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Kaur U, Shrestha D, Hussain MDA, Dalal P, Kalita M, Sharma V, Sharma S. Prompt Impact of Muscle Energy Technique on Pectoralis Muscle Tightness in Computer Users: A Quasi-Experimental Study. J Lifestyle Med 2023; 13:123-128. [PMID: 37970323 PMCID: PMC10630720 DOI: 10.15280/jlm.2023.13.2.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/20/2023] [Accepted: 07/27/2023] [Indexed: 11/17/2023] Open
Abstract
Tightness of the pectoralis minor muscle has been a common characteristic of abnormal posture. Prolonged inappropriate posture while using computers/laptops results in musculoskeletal problems, mainly in the upper limb. This study aims to see how the muscular energy technique affected pectoralis minor tightness in computer users right away. This study included 65 individuals aged 20-40 years following the inclusion/exclusion criteria. Participants received muscle energy technique for the pectoralis minor muscle. Pre- and post-assessment included the evaluation of pectoralis minor length, round shoulder posture (RSP), and forward head posture (FHP). We used the Kolmogorov-Smirnov test to assess the normality of data, as this study included > 50 participants. Data analysis was conducted using a paired t-test for within-group analysis. The outcome measures demonstrated significant improvement (p < 0.001). In conclusion, the muscle energy technique is effective in reducing muscle tightness, improving RSP and reducing FHP.
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Affiliation(s)
- Upneet Kaur
- Department of Musculoskeletal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India
| | - Diggaj Shrestha
- Department of Musculoskeletal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India
| | - MD Ashraf Hussain
- Department of Cardiopulmonary Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India
| | - Parul Dalal
- Department of Musculoskeletal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India
| | - Manalisa Kalita
- Department of Musculoskeletal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India
| | - Vartika Sharma
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India
| | - Sunita Sharma
- Department of Musculoskeletal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India
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Bellotti S, Busato M, Cattaneo C, Branchini M. Effectiveness of the Fascial Manipulation Approach Associated with a Physiotherapy Program in Recurrent Shoulder Disease. Life (Basel) 2023; 13:1396. [PMID: 37374178 DOI: 10.3390/life13061396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Shoulder pain is a serious clinical disease frequently related to absence from work. It is characterized by pain and stiffness, probably connected to the presence of an inflammatory substrate involving gleno-humeral capsule and collagen tissues. A physiotherapy program has shown to be effective for the conservative treatment of this disorder. Our aim is to assess if a manual treatment directed to fascial tissues could obtain better improvement regarding pain, strength, mobility, and function. A total of 94 healthcare workers with recurrent shoulder pain were recruited and then randomized in two groups: the control group (CG) underwent a five-session physiotherapy program; the study group (SG) underwent three sessions of physiotherapy and two sessions of fascial manipulation (FM) technique. At the end of the treatment phase, both groups improved every outcome. Despite few statistical differences between groups, at the follow-up visit, a greater percentage of subjects in SG overcame the minimal clinical important difference (MCID) in every outcome. We conclude that FM is effective for treatment of shoulder pain and further studies should better assess how to manage this treatment to obtain better results.
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Vila-Dieguez O, Heindel MD, Awokuse D, Kulig K, Michener LA. Exercise for rotator cuff tendinopathy: Proposed mechanisms of recovery. Shoulder Elbow 2023; 15:233-249. [PMID: 37325389 PMCID: PMC10268139 DOI: 10.1177/17585732231172166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 06/17/2023]
Abstract
Rotator cuff (RC) tendinopathy is a common recurrent cause of shoulder pain, and resistance exercise is the first-line recommended intervention. Proposed causal mechanisms of resistance exercise for patients with RC tendinopathy consist of four domains: tendon structure, neuromuscular factors, pain and sensorimotor processing, and psychosocial factors. Tendon structure plays a role in RC tendinopathy, with decreased stiffness, increased thickness, and collagen disorganization. Neuromuscular performance deficits of altered kinematics, muscle activation, and force are present in RC tendinopathy, but advanced methods of assessing muscle performance are needed to fully assess these factors. Psychological factors of depression, anxiety, pain catastrophizing, treatment expectations, and self-efficacy are present and predict patient-reported outcomes. Central nervous system dysfunctions also exist, specifically altered pain and sensorimotor processing. Resisted exercise may normalize these factors, but limited evidence exists to explain the relationship of the four proposed domains to trajectory of recovery and defining persistent deficits limiting outcomes. Clinicians and researchers can use this model to understand how exercise mediates change in patient outcomes, develop subgroups to deliver patient-specific approach for treatment and define metrics to track recovery over time. Supporting evidence is limited, indicating the need for future studies characterizing mechanisms of recovery with exercise for RC tendinopathy.
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Affiliation(s)
- Oscar Vila-Dieguez
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Matthew D. Heindel
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Daniel Awokuse
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Kornelia Kulig
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lori A. Michener
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Reiner M, Gabriel A, Sommer D, Bernsteiner D, Tilp M, Konrad A. Effects of a High-Volume 7-Week Pectoralis Muscle Stretching Training on Muscle Function and Muscle Stiffness. SPORTS MEDICINE - OPEN 2023; 9:40. [PMID: 37261567 DOI: 10.1186/s40798-023-00582-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/14/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND There is evidence that high-volume static stretching training of the lower limbs can increase the range of motion (ROM) while decreasing muscles stiffness. However, to date, there is no evidence on the effects of upper limb stretching training or its effect mechanism. Therefore, this study aimed to investigate the effects of a comprehensive 7-week static stretching training program of the pectoralis major muscle (PMa) on glenohumeral joint ROM, muscle force, and muscle stiffness. METHODS Thirty-eight healthy, physically active participants (23 male, 15 female) were randomly assigned to either the PMa-static stretching intervention (PMa-SS) group or the control group. The PMa-SS group performed a 7-week intervention comprising three sessions a week for 15 min per session, including three static stretching exercises of the PMa for 5 min each. Before and after the intervention period, shoulder extension ROM, muscle stiffness of the PMa (pars clavicularis), and maximal voluntary isometric contraction (MVIC) peak torque (evaluated at both long (MVIClong) and short (MVICshort) muscle lengths) were investigated on a custom-made testing device at 45° shoulder abduction. RESULTS In the PMa-SS group, the shoulder extension ROM (+ 6%; p < 0.01; d = 0.92) and the MVIClong (+ 11%; p = 0.01; d = 0.76) increased. However, there were no significant changes in MVICshort or in PMa muscle stiffness in the PMa-SS group. In the control group, no changes occurred in any parameter. CONCLUSION In addition to the increase in ROM, we also observed an improved MVIC at longer but not shorter muscle lengths. This potentially indicates an increase in fascicle length, and hence a likely increase in sarcomeres in series.
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Affiliation(s)
- Marina Reiner
- Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, 8010, Graz, Austria
| | - Anna Gabriel
- Professorship of Conservative and Rehabilitative Orthopedics, Department of Sport and Health Science, Technical University of Munich, Munich, Germany
| | - Daniel Sommer
- Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, 8010, Graz, Austria
| | - Daniel Bernsteiner
- Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, 8010, Graz, Austria
| | - Markus Tilp
- Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, 8010, Graz, Austria
| | - Andreas Konrad
- Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, 8010, Graz, Austria.
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Ben Kibler W, Lockhart JW, Cromwell R, Sciascia A. Managing Scapular Dyskinesis. Phys Med Rehabil Clin N Am 2023; 34:427-451. [PMID: 37003662 DOI: 10.1016/j.pmr.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Scapular dyskinesis, the impairment of optimal scapular position and motion, is common in association with shoulder injury. A comprehensive evaluation process can show the causative factors and lead to effective treatment protocols. The complexity of scapular motion and the integrated relationship between the scapula, humerus, trunk, and legs suggest a need to develop rehabilitation programs that involve all segments working as a unit rather than isolated components. This is best accomplished with an integrated rehabilitation approach that includes rectifying deficits in mobility, strength, and motor control but not overtly focusing on any one area.
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Hasan S, Iqbal A, Alghadir AH, Alonazi A, Alyahya D. The Combined Effect of the Trapezius Muscle Strengthening and Pectoralis Minor Muscle Stretching on Correcting the Rounded Shoulder Posture and Shoulder Flexion Range of Motion among Young Saudi Females: A Randomized Comparative Study. Healthcare (Basel) 2023; 11:healthcare11040500. [PMID: 36833034 PMCID: PMC9956189 DOI: 10.3390/healthcare11040500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The shortening of the pectoralis minor muscle (PMi-M) and weakening of the lower trapezius muscle (LTr-M) affect scapular movement, resulting in the development of a rounded shoulder posture and reduction in the shoulder flexion range of motion (SFROM). OBJECTIVE This study evaluated the combined effect of LTr-M strengthening and PMi-M stretching on correcting the rounded shoulder postures and SFROM among young Saudi females. METHODS This study was based on a two-arm parallel-group repeated measures randomized comparative design. A total of sixty female participants with rounded shoulder postures were recruited and randomly allocated into groups 1 and 2 (n = 30/group). Each group performed supervised PMi-M stretching; however, group 2 performed a combination of LTr-M strengthening and PMi-M stretching. The outcomes, including rounded shoulder posture and SFROM, were assessed using the pectoralis minor length test (PMLT) and universal goniometer. A repeated measure ANOVA was used to compare the differences within-group and between-group for the outcomes measures at one-week (baseline) pre-intervention, two weeks, and three -weeks post-intervention. The significance level was set at q > 2.00 and p < 0.05 for all respective statistical analyses. RESULTS The within-group comparison revealed significant improvements (q > 2.00) in the outcomes of PMLT and SFROM when comparing their post-intervention scores to the baseline scores. The between-group comparison revealed a significant and an insignificant (q < 2.00) difference in the outcomes of PMLT and SFROM, respectively when comparing their scores at the second- and third-week post-intervention. Furthermore, the effect size of the intervention suggests an advantage of group 2 over group 1 in increasing the resting length of the PMi-M only among young Saudi females. CONCLUSIONS The combined effect of LTr-M strengthening and PMi-M stretching was more beneficial than PMi-M stretching alone in correcting the rounded shoulder posture among young Saudi females by increasing PMi-M resting length. However, it could not yield a differential improvement in the SFROM outcome among them.
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Affiliation(s)
- Shahnaz Hasan
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, P.O. Box 66, Al-Majmaah 11952, Saudi Arabia
| | - Amir Iqbal
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia
- Correspondence: or ; Tel.: +966-14698543
| | - Ahmad H. Alghadir
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia
| | - Asma Alonazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, P.O. Box 66, Al-Majmaah 11952, Saudi Arabia
| | - Danah Alyahya
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, P.O. Box 66, Al-Majmaah 11952, Saudi Arabia
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Powell JK, Schram B, Lewis J, Hing W. "You have (rotator cuff related) shoulder pain, and to treat it, I recommend exercise." A scoping review of the possible mechanisms underpinning exercise therapy. Musculoskelet Sci Pract 2022; 62:102646. [PMID: 35964499 DOI: 10.1016/j.msksp.2022.102646] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Exercise is considered to be both essential and at the forefront of the management of rotator cuff-related shoulder pain (RCRSP). Despite this, many fail to substantially improve with exercise-based treatment. Hence, expanding the current knowledge about the possible mechanisms of exercise for RCRSP is critical. OBJECTIVE To synthesise the range of mechanisms proposed for exercise in people with RCRSP. DESIGN Scoping review METHODS: A systematic search of the Physiotherapy Evidence Database (PEDro) was conducted from inception to July 3, 2022. Two reviewers conducted the search and screening process and one reviewer extracted the data from each study. Randomised clinical trials using exercise for the management of RCRSP of any duration were included. The PEDro search terms used were "fitness training", "strength training", "stretching, mobilisation, manipulation, massage", "upper arm, shoulder, or shoulder girdle", "pain", and "musculoskeletal". Data were analysed using quantitative and qualitative approaches. RESULTS 626 studies were identified and 110 were included in the review. Thirty-two unique mechanisms of exercise were suggested by clinical trialists, from which 4 themes emerged: 1) neuromuscular 2) tissue factors 3) neuro-endocrine-immune 4) psychological. Neuromuscular mechanisms were proposed most often (n = 156, 77%). Overall, biomedical mechanisms of exercise were proposed in 95% of cases. CONCLUSIONS The causal explanation for the beneficial effect of exercise for RCRSP in clinical research is dominated by biomedical mechanisms, despite a lack of supporting evidence. Future research should consider testing the mechanisms identified in this review using mediation analysis to progress knowledge on how exercise might work for RCRSP.
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Affiliation(s)
- Jared K Powell
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia.
| | - Ben Schram
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
| | - Jeremy Lewis
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom; Clinical Therapies, University of Limerick, Ireland
| | - Wayne Hing
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
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Ahmed AS, Graf AR, Karzon AL, Graulich BL, Egger AC, Taub SM, Gottschalk MB, Bowers RL, Wagner ER. Pectoralis minor syndrome - review of pathoanatomy, diagnosis, and management of the primary cause of neurogenic thoracic outlet syndrome. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:469-488. [PMID: 37588453 PMCID: PMC10426640 DOI: 10.1016/j.xrrt.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Thoracic outlet syndrome is an umbrella term for compressive pathologies in the supraclavicular and infraclavicular fossae, with the vast majority being neurogenic in nature. These compressive neuropathies, such as pectoralis minor syndrome, can be challenging problems for both patients and physicians. Robust understanding of thoracic outlet anatomy and scapulothoracic biomechanics are necessary to distinguish neurogenic vs. vascular disorders and properly diagnose affected patients. Repetitive overhead activity, particularly when combined with scapular dyskinesia, leads to pectoralis minor shortening, decreased volume of the retropectoralis minor space, and subsequent brachial plexus compression causing neurogenic thoracic outlet syndrome. Combining a thorough history, physical examination, and diagnostic modalities including ultrasound-guided injections are necessary to arrive at the correct diagnosis. Rigorous attention must be paid to rule out alternate etiologies such as peripheral neuropathies, vascular disorders, cervical radiculopathy, and space-occupying lesions. Initial nonoperative treatment with pectoralis minor stretching, as well as periscapular and postural retraining, is successful in the majority of patients. For patients that fail nonoperative management, surgical release of the pectoralis minor may be performed through a variety of approaches. Both open and arthroscopic pectoralis minor release may be performed safely with effective resolution of neurogenic symptoms. When further indicated by the preoperative workup, this can be combined with suprascapular nerve release and brachial plexus neurolysis for complete infraclavicular thoracic outlet decompression.
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Affiliation(s)
- Adil S. Ahmed
- Department of Orthopaedic Surgery, Hand & Upper Extremity Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Alexander R. Graf
- Department of Orthopaedic Surgery, Hand & Upper Extremity Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Anthony L. Karzon
- Department of Orthopaedic Surgery, Hand & Upper Extremity Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Anthony C. Egger
- Department of Orthopaedic Surgery, Hand & Upper Extremity Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah M. Taub
- Department of Orthopaedic Surgery, Hand & Upper Extremity Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael B. Gottschalk
- Department of Orthopaedic Surgery, Hand & Upper Extremity Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert L. Bowers
- Department of Orthopaedic Surgery, Sports Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric R. Wagner
- Department of Orthopaedic Surgery, Hand & Upper Extremity Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Ellenbecker T, Roetert EP, Petracek K, Kovacs M, Barajas N, Bailie D. Bilateral Comparison of Anterior Shoulder Position in Elite Tennis Players. Int J Sports Phys Ther 2022; 17:863-869. [PMID: 35949371 PMCID: PMC9340837 DOI: 10.26603/001c.36629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background In elite tennis players, musculoskeletal adaptations in the dominant upper extremity have been reported for range of motion, strength, and scapular biomechanics. In addition to scapular dysfunction, tightness and inflexibility of the pectoral musculature have been identified as risk factors for the development of overuse shoulder injury in overhead athletes. Hypothesis Differences in anterior shoulder position will be identified between the dominant and non-dominant extremity in elite tennis players. The purpose of this study was to examine bilateral differences in anterior shoulder posture measured using a double square in elite tennis players without shoulder injury. Study Design Descriptive Laboratory Study. Methods Three hundred and six uninjured elite tennis players were measured in the supine position using a double square method to measure anterior shoulder position. The distance from the surface of the table to the anterior most position of the shoulder (in millimeters) was measured bilaterally and compared. A dependent t-test was used to test for significant differences in anterior shoulder position between the dominant and non-dominant extremity. Results One hundred thirty-three males and 173 females were included in this study with a mean age of 16.58 years. The mean difference between extremities indicates increased anterior shoulder positioning on the dominant shoulder of 7.65 mm in females, and 8.72 in males. Significantly greater (p<.001) anterior shoulder position measures were documented on the dominant shoulder as compared to the non-dominant shoulder. Conclusions The results of this study showed significantly (p<.001) greater anterior shoulder position on the dominant extremity of elite male and female tennis players. The differences of 7-8mm between extremities has clinical application for interpreting anterior shoulder position test results in this population. Level of Evidence 3.
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Affiliation(s)
- Todd Ellenbecker
- Rehab Plus Sports Therapy Scottsdale, AZ, USA; Vice President Medical Services, ATP Tour, Scottsdale, AZ, USA
| | - E Paul Roetert
- Managing Director of USTA University, United States Tennis Association, Orlando, FL, USA
| | | | - Mark Kovacs
- International Tennis Performance Association, Atlanta, GA, USA; Kovacs Institute, Atlanta, GA, USA
| | | | - David Bailie
- Arizona Institute for Sports Knees & Shoulders, Scottsdale, AZ, USA
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Haeni D, Martinez-Catalan N, Esper RN, Wagner ER, El Hassan BT, Sanchez-Sotelo J. Arthroscopic release of the pectoralis minor tendon from the coracoid for pectoralis minor syndrome. J Exp Orthop 2022; 9:57. [PMID: 35713735 PMCID: PMC9206061 DOI: 10.1186/s40634-022-00491-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/31/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose The term “pectoralis minor syndrome” refers to this constellation of symptoms that can occur when the pectoralis minor (Pm) is shortened and contracted. Release of the tendon of the Pm from the coracoid has been reported to provide substantial clinical improvement to patients presenting with pectoralis minor syndrome. The purpose of this study was (1) to describe the technique for endoscopic release of pectoralis minor tendon at the subdeltoid space, (2) to classify the pectoralis minor syndrome according to its severity and (3) and to report the short-term outcomes of this procedure in a consecutive series of patients diagnosed with pectoralis minor syndrome. Methods Endoscopic release of the pectoralis minor tendon was performed in a series of 10 patients presenting with pectoralis minor syndrome. There were six females and four males with a median age at the time of surgery of 42 (range from 20 to 58) years. Four shoulders were categorized as grade I (scapular dyskinesis), and six as grade II (intermittent brachial plexopathy). Shoulders were evaluated for pain, motion, satisfaction, subjective shoulder value (SSV), quick-DASH, ASES score, and complications. The mean follow-up time was 19 (range, 6 to 49) months. Results Arthroscopic release of the tendon of the Pm led to substantial resolution of pectoralis minor syndrome symptoms in all but one shoulder, which was considered a failure. Preoperatively, the median VAS for pain was 8.5 (range, 7–10) and the mean SSV was 20% (range, 10% - 50%). At most recent follow-up the mean VAS for pain was 1 (range, 0–6) and the mean SSV 80% (range, 50% - 90%). Before surgery, mean ASES and quick-DASH scores were 19.1 (range, 10–41.6) and 83.1 (range, 71 and 95.5) points respectively. At most recent follow-up, mean ASES and quick-DASH scores were 80.1 (range, 40–100) and 19.3 (range, 2.3–68) points respectively. No surgical complications occurred in any of the shoulder included in this study. Conclusions Endoscopic release of the tendon of the pectoralis minor from the coracoid improves pain, function and patient reported outcomes in the majority of patients presenting with the diagnosis of isolated pectoralis minor syndrome. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-022-00491-x.
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Affiliation(s)
- David Haeni
- ALTIUS Swiss Sportmed Center, Rheinfelden, Switzerland
| | - Natalia Martinez-Catalan
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA.,Department of Orthopedic Surgery, Hospital Fundación Jiménez Diaz, Madrid, Spain
| | - Ronda N Esper
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA
| | - Eric R Wagner
- Departments of Orthopedic Surgery, Emory University, Atlanta, GA, USA
| | - Bassem T El Hassan
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA
| | - Joaquin Sanchez-Sotelo
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA.
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11
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Schydlowsky P, Szkudlarek M, Madsen OR. Comprehensive supervised heavy training program versus home training regimen in patients with subacromial impingement syndrome: a randomized trial. BMC Musculoskelet Disord 2022; 23:52. [PMID: 35033043 PMCID: PMC8760780 DOI: 10.1186/s12891-021-04969-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 12/17/2021] [Indexed: 12/05/2022] Open
Abstract
Background There is no consensus on the best training regimen for subacromial impingement syndrome (SIS). Several have been suggested, but never tested. The purpose of the study is to compare a comprehensive supervised training regimen (STR) based on latest evidence including heavy slow resistance training with a validated home-based regimen (HTR). We hypothesized that the STR would be superior to the HTR. Methods Randomised control trial with blinded assessor. 126 consecutive patients with SIS were recruited and equally randomised to 12 weeks of either supervised training regimen (STR), or home-based training regimen (HTR). Primary outcomes were Constant Score (CS) and Shoulder Rating Questionnaire (SRQ) from baseline and 6 months after completed training. Results were analyzed according to intention-to treat principles. The study was retrospectively registered in ClinicalTrials.gov. Date of registration: 07/06/2021. Identification number: NCT04915430. Results CS improved by 22.7 points for the STR group and by 23,7 points for the HTR (p = 0.0001). The SRQ improved by 17.7 and 18.1 points for the STR and the HTR groups respectively (p = 0.0001). The inter-group changes were non-significant. All secondary outcomes (passive and active range of motion, pain on impingement test, and resisted muscle tests) improved in both groups, without significant inter-group difference. Conclusion We found no significant difference between a comprehensive supervised training regimen including heavy training principles, and a home-based training program in patients with SIS.
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Affiliation(s)
| | - Marcin Szkudlarek
- Reumatologiklinikken i Værløse, Bymidten 11,1, 3500, Værløse, Denmark.,Department of Rheumatology, Zealand University Hospital at Køge, Køge, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole Rintek Madsen
- Department of Rheumatology and Spine Diseases, Gentofte University Hospital and Rigshospitalet, DK-2900, Hellerup, Denmark
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Ziebart C, Pt CM, Pt JL. Low Risk of Fracture With End-Range Movements of the Hip in People With Low Bone Mineral Density: A Narrative Review. Gerontol Geriatr Med 2021; 7:23337214211052398. [PMID: 34820484 PMCID: PMC8606974 DOI: 10.1177/23337214211052398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The risks of end-range movements for people with osteoporosis, specifically at the hips and shoulder, are not well understood. Objectives: To synthesize literature on the safety of stretching for people with osteoporosis by searching: 1) biomechanical literature to determine how much force results from an end-range maneuverer and is required to fracture joint components (focusing on the hip joint) and 2) clinical literature to describe techniques used, populations studied, effects, and reported adverse events. Methods: We conducted two separate search strategies in PubMed, EMBASE, and Scopus (1955-2020). Results: 16 articles described either biomechanical or clinical effects of passive and active end ranges of the hip joint. The largest load in the hip, described in the literature was in a crescent lunge during yoga. The moment produced in a crescent lunge is much smaller than that of the tensile strength of osteoporotic bone, suggesting the crescent lunge movement could be considered safe. Clinically, no adverse events were reported in exercise, stretching or yoga interventions. Conclusion: This review found no evidence that end range movements of the hip are unsafe, but there is little evidence. No studies were identified that explored the risk of humeral fracture during end range stretches.
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Affiliation(s)
- Christina Ziebart
- Health and Rehabilitation Sciences, Western University, 1201 Western Rd., London, ON N6A 3K7, Canada
| | | | - Judi Laprade Pt
- Division of Anatomy, University of Toronto, Toronto, ON, Canada
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13
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Almeida RF, Pereira ND, Ribeiro LP, Barreto RPG, Kamonseki DH, Haik MN, Camargo PR. Is the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire Adequate to Assess Individuals With Subacromial Pain Syndrome? Rasch Model and International Classification of Functioning, Disability and Health. Phys Ther 2021; 101:6145042. [PMID: 33609355 DOI: 10.1093/ptj/pzab065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/25/2020] [Accepted: 12/31/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is widely used to assess patients with symptoms of subacromial pain syndrome (SPS). No study has analyzed the DASH by using the Rasch model in these patients and related the level of difficulty of the items with the International Classification of Functioning Disability and Health (ICF) domains. The purpose of this study was to evaluate the measurement properties of the DASH in individuals with SPS and to describe which ICF components are influenced by SPS based on the DASH. METHODS The full version of the DASH was used to assess upper limb pain and function in individuals with SPS. Responses were assessed using the Rasch model. DASH items were grouped according to the level of difficulty and associated with the ICF domains to identify the most compromised aspect in these individuals. RESULTS Reliability and internal consistency for the DASH were shown to be 0.93 and 0.95, respectively. Item 3 ("Turn a key") was the easiest and 25 ("Pain during specific activity") the most difficult. Only item 30 ("Less capable/confident/useful") was as an erratic item. Item 15 ("Put on a sweater") showed differential functioning by age and item 11 ("Carry a heavy object") by sex. Seven items showed differential functioning related to the angular onset of pain during arm elevation. Sixty percent of the most difficult items belonged to the "Body function" domain of the ICF. CONCLUSION Although some psychometric properties of the DASH are adequate according to the Rasch model, adjustments to some items are necessary for individuals with SPS. Clinicians should be cautious when interpreting the DASH, especially in patients with angular onset of pain above 120 degrees of arm elevation. IMPACT The information contained in this study should be used by clinicians to interpret the results of the DASH when assessing individuals with SPS. The DASH may not be adequate to assess those with shoulder pain above 120 degrees of arm elevation. These results are not generalizable to other shoulder pathologies.
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Affiliation(s)
- Rafaela F Almeida
- Department of Physical Therapy, Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Natalia D Pereira
- Department of Physical Therapy, Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Larissa P Ribeiro
- Department of Physical Therapy, Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Rodrigo Py G Barreto
- Department of Physical Therapy, Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Danilo H Kamonseki
- Department of Physical Therapy, Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Melina N Haik
- Department of Physical Therapy, Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Paula R Camargo
- Department of Physical Therapy, Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
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14
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Rosa DP, Borstad JD, Ferreira JK, Gava V, Santos RV, Camargo PR. Comparison of specific and non-specific treatment approaches for individuals with posterior capsule tightness and shoulder impingement symptoms: A randomized controlled trial. Braz J Phys Ther 2021; 25:648-658. [PMID: 34001426 DOI: 10.1016/j.bjpt.2021.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/11/2021] [Accepted: 04/06/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Posterior capsule tightness (PCT) is associated with shoulder pain and altered shoulder kinematics, range of motion (ROM), external rotation (ER) strength, and pain sensitization. OBJECTIVE To assess the effects of two interventions on shoulder kinematics, Shoulder Pain and Disability Index (SPADI) scores, ROM, strength, and pressure pain threshold (PPT) in individuals with PCT and shoulder impingement symptoms. METHODS In this prospectively registered randomized controlled trial 59 individuals were randomized to either an Experimental Intervention Group (EIG, n=31) or a Control Intervention Group (CIG, n=28). The low flexion (LF) test was used to determine the presence of PCT. Shoulder kinematics, SPADI scores, internal rotation (IR) and ER ROM, ER strength, and PPT were measured pre- and post-treatment. Those in the EIG received an intervention specific to pain and PCT and those in the CIG received a non-specific intervention, both 4 weeks in duration. RESULTS Individuals in the EIG demonstrated more scapular upward rotation (P=.03; mean difference (MD)=3.3°; 95% Confidence Interval (CI)=1.3°, 4.9°) and improved value on the LF test (P=.02; MD=4.6°; 95%CI=0.7°, 8.6°) than those in the CIG after treatment. Both groups presented less anterior (P<.01; MD=-0.7mm; 95%CI=-1.3mm, -0.2mm) and superior (P<.01; MD=-0.5mm; 95%CI=-0.9mm, -0.2mm) humeral translations, decreased SPADI score (P<.01; MD=-23.6; 95%CI=-28.7, -18.4), increased IR ROM (P<.01; MD=4.6°; 95%CI=1.8°, 7.8°) and PPTs for upper trapezius (P<.01; MD=60.1kPa; 95%CI=29.3kPa, 90.9kPa), infraspinatus (P=.04; MD=47.3kPa; 95%CI=2.1kPa, 92.5kPa), supraspinatus (P<.01; MD=63.7kPa; 95%CI=29.6kPa, 97.9kPa), and deltoid (P<.01; MD=40.9kPa; 95%CI=12.3kPa, 69.4kPa) after treatment. CONCLUSION The experimental intervention was more effective at improving PCT as measured through changes in the LF test. No benefit of the specific approach over the non-specific intervention was noted for the remaining variables.
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Affiliation(s)
- Dayana P Rosa
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - John D Borstad
- Department of Physical Therapy, The College of St. Scholastica, Duluth, MN, USA
| | - Julia K Ferreira
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Vander Gava
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Rodrigo V Santos
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Paula R Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil.
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15
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Umehara J, Nakamura M, Saeki J, Tanaka H, Yanase K, Fujita K, Yamagata M, Ichihashi N. Acute and Prolonged Effects of Stretching on Shear Modulus of the Pectoralis Minor Muscle. JOURNAL OF SPORTS SCIENCE AND MEDICINE 2021; 20:17-25. [PMID: 33707982 DOI: 10.52082/jssm.2021.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/23/2020] [Indexed: 12/17/2022]
Abstract
Increased muscle stiffness of the pectoralis minor (PMi) could deteriorate shoulder function. Stretching is useful for maintaining and improving muscle stiffness in rehabilitation and sport practice. However, the acute and prolonged effect of stretching on the PMi muscle stiffness is unclear due to limited methodology for assessing individual muscle stiffness. Using shear wave elastography, we explored the responses of shear modulus to stretching in the PMi over time. The first experiment (n = 20) aimed to clarify the acute change in the shear modulus during stretching. The shear modulus was measured at intervals of 30 s × 10 sets. The second experiment (n = 16) aimed to observe and compare the prolonged effect of different durations of stretching on the shear modulus. Short and long stretching duration groups underwent 30s × 1 set and 30s × 10 sets, respectively. The assessments of shear modulus were conducted before, immediately after, and at 5, 10, and 15 min post-stretching. In experiment I, the shear modulus decreased immediately after a bout (30 s) of stretching (p < 0.001, change: -2.3 kPa, effect size: r = 0.72) and further decreased after 3 repetitions (i.e., 90 s) of stretching (p = 0.03, change: -1.0 kPa, effect size: r = 0.53). In experiment II, the change in the shear modulus after stretching was greater in the long duration group than in the short duration group (p = 0.013, group mean difference: -2.5 kPa, partial η 2 = 0.36). The shear modulus of PMi decreased immediately after stretching, and stretching for a long duration was promising to maintain the decreased shear modulus. The acute and prolonged effects on the PMi shear modulus provide information relevant to minimum and persistent stretching time in rehabilitation and sport practice.
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Affiliation(s)
- Jun Umehara
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.,Center for Information and Neural Networks, National Institute of Information and Communications Technology, Osaka, Japan
| | - Masatoshi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Junya Saeki
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.,Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Hiroki Tanaka
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan.,Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Ko Yanase
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Kosuke Fujita
- Department of Community Healthcare and Geriatrics, Graduate School of Medicine, Nagoya University, Aichi, Japan
| | - Momoko Yamagata
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.,Graduate School of Human Development and Environment, Kobe University, Hyogo, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan
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16
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Kamonseki DH, Haik MN, Camargo PR. Scapular movement training versus standardized exercises for individuals with chronic shoulder pain: protocol for a randomized controlled trial. Braz J Phys Ther 2021; 25:221-229. [PMID: 32855073 PMCID: PMC7990736 DOI: 10.1016/j.bjpt.2020.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Scapular focused exercise interventions are frequently used to treat individuals with shoulder pain. However, evidence for changes in scapular motion after intervention is limited. OBJECTIVE To compare the effects of scapular movement training versus standardized exercises for individuals with shoulder pain. METHODS This will be a single-blinded randomized controlled trial. Sixty-four individuals with shoulder pain for at least 3 months, scapular dyskinesis, and a positive scapular assistance test will be randomly allocated to one of two groups: Scapular Movement Training (group 1) and Standardized Exercises (group 2). Group 1 will receive education about scapular position and movement, and be trained to modify the scapular movement pattern. Group 2 will perform stretching and strengthening exercises. Both groups will be treated twice a week for eight weeks. Three-dimensional scapular kinematics and muscle activity of the serratus anterior and upper, middle, and lower trapezius during elevation and lowering of the arm will be assessed at baseline and after 8 weeks of treatment. Pain intensity, function, fear avoidance beliefs, and kinesiophobia will be assessed at baseline and after 4 and 8 weeks of treatment, and 4 weeks after the end of treatment. CONCLUSIONS The results of this study may contribute to a better understanding of the efficacy of scapular focused treatments for individuals with shoulder pain. CLINICAL TRIAL REGISTRATION NCT03528499.
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Affiliation(s)
- Danilo Harudy Kamonseki
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Melina Nevoeiro Haik
- Department of Physical Therapy, Center of Health and Sport Science, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil
| | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil.
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17
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Mashola MK, Korkie E, Mothabeng DJ. Pain and its impact on functioning and disability in manual wheelchair users with spinal cord injury: a protocol for a mixed-methods study. BMJ Open 2021; 11:e044152. [PMID: 33408217 PMCID: PMC7789463 DOI: 10.1136/bmjopen-2020-044152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Approximately 80% of people with spinal cord injury experience clinically significant chronic pain. Pain (whether musculoskeletal or neuropathic) is consistently rated as one of the most difficult problems to manage and negatively affects the individual's physical, psychological and social functioning and increases the risk of pain medication misuse and poor mental health. The aim of this study is to therefore determine the presence of pain and its impact on functioning and disability as well as to develop a framework for self-management of pain for South African manual wheelchair users with spinal cord injury. METHODS AND ANALYSIS Community-dwelling participants with spinal cord injury will be invited to participate in this three-phase study. Phase 1 will use a quantitative, correlational design to determine factors related to pain such as pectoralis minor length, scapular dyskinesis, wheelchair functioning, physical quality of life, community reintegration and pain medication misuse. Demographic determinants of pain such as age, gender, type of occupation, completeness of injury and neurological level of injury will also be investigated. Participants with pain identified in phase 1 will be invited to partake in a qualitative descriptive and contextually designed phase 2 to explore their lived experience of pain through in-depth interviews. The results of phases 1 and 2 will then be used with the assistance from experts to develop a framework for self-management of pain using a modified Delphi study. Data analysis will include descriptive and inferential statistics (quantitative data) and thematic content analysis (qualitative data). ETHICS AND DISSEMINATION Approval for this study is granted by the Faculty of Health Sciences Research Ethics Committee of the University of the Pretoria (approval number 125/2018). This study is registered with the South African National Health Research Database (reference GP201806005). This study's findings will be shared in academic conferences and published in scientific peer-reviewed journals.
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Affiliation(s)
- Mokgadi Kholofelo Mashola
- Department of Physiotherapy, School of Healthcare Sciences, University of Pretoria, Pretoria, South Africa
- Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elzette Korkie
- Department of Physiotherapy, School of Healthcare Sciences, University of Pretoria, Pretoria, South Africa
| | - Diphale Joyce Mothabeng
- Department of Physiotherapy, School of Healthcare Sciences, University of Pretoria, Pretoria, South Africa
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18
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Komati MA, Korkie FE, Becker P. Pectoralis minor length measurements in three different scapula positions. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1487. [PMID: 33241159 PMCID: PMC7670008 DOI: 10.4102/sajp.v76i1.1487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022] Open
Abstract
Background The pectoralis minor (PM) muscle is commonly regarded as a contributor to abnormal scapula positioning. Subsequently, the muscle length of the scapular stabilising muscles may be affected, as these muscles assume a lengthened position, which over time causes weakness. There are inconsistencies regarding PM muscle length values because of the different techniques and positions used when the length of the PM muscle is measured. Objective To determine the PM muscle length in participants aged 18−24 using a Vernier® caliper and expressed as pectoralis minor index (PMI), with the scapula in three different positions. Method The PM muscle length of 144 participants was measured with a Vernier® caliper (intraclass correlation coefficient 0.83−0.87). Measurements were made with the scapula in the resting position, in an active and a passive posterior tilt position. Results Significant differences were observed in PMI between the resting scapula position – 10.04 (confidence interval, CI 9.93–10.14) and active posterior tilt – 10.19 (CI 10.09–10.30) (p < 0.001); the resting position – 10.04 (CI 9.93–10.14) and passive posterior tilt – 10.77 (10.66–10.87) (p < 0.001) and active – 10.19 (CI 10.09–10.30) and passive posterior tilt 10.77 (10.66–10.87) (p < 0.001). The dominant side had lower PMI values than the non-dominant side. Conclusion The significant differences between the active and posterior tilt positions suggested that optimal muscle length of PM was affected by the inner range strength of the lower fibres of Trapezius. Clinical implications It is important that in clinical practice not only the length of PM in scapular misalignment but also the strength of the antagonistic muscles is considered.
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Affiliation(s)
- Muhle A Komati
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Francina E Korkie
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Piet Becker
- Department of Biostatistics, Research Office, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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19
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Navarro-Ledesma S, Fernandez-Sanchez M, Struyf F, Luque Suarez A. Association of Both Scapular Upward Rotation and Scapulothoracic Muscle Lengths With Shoulder Pain, Function, and Range of Movement. J Manipulative Physiol Ther 2020; 43:824-831. [PMID: 32928568 DOI: 10.1016/j.jmpt.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/23/2019] [Accepted: 12/06/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Our aim was to analyze whether shoulder pain is related to scapular upward rotation (SUR) or to the lengths of the pectoralis minor and levator scapulae muscles. METHODS This cross-sectional, observational study was carried out in 3 primary-care centers; 54 individuals with chronic shoulder pain participated. Scapular upward rotation and the lengths of the pectoralis minor and levator scapulae muscles were assessed. RESULTS The level of association was small between shoulder pain and function and (1) the lengths of the pectoralis minor (r = 0.08, P = .93) and levator scapulae (r = -0.01, P = .57) muscles and (2) SUR at 45° (r = 0.17, P = .21), 90° (r = 0.08, P = .57), and 135° (r = 0.10, P = 0.45) of shoulder elevation. CONCLUSION The relationship was small between shoulder pain and function and (1) SUR (45°, 90°, and 135° of shoulder elevation) and (2) the lengths of the pectoralis minor and levator scapulae muscles. Thus, the use of SUR and pectoralis minor and levator scapulae lengths in shoulder assessment should be undertaken with caution. Other factors such as psychological factors, central/peripheral sensitization, and intrinsic properties of the tissue have to be taken into account.
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Affiliation(s)
| | | | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Alejandro Luque Suarez
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, Málaga, Spain; Instituto de la Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
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20
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Ahmed S, Brown J, Gray J. Predictors of throwing performance in amateur male cricketers: A musculoskeletal approach. Eur J Sport Sci 2020; 21:1119-1128. [PMID: 32883180 DOI: 10.1080/17461391.2020.1819434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Optimal throwing speed and accuracy is built on a complex interaction of multiple variables. Although strength and power has been associated with throwing speed in cricketers, the individual muscles that contribute to optimal function of the shoulder-complex has not been adequately explored in connection with throwing performance. Consequently, this study aimed to investigate the correlation between musculoskeletal variables and overhead throwing performance in cricketers. Thirty-two amateur male cricketers were tested using a battery of 16 tests (strength, flexibility, scapula positioning) as well as a throwing speed (TS) and a novel accuracy test (TA). Only two of the sixteen tests were correlated with throwing performance in the multiple regression analysis. Non-dominant hip abduction strength correlated positively with TS (p < 0.05): on average, a strength increase of 10 newtons (N) was associated with an increase in TS of 0.60 km/h (95% CI: 0.12-1.08). Non-dominant pectoralis minor length correlated positively with TA (p < 0.01): on average, a one-centimetre increase in the length correlated to an increase, of 0.633 points (95% CI: 0.225-1.041). This cross-sectional study demonstrated that from an array of musculoskeletal variables, only non-dominant hip abduction strength correlated with TS, while only non-dominant pectoralis minor length correlated with TA in amateur cricketers.
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Affiliation(s)
- Safwaan Ahmed
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Newlands, South Africa
| | - James Brown
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,IOC Research Centre, Cape Town, South Africa
| | - Janine Gray
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Newlands, South Africa.,Department of Orthopaedics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Cricket South Africa, Johannesburg, South Africa
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21
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Ribeiro LP, Barreto RPG, Pereira ND, Camargo PR. Comparison of scapular kinematics and muscle strength between those with a positive and a negative Scapular Assistance Test. Clin Biomech (Bristol, Avon) 2020; 73:166-171. [PMID: 32000046 DOI: 10.1016/j.clinbiomech.2019.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 11/21/2019] [Accepted: 12/31/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Scapular Assistance Test was suggested to directly assess the influence of scapular motion on pain and indirectly measure the function of the scapular rotators. However, it is still not clear if individuals with a positive Scapular Assistance Test actually present changes in scapular motion and muscle strength. This study compared scapular kinematics and muscle strength between those with a positive Scapular Assistance Test and those with a negative Scapular Assistance Test. METHODS Fifty individuals with shoulder pain were randomly allocated to: positive (n = 25) or negative Scapular Assistance Test (n = 25) group. Scapular kinematics was measured during elevation and lowering of the arm. Strength of the serratus anterior and lower trapezius was also measured. Two-way analysis of variance was used to compare kinematics between groups. Unpaired Student's t-test and Mann-Whitney test were used to compare strength of serratus anterior and lower trapezius, respectively. FINDINGS There were no differences (P > 0.05) in scapular internal rotation and upward rotation between both groups. For scapular tilt, there was group main effect (P < 0.05) during elevation and lowering of the arm, whereas the positive Scapular Assistance Test group presented greater scapular anterior tilt. There was no difference (P > 0.05) in strength between groups. INTERPRETATION Individuals with a positive Scapular Assistance Test are more likely to present decreased scapular posterior tilt in those with shoulder pain. Strength of the scapular muscles seems to be same in those with a positive and a negative Scapular Assistance Test.
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Affiliation(s)
- Larissa Pechincha Ribeiro
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Rodrigo Py Gonçalves Barreto
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Natalia Duarte Pereira
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil.
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22
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Comparison of Myofascial Release Techniques on Pectoralis Minor Length, Glenohumeral Total Arc of Motion, and Skin Temperature: A Pilot Study. J Sport Rehabil 2020; 29:137-141. [PMID: 30526261 DOI: 10.1123/jsr.2018-0130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 10/15/2018] [Accepted: 10/28/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT The pectoralis minor (PM) is an important postural muscle that may benefit from myofascial techniques, such as Graston Technique® (GT) and self-myofascial release (SMR). OBJECTIVE To examine the effects of GT and SMR on PM length, glenohumeral total arc of motion (TAM), and skin temperature. DESIGN Cohort. SETTING Laboratory. PARTICIPANTS Twenty-six healthy participants (19 females and 7 males; age = 20.9 [2.24] y, height = 170.52 [8.66] cm, and weight = 72.45 [12.32] kg) with PM length restriction participated. INTERVENTIONS Participants were randomized to the intervention groups (GT = 12 and SMR = 14). GT and SMR interventions were both applied for a total of 5 minutes during each of the 3 treatment sessions. MAIN OUTCOME MEASURES PM length, TAM, and skin temperature were collected before and after each intervention session (Pre1, Post1, Pre2, Post2, Pre3, and Post3) and at 1-week follow-up (follow-up). Separate intervention by time analyses of variance examined differences for each outcomes measure. Bonferroni post hoc analyses were completed when indicated. Significance was set a priori at P ≤ .05. RESULTS No significant intervention by time interactions were identified for PM length, TAM, or temperature (P > .05). No significant intervention main effects were identified for PM length (P > .05), TAM (P > .05), or temperature (P > .05) between the GT or SMR technique groups. Overall, time main effects were found for PM length (P = .02) and temperature (P < .001). Post hoc analysis showed a significant increase in PM length for both intervention groups at follow-up (P = .03) compared with Post2. Furthermore, there were significant increases in temperature at Post1 (P < .001), Post2 (P = .01), and Post3 (P < .001) compared with Pre1; Post2 was increased compared with Pre2 (P = .003), Pre3 (P < .001), and follow-up (P = .01); Post3 increased compared with Pre3 (P = .01) and follow-up (P = .01). CONCLUSION Serial application of GT and SMR to the PM did not result in increases in PM length or TAM. Regardless of intervention, skin temperature increased following each intervention.
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Nodehi Moghadam A, Rahnama L, Noorizadeh Dehkordi S, Abdollahi S. Exercise therapy may affect scapular position and motion in individuals with scapular dyskinesis: a systematic review of clinical trials. J Shoulder Elbow Surg 2020; 29:e29-e36. [PMID: 31420226 DOI: 10.1016/j.jse.2019.05.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Therapeutic exercise for scapular muscles is suggested to be effective in reducing shoulder pain in patients with rotator cuff disorders, whereas its effectiveness on scapular position and motion has remained unclear. Therefore, the aim of this systematic review was to investigate whether exercise therapy improves scapular position and motion in individuals with scapular dyskinesis. METHODS This study is a wide systematic review including any type of clinical trial in which the effect of any type of therapeutic exercise, including scapular muscle strengthening, stretching, and scapular stabilization exercise, is investigated in adult participants. RESULTS Twenty studies were included in this systematic review. Studies were categorized on the basis of the techniques they used to measure scapular position and motion and the included participants. Methodologic quality of the studies was assessed by the Cochrane tool of assessing the risk of bias. Eight studies used 3-dimensional techniques for measuring scapular motions. Among them, 5 studies showed significant effects of exercise on scapular motion, of which 3 studies investigated individuals with subacromial impingement syndrome (SIS). The other 12 studies used 2-dimensional measurement techniques, of which 8 studies reported significant effects of exercise on scapular position and motion both in SIS patients and in asymptomatic individuals. However, their methodologic quality was debatable. Therefore, there was conflicting evidence for the effect of exercise on scapular dyskinesis. CONCLUSION There is a lack of evidence for beneficial effects of exercise in improving scapular position and motion in individuals with scapular dyskinesis. However, exercise is beneficial in reducing pain and disability in individuals with SIS.
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Affiliation(s)
- Afsun Nodehi Moghadam
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Leila Rahnama
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Shohreh Noorizadeh Dehkordi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Abstract
STUDY DESIGN Clinical commentary. INTRODUCTION/PURPOSE Pain and movement are universally relevant phenomena that influence human experiences in readily observable ways. Improved understanding of pain-movement relationships can guide medical and rehabilitative approaches to recovery and decrease risk of dysfunctional long-term consequences of otherwise normal neuromuscular responses. Therefore, the overall intent of this article is to elucidate the relationships between pain and movement as they relate to clinical decision making. CONCLUSIONS Motor output is highly adaptable, can be influenced by multiple mechanisms at various levels along the nervous system, and may vary between individuals despite similar diagnoses. Therefore, interventions need to be individualized and consider both the types of motor response observed (ie, whether the response is protective or maladaptive), and the patient's acute physical activity tolerance when prescribing exercise/movement.
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Does pectoralis minor stretching provide additional benefit over an exercise program in participants with subacromial pain syndrome? A randomized controlled trial. Musculoskelet Sci Pract 2019; 44:102052. [PMID: 31472414 DOI: 10.1016/j.msksp.2019.102052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/18/2019] [Accepted: 08/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Adaptive shortening of the pectoralis minor is one of the biomechanical mechanisms associated with subacromial pain syndrome (SPS). OBJECTIVE To compare the effects of an exercise program alone with an exercise program in combination with pectoralis minor stretching in participants with SPS. DESIGN Randomized controlled trial. METHODS Eighty adult participants with SPS were randomly allocated to two groups. The control group (n = 40) received a 12-week specific exercise program and the intervention group (n = 40) received the same program plus stretching exercises of the pectoralis minor muscle. The primary outcome measure was shoulder function assessed by a Constant-Murley questionnaire, and the secondary outcomes were the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, visual analog scale (VAS), and pectoralis minor resting length. RESULTS The present study shows no difference between the two interventions according to the Constant-Murley questionnaire (1.5 points; p = 0.58), VAS at rest (0.2 cm; p = 0.11), VAS at movement (0.5 cm; p = 0.08), and pectoralis minor resting length (0.3 cm; p = 0.06). The DASH questionnaire showed greater functional improvement in the control group (5.4 points; p = 0.02). Finally, only pectoralis minor length index showed difference statistical significant in favor of intervention group (0.3%; p = 0.04). CONCLUSION In the short-term, the addition of a program of stretching exercises of the pectoralis minor does not provide significant clinical benefit with respect to functional improvement or pain reduction in participants with SPS. TRIAL REGISTRATION Brazilian registry of clinical trials UTN number U1111-1210-3555. Registered 5 March 2018.
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Acute Effects of Pectoralis Minor Self-Mobilization on Shoulder Motion and Posture: A Blinded and Randomized Placebo-Controlled Study in Asymptomatic Individuals. J Sport Rehabil 2019; 29:420-424. [PMID: 30860417 DOI: 10.1123/jsr.2018-0220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 01/12/2019] [Accepted: 02/06/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Tightness of the pectoralis minor is a common characteristic that has been associated with aberrant posture and shoulder pathology. Determining conservative treatment techniques for maintaining and lengthening this muscle is critical. Although some gross stretching techniques have been proven effective, there are currently no empirical data regarding the effectiveness of self-myofascial release for treating tightness of this muscle. OBJECTIVE To determine the acute effectiveness of a self-myofascial release with movement technique of the pectoralis minor for improving shoulder motion and posture among asymptomatic individuals. DESIGN Randomized controlled trial. SETTING Orthopedic rehabilitation clinic. PARTICIPANTS A total of 21 physically active, college-aged individuals without shoulder pain volunteered to participate in this study. MAIN OUTCOME MEASURES Glenohumeral internal rotation, external rotation, and flexion range of motion (ROM), pectoralis minor length, and forward scapular posture were measured in all participants. The intervention group received one application of a self-soft-tissue mobilization of the pectoralis minor with movement. The placebo group completed the same motions as the intervention group, but with minimal pressure applied to the xiphoid process. Separate analyses of covariance were used to determine differences between groups (P < .05). RESULTS Separate analyses of covariance showed that the self-mobilization group had significantly more flexion ROM, pectoralis minor length, and less forward scapular posture posttest than the placebo group. However, the difference in forward scapular posture may not be clinically significant. No differences were found between groups for external or internal rotation ROM. CONCLUSIONS The results of this study indicate that an acute self-myofascial release with movement is effective for improving glenohumeral flexion ROM and pectoralis minor length, and may assist with forward scapular posture. Clinicians should consider this self-mobilization in the prevention and rehabilitation of pathologies associated with shortness of the pectoralis minor.
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Vincent HK, Vincent KR. Rehabilitation and Prehabilitation for Upper Extremity in Throwing Sports: Emphasis on Lacrosse. Curr Sports Med Rep 2019; 18:229-238. [PMID: 31385839 DOI: 10.1249/jsr.0000000000000606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Lacrosse imposes multiple simultaneous physical demands during play including throwing and catching a ball while holding a crosse, running, cutting, and jumping. Often, these skills are completed while experiencing contact from another player leading to both on-and-off platform movements. Other motions include defensive blocking and pushing past defenders. Repetitive motions over sustained durations in practice or competition impart mechanical stresses to the shoulder or elbow joints, supportive muscles, and connective tissue. Preparation for lacrosse participation involves bilateral optimization of strength and durability of stabilizer muscles. Passing and shooting skills are encouraged to be equally effective on both sides; therefore, symmetric strength and flexibility are vital for prehabilitation and rehabilitation efforts. This article will: 1) provide insights on the upper-extremity musculoskeletal demands of lacrosse and related sports with similar throwing motion and 2) describe prehabilitation and rehabilitation methods that improve athlete durability and reduce likelihood of upper-extremity injury.
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Affiliation(s)
- Heather K Vincent
- Department of Orthopaedics and Rehabilitation, UF Health Sports Performance Center, University of Florida, Gainesville, FL
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Lai CC, Chen SY, Yang JL, Lin JJ. Effectiveness of stretching exercise versus kinesiotaping in improving length of the pectoralis minor: A systematic review and network meta-analysis. Phys Ther Sport 2019; 40:19-26. [PMID: 31442850 DOI: 10.1016/j.ptsp.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Shortness of the pectoralis minor (PM) is a potential mechanism underlying shoulder impingement syndrome. Few studies have examined the effects of kinesiotaping and stretching exercise on PM length or index. This systematic review and network meta-analysis investigated the effects of stretching exercise and kinesiotaping on PM length and index in adults. METHODS This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomised controlled trials including adults with or without symptomatic shoulders were included. Heterogeneity between studies was assessed using I2 statistics, and publication bias was evaluated by constructing a funnel plot. RESULTS We extracted data from six randomised controlled trials that included 263 participants (age range: 18-50 years). Compared with usual care, kinesiotaping resulted in greater improvement in PM length (mean difference, 1.15 cm; 95% confidence interval [CI]: 0.20-2.10 cm). Compared with usual care and kinesiotaping, proprioceptive neuromuscular facilitation (PNF) stretching increased PMI significantly, with a mean difference of 1.40 (95% CI: 1.17-1.63) and 1.08 (95% CI: 0.29-1.87) cm, respectively. CONCLUSION Compared with no intervention, kinesiotaping is beneficial for lengthening the PM. Intervention with static stretching alone has no effect on PM length. Compared with kinesiotaping alone and no intervention, PNF stretching increases PMI.
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Affiliation(s)
- Chih-Chin Lai
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Shiau-Yee Chen
- Department of Physical Medicine and Rehabilitation, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jing-Lan Yang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiu-Jenq Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Rosa DP, Borstad JD, Ferreira JK, Camargo PR. The Influence of Glenohumeral Joint Posterior Capsule Tightness and Impingement Symptoms on Shoulder Impairments and Kinematics. Phys Ther 2019; 99:870-881. [PMID: 30921461 DOI: 10.1093/ptj/pzz052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/18/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Posterior capsule tightness (PCT) and shoulder impingement syndrome (SIS) symptoms are both associated with altered shoulder biomechanics and impairments. However, their combined effect on kinematics, pain, range of motion (ROM), strength, and function remain unknown. OBJECTIVE The purpose of this study was to determine if the combination of PCT and SIS affects scapular and humeral kinematics, glenohumeral joint ROM, glenohumeral joint external rotation strength, pain, and function differently than does either factor (PCT or SIS) alone. DESIGN The design was a cross-sectional group comparison. METHODS Participants were placed into 1 of 4 groups based on the presence or absence of SIS and PCT: control group (n = 28), PCT group (n = 27), SIS group (n = 25), and SIS + PCT group (n = 25). Scapular kinematics and humeral translations were quantified with an electromagnetic motion capture system. Shoulder internal rotation and external rotation ROM, external rotation strength, and pain and Shoulder Pain and Disabilities Index scores were compared between groups with ANOVA. RESULTS The SIS group had greater scapular internal rotation (mean difference = 5.13°; 95% confidence interval [CI] = 1.53°-8.9°) and less humeral anterior translation (1.71 mm; 95% CI = 0.53-2.9 mm) than the other groups. Groups without PCT had greater internal rotation ROM (16.05°; 95% CI = 5.09°-28.28°). The SIS + PCT group had lower pain thresholds at the levator scapulae muscle (108.02 kPa; 95% CI = 30.15-185.88 kPa) and the highest Shoulder Pain and Disabilities Index score (∼ 44.52; 95% CI = 33.41-55.63). LIMITATIONS These results may be limited to individuals with impingement symptoms and cannot be generalized to other shoulder conditions. CONCLUSIONS Decreased ROM and lower pain thresholds were found in individuals with both impingement symptoms and PCT. However, the combination of factors did not influence scapular and humeral kinematics.
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Affiliation(s)
- Dayana P Rosa
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - John D Borstad
- Department of Physical Therapy, The College of St Scholastica, Duluth, Minnesota
| | - Julia K Ferreira
- Department of Physical Therapy, Universidade Federal de São Carlos
| | - Paula R Camargo
- Department of Physical Therapy, Universidade Federal de São Carlos, Rodovia Washington Luís, Km 235, 13565-905 São Carlos, São Paulo, Brazil
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Navarro-Ledesma S, Fernandez-Sanchez M, Struyf F, Martinez-Calderon J, Miguel Morales-Asencio J, Luque-Suarez A. Differences in scapular upward rotation, pectoralis minor and levator scapulae muscle length between the symptomatic, the contralateral asymptomatic shoulder and control subjects: a cross-sectional study in a Spanish primary care setting. BMJ Open 2019; 9:e023020. [PMID: 31196895 PMCID: PMC6575639 DOI: 10.1136/bmjopen-2018-023020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the potential differences in both scapular positioning and scapular movement between the symptomatic and asymptomatic contralateral shoulder, in patients with unilateral subacromial pain syndrome (SAPS), and when compared with participants free of shoulder pain. SETTING Three different primary care centres. PARTICIPANTS A sample of 73 patients with SAPS in their dominant arm was recruited, with a final sample size of 54 participants. PRIMARY OUTCOME MEASURES The scapular upward rotation (SUR), the pectoralis minor and the levator scapulae muscles length tests were carried out. RESULTS When symptomatic shoulders and controls were compared, an increased SUR at all positions (45°, 90° and 135°) was obtained in symptomatic shoulders (2/3,98/8,96°, respectively). These differences in SUR surpassed the minimal detectable change (MDC95) (0,91/1,55/2,83° at 45/90/135° of shoulder elevation). No differences were found in SUR between symptomatic and contralateral shoulders. No differences were found in either pectoralis minor or levator scapulae muscle length in all groups. CONCLUSIONS SUR was greater in patients with chronic SAPS compared with controls at different angles of shoulder elevation.
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Affiliation(s)
- Santiago Navarro-Ledesma
- Department of Physiotherapy, University of Granada. Faculty of Health Sciences, Granada, Spain
- Department of Physiotherapy, University of Malaga. Faculty of Health Sciences, Malaga, Spain
| | | | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Universiteit Antwerpen, Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | | | - Jose Miguel Morales-Asencio
- Universidad de Málaga. Facultad de Ciencias de la Salud. Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Department of Nursing, University of Malaga. Faculty of Health Sciences, Malaga, Spain
| | - Alejandro Luque-Suarez
- Department of Physiotherapy, University of Malaga. Faculty of Health Sciences, Malaga, Spain
- Universidad de Málaga. Facultad de Ciencias de la Salud. Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
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Rosa DP, Borstad JD, Pogetti LS, Camargo PR. In response to the letter to the editor regarding: Resting pectoralis minor muscle length: An accurate way to determine if the muscle is shortened? J Hand Ther 2019; 30:e7-e8. [PMID: 28801198 DOI: 10.1016/j.jht.2017.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/11/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Dayana P Rosa
- Federal University of São Carlos, São Carlos, Brazil
| | - John D Borstad
- Department of Physical Therapist, The College of St. Scholastica, Duluth, MN, USA
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Ebaugh D, Finley M, Goodstadt N. Resting pectoralis minor muscle length: An accurate way to determine if the muscle is shortened? J Hand Ther 2019; 30:e9. [PMID: 28705435 DOI: 10.1016/j.jht.2017.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/11/2017] [Indexed: 02/09/2023]
Affiliation(s)
- David Ebaugh
- Physical Therapy & Rehabilitation Sciences Department, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA.
| | - Margaret Finley
- Physical Therapy & Rehabilitation Sciences Department, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Noel Goodstadt
- Physical Therapy & Rehabilitation Sciences Department, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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Murta BAJ, Santos TRT, Araujo PA, Resende RA, Ocarino JM. Influence of reducing anterior pelvic tilt on shoulder posture and the electromyographic activity of scapular upward rotators. Braz J Phys Ther 2019; 24:135-143. [PMID: 30826186 DOI: 10.1016/j.bjpt.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 02/06/2019] [Accepted: 02/13/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Modifications of posture in a segment may influence the posture of adjacent and nonadjacent segments and muscular activity. The spine-shoulder and spine-pelvis relationships suggest that the pelvis may influence shoulder posture. OBJECTIVE To investigate the effect of the active reduction of the anterior pelvic tilt on shoulder and trunk posture during static standing posture and on the electromyographic activity of the scapular upward rotators during elevation and lowering of the arm. METHODS Thirty-one young adults were assessed in a relaxed standing position and a standing position with 30% active reduction of the anterior pelvic tilt. The pelvic tilt, trunk posture, and forward shoulder posture during the static standing posture and the electromyographic activity during elevation and lowering of the arm were assessed. RESULTS Paired t-tests indicated that the active reduction of the anterior pelvic tilt reduced the trunk extension (MD=1.09; 95%CI=-2.79 to -1.03). There were no effects on the forward shoulder posture (MD=0.09; 95%CI=-0.92 to 1.09). Repeated measures of analyses of variance indicated an increase in lower trapezius electromyographic activity (MD=3.6; 95%CI=1.28 to 5.92). There was a greater reduction in upper trapezius activity after pelvic tilt reduction during arm elevation (MD=1.52%; 95%CI=-2.79 to -0.25) compared to that during the lowering phase. There were no effects of pelvic tilt reduction on the electromyographic activity of the serratus anterior (MD=3.26; 95%CI=-3.36 to 9.87). CONCLUSION The influence of pelvic posture on the trunk posture and lower trapezius activation should be considered when assessing or planning exercise for individuals with shoulder or trunk conditions.
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Affiliation(s)
- Barbara Alice Junqueira Murta
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Thiago Ribeiro Teles Santos
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Priscila Albuquerque Araujo
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Renan Alves Resende
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Juliana Melo Ocarino
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
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Umehara J, Nakamura M, Nishishita S, Tanaka H, Kusano K, Ichihashi N. Scapular kinematic alterations during arm elevation with decrease in pectoralis minor stiffness after stretching in healthy individuals. J Shoulder Elbow Surg 2018; 27:1214-1220. [PMID: 29602634 DOI: 10.1016/j.jse.2018.02.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pectoralis minor tightness may be seen in individuals with scapular dyskinesis, and stretching is used for the treatment of altered scapular motion in sports and clinical fields. However, few researchers have reported on the effects of pectoralis minor stiffness on scapular motion during arm elevation. This study investigated whether an acute decrease of pectoralis minor stiffness after stretching changes the scapular motion during arm elevation. METHODS The study allocated 15 dominant and 15 nondominant upper limbs in healthy men as control and interventional limbs, respectively. In the intervention limb group, the shoulder was passively and horizontally abducted at 150° of elevation for 5 minutes to stretch the pectoralis minor muscle. Before and after stretching, an electromagnetic sensor was used to examine 3-dimensional scapular motion during abduction and scaption. Ultrasonic shear wave elastography was used to measure pectoralis minor stiffness before and immediately after stretching and after arm elevation. RESULTS In the interventional limb, pectoralis minor stiffness decreased by 3.2 kPa immediately after stretching and by 2.5 kPa after arm elevation. The maximal changes in scapular kinematics after stretching were 4.8° of external rotation and 3.3° of posterior tilt in abduction, and 4.5° of external rotation and 3.7° of posterior tilt in scaption. Upward rotation in abduction or scaption did not change. CONCLUSIONS Stretching for the pectoralis minor muscle increases external rotation and posterior tilt of the scapula during arm elevation.
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Affiliation(s)
- Jun Umehara
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Masatoshi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Satoru Nishishita
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Tanaka
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Ken Kusano
- Institute of Sports Science, ASICS Corporation, Kobe, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Ebaugh D, Pollen T, Mohring J, Gerrity K, Goodstadt N, Finley M. Pectoralis minor muscle elongation and scapulothoracic motion do not differ in individuals with short versus typical resting pectoralis minor muscle length: a cross-sectional study. Braz J Phys Ther 2018; 22:519-526. [PMID: 29914856 DOI: 10.1016/j.bjpt.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/26/2018] [Accepted: 05/24/2018] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Individuals with short resting pectoralis minor muscle length have been shown to have aberrant scapulothoracic motion when compared to individuals with long resting pectoralis minor muscle length. However, the degree to which the pectoralis minor muscle can be lengthened and whether or not scapulothoracic motion differs between individuals with short and typical resting pectoralis minor muscle length is unknown. OBJECTIVES To determine if: (1) pectoralis minor muscle elongation (percent pectoralis minor muscle can be actively and passively lengthened beyond resting length), (2) pectoralis minor muscle percent length change during overhead reaching, and (3) scapulothoracic motion during overhead reaching differ between individuals with short and typical resting pectoralis minor muscle length. DESIGN Two group comparison. METHODS Thirty healthy individuals were placed into a short or typical resting pectoralis minor muscle length group. A caliper was used to measure resting pectoralis minor muscle length and pectoralis minor muscle length during active and passive muscle lengthening. An electromagnetic tracking system was used to measure pectoralis minor muscle length change as well as scapular, humeral, and trunk motion during several arm elevation tasks. Pectoralis minor muscle elongation and length change during arm elevation tasks were compared between groups using independent t-tests. Two-factor mixed-model analyses of variance were used to compare scapulothoracic motion at arm elevation angles of 30°, 60°, 90°, and 120°. RESULTS Pectoralis minor muscle elongation and pectoralis minor muscle length change during arm elevation did not differ between groups. Scapulothoracic motion did not differ between groups across arm elevation tasks. CONCLUSIONS Although resting pectoralis minor muscle length differed between groups, pectoralis minor muscle lengthening and scapulothoracic motion were similar between participants with short and typical resting pectoralis minor muscle length. Additional studies are needed to better understand the role of pectoralis minor muscle elongation on scapulothoracic motion.
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Affiliation(s)
- David Ebaugh
- Physical Therapy & Rehabilitation Sciences Department, College of Nursing & Health Professions, Drexel University, Philadelphia, PA, USA.
| | - Travis Pollen
- Physical Therapy & Rehabilitation Sciences Department, College of Nursing & Health Professions, Drexel University, Philadelphia, PA, USA
| | - Jason Mohring
- Physical Therapy & Rehabilitation Sciences Department, College of Nursing & Health Professions, Drexel University, Philadelphia, PA, USA
| | | | - Noel Goodstadt
- Physical Therapy & Rehabilitation Sciences Department, College of Nursing & Health Professions, Drexel University, Philadelphia, PA, USA
| | - Margaret Finley
- Physical Therapy & Rehabilitation Sciences Department, College of Nursing & Health Professions, Drexel University, Philadelphia, PA, USA
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Rosa DP, Santos RV, Gava V, Borstad JD, Camargo PR. Shoulder external rotation range of motion and pectoralis minor length in individuals with and without shoulder pain. Physiother Theory Pract 2018; 35:986-994. [DOI: 10.1080/09593985.2018.1459985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Dayana P. Rosa
- Department of Physical Therapist, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Rodrigo V. Santos
- Department of Physical Therapist, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Vander Gava
- Department of Physical Therapist, Federal University of São Carlos, São Carlos, SP, Brazil
| | - John D. Borstad
- Department of Physical Therapist, The College of St. Scholastica, Duluth, MN, USA
| | - Paula R. Camargo
- Department of Physical Therapist, Federal University of São Carlos, São Carlos, SP, Brazil
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Kim MK, Lee JC, Yoo KT. The effects of shoulder stabilization exercises and pectoralis minor stretching on balance and maximal shoulder muscle strength of healthy young adults with round shoulder posture. J Phys Ther Sci 2018; 30:373-380. [PMID: 29581654 PMCID: PMC5857441 DOI: 10.1589/jpts.30.373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/12/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to analyze the effects of pectoralis minor stretching and shoulder strengthening with an elastic band on balance and maximal shoulder muscle strength in young adults with rounded shoulder posture. [Subjects and Methods] Nineteen subjects with rounded shoulder posture were randomly divided into 2 groups: a shoulder stabilization exercise group and a stretching exercise group. The groups performed each exercise for 40 minutes, 3 times a week, for 4 weeks. Static balance (eyes open and closed), dynamic balance (the limits of stability in 4 directions) and shoulder muscle strength in 5 directions were measure before and after the exercises. [Results] The stretching exercise demonstrated a significant difference between the pre- and post-exercise in the static balance with eyes closed and extension and horizontal abduction strength while the stabilization exercise demonstrated significant difference in the left and right directions between the pre- and post-exercise of the dynamic balance and flexion strength. The stabilization exercise demonstrated significant differences shown in the flexion between the pre- and post-test. [Conclusion] The shoulder stabilization and stretching exercises improved the static balance, dynamic balance, and muscle strength.
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Affiliation(s)
- Mi-Kyoung Kim
- Department of Physical Therapy, Namseoul University: Daehak-ro, Seonghwan-eup, Seobuk-gu, Cheonan-si, Chungcheongnam-do 31020, Republic of Korea
| | - Jung Chul Lee
- Department of Hotel Management, Namseoul University, Republic of Korea
| | - Kyung-Tae Yoo
- Department of Physical Therapy, Namseoul University: Daehak-ro, Seonghwan-eup, Seobuk-gu, Cheonan-si, Chungcheongnam-do 31020, Republic of Korea
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Finley MA, Ebaugh D. Association of Pectoralis Minor Muscle Extensibility, Shoulder Mobility, and Duration of Manual Wheelchair Use. Arch Phys Med Rehabil 2017; 98:2028-2033. [PMID: 28465225 DOI: 10.1016/j.apmr.2017.03.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/31/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the relation of pectoralis minor muscle (PMm) length and extensibility to shoulder pain, shoulder girdle motion, and duration of manual wheelchair (MWC) use, and to compare differences in muscle length, muscle extensibility, peak humeral elevation, and pain among groups based on duration of wheelchair use. DESIGN Cross-sectional cohort study. SETTING Laboratory setting. PARTICIPANTS Individuals with spinal cord injury (SCI) who used an MWC for daily community and home mobility (N=22; 18 men; mean age, 41.7y; duration wheelchair use, 14.6y). Participants were stratified into groups based on duration of wheelchair use: <5 years (n=6), 5 to 15 years (n=8), and >15 years (n=8). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Clinical measures of PMm length and extensibility, shoulder girdle motion, and shoulder pain (Wheelchair User's Shoulder Pain Index). RESULTS Significant high correlations were found among duration of wheelchair use, passive PMm length, passive PMm extensibility, and peak humerothoracic elevation. Moderate correlation of peak humerothoracic elevation to pain was found. Individuals with >15 years wheelchair use had reduced PMm extensibility and reduced peak humerothoracic elevation than those with <5 years duration of use. CONCLUSIONS To our knowledge, this is the first investigation to identify the association of reduced PMm extensibility with reduced shoulder girdle mobility, pain, and duration of wheelchair use in individuals with SCI.
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Affiliation(s)
- Margaret A Finley
- Department of Physical Therapy and Rehabilitation Science, Drexel University, Philadelphia, PA.
| | - David Ebaugh
- Department of Physical Therapy and Rehabilitation Science, Drexel University, Philadelphia, PA; Department of Health Sciences, Drexel University, Philadelphia, PA
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