated with alterations in scapulohumeral rhythm kinematics during maximum resistive shoulder elevation. Journal of Orthopaedic & Sports Physical Therapy , 28 (2), 74-80.

1. Borstad, J. D., Szucs, K., & Navalgund, A. (2009). Scapula kinematic alterations following a modified push-up plus task. Human movement science , 28 (6), 738-751.

1. Cools, A. M., Witvrouw, E. E., Declercq, G. A., Vanderstraeten, G. G., & Cambier, D. C. (2004). Evaluation of isokinetic force production and associated muscle activity in the scapular rotators during a protraction-retraction movement in overhead athletes with impingement symptoms. British journal of sports medicine , 38 (1), 64-68.

1. Lawrence, R. L., Braman, J. P., Laprade, R. F., & Ludewig, P. M. (2014). Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 1: sternoclavicular, acromioclavicular, and scapulothoracic joints. journal of orthopaedic & sports physical therapy , 44 (9), 636-A8.

1. Lin, J. J., Hanten, W. P., Olson, S. L., Roddey, T. S., Soto-quijano, D. A., Lim, H. K., & Sherwood, A. M. (2005). Functional activity characteristics of individuals with shoulder dysfunctions. Journal of Electromyography and Kinesiology , 15 (6), 576-586.

1. Ludewig, P. M., & Cook, T. M. (2000). Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Physical therapy , 80 (3), 276-291 .

1. Ludewig, P. M., Hoff, M. S., Osowski, E. E., Meschke, S. A., & Rundquist, P. J. (2004). Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises. The American journal of sports medicine , 32 (2), 484-493.

1. Lear, L. J., & Gross, M. T. (1998). An electromyographical analysis of the scapular stabilizing synergists during a push-up progression. Journal of Orthopaedic & Sports Physical Therapy , 28 (3), 146-157

1. Ludewig, P. M., Hoff, M. S., Osowski, E. E., Meschke, S. A., & Rundquist, P. J. (2004). Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises. The American journal of sports medicine , 32 (2), 484-493.

1. Castelein, B., Cagnie, B., Parlevliet, T., & Cools, A. (2016). Serratus anterior or pectoralis minor: Which muscle has the upper hand during protraction exercises?. Manual therapy , 22 , 158-164.

1. Martins, J., Tucci, H. T., Andrade, R., Araújo, R. C., Bevilaqua-Grossi, D., & Oliveira, A. S. (2008). Electromyographic amplitude ratio of serratus anterior and upper trapezius muscles during modified push-ups and bench press exercises. The Journal of Strength & Conditioning Research , 22 (2), 477-484.

1. Lehman, G. J., Gilas, D., & Patel, U. (2008). An unstable support surface does not increase scapulothoracic stabilizing muscle activity during push up and push up plus exercises. Manual therapy , 13 (6), 500-506.

1. de Oliveira, A. S., de Morais Carvalho, M., & de Brum, D. P. C. (2008). Activation of the shoulder and arm muscles during axial load exercises on a stable base of support and on a medicine ball. Journal of Electromyography and Kinesiology , 18 (3), 472-479.

1. Kim, S. H., Kwon, O. Y., Kim, S. J., Park, K. N., Choung, S. D., & Weon, J. H. (2014). Serratus anterior muscle activation during knee push-up plus exercise performed on static stable, static unstable, and oscillating unstable surfaces in healthy subjects. Physical Therapy in Sport , 15 (1), 20-25.

1. Kim, E. R., Oh, J. S., & Yoo, W. G. (2014). Effect of vibration frequency on serratus anterior muscle activity during performance of the push-up plus with a redcord sling. Journal of physical therapy science , 26 (8), 1275-1276.

1. Pirauá, A. L. T., Pitangui, A. C. R., Silva, J. P., dos Passos, M. H. P., de Oliveira, V. M. A., Batista, L. D. S. P., & de Araújo, R. C. (2014). Electromyographic analysis of the serratus anterior and trapezius muscles during push-ups on stable and unstable bases in subjects with scapular dyskinesis. Journal of Electromyography and Kinesiology , 24 (5), 675-681.

1. Ekstrom, R. A., Donatelli, R. A., & Soderberg, G. L. (2003). Surface electromyographic analysis of exercises for the trapezius and serratus anterior muscles. Journal of Orthopaedic & Sports Physical Therapy , 33 (5), 247-258.

1. Moseley JR, J. B., Jobe, F. W., Pink, M., Perry, J., & Tibone, J. (1992). EMG analysis of the scapular muscles during a shoulder rehabilitation program. The American journal of sports medicine , 20 (2), 128-134.

1. Büll, M. L., & Vitti, M. (1990). Electromyographic study of the trapezius (pars superior) and serratus anterior (pars inferior) in free movements of the arm. Anatomischer Anzeiger , 171 (2), 125-133.

1. Tsuruike, M., & Ellenbecker, T. S. (2015). Serratus anterior and lower trapezius muscle activities during multi-joint isotonic scapular exercises and isometric contractions. Journal of athletic training , 50 (2), 199-210.

1. Hardwick DH, Beebe JA, McDonnell MK, Lang CE. (2006). A comparison of serratus anterior muscle activation during a wall slide exercise and other traditional exercises. Journal of Orthopaedic & Sports Physical Therapy. 36(12) 903-910

1. Ha, Sung-min., Kown, Oh-yum., Cynn, Heon-seock., Lee, Won-hwee., Park, Kyue-nam., Kim, Si-hyun., & Jun, Do-young. (2012) Comparison of electromyographic activity of the lower trapezius and serratus anterior muscle in different arm-lifting scapular posterior tilt exercises. Ph ysical Therapy in Sport , 13, 227-232.

1. Ha, S. M., Kwon, O. Y., Cynn, H. S., Lee, W. H., Park, K. N., Kim, S. H., & Jung, D. Y. (2012). Comparison of electromyographic activity of the lower trapezius and serratus anterior muscle in different arm-lifting scapular posterior tilt exercises. Physical Therapy in Sport , 13 (4), 227-232.

1. Cools, A. M., Dewitte, V., Lanszweert, F., Notebaert, D., Roets, A., Soetens, B., … & Witvrouw, E. E. (2007). Rehabilitation of scapular muscle balance: which exercises to prescribe?. The American journal of sports medicine , 35 (10), 1744-1751

1. Decker, M. J., Hintermeister, R. A., Faber, K. J., & Hawkins, R. J. (1999). Serratus anterior muscle activity during selected rehabilitation exercises. The American journal of sports medicine , 27 (6), 784-791.

1. Lucas, K. R., Polus, B. I., & Rich, P. A. (2004). Latent myofascial trigger points: their effects on muscle activation and movement efficiency. Journal of Bodywork and Movement Therapies , 8 (3), 160-166.
   • Additional Research on Function

1. Evcik, D., & Yücel, A. (2003). Lumbar lordosis in acute and chronic low back pain patients. Rheumatology international , 23 (4), 163-165.

1. Christie, H. J., Kumar, S., & Warren, S. A. (1995). Postural aberrations in low back pain. Archives of physical medicine and rehabilitation , 76 (3), 218-224.

1. Schultz, A., Andersson, G., Ortengren, R., Haderspeck, K., & Nachemson, A. (1982). Loads on the lumbar spine. Validation of a biomechanical analysis by measurements of intradiscal pressures and myoelectric signals. JBJS , 64 (5), 713-720.

1. Kang, T., Lee, J., Seo, J., & Han, D. (2017). The effect of bridge exercise method on the strength of rectus abdominis muscle and the muscle activity of paraspinal muscles while doing treadmill walking with high heels. Journal of physical therapy science , 29 (4), 707-712

1. Yoo, W. G. (2014). Effect of the individual strengthening exercises for posterior pelvic tilt muscles on back pain, pelvic angle, and lumbar ROM of a LBP patient with excessive lordosis: a case study. Journal of physical therapy science, 26(2), 319-320.

1. Chang, M., Slater, L. V., Corbett, R. O., Hart, J. M., & Hertel, J. (2017). Muscle activation patterns of the lumbo-pelvic-hip complex during walking gait before and after exercise. Gait & posture , 52 , 15-21.

1. Brookbush, B. Lumbo Pelvic Hip Complex Dysfunction. https://brentbrookbush.com/articles/postural-dysfunction-movement-impairment/lumbo-pelvic-hip-complex-dysfunction-lphcd/

1. Schleip, R. (2003). Fascial plasticity–a new neurobiological explanation: Part 1. Journal of Bodywork and movement therapies, 7 (1), 11-19.

1. Schleip, R. (2003). Fascial plasticity–a new neurobiological explanation Part 2. Journal of Bodywork and movement therapies, 7 (2), 104-116.

1. Calatayud, J., Casaña, J., Martín, F., Jakobsen, M. D., Colado, J. C., & Andersen, L. L. (2017). Progression of Core Stability Exercises Based on the Extent of Muscle Activity. American Journal of Physical Medicine & Rehabilitation , 96 (10), 694-699

1. Marshall, P. W., & Murphy, B. A. (2005). Core stability exercises on and off a Swiss ball. Archives of physical medicine and rehabilitation , 86 (2), 242-249.

1. Kang, T., Lee, J., Seo, J., & Han, D. (2017). The effect of bridge exercise method on the strength of rectus abdominis muscle and the muscle activity of paraspinal muscles while doing treadmill walking with high heels. Journal of physical therapy science, 29 (4), 707-712.

1. Yoo, W. G. (2014). Effect of the individual strengthening exercises for posterior pelvic tilt muscles on back pain, pelvic angle, and lumbar ROM of a LBP patient with excessive lordosis: a case study. Journal of physical therapy science, 26(2), 319-320.

1. Chang, M., Slater, L. V., Corbett, R. O., Hart, J. M., & Hertel, J. (2017). Muscle activation patterns of the lumbo-pelvic-hip complex during walking gait before and after exercise. Gait & posture , 52 , 15-21.