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Kofoed C, Palmsten A, Diercks J, Obermeier M, Tompkins M, Chmielewski TL. The Clinical Utility of the Seated Wall Angel as a Test with Scoring. Int J Sports Phys Ther 2024; 19:1228-1237. [PMID: 39371191 PMCID: PMC11446728 DOI: 10.26603/001c.123512] [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: 02/27/2024] [Accepted: 08/15/2024] [Indexed: 10/08/2024] Open
Abstract
Background The seated wall angel (SWA) is an intervention to improve upper quarter mobility but has not been described as a clinical test with scoring. Hypothesis/ Purpose To explore the clinical utility of the SWA as a test with scoring. The authors hypothesized that SWA test scores would be lower on the injured than uninjured side, improve over time, and show stronger association with patient-reported shoulder function than shoulder mobility tests. Study Design Prospective cohort. Methods Patients diagnosed with anterior shoulder instability and referred to physical therapy participated. Testing occurred after physical therapy examination (initial) and six weeks later (follow-up). Rehabilitation was not controlled. Testing included clinical tests (SWA, passive shoulder external rotation range of motion, total arc of motion) and patient-reported outcomes including the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, (ASES) and the Western Ontario Shoulder Instability Index (WOSI). The SWA test was scored 0 to 3 points bilaterally based on number of body contacts with the wall (i.e., elbows and fingertips, posterior fingers, posterior forearm). Passive range of motion was measured with a standard goniometer. SWA scores were compared between sides at initial testing and compared between testing timepoints on the injured side. Associations among injured side clinical test values and patient-reported outcome scores were examined. Results Mean (SD) SWA score on the injured side was significantly lower than the uninjured side at initial testing [1.6 (1.0) vs 2.2 (1.1), p = 0.045] and significantly increased at follow-up testing [2.4 (1.0), p = 0.041]. Only SWA test score was significantly correlated with ASES (r=0.597) and WOSI (r=-0.648) scores at initial testing, and SWA test score was significantly correlated with WOSI score at follow-up testing (r=-0.611). Conclusions The clinical utility of the SWA test is supported by distinguishing the injured and uninjured sides and having stronger associations with patient-reported shoulder function than shoulder mobility tests.
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Daher M, Fares MY, Boufadel P, Zalaquett Z, Koa J, Sakr I, Pill SG, Hasan SS, Vaccaro AR, Abboud JA. Untwining the intertwined: a comprehensive review on differentiating pathologies of the shoulder and spine. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:385-392. [PMID: 39157237 PMCID: PMC11329023 DOI: 10.1016/j.xrrt.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Background The anatomic interplay and overlap between the cervical spine and the shoulder constitutes a challenge for shoulder and spine surgeons, as symptoms of spine and shoulder pathologies are often similar and may lead to entity misdiagnosis. Methods PubMed, Cochrane, and Google Scholar (page 1-20) searches were updated to October 2023 in search of the qualified papers. Boolean Operators were used with a combination of the keywords "spine" OR "neck" And "Shoulder". Furthermore, reference lists from papers were also searched to find literature. Results It is of pivotal importance to conduct comprehensive preoperative clinical investigation to appropriately evaluate and assess the source of the pathology and the leading causes behind it. Certain markers can help guide surgeons towards etiologies, and these include areas of pain and physical exam findings with the arm squeeze test having the highest sensitivity and specificity for diagnosing cervical radiculopathy. As for the shoulder, despite its low sensitivity, the Yergason test had the highest specificity for diagnosing subacromial impingement. Local anesthetic injection can help as well in the diagnostic approach. Moreover, the interplay between these anatomic locations is not solely related to preoperative diagnosis. Studies have shown that previous surgery for cervical spine pathology may negatively affect the outcomes of shoulder procedures like arthroplasties. Conclusion Shoulder and spine surgeons should be wary and vigilant of accurately diagnosing the etiology of the presenting symptoms to ensure proper management and optimize prognosis.
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Affiliation(s)
- Mohammad Daher
- Rothman Institute/Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Mohamad Y. Fares
- Rothman Institute/Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Peter Boufadel
- Rothman Institute/Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Ziad Zalaquett
- Orthopedic Department, Hôtel Dieu de France, Beirut, Lebanon
| | - Jonathan Koa
- Rothman Institute/Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Itala Sakr
- Orthopedic Department, Hôtel Dieu de France, Beirut, Lebanon
| | - Stephan G. Pill
- Orthopedics Department, Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA
| | - Samer S. Hasan
- Cincinnati Sports Medicine Research and Education Foundation, Cincinnati, OH, USA
| | - Alex R. Vaccaro
- Rothman Institute/Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Joseph A. Abboud
- Rothman Institute/Thomas Jefferson Medical Center, Philadelphia, PA, USA
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Szewczyk D, Sadura-Sieklucka T, Tarnacka B, Sokołowska B. Is there a connection between spine alignment, chest mobility, shoulder joint and respiratory parameters of patients with ankylosing spondylitis? Rheumatol Int 2024; 44:1481-1486. [PMID: 38914771 PMCID: PMC11222267 DOI: 10.1007/s00296-024-05642-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/05/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Ankylosing spondylitis is chronic progressive disease, which decrease functions of musculoskeletal system including chest area. Those changes influences respiratory mechanics, worsen conditions of proper ventilation of lungs. OBJECTIVES Rating of functional and respiratory parameters and dependence between them at patients with ankylosing spondylitis. MATERIALS & METHODS The study included 45 patients with diagnosed ankylosing spondylitis. Chest and upper limbs mobility, resting spinal curvature alignment were assessed, and respiratory parameters were measured in a plethysmographic chamber JAGGER MasterScreen Body. RESULTS Ankylosing spondylitis patients had lower respiratory parameters especially sReff, and FRC. Restriction of chest and upper limbs mobility was also demonstrated. Forward head extension was observed based on the occipital wall test. Correlations between functional parameters and correlations between functional and respiratory parameters were shown, in particular MIP, MEP, sReff, Rtot, TLC, ERV. CONCLUSIONS The study confirmed a decrease in functional and respiratory parameters in the examined patients with ankylosing spondylitis compared to the applicable standards. A significant relationship was found between functional parameters in the upper body and respiratory parameters, which worsen with increasing thoracic dysfunction. The obtained results indicate the directions of therapy that should be taken into account to improve respiratory parameters and reduce respiratory dysfunction in these patients. Chest-focused physiotherapy appears to be an important element in improving function in patients with ankylosing spondylitis.
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Affiliation(s)
- Daniel Szewczyk
- Department of Rehabilitation, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Teresa Sadura-Sieklucka
- Department of Geriatrics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.
| | | | - Beata Sokołowska
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
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Kromer TO, Kohl M, Bastiaenen CHG. Factors predicting long-term outcomes following physiotherapy in patients with subacromial pain syndrome: a secondary analysis. BMC Musculoskelet Disord 2024; 25:579. [PMID: 39048996 PMCID: PMC11267964 DOI: 10.1186/s12891-024-07686-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Although patients with shoulder complaints are frequently referred to physiotherapy, putative predictive factors for outcomes are still unclear. In this regard, only a limited amount of scientific data for patients with subacromial pain syndrome exist, with inconsistent results. An improved knowledge about the ability of baseline variables to predict outcomes could help patients make informed treatment decisions, prevent them from receiving ineffective treatments, and minimize the risk of developing chronic pain. AIM The aims of this secondary longitudinal analysis are threefold: First, to investigate baseline differences between patients with and without successful long-term outcomes following physiotherapy. Second, to compare the predictive ability of two sets of putative predictive variables on outcomes, one based on the literature and one based on the data of the original trial. Third, to explore the contribution of short-term follow-up data to predictive models. METHODS Differences between responders and nonresponders were calculated. The predictive ability of variables defined through literature and of variables based on the Akaike Information Criterion (AIC) from the original trial dataset on the Shoulder Pain and Disability Index and the Patients' Global Impression of Change at the one-year follow-up were analyzed. To test the robustness of the results, different statistical models were used. To investigate the contribution of follow-up data to prediction, short-term data were included in the analyses. RESULTS A sample of 87 patients with subacromial pain syndrome was analyzed. 77% (n = 67) of these participants were classified as responders. Higher expectations and short-term change scores were positive, and higher fear avoidance beliefs, greater baseline disability and pain levels were negative predictors of long-term outcomes in patients with subacromial pain syndrome. CONCLUSIONS Although our results are in line with previous research and support the use of clinical factors for prediction, our findings suggest that psychological factors, especially patient expectations and fear avoidance beliefs, also contribute to long-term outcomes and should therefore be considered in the clinical context and further research. However, the hypotheses and recommendations generated from our results need to be confirmed in further studies due to their explorative nature. TRIAL REGISTRATION The original trial was registered at Current Controlled Trials under the trial registration number ISRCTN86900354 on March 17, 2010.
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Affiliation(s)
- Thilo Oliver Kromer
- Faculty of Health, Safety, Society, Furtwangen University, Study Center Freiburg, Konrad-Goldmann-Straße 7, 79100, Freiburg, Germany.
- Caphri Research Institute, Research line Functioning & Rehabilitation, Maastricht University, Maastricht, The Netherlands.
| | - Matthias Kohl
- Faculty of Medical and Life Sciences, Institute of Precision Medicine, Campus Villingen- Schwenningen, Furtwangen University, Furtwangen, Germany
| | - Caroline H G Bastiaenen
- Caphri Research Institute, Research line Functioning & Rehabilitation, Maastricht University, Maastricht, The Netherlands
- Research line Functioning & Rehabilitation, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
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Manoso-Hernando D, Bailón-Cerezo J, Elizagaray-García I, Achútegui-García-Matres P, Suárez-Díez G, Gil-Martínez A. Cervical and Thoracic Spine Mobility in Rotator Cuff Related Shoulder Pain: A Comparative Analysis with Asymptomatic Controls. J Funct Morphol Kinesiol 2024; 9:128. [PMID: 39189213 PMCID: PMC11348207 DOI: 10.3390/jfmk9030128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 08/28/2024] Open
Abstract
Rotator cuff related shoulder pain (RCRSP) is a prevalent clinical presentation characterized by substantial diagnostic uncertainty. Some of this uncertainty relates to the involvement of the cervical and thoracic spine as a source of or contributing factor to RCRSP. Thirty-two RCRSP cases and thirty-two asymptomatic controls (AC), recruited from Hospital La Paz-Carlos III between March 2023 and September 2023, were matched for age, gender and hand dominance. Assessed variables included cervical, thoracic range of motion (ROM) and neck disability index (NDI). Independent t-tests were used to compare each of these measurements and multiple linear regression was used to examine the capacity of neck or psychosocial variables to predict the variability of the NDI. The RCRSP group had significantly reduced cervical rotation [RCRSP (111.14 ± 22.98); AC (130.23 ± 21.20), d = 0.86, p < 0.01] and flexo-extension ROM [RCRSP (112.47 ± 2.07); AC (128.5 ± 17.85), d = 0.80, p < 0.01] as well as thoracic spine flexion [RCRSP (33.02 ± 1.14); AC (34.14 ± 1.01), d = 1.04, p < 0.01], extension [RCRSP (28.63 ± 0.89); AC (27.37 ± 0.89), d = -1.40, p < 0.01], right rotation [RCRSP (40.53 ± 10.39); AC (54.45 ± 9.75), d = 1.38, p < 0.01], left rotation [RCRSP (39.00 ± 11.26); AC (54.10 ± 10.51), d = 1.39, p < 0.01] and a significantly increased NDI score [RCRSP (17.56 ± 7.25); AC (2.47 ± 3.25), d = -2.69, p < 0.01]. The variables best explaining neck disability were central sensitization index and SF-12 total score (adjusted R2 = 0.75; p < 0.01). These results suggest that clinicians should assess cervical and thoracic spine mobility in patients with RCRSP.
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Affiliation(s)
- Daniel Manoso-Hernando
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (D.M.-H.); (J.B.-C.); or (A.G.-M.)
| | - Javier Bailón-Cerezo
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (D.M.-H.); (J.B.-C.); or (A.G.-M.)
| | - Ignacio Elizagaray-García
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (D.M.-H.); (J.B.-C.); or (A.G.-M.)
| | - Pablo Achútegui-García-Matres
- Unidad de Fisioterapia, Hospital Universitario La Paz-Carlos III (IdiPAZ), 28029 Madrid, Spain; (P.A.-G.-M.); (G.S.-D.)
| | - Guillermo Suárez-Díez
- Unidad de Fisioterapia, Hospital Universitario La Paz-Carlos III (IdiPAZ), 28029 Madrid, Spain; (P.A.-G.-M.); (G.S.-D.)
| | - Alfonso Gil-Martínez
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (D.M.-H.); (J.B.-C.); or (A.G.-M.)
- Unidad de Fisioterapia, Hospital Universitario La Paz-Carlos III (IdiPAZ), 28029 Madrid, Spain; (P.A.-G.-M.); (G.S.-D.)
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Manoso-Hernando D, Bailón-Cerezo J, Angulo-Díaz-Parreño S, Reina-Varona Á, Elizagaray-García I, Gil-Martínez A. Shoulder mobility and strength impairments in patients with rotator cuff related shoulder pain: a systematic review and meta analysis. PeerJ 2024; 12:e17604. [PMID: 38948223 PMCID: PMC11214432 DOI: 10.7717/peerj.17604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Background The methods previously proposed in the literature to assess patients with rotator cuff related shoulder pain, based on special orthopedic tests to precisely identify the structure causing the shoulder symptoms have been recently challenged. This opens the possibility of a different way of physical examination. Objective To analyze the differences in shoulder range of motion, strength and thoracic kyphosis between rotator cuff related shoulder pain patients and an asymptomatic group. Method The protocol of the present research was registered in the International Prospective Register of Systematic Review (PROSPERO) (registration number CRD42021258924). Database search of observational studies was conducted in MEDLINE, EMBASE, WOS and CINHAL until July 2023, which assessed shoulder or neck neuro-musculoskeletal non-invasive physical examination compared to an asymptomatic group. Two investigators assessed eligibility and study quality. The Newcastle Ottawa Scale was used to evaluate the methodology quality. Results Eight studies (N = 604) were selected for the quantitative analysis. Meta-analysis showed statistical differences with large effect for shoulder flexion (I2 = 91.7%, p < 0.01, HG = -1.30), external rotation (I2 = 83.2%, p < 0.01, HG = -1.16) and internal rotation range of motion (I2 = 0%, p < 0.01, HG = -1.32). Regarding to shoulder strength; only internal rotation strength showed statistical differences with small effect (I2 = 42.8%, p < 0.05, HG = -0.3). Conclusions There is moderate to strong evidence that patients with rotator cuff related shoulder pain present less shoulder flexion, internal and external rotation range of motion and less internal rotation strength than asymptomatic individuals.
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Affiliation(s)
- Daniel Manoso-Hernando
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
| | - Javier Bailón-Cerezo
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
| | | | - Álvaro Reina-Varona
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
| | | | - Alfonso Gil-Martínez
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
- Unidad de Fisioterapia, Hospital Universitario La Paz-Carlos III (IdiPAZ), Madrid, Spain
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Warneke K, Lohmann LH, Wilke J. Effects of Stretching or Strengthening Exercise on Spinal and Lumbopelvic Posture: A Systematic Review with Meta-Analysis. SPORTS MEDICINE - OPEN 2024; 10:65. [PMID: 38834878 DOI: 10.1186/s40798-024-00733-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 05/22/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Abnormal posture (e.g. loss of lordosis) has been associated with the occurrence of musculoskeletal pain. Stretching tight muscles while strengthening the antagonists represents the most common method to treat the assumed muscle imbalance. However, despite its high popularity, there is no quantitative synthesis of the available evidence examining the effectiveness of the stretch-and-strengthen approach. METHODS A systematic review with meta-analysis was conducted, searching PubMed, Web of Science and Google Scholar. We included controlled clinical trials investigating the effects of stretching or strengthening on spinal and lumbopelvic posture (e.g., pelvic tilt, lumbar lordosis, thoracic kyphosis, head tilt) in healthy individuals. Effect sizes were pooled using robust variance estimation. To rate the certainty about the evidence, the GRADE approach was applied. RESULTS A total of 23 studies with 969 participants were identified. Neither acute (d = 0.01, p = 0.97) nor chronic stretching (d=-0.19, p = 0.16) had an impact on posture. Chronic strengthening was associated with large improvements (d=-0.83, p = 0.01), but no study examined acute effects. Strengthening was superior (d = 0.81, p = 0.004) to stretching. Sub-analyses found strengthening to be effective in the thoracic and cervical spine (d=-1.04, p = 0.005) but not in the lumbar and lumbopelvic region (d=-0.23, p = 0.25). Stretching was ineffective in all locations (p > 0.05). CONCLUSION Moderate-certainty evidence does not support the use of stretching as a treatment of muscle imbalance. In contrast, therapists should focus on strengthening programs targeting weakened muscles.
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Affiliation(s)
- Konstantin Warneke
- Institute of Sport Science, Department of Movement Sciences, Alpen-Adrian-University Klagenfurt, Klagenfurt, Austria
| | - Lars Hubertus Lohmann
- Department of Human Movement Science and Exercise Physiology, Institute of Sport Science, Friedrich Schiller University, Jena, Germany.
| | - Jan Wilke
- Institute of Sport Science, Department of Movement Sciences, Alpen-Adrian-University Klagenfurt, Klagenfurt, Austria
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Waghe VR, Jachak S, Raghuveer R, Sharath HV. Kinematic Assessment Utilizing Xsens Gait Motion Analysis in Upper Cross Syndrome: A Case Report. Cureus 2024; 16:e60485. [PMID: 38883075 PMCID: PMC11180515 DOI: 10.7759/cureus.60485] [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: 02/01/2024] [Accepted: 05/17/2024] [Indexed: 06/18/2024] Open
Abstract
Upper crossed syndrome (UCS) characterizes a prevalent postural dysfunction involving dysfunctional tone in the musculature of the shoulder girdle and cervicothoracic region. The discordant balance among the sternocleidomastoid, pectoralis major, levator scapulae, and upper trapezius musculature potentially precipitated cervical discomfort, thereby hindering routine activities and fostering the progression of UCS. Clinical scales are routinely utilized to assess and monitor the progress of rehabilitation; nonetheless, they often present inherent limitations. In contrast, advancements in three-dimensional (3D) motion capture technology furnish detailed kinematic data, thereby augmenting the capacity to objectively quantify and elucidate movement deficits with heightened precision. This case highlights the critical significance of employing kinematic analysis with Xsens as an outcome measure to elucidate the intricacies of UCS, thereby offering invaluable insights for therapeutic interventions in similar clinical scenarios and providing objective insights into movement biomechanics, muscular function, and functional limitations. Leveraging this information, clinicians can skillfully tailor treatment modalities to address underlying musculoskeletal imbalances, ultimately optimizing patient outcomes. In this case study, we examine the kinematic analysis of a 48-year-old office worker experiencing persistent headaches, restricted range of motion, and neck and shoulder pain over a four-month period. Despite prior interventions, symptomatology deteriorated, prompting consultation with a neurophysiotherapist. The evaluation revealed localized pain in the right shoulder, upper back, and neck, characterized by gradual onset and dull ache, exacerbated by activity and alleviated by rest and medication, without diurnal fluctuations. Physical examination delineated UCS features. Following the implementation of a four-week physiotherapy rehabilitation protocol, initial assessments utilizing Xsens gait motion analysis were undertaken. Subsequent to the rehabilitation program, significant improvements were noted across various parameters. These encompassed augmented range of motion, heightened muscular strength, and enhanced flexibility. Additionally, discernible enhancements were observed in posture and gait, characterized by the restoration of normal cervical spine curvature and an expanded range of motion.
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Affiliation(s)
- Vaishnavi R Waghe
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shrushti Jachak
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raghumahanti Raghuveer
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - H V Sharath
- Department of Pediatrics, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Chang MC, Choo YJ, Hong K, Boudier-Revéret M, Yang S. Treatment of Upper Crossed Syndrome: A Narrative Systematic Review. Healthcare (Basel) 2023; 11:2328. [PMID: 37628525 PMCID: PMC10454745 DOI: 10.3390/healthcare11162328] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Upper crossed syndrome (UCS) is a common musculoskeletal condition that is characterized by tightness and weakness of the muscles of the neck, shoulders, and upper back. The aim of this current study is to summarize and provide an overview of the treatment in patients with UCS. MATERIALS AND METHODS A MEDLINE (PubMed), Cochrane library, Embase, Scopus, and Web of Science database search was conducted for English-language articles about upper crossed syndrome that were published until 19 January 2023. To identify potentially relevant articles, the following key search phrases were combined: "upper crossed syndrome", "upper cross syndrome", "diagnosis", and "treatment". A total of 233 articles were identified. After reading the titles and abstracts and assessing their eligibility based on the full-text articles, 11 articles were finally included in this review. The risk of bias (RoB) was assessed using RoB-2 and ROBINS-I for the randomized controlled trials (RCTs) and the non-randomized clinical trial (non-RCT), respectively. RESULTS Among eleven studies that investigated the effect of treatment programs for UCS, five studies compared the therapeutic effect of exercise programs with controls, whereas six compared different rehabilitative treatment strategies, such as the muscle energy technique, soft-tissue mobilization, and stretching exercises. In addition, regarding the study design, ten studies were RCTs and only one study was a prospective observational study. CONCLUSIONS Treatment programs including various types of exercises and techniques to correct an abnormal posture and restore neuromuscular imbalances are effective for decreasing pain and improving neck disabilities and postural deviations in patients with UCS.
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Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Gyeongsan 38436, Republic of Korea; (M.C.C.)
| | - Yoo Jin Choo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Gyeongsan 38436, Republic of Korea; (M.C.C.)
| | - Keeyong Hong
- Cheonho S Orthopedic Clinic, Seoul 06014, Republic of Korea
| | - Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada;
| | - Seoyon Yang
- Department of Rehabilitation Medicine, School of Medicine, Ewha Woman’s University Seoul Hospital, Seoul 07804, Republic of Korea
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Menés Fernández L, Salvat I, Adillón C. Expressed Beliefs about the Cause of Pain in a Pediatric Population: A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1007. [PMID: 37371238 DOI: 10.3390/children10061007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
(1) Background: The aims of this study are to explore what beliefs children and adolescents manifest about the cause of the pain they describe, to compare whether there are differences between beliefs by age and the persistence of pain, and to relate the explanations of the cause of pain with current scientific evidence. (2) Methods: a cross-sectional qualitative study was used. The primary endpoint of the study was obtaining explanations of the cause of pain recorded by means of an open-ended question. The participants were school-age children attending a charted school in the province of Barcelona. (3) Results: The children and adolescents proposed a diverse range of explanations for the cause of pain that they reported in their responses. The most frequent explanation for the cause of pain were pathologies and injuries (45.95%), ergonomic issues (22.60%) and psychological issues (15.95%). (4) Conclusions: There is a lot of variety in the explanations that young people give about the cause of their pain in schoolchildren aged between 10 and 16 years old. There exists a high prevalence of explanations non-associated with tissue damage (ENAD) concerning the causes of pain described. It is necessary that future health prevention programs dedicated to early ages consider which beliefs about the cause of pain are the most frequent in the pediatric population.
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Affiliation(s)
- Laura Menés Fernández
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Isabel Salvat
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Cristina Adillón
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
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Powell JK, Schram B, Lewis J, Hing W. Physiotherapists nearly always prescribe exercise for rotator cuff-related shoulder pain; but why? A cross-sectional international survey of physiotherapists. Musculoskeletal Care 2023; 21:253-263. [PMID: 36089802 DOI: 10.1002/msc.1699] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS This cross-sectional international survey explored the beliefs of physiotherapists regarding the possible mechanisms of benefit of exercise for rotator cuff-related shoulder pain (RCRSP). Clinical practice guidelines recommend physiotherapists use exercise as a primary treatment to help people with RCRSP, but the explanations provided to patients by physiotherapists regarding its mechanism of effect is unknown. MATERIALS AND METHODS Registered physiotherapists were surveyed about 'how and why' they believe exercise provides a clinical benefit for people with RCRSP. Information was also gathered about commonly used exercise types and preferred diagnostic labels. The survey was designed and reported in concordance with Consensus-Based Checklist for Reporting of Survey Studies guidelines. RESULTS Four hundred and eighty physiotherapists from forty-nine countries completed the survey. Psychosocial and biomedical mechanisms of exercise were evenly selected by participants. Improving muscle strength, muscle endurance, pain self-efficacy and reducing kinesiophobia, and fear avoidance beliefs were the most common individual mechanisms thought to underpin exercise therapy for RCRSP. Rotator cuff-related shoulder pain was the most commonly used diagnostic label. DISCUSSION AND CONCLUSION Physiotherapists hold beliefs regarding exercise mechanisms that is largely concordant with the current evidence base, which is commendable. Future research should consider the patients perspective and consider testing commonly selected mechanisms of exercise, such as shoulder muscle strength, pain self-efficacy and kinesiophobia as possible mediators of recovery.
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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, UK
- Musculoskeletal Research, Clinical Therapies, University of Limerick, 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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12
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Matsuzawa K, Matsui T, Azuma Y, Miyazaki T, Hiramoto M, Hashimoto R, Kida N, Morihara T. Spine Alignment in Standing and Maximal Upper Limb Elevation in Baseball Players with Lumbar Spondylolysis and Those without Low Back Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3231. [PMID: 36833924 PMCID: PMC9965598 DOI: 10.3390/ijerph20043231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/02/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
The changes in lumbar lordosis angle (LL) and sacral slope angle (SS) related to upper limb elevation and thoracic kyphosis angle (TK) in baseball players with spondylolysis remain unclear. Herein, we investigated baseball players with spondylolysis and those without low back pain, comparing LL and SS with upper limb elevation within and between groups and TK between groups. Baseball players with spondylolysis were enrolled as subjects, and baseball players without low back pain were enrolled as controls (n = 8 each). X-rays were obtained in the standing position and with maximal elevation position of the upper limb (elevation position). LL and SS were measured in the standing and elevated positions, and TK was measured in the standing position. LL was significantly larger in individuals with spondylolysis than controls. The SS of the control group was significantly larger in the elevated position than in the standing position, while the SS of the spondylolysis group was not significantly different between positions. SS was significantly larger in the spondylolysis group than in the control group, only in the standing position. Physical therapy for spondylolysis should focus on hyperlordosis alignment in the standing and maximal elevation positions of both upper limbs, sacral hyper-slope alignment in the standing position, and decreased sacral slope motion.
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Affiliation(s)
- Kanta Matsuzawa
- Marutamachi Rehabilitation Clinic, Kyoto 604-8405, Japan
- Department of Biotechnology, Graduate School of Science and Technology, Kyoto Institute of Technology, Kyoto 606-0951, Japan
| | | | | | - Tetsuya Miyazaki
- Marutamachi Rehabilitation Clinic, Kyoto 604-8405, Japan
- Department of Biotechnology, Graduate School of Science and Technology, Kyoto Institute of Technology, Kyoto 606-0951, Japan
| | | | - Ruo Hashimoto
- Marutamachi Rehabilitation Clinic, Kyoto 604-8405, Japan
| | - Noriyuki Kida
- Department of Biotechnology, Graduate School of Science and Technology, Kyoto Institute of Technology, Kyoto 606-0951, Japan
| | - Toru Morihara
- Marutamachi Rehabilitation Clinic, Kyoto 604-8405, Japan
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13
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Choi M, Chung J. Biomechanical and functional analysis of the shoulder complex and thoracic spine in patients with subacromial impingement syndrome: A case control study. Medicine (Baltimore) 2023; 102:e32760. [PMID: 36705396 PMCID: PMC9875974 DOI: 10.1097/md.0000000000032760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The motions of the shoulder are mainly carried out through the glenohumeral joint, but are also assisted by the scapulothoracic joint. Therefore, changes in the biomechanics of the thoracic spine and scapula affect the function of the shoulder. However, there is limited information on the biomechanical and functional characteristics of the shoulder complex and thoracic spine in patients with subacromial impingement syndrome (SIS). In this study, the biomechanical and functional characteristics of the shoulder complex and thoracic spine were analyzed in patients with SIS compared to healthy individuals. A total of 108 participants were included in this study. Participants were classified into 2 groups, the SIS (n = 55) and healthy (n = 53) groups. The shoulder and thoracic range of motion (ROM), scapular position, and isokinetic shoulder strength were measured in all participants. The shoulder ROM was significantly decreased in the SIS group compared to the healthy group (P < .001). The thoracic spine ROM showed significantly limited extension in the SIS group (P < .001). The scapular position showed significantly increased anterior tilting (P = .005), internal rotation (P = .032), protraction (P < .001), and decreased upward rotation (P = .002) in the SIS group. The isokinetic shoulder external rotation (P < .001) and abduction (P < .001) strength were significantly lower in the SIS group. Patients with SIS showed reduced shoulder ROM and end-range extension of the thoracic spine compared to healthy individuals, and the scapula was in a more anterior-tilted, protracted, and downward rotated position. In addition, it showed lower external rotation and abduction strength. These results suggest the need for interventions to improve the limited thoracic extension and altered scapular position, which may affect shoulder ROM and muscle strength in the rehabilitation of patients with SIS.
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Affiliation(s)
- Moonyoung Choi
- Department of Sports Science Convergence, Dongguk University, Seoul, Republic of Korea
| | - Jinwook Chung
- Department of Sports Science Convergence, Dongguk University, Seoul, Republic of Korea
- * Correspondence: Jinwook Chung, Department of Sports Science Convergence, Dongguk University, 30, Pildong-ro 1-gil, Jung-gu, Seoul 04620, Republic of Korea (e-mail: )
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14
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Le Solliec T, Blache Y, Rogowski I. Effects of an 8-week multimodal program on thoracic posture, glenohumeral range of motion and serve performance in competitive young tennis players. Front Sports Act Living 2023; 5:1128075. [PMID: 36935884 PMCID: PMC10020231 DOI: 10.3389/fspor.2023.1128075] [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: 12/20/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Intensive tennis practice is known to generate sport-specific adaptations at the shoulder region and influence the sagittal spinal curvature. However, increased thoracic kyphosis decreases the shoulder functional capacity, which could limit tennis performance. Therefore, the aim of this study was to investigate the effects of an 8-week multimodal program on thoracic posture, glenohumeral range of motion, and serve performance in competitive young tennis players. Methods Eighteen male and four female players (age: 16.0 ± 2.4 years, height: 170.7 ± 11.0 cm; mass: 62.1 ± 11.5 kg; International Tennis Number: 3-4) performed their regular training during 8 weeks, which was used as a reference period, and implemented a multimodal program including stretching, strengthening, and myofascial release exercises, four times per week during 8 additional weeks, which corresponded to the intervention period. The thoracic curvature angle and mobility, the biacromial and interscapular distances, the glenohumeral range of motion and the tennis serve performance were assessed three times, i.e., before and after the regular training and after the 8-week multimodal program. Results The results showed that the 8-week regular training had no significant effects on thoracic curvature angle [effect size (ES) = 0.02-0.36, p = 0.06-0.46] and mobility (ES = 0.05-0.26, p = 0.13-0.42), biacromial (ES = 0.05, p = 0.18) and interscapular distances (ES = 0.03, p = 0.45), ranges of motion in glenohumeral internal (ES = 0.04, p = 0.43) and external rotation (ES = 0.43, p = 0.06), and tennis serve accuracy (ES = 0.33, p = 0.07) and velocity (ES = 0.09, p = 0.35). The 8-week multimodal program increased moderately the thoracic mobility (ES = 0.55, p = 0.01), moderately to strongly the serve accuracy and velocity (ES = 0.65, p = 0.003, for both), strongly decreased the interscapular distance (ES = 1.02, p < 0.001), and strongly increased the range of motion in glenohumeral internal (ES = 0.90, p < 0.001) and external rotation (ES = 1.49, p < 0.001). Discussion These findings indicated that an 8-week multimodal program, including spine and glenohumeral mobility and shoulder girdle strength exercises, performed four times per week during 8 weeks, is moderately relevant to rectify the sagittal thoracic curvature in competitive tennis players, while such a program may help regain the range of motion in glenohumeral rotation without tennis serve performance impairment.
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15
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Mete O, Oskay D, Haznedaroğlu Ş, Tufan A, Yildiz TI. Comparison of shoulder muscle strength, shoulder range of motion and scapular motion in men with ankylosing spondylitis and healthy men: a case-controlled study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background/Aims Ankylosing spondylitis mainly affects the vertebral column, meaning that the assessment of the physical function of the upper extremity and scapulothoracic region in ankylosing spondylitis is often overlooked. Therefore, the aim of this study was to investigate shoulder muscle strength, shoulder active range of motion and three-dimensional scapular motion in patients with ankylosing spondylitis. Methods The study included 18 men with ankylosing spondylitis, and 16 age-matched typically healthy men as the control group. Muscle strength, active range of motion, and three-dimensional scapular motion were assessed with a digital hand-held dynamometer, an inclinometer, and an electromagnetic tracking device respectively. Results A decrease in shoulder flexion and abduction muscle strength on both the dominant side (P<0.001, P=0.001) and non-dominant side (P<0.001, P<0.001) was found in the ankylosing spondylitis group compared to the control group. A decrease in shoulder flexion, abduction, and external and internal rotation active range of motion on both the dominant side (P=0.001, P<0.001, P=0.015, P<0.001, respectively) and non-dominant side (P=0.001, P<0.001, P=0.017, P<0.001 respectively) was observed in the ankylosing spondylitis group. There was an increase in the upward rotation of the scapula on the non-dominant side at 30, 60, and 90° humeral elevations in the ankylosing spondylitis group compared to the control group (P=0.018, P=0.003, P=0.001 respectively). The other parameters of the scapular motion did not differ between groups (P>0.05). Conclusions This study showed that shoulder muscle strength and active range of motion were lower, and the upward rotation of the scapula was greater in men with ankylosing spondylitis compared to typically healthy men. The kinetics and kinematics parameters of the shoulder and scapula should be considered when assessing the physical function of patients with ankylosing spondylitis.
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Affiliation(s)
- Oguzhan Mete
- Gulhane Faculty of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Deran Oskay
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Gazi University, Ankara, Turkey
| | | | | | - Taha Ibrahim Yildiz
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Hacettepe University, Ankara, Turkey
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16
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Jung SH, Hwang UJ, Kim JH, Gwak GT, Kwon OY. Effect of improved thoracic kyphosis on forward shoulder posture after mobilization in individuals with thoracic hyperkyphosis. Clin Biomech (Bristol, Avon) 2022; 97:105707. [PMID: 35763888 DOI: 10.1016/j.clinbiomech.2022.105707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/21/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thoracic hyperkyphosis structurally alters the position of the scapula to cause forward shoulder posture. However, the effect of improved thoracic hyperkyphosis on forward shoulder posture is unclear. The objective of this study was to determine the effect of eight weeks of thoracic mobilization on improving thoracic hyperkyphosis and forward shoulder posture and determine the cutoff change ratio in kyphosis for improving forward shoulder posture using the decision tree method. METHOD This study included 19 participants with thoracic hyperkyphosis who underwent thoracic mobilization for eight weeks. Forward shoulder posture (acromion-to-the-wall index) and thoracic kyphosis were measured before and after thoracic mobilization. FINDINGS The intervention significantly improved thoracic kyphosis and forward shoulder posture. The cutoff change ratio in kyphosis for improving forward shoulder posture was >13.79%. In the subgroup analysis of participants with a change ratio of kyphosis >13.79% (seven cases), all patients showed improved forward shoulder posture. In contrast, in the subgroup with a change ratio of kyphosis ≤13.79% (12 cases), eight cases showed improved forward shoulder posture, while four cases showed no improvement. INTERPRETATION Thoracic mobilization can be recommended in shoulder rehabilitation programs to improve forward shoulder posture to manage and prevent scapular malalignment in individuals with thoracic hyperkyphosis. We suggest that a high probability of improvement in forward shoulder posture can be expected when kyphosis is improved by >13.79%.
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Affiliation(s)
- Sung-Hoon Jung
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju, South Korea
| | - Ui-Jae Hwang
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju, South Korea
| | - Jun-Hee Kim
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju, South Korea
| | - Gyeong-Tae Gwak
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju, South Korea
| | - Oh-Yun Kwon
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju, South Korea.
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17
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Yaghoubitajani Z, Gheitasi M, Bayattork M, Andersen LL. Corrective exercises administered online vs at the workplace for pain and function in the office workers with upper crossed syndrome: randomized controlled trial. Int Arch Occup Environ Health 2022; 95:1703-1718. [PMID: 35391580 PMCID: PMC8989105 DOI: 10.1007/s00420-022-01859-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022]
Abstract
Objective To evaluate the effects of online-supervised versus workplace corrective exercises on neck–shoulder pain (NSP), sick leave, posture, workability, and muscular activity among office workers with the upper crossed syndrome (UCS). Methods We performed a parallel-group randomized control trial at Shahid Beheshti University, Tehran, Iran, assigning 36 office workers to online-supervised, workplace, and control groups (mean (SD) age 38.91 ± 3.87, 38.58 ± 7.34, 37.00 ± 8.12). Inclusion criteria were alignment alteration (forward head (≥ 45°), rounding shoulder (≥ 52°), rounding back (≥ 42°), and pain intensity ≥ 3 in neck and shoulder. The two intervention groups performed 8-week exercise program, while the control group continued usual activities. Primary (NSP and sick leave) and secondary outcomes [postural angles, workability, and muscular activity were measured by VAS, outcome evaluation questionnaire (OEQ), photogrammetry, workability index, and EMG, respectively, at the baseline and an 8-week follow-up]. Results ANCOVA results revealed improvements for the online-supervised group versus control for NSP (P = 0.007), postural angles (P = 0.000, P = 0.001, P = 0.005), workability (P = 0.048, P = 0.042), and upper trapezius activation (P = 0.024, P = 0.016), respectively. Using paired t tests, both intervention groups improved from baseline to follow-up for NSP (P = 0.000, P = 0.002), forward head posture (P = 0.000, P = 0.000), round shoulders (P = 0.001, P = 0.031), and round back (P = 0.034, P = 0.008), respectively. Related parameters of workability (P = 0.041, P = 0.038), upper trapezius (P = 0.005, P = 0.005, P = 0.022), and serratus anterior (P = 0.020, P = 0.015) changed only in the online-supervised group. Conclusion Online-supervised corrective exercise seems to improve a range of parameters related to work performance. These findings are highly applicable in light of the ongoing COVID pandemic; many workers have to work from home.
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Affiliation(s)
- Zohreh Yaghoubitajani
- Department of Health and Sport Rehabilitation, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Mehdi Gheitasi
- Department of Health and Sport Rehabilitation, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran.
| | - Mohammad Bayattork
- Sport Sciences and Physical Education, Faculty of Humanities Science, University of Hormozgan, Bandar Abbas, Iran
| | - Lars Louis Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Sport Sciences, Department of Health Science and Technology, Aalborg University, 9220, Aalborg, Denmark
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18
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Mechanical Hyperalgesia but Not Forward Shoulder Posture Is Associated with Shoulder Pain in Volleyball Players: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11061472. [PMID: 35329798 PMCID: PMC8950069 DOI: 10.3390/jcm11061472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/22/2022] [Accepted: 03/05/2022] [Indexed: 02/04/2023] Open
Abstract
Shoulder antepulsion, altered scapular kinematics and imbalance of muscle activity are commonly associated with shoulder pain. This study aimed to observe if there is an association between the forward shoulder angle (FSA) and the pectoralis minor length index (PMI) in volleyball players with and without shoulder pain. Furthermore, this study observed if there is an association between shoulder posture and upper limb mechanical hyperalgesia in volleyball players with and without shoulder pain. Methods: a cross-sectional study was conducted in the Physiotherapy and Pain Research Center in Alcalá de Henares (Spain). A total of 56 volleyball players met the inclusion criteria and agreed to enter the study. Subjects were divided into two groups: shoulder pain group (SPG) and control group (without pain). The following measurements of the dominant sides of the players were collected: FSA, PMI, and pressure pain threshold (PPT) in serratus anterior, lower trapezius, infraspinatus, teres minor, upper trapezius, levator scapulae, pectoralis major, radial nerve, cubital nerve, and median nerve. Results: The Spearman’s Rho revealed no significant correlations were found between FSA and PMI. Moreover, Spearman’s Rho test revealed in the SPG a negative moderate correlation between FSA and Infraspinatus-PPT (Rho = −0.43; p = 0.02); FSA and levator scapulae-PPT (Rho = −0.55; p < 0.01); FSA and pectoralis major-PPT (Rho = −0.41; p = 0.02); PMI and cubital nerve-PPT (Rho = −0.44; p = 0.01). Conclusions: No association was found between the forward shoulder angle and the pectoralis minor index in volleyball players with and without shoulder pain. There is a moderate negative association between shoulder forward angle and muscle mechanical hyperalgesia in volleyball players with shoulder pain, but no such associations were found in volleyball players without shoulder pain. Treatment of the infraspinatus, levator scapulae, pectoralis major, and pectoralis minor muscles could improve shoulder pain and ulnar nerve mechanosensitivity.
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19
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Gonçalves DHM, de Oliveira AS, Freire LC, Silva ABM, Garbelotti SA, Lucareli PRG. Three-dimensional kinematic analysis of upper limb movements between individuals with and without subacromial shoulder pain exploring the statistical parametric mapping. J Biomech 2021; 129:110806. [PMID: 34666249 DOI: 10.1016/j.jbiomech.2021.110806] [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] [Received: 02/06/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/27/2022]
Abstract
Subacromial shoulder pain (SSP) accounts for 44-65% of all cases of shoulder pain. Kinematic alterations in the upper limbs have been observed in individuals with SSP, although there is no consensus on such alterations in the literature. Therefore, the present study aimed to compare the three-dimensional kinematics of the scapula, trunk, and arm during shoulder flexion-extension and abduction-adduction movements in individuals with SSP and a control group using statistical parametric mapping (SPM). We evaluated 117 participants [61 with SSP and 56 in the control group (CG)]. The three-dimensional kinematic analysis was performed starting from arm extension/adduction (0%), moving to flexion/abduction, and ending returning to extension/adduction, respectively (100%) in both groups. SSP group flexed more their trunk (0-100%, p < 0.001) and rotated scapula internally (0-20%, p < 0.001 and 75-100%, p < 0.001); rotated upwards (17-32%, p < 0.005 and 58-87%, p < 0.003) and posteriorly tilted (28-79%,p < 0.001 and 81-95%,p < 0.006) less than CG group during arm abduction-adduction. Through arm flexion-extension, the SSP group flexed (38-82% p < 0.009) less their trunk, rotated upwards (5-10% p = 0.021) less their scapula, and posteriorly tilted scapula (0-100% p < 0.001) more than CG. Combining conventional variables used to describe motion in individuals with SSP, such as minimum and maximum values, range of motion, and results provided by SPM can furnish a detailed description of the compensations and limitations of the patient, enabling a better understanding of the function of the scapular girdle as well as improvements in the evaluation process and clinical decision making.
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Affiliation(s)
| | | | - Lucas Cruz Freire
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Ana Beatriz Marcelo Silva
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | | | - Paulo Roberto Garcia Lucareli
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil.
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20
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Jenkins HJ, Downie AS, Fernandez M, Hancock MJ. Decreasing thoracic hyperkyphosis - Which treatments are most effective? A systematic literature review and meta-analysis. Musculoskelet Sci Pract 2021; 56:102438. [PMID: 34375856 DOI: 10.1016/j.msksp.2021.102438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND A variety of treatments aim to reduce thoracic hyperkyphosis in adults, thereby improving posture and reducing possible complications. OBJECTIVE To investigate the effectiveness of treatments to reduce thoracic hyperkyphosis. DESIGN Systematic review and meta-analysis. METHODS MEDLINE, EMBASE, CINAHL, and CENTRAL were searched from inception to March 2021. Two authors independently selected randomised controlled trials assessing the effectiveness of treatments to reduce thoracic hyperkyphosis in adults. Raw data on mean change in thoracic kyphosis were extracted and standardised mean differences (SMD) calculated. Meta-analysis was performed on studies homogenous for study population and intervention. Strength of evidence was assessed using GRADE. RESULTS Twenty-eight studies were included, with five meta-analyses performed. Low to moderate-quality evidence found structured exercise programs of three-months duration or less effective in reducing thoracic hyperkyphosis in younger (SMD -2.8; 95%CI -4.3 to -1.3) and older populations (SMD -0.3; 95%CI -0.6 to 0.0). Low-quality evidence found bracing for three months or more effective in older participants (SMD -1.0, 95%CI -1.3 to -0.7). A single study demonstrated the effectiveness of multimodal care in younger participants. The available evidence suggests multimodal care, structured exercise programs over three months duration, and taping in older adults, and biofeedback and muscle stimulation in younger adults, are ineffective in reducing thoracic hyperkyphosis. CONCLUSION Low to moderate-quality evidence indicates that structured exercise programs are effective to reduce thoracic hyperkyphosis. Low-quality evidence indicates that bracing is effective to reduce thoracic hyperkphosis in older adults.
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Affiliation(s)
- Hazel J Jenkins
- Department of Chiropractic, Macquarie University, Sydney, Australia.
| | - Aron S Downie
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Matthew Fernandez
- School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia
| | - Mark J Hancock
- Department of Health Professions, Macquarie University, Sydney, Australia
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21
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Verdugo F, Begon M, Gibet S, Wanderley MM. Proximal-to-Distal Sequences of Attack and Release Movements of Expert Pianists during Pressed-Staccato Keystrokes. J Mot Behav 2021; 54:316-326. [PMID: 34384342 DOI: 10.1080/00222895.2021.1962237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aims of this study were to i) evaluate proximal-to-distal sequencing (PDS) in pianists' attack and release movements during pressed-staccato keystrokes, and ii) investigate if trunk motion facilitates PDS of upper-limb movements. Nine expert pianists performed a series of loud pressed-staccato keystrokes. Kinematic data was recorded with a 3 D motion capture system. PDS was assessed by comparing temporal organization of peak velocities from the pelvis to the wrist. Evidence of PDS was found across the kinematic chain. Pianists' use of PDS differed mainly between scapula and shoulder movements. Trunk motion facilitated PDS by increasing anticipatory shoulder movements and by preceding shoulder-girdle attack and release movements. Implications might relate to research on performance optimization and injury prevention strategies.
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Affiliation(s)
- Felipe Verdugo
- Input Devices and Music Interaction Laboratory, Centre for Interdisciplinary Research in Music Media and Technology, Schulich School of Music, McGill University, Montreal, Canada.,IRISA, Université Bretagne Sud, Vannes, France.,Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des sciences de l'activité physique, Faculté de médecine, Université de Montréal, Laval, Canada
| | - Mickaël Begon
- Laboratoire de Simulation et Modélisation du Mouvement, École de Kinésiologie et des sciences de l'activité physique, Faculté de médecine, Université de Montréal, Laval, Canada.,Sainte-Justine Hospital Research Center, Montreal, Canada
| | | | - Marcelo M Wanderley
- Input Devices and Music Interaction Laboratory, Centre for Interdisciplinary Research in Music Media and Technology, Schulich School of Music, McGill University, Montreal, Canada
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Johnston HA, Drake JDM. Multivariate shoulder and spine relationship using planar range of motion assessment. Musculoskelet Sci Pract 2021; 54:102398. [PMID: 34045171 DOI: 10.1016/j.msksp.2021.102398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022]
Abstract
CONTEXT Goniometry and posture are commonly used metrics in clinical assessment of the shoulder and spine. When both the shoulder and spine are assessed individually using these techniques, there are structural and functional musculoskeletal relationships between the two anatomical regions that may be overlooked. OBJECTIVE To determine the relationships between and within the shoulder and spine as measured by active range of motion (ROM) and spine curvature. DESIGN Cross-sectional. SETTING Clinical assessment in university setting. PARTICIPANTS 163 asymptomatic, right hand dominant, young adults; INTERVENTION: None. MAIN OUTCOME MEASURES A multivariate canonical correlation was used to identify a shoulder-spine relationship using active ROM assessments. RESULTS A shoulder-spine relationship was determined using planar assessments and multivariate analyses of these two areas. Measures contributing to this relationship included shoulder flexion, internal rotation, external rotation, and trunk flexion and lumbar lordosis. CONCLUSIONS The findings of this study suggest that assessment of shoulder ROM should be interpreted with respect to spine region and vice versa, regardless of presenting region of concern, owing to the multivariate shoulder-spine ROM relationship when considering multiple measures of ROM and posture.
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Affiliation(s)
- Heather A Johnston
- School of Kinesiology and Health Science, Faculty of Health, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada
| | - Janessa D M Drake
- School of Kinesiology and Health Science, Faculty of Health, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada.
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23
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Hagiwara Y, Kanazawa K, Ando A, Sekiguchi T, Yabe Y, Takahashi M, Koide M, Yoshida S. Contracted joint capsule affects labral and chondral lesions in patients with frozen shoulder. Knee Surg Sports Traumatol Arthrosc 2021; 29:2640-2647. [PMID: 34085108 DOI: 10.1007/s00167-021-06600-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/30/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Intra-articular pathologies, such as labral and chondral lesions, are common in patients with frozen shoulder. This study evaluated the correlations between the range of motion and labral and chondral lesions in patients with frozen shoulder and investigated their pathophysiologies. METHODS In total, 125 individuals (53 men and 72 women) who underwent arthroscopic pan-capsular release between 2014 and 2020 were included in the study. The range of motion was measured using scapular fixation and true glenohumeral motion under general anaesthesia. The American Shoulder and Elbow Surgeons Shoulder score and the Shoulder Rating Scale score of the University of California, Los Angeles were used to compare intra-articular pathologies. RESULTS More than 80% of patients with frozen shoulder had labral pathologies, and nearly half of them had chondral pathologies. Labral lesions extending to the anterior rim of the glenoid had a greater range of motion and the greatest total American Shoulder and Elbow Surgeons Shoulder score. More severe chondral lesions had a lesser range of motion, but presented the greatest function scores and the lowest strength scores according to the Shoulder Rating Scale of the University of California, Los Angeles. The pain scores of the American Shoulder and Elbow Surgeons Shoulder score and the Shoulder Rating Scale of the University of California, Los Angeles were not correlated with the degree of these pathologies. The traction force affected the labrum during true range of motion, and the compression force occurred on the articular cartilage during internal rotation at 90° of forward flexion during diagnostic arthroscopy. CONCLUSION Labral and chondral lesions are common in patients with frozen shoulder. Adherence to the capsulolabral complex induced a limited range of motion and labral and chondral pathologies. Diagnostic arthroscopy with motion is an important method of reproducing the pathogenesis of intra-articular structures for patients with frozen shoulder. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yoshihiro Hagiwara
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan.
| | - Kenji Kanazawa
- Department of Orthopaedic Surgery, South Miyagi Medical Center, Ohgawara, Japan
| | - Akira Ando
- Department of Orthopedic Surgery, Matsuda Hospital, Sendai, Japan
| | - Takuya Sekiguchi
- Department of Orthopedic Surgery, Japan Railway Company Sendai Hospital, Sendai, Japan
| | - Yutaka Yabe
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan
| | - Masaki Takahashi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan
| | - Masashi Koide
- Department of Orthopedic Surgery, Matsuda Hospital, Sendai, Japan
| | - Shinichirou Yoshida
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan
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24
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Escalante G, Fine D, Ashworth K, Kolber MJ. Progressive Exercise Strategies to Mitigate Shoulder Injuries Among Weight-Training Participants. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Comprehensive corrective exercise program improves alignment, muscle activation and movement pattern of men with upper crossed syndrome: randomized controlled trial. Sci Rep 2020; 10:20688. [PMID: 33244045 PMCID: PMC7692548 DOI: 10.1038/s41598-020-77571-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/13/2020] [Indexed: 12/14/2022] Open
Abstract
Upper crossed syndrome (UCS) refers to the altered muscle activations and movement patterns in scapulae along with some abnormal alignment in the upper quarter, which may contribute to the dysfunction of the cervicothoracic and glenohumeral joints. The present study aimed to investigate the effectiveness of a comprehensive corrective exercise program (CCEP) and subsequent detraining on alignment, muscle activation, and movement pattern in men with the UCS. This randomized controlled trial included 24 men. The intervention group conducted CCEP (8 weeks), followed by four weeks of detraining and the control group maintained normal daily activities. Electromyography of selected muscles, scapular dyskinesis test, head, shoulder, and thoracic spine angle were measured at baseline, post-test, and follow-up. There were significant differences for Group x time interaction and also for within-group from pre-test to post-test and follow-up in all outcomes. Also, significant differences were observed in three outcomes at post-test and follow-up between the CCEP and control group in favor of the CCEP. In Conclusion, the present study demonstrates that the CCEP for individuals with UCS is feasible and effective, improving muscle activation imbalance, movement patterns, and alignment. Importantly, these improvements were maintained after four weeks of detraining, suggesting lasting neuromuscular re-training adaptations.
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26
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Hagiwara Y, Kanazawa K, Ando A, Sekiguchi T, Yabe Y, Takahashi M, Koide M, Takahashi N, Sugaya H. Clinical outcomes of arthroscopic pan-capsular release with or without entire coracohumeral ligament release for patients with frozen shoulder. JSES Int 2020; 4:826-832. [PMID: 33345222 PMCID: PMC7738570 DOI: 10.1016/j.jseint.2020.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background We aimed to retrospectively determine the effects of arthroscopic pan-capsular release with or without entire coracohumeral ligament (CHL) release and diabetes mellitus (DM) in patients with frozen shoulder (FS). Methods The study included 34 patients (20 male and 14 female patients) who underwent arthroscopic pan-capsular release without entire CHL release (group 1) and 26 patients (6 male and 20 female patients) who underwent entire CHL release for FS (group 2). Patients with a minimum of 12 months of follow-up were included, and range of motion (ROM) and the shoulder rating scale of the University of California at Los Angeles (UCLA) scoring system were evaluated. Results In group 2, external rotation and hand-behind-the-back (HBB) ROMs were significantly increased compared with group 1 at the final follow-up (external rotation, 53.1° ± 15.2° vs. 41.3° ± 20.5° [P = .044]; HBB level, T6 [interquartile range, T5-T9] vs. T11 [interquartile range, T8-L4] [P < .001]). Total UCLA scores and UCLA scores for pain (9.2 ± 1.5 vs. 10.0, P = .003), function (8.5 ± 1.4 vs. 10.0, P < .001), and active forward flexion (4.6 ± 0.6 vs. 4.9 ± 0.2, P < .011) were significantly greater in group 2 at the final follow-up. Patients without DM tended to have greater recovery of forward flexion and HBB ROMs and better total, pain, and function UCLA scores compared with those with DM. In group 2, there were no significant differences in ROMs and UCLA scores between the patients with DM and those without DM. Conclusion Arthroscopic entire CHL release is an essential treatment option for FS patients to regain ROMs and function and to reduce pain.
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Affiliation(s)
- Yoshihiro Hagiwara
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kenji Kanazawa
- Department of Orthopaedic Surgery, South Miyagi Medical Center, Ōgawara, Japan
| | - Akira Ando
- Department of Orthopaedic Surgery, Matsuda Hospital, Sendai, Japan
| | - Takuya Sekiguchi
- Department of Orthopaedic Surgery, Japan Railway Company Sendai Hospital, Sendai, Japan
| | - Yutaka Yabe
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Masaki Takahashi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Masashi Koide
- Department of Orthopaedic Surgery, Matsuda Hospital, Sendai, Japan
| | - Norimasa Takahashi
- Department of Orthopaedic Surgery, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Hiroyuki Sugaya
- Department of Orthopaedic Surgery, Funabashi Orthopaedic Hospital, Funabashi, Japan
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27
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Hagiwara Y, Kanazawa K, Ando A, Sekiguchi T, Koide M, Yabe Y, Suzuki K, Itoi E. Effects of joint capsular release on range of motion in patients with frozen shoulder. J Shoulder Elbow Surg 2020; 29:1836-1842. [PMID: 32414610 DOI: 10.1016/j.jse.2020.01.085] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/11/2020] [Accepted: 01/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND A thickened joint capsule is believed to be one of the most specific manifestations of and the primary restraint against range of motion (ROM) in frozen shoulders. The purpose of this study was to evaluate the relationship among ROMs under general anesthesia before surgery and the effects of each joint capsular release on ROM. METHODS ROM was measured using a goniometer with scapular fixation. Arthroscopic pan-capsular release was performed with the patient in the beach-chair position in the following order: (1) rotator interval, (2) coracohumeral ligament, (3) superior capsule, (4) middle glenohumeral ligament, (5) anterior inferior glenohumeral ligament, and (6) posterior inferior glenohumeral ligament. ROMs in forward flexion (FF), lateral elevation (LE), external rotation with the arm at the side (ER1), external rotation at 90° of LE (ER2), internal rotation at 90° of LE (IR2), horizontal flexion, external rotation at 90° of FF (ER3), and internal rotation at 90° of FF (IR3) were evaluated before and after each release. RESULTS A total of 32 consecutive shoulders were included. After each capsular release, the ROM recovered; the final ROM was significantly greater on the affected side than on the unaffected side. Significant correlations were found between FF and LE, FF and ER1, ER1 and ER2, ER1 and ER3, ER2 and ER3, and IR2 and IR3 on both sides, regardless of surgery. CONCLUSION Each segment of the joint capsule affected ROM in all directions, supporting the need for whole-joint capsular release; ROM was significantly greater on the affected side than on the unaffected side after surgery.
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Affiliation(s)
- Yoshihiro Hagiwara
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
| | - Kenji Kanazawa
- Department of Orthopaedic Surgery, South Miyagi Medical Center, Ōgawara, Japan
| | - Akira Ando
- Department of Orthopaedic Surgery, Matsuda Hospital, Sendai, Japan
| | - Takuya Sekiguchi
- Department of Orthopaedic Surgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Masashi Koide
- Department of Orthopaedic Surgery, Matsuda Hospital, Sendai, Japan
| | - Yutaka Yabe
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kazuaki Suzuki
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
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28
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De-la-Cruz-Torres B, Sánchez-López MD. Effectiveness of a 12-Week Physical Exercise Program on Lower-Limb Malalignment in School-age Rugby: A Randomized Clinical Trial. J Manipulative Physiol Ther 2020; 43:531-538. [PMID: 32888702 DOI: 10.1016/j.jmpt.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 10/23/2019] [Accepted: 11/22/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We sought to assess the effectiveness of 12 weeks of a physical exercise program (PEP) in child rugby players with lower-limb overpronation during gait. METHODS This was a randomized clinical trial. A total of 123 young athletes (mean ± standard deviation age, 10.35 ± 1.22 years) were evaluated, 20 of whom had lower-limb overpronation (n = 40 extremities). Participants were randomly assigned to 2 groups: the experimental group, who performed their normal training and a PEP for 12 weeks, and the control group, who continued with their normal training for the same time. The PEP was focused on stretching the hypertonic muscle and potentiating the weakened muscles of the lower body. All participants underwent biomechanical analysis including the Helbing angle, the femorotibial angle, and the Fick angle in both limbs. RESULTS All participants (n = 20) completed the study. Baseline measurements showed no significant differences between groups in any of the variables tested. After 12 weeks, there were significant differences between groups (P < .001 for all angles). No improvement was found in the control group; however, meaningful improvement was found in all variables in the experimental group: Helbing angle (175°, P < .001, effect size [ES] = 1.94), femorotibial angle (173°, P < .001, ES = 1.77), Fick angle (12°, P < .001, ES = 1.55). The number needed to treat was 2 for femorotibial angle and Helbing angle, and 3 for Fick angle. CONCLUSION A 12-week PEP produced significant improvements in these 3 biomechanical variables. We also conclude that young athletes with a pathological gait pattern reached a normal gait pattern.
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29
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Hunter DJ, Rivett DA, McKeirnan S, Smith L, Snodgrass SJ. Relationship Between Shoulder Impingement Syndrome and Thoracic Posture. Phys Ther 2020; 100:677-686. [PMID: 31825488 DOI: 10.1093/ptj/pzz182] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/20/2019] [Accepted: 08/21/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Shoulder impingement syndrome (SIS) is the most common form of shoulder pain and a persistent musculoskeletal problem. Conservative and invasive treatments, aimed at the shoulder joint, have had limited success. Research suggests shoulder function is related to thoracic posture, but it is unknown whether thoracic posture is associated with SIS. OBJECTIVE The objective of this study was to investigate whether there is a relationship between SIS and thoracic posture. DESIGN This was a case control study. METHODS Thoracic posture of 39 participants with SIS and 39 age-, gender-, and dominant arm-matched controls was measured using the modified Cobb angle from a standing lateral radiograph. Thoracic range of motion (ROM) was also measured using an inclinometer. Between-group differences were compared using t tests. The relationship between thoracic posture and thoracic ROM was determined with linear regression. RESULTS Twenty women and 19 men with SIS (mean age = 57.1 years, SD = 11.1) and 39 age-matched, gender-matched, and dominant arm-matched controls (mean age = 55.7years, SD = 10.6) participated. Individuals with SIS had greater thoracic kyphosis (mean difference = 6.2o, 95% CI 2.0-10.4) and less active thoracic extension (7.8o, 95% CI = 2.2-13.4). Greater thoracic kyphosis was associated with less extension ROM (ie, more flexion when attempting full extension: β = 0.71, 95% CI = 0.45-0.97). LIMITATIONS These cross-sectional data can only demonstrate association and not causation. Both radiographic measurements and inclinometer measurements were not blinded. CONCLUSION Individuals with SIS had a greater thoracic kyphosis and less extension ROM than age- and gender-matched healthy controls. These results suggest that clinicians could consider addressing the thoracic spine in patients with SIS.
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Affiliation(s)
- Donald J Hunter
- BAppSc(Osteo), MOsteo, Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Darren A Rivett
- BAppSc(Phty), MAppSc(ManipPhty), PhD, Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle
| | - Sharmain McKeirnan
- BAppSc(MedRadTech), Hons, PhD, Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle
| | - Lyn Smith
- MB BCh, Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle
| | - Suzanne J Snodgrass
- BSc(PhysTher), MMedSc(Physio), PhD, Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle
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30
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Bayattork M, Seidi F, Minoonejad H, Andersen LL, Page P. The effectiveness of a comprehensive corrective exercises program and subsequent detraining on alignment, muscle activation, and movement pattern in men with upper crossed syndrome: protocol for a parallel-group randomized controlled trial. Trials 2020; 21:255. [PMID: 32164773 PMCID: PMC7069207 DOI: 10.1186/s13063-020-4159-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 02/11/2020] [Indexed: 11/13/2022] Open
Abstract
Background Upper crossed syndrome (UCS) refers to specific altered muscle activation and changed movement patterns along with some postural deviations in the upper quarter of the body. This syndrome might contribute to the dysfunction of the cervicothoracic and glenohumeral joints. Objectives The present study will aim to investigate the effectiveness of a comprehensive corrective exercises program (CCEP) and subsequent detraining on alignment, muscle activation and movement pattern in men with UCS. Methods/design This is a parallel-group randomized controlled trial. Participants will be 22 men aged 18 to 28 years who are suffering from UCS. Participants in the intervention group will conduct CCEP (three times a week for 8 weeks), followed by 4 weeks of detraining. The control group will do their daily activities. Participants will be randomized (1:1) into the intervention or the control group. The primary outcome will be upper trapezius activations. Secondary outcomes consist of electromyography of middle and lower trapezius and serratus anterior muscles, scapular dyskinesis test, forward head and shoulder angles, thoracic kyphosis angle, and neck flexion pattern test. Discussion We propose to evaluate the effectiveness of a randomized controlled trial of a CCEP in men with UCS on their alignment, selected muscle activations, and relevant movement patterns. Results from our trial may provide new insights into the effects of exercise not only on the alignment but also on muscle activation and movement patterns that are important outcomes for people with postural malalignments and, if successful, could assist therapists in evidence-based clinical decision-making. Trial registration Iranian Registry of Clinical Trials, IRCT20181004041232N1. Registered on 26 October 2018.
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Affiliation(s)
- Mohammad Bayattork
- Health and Sports Medicine Department, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran.,Sport Sciences and Physical Education, Faculty of Humanities Science, University of Hormozgan, Bandar Abbas, Iran
| | - Foad Seidi
- Health and Sports Medicine Department, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran.
| | - Hooman Minoonejad
- Health and Sports Medicine Department, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Lars Louis Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Sport Sciences, Department of Health Science and Technology, Aalborg University, DK-9220, Aalborg, Denmark
| | - Phil Page
- Performance Health, Baton Rouge, Louisiana, USA
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31
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Barrett E, Conroy C, Corcoran M, Sullivan KO, Purtill H, Lewis J, McCreesh K. An evaluation of two types of exercise classes, containing shoulder exercises or a combination of shoulder and thoracic exercises, for the treatment of nonspecific shoulder pain: A case series. J Hand Ther 2019; 31:301-307. [PMID: 29217293 DOI: 10.1016/j.jht.2017.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A case series was carried out. INTRODUCTION There is a lack of evidence exploring the effectiveness of group exercise classes for people with nonspecific shoulder pain (NSSP). Also, there is a lack of research that measures potential reductions in thoracic kyphosis after exercise interventions in people with NSSP. PURPOSE OF THE STUDY To observe changes in shoulder pain, disability, and thoracic kyphosis in 2 groups of people with NSSP, after 2 different types of group exercise classes. METHODS People with NSSP received a 6-week block of exercises classes containing either shoulder exercises alone (shoulder group, n = 20) or a mixture of shoulder and thoracic extension exercises (thoracic group, n = 19). The Disabilities of the Arm, Shoulder and Hand questionnaire for disability and the Numeric Rating Scale for pain were measured at baseline, 6 weeks, and 6 months. Thoracic kyphosis was measured at baseline and 6 weeks using the manual inclinometer. RESULTS Significant and clinically meaningful improvements in Numeric Rating Scale and Disabilities of the Arm, Shoulder and Hand were demonstrated in both groups at 6-week and 6-month follow-up (P < .001). Effect sizes ranged from 0.78-1.16 in the shoulder group and 0.85-1.88 in the thoracic group. Thoracic kyphosis did not change beyond measurement error in either group. DISCUSSION/CONCLUSION Group exercise classes can improve shoulder pain and disability in people with NSSP. Resting thoracic kyphosis did not change after either exercise intervention, which suggests that the treatment effect was not due to a change in static thoracic spine posture.
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Affiliation(s)
- Eva Barrett
- School of Nursing and Midwifery, National University of Ireland Galway, University Road, Galway, Ireland.
| | - Carmela Conroy
- Physiotherapy Department, St. John's Hospital, Limerick, Ireland
| | - Marie Corcoran
- Physiotherapy Department, Midland Regional Hospital, Portlaoise, Ireland
| | - Kieran O' Sullivan
- Sports Spine Centre, Aspetar Sports and Orthopaedic Hospital, Doha, Qatar
| | - Helen Purtill
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Jeremy Lewis
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland; Department of Allied Health Professions and Midwifery, University of Hertfordshire, Hertfordshire, UK; Musculoskeletal Services, Central London Community Healthcare NHS Trust, London, UK
| | - Karen McCreesh
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
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32
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Heneghan NR, Webb K, Mahoney T, Rushton A. Thoracic spine mobility, an essential link in upper limb kinetic chains in athletes: A systematic review. TRANSLATIONAL SPORTS MEDICINE 2019. [DOI: 10.1002/tsm2.109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Nicola R. Heneghan
- Centre of Precision Rehabilitation for Spinal Pain School of Sport, Exercise & Rehabilitation Sciences University of Birmingham Birmingham UK
| | - Katie Webb
- Physiotherapy Department Northwick Park Hospital Harrow UK
| | - Tom Mahoney
- Physiotherapy Department Sandwell General Hospital West Bromwich UK
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain School of Sport, Exercise & Rehabilitation Sciences University of Birmingham Birmingham UK
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Morais N, Cruz J, Marques A. The Kinematic Chain of Arm Elevation Is Impaired in Patients with Chronic Obstructive Pulmonary Disease. COPD 2019; 16:240-245. [PMID: 31272244 DOI: 10.1080/15412555.2019.1632281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) often complain about difficulties in performing activities with their arms above shoulders height. These difficulties have been associated with increased cardiorespiratory demand and altered lung mechanics; however, musculoskeletal-related mechanisms may also contribute to constrain the mechanics of the upper body quadrant, increasing the effort to perform the activities. This exploratory research aimed to assess potential changes in the kinematic chain of arm elevation in patients with COPD. A secondary analysis from a cross-sectional exploratory case-control and prediction study was conducted in 15 patients with COPD (2 females) and 15 controls (8 females) matched for age and body mass index. The sagittal alignment and active range of motion (ROM) of the head, thoracic spine and shoulder complex were measured, using a computer software, in digital lateral photographs obtained in three different testing positions: arms at rest, arms at 90° of shoulder flexion and full arm elevation. From rest to full arm elevation, both groups moved from a more flexed to a less flexed or more upright thoracic spine position (∼7°, p < 0.001, 0.419 < ηp2 <0.767). However, the COPD group showed significantly less shoulder flexion (∼12°, p = 0.007, d = 1.05) and thoracic spine extension (∼6°, p = 0.015, ηp2 = 0.139) ROM than the control group in the full arm elevation position. These findings suggest that this population may show changes in the kinematic chain of arm elevation that possibly contribute to arm movement-related complains and limited performance in their daily living.
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Affiliation(s)
- Nuno Morais
- School of Health Sciences (ESSLei), Centre for Rapid and Sustainable Product Development (CDRSP), Polytechnic Institute of Leiria , Leiria , Portugal
| | - Joana Cruz
- School of Health Sciences (ESSLei), Center for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria , Leiria , Portugal
| | - Alda Marques
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA) , Aveiro , Portugal.,Center for Health Technology and Services Research (CINTESIS) , Aveiro , Portugal
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34
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Meadows S, Smith G, Vaswani R. Physiotherapist survey: Increasing thoracic spine movement within the management of chronic subacromial impingement syndrome. J Bodyw Mov Ther 2019; 24:93-99. [PMID: 31987570 DOI: 10.1016/j.jbmt.2019.06.013] [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: 06/13/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
AIMS This study's primary aim is to address two questions. Firstly; what evidence exists regarding the inclusion of increasing thoracic movement within the management of subacromial impingement syndrome SIS?; and secondly, what proportion of Society of Musculoskeletal Medicine (SOMM) physiotherapists use this form of treatment within SIS management? METHODS An online survey was conducted using a questionnaire incorporating a vignette describing a patient with chronic SIS. The SOMM physiotherapy members were sampled using convenience sampling. FINDINGS This study has identified some evidence supporting increasing movement of the thoracic spine in the management of patients with SIS. No study or guideline protocols have been identified that advocate the use of this form of treatment, nor research identified that investigates physiotherapists' use of this form of treatment within SIS management. Of the 1340 physiotherapists surveyed, 52 responded of which 79% stated that they would use treatment aimed at increasing movement of the thoracic spine within SIS management. Chi Square analysis suggests no significant association between using this treatment and number of years experience (p value = 0.15) or courses attended (p = 0.62). CONCLUSIONS Evidence suggests it is beneficial to include treatment to increase thoracic spine mobility within SIS management. This study highlights the need for the clinician to be aware of the role of the thoracic spine in relation to the biomechanics of the shoulder complex. Of the sample of SOMM physiotherapists obtained, the majority stated that they would use this form of treatment. Further research is recommended.
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Affiliation(s)
- Simon Meadows
- WH&C NHS Trust, Physiotherapy Department, Evesham, UK.
| | - Gordon Smith
- University of Worcester, Institute of Health & Society (Physiotherapy), Worcester, UK
| | - Ramesh Vaswani
- Society of Musculoskeletal Medicine (SOMM), Liverpool, UK
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Forsyth AL, Joshi RY, Canning CG, Allen NE, Paul SS. Flexed Posture in Parkinson Disease: Associations With Nonmotor Impairments and Activity Limitations. Phys Ther 2019; 99:893-903. [PMID: 30830153 DOI: 10.1093/ptj/pzz033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/18/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND People with Parkinson disease (PD) are twice as likely to develop flexed truncal posture as the general older population. Little is known about the mechanisms responsible beyond associations with age, axial motor impairments, and disease severity. OBJECTIVE The objective was to explore: (1) the associations of the nonmotor impairments of PD with flexed posture, and (2) the relationships of flexed posture with activity limitations. DESIGN This was a cross-sectional study. METHODS Seventy people with PD participated. Posture was measured in standing as the distance between the seventh cervical vertebra and a wall. Nonmotor impairments (cognition, depression, pain, fatigue, and proprioception) and activity performance (upper limb activity, bed transfers, respiratory function, and speech volume) were variously assessed using objective measures and self-report questionnaires. Univariate and multivariate regression analyses were performed to ascertain relationships between nonmotor impairments and truncal posture, and between truncal posture and activities. RESULTS Greater disease severity, greater axial impairment, poorer spinal proprioception, greater postural fatigue, and male sex were significantly associated with flexed truncal posture. The multivariate model containing these factors in addition to age explained 30% of the variability in flexed truncal posture, with male sex and axial motor impairment continuing to make independent contributions. A significant association was found between greater flexed truncal posture and poorer upper limb activity performance and respiratory function. LIMITATIONS A limitation to this study was that participants had mild-to-moderate disease severity. CONCLUSIONS Spinal proprioception and postural fatigue were the only nonmotor impairments to make significant contributions to flexed posture. Given the negative influence of flexed posture on upper limb activity and respiratory function, interventions targeting spinal proprioception and postural awareness should be considered for people with PD who might develop flexed posture.
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Affiliation(s)
- Aimi L Forsyth
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney; and Lady Davidson Private Hospital, Sydney, Australia
| | - Riddhi Y Joshi
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Australia
| | - Natalie E Allen
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Australia
| | - Serene S Paul
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney NSW 2141, Australia
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Hanson JH, Ostrem JD, Davies BL. Effect of Kinesiology Taping on Upper Torso Mobility and Shoulder Pain and Disability in US Masters National Championship Swimmers: An Exploratory Study. J Manipulative Physiol Ther 2019; 42:247-253. [PMID: 31221494 DOI: 10.1016/j.jmpt.2018.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 07/10/2018] [Accepted: 11/02/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to observe changes in shoulder pain and upper-extremity functional movement after kinesiology taping (KT) in competitive swimmers. METHODS Seventy-six healthy participants competing in the US Masters Swimming 2017 National Championship participated in the study. Participants performed functional movement of shoulder flexion along with Disabilities of the Arm, Shoulder, and Hand index assessments for the shoulder before and 30 minutes after application of KT. RESULTS A change in the functional movement assessment was observed after KT application when compared to the pre-KT application (33.56 ± 1.39 cm vs 35.35 ± 1.52 cm, P < .001). A statistical significant change for pain and disability scores of 2.17 was observed (12.29 ± 1.22 vs 10.12 ± 1.16, P < .01). CONCLUSION For the participants in this study, KT changed shoulder pain and active functional movement scores significantly in swimmers.
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Affiliation(s)
- Jasmine H Hanson
- Kinesiology and Health Sciences, Concordia University-St. Paul, St. Paul, Minnesota; Human Performance Center, Northwestern Health Sciences University, Bloomington, Minnesota.
| | - Joseph D Ostrem
- Kinesiology and Health Sciences, Concordia University-St. Paul, St. Paul, Minnesota
| | - Brenda L Davies
- Kinesiology and Health Sciences, Concordia University-St. Paul, St. Paul, Minnesota
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Weisman A, Masharawi Y. Does Altering Sitting Posture Have a Direct Effect on Clinical Shoulder Tests in Individuals With Shoulder Pain and Rotator Cuff Degenerative Tears? Phys Ther 2019; 99:194-202. [PMID: 30351428 DOI: 10.1093/ptj/pzy111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 08/07/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Posture variations have been repeatedly linked to shoulder kinematics, strength, range of motion, and rotator cuff diseases. However, to our knowledge, no study has yet examined their possible link with shoulder pain provocation and pain levels during clinical shoulder tests. OBJECTIVE The objective was to examine whether changing posture while sitting modifies pain provocation and pain level during performance of 3 clinical shoulder tests in participants with shoulder pain and rotator cuff degenerative tears (RCDTs). METHODS Seventy individuals were allocated into 2 groups by an experienced physical therapist: 35 participants with symptomatic shoulders and RCDT diagnosed by ultrasound (tear size = 1.0 +/- 0.5 cm) and 35 control participants with no symptoms in the upper limb. All participants were tested by a second physical therapist for pain provocation (yes/no) and pain level (visual analog scale) using 3 common clinical shoulder tests: the Neer, the Hawkins-Kennedy, and the empty can while sitting in a neutral, slouched, and upright posture. Shoulder muscle forces were examined by a hand-held dynamometer for possible correlations only in the neutral posture. All participants were asked to fill out the quick DASH (disabilities of the arm shoulder and hand) questionnaire. RESULTS In the symptomatic group, all 3 clinical tests demonstrated similar pain provocation (100% repeatability) and pain level in all 3 sitting postures (visual analog scale scores 3.7-4.4). Muscle force mean ranges of the study groups were 4.4 to 7 kg and, in the control group, 6 to 10.5 kg. No correlations were found between age, body mass index, shoulder pain, hand dominance, onset of symptoms, severity, and tear size with any of the dependent variables. CONCLUSIONS Changing posture while sitting did not directly affect pain provocation and pain levels during performance of 3 clinical shoulder tests in participants with shoulder pain and RCDTs.
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Affiliation(s)
- Asaf Weisman
- Clalit Health Services, Holon, Israel; and Spinal Research Laboratory, Department of Physical Therapy, Tel Aviv University, Tel Aviv, Israel
| | - Youssef Masharawi
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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Abstract
The diversity of models of care in contemporary musculoskeletal physical therapy can be confusing for patients and practicing clinicians. There is, however, a common theme to many of these seemingly disparate models of care: symptom modification. Symptom modification aims at reducing symptoms and improving function with a variety of clinical approaches. This Viewpoint explores the role of symptom modification in rehabilitation and specifically addresses (1) symptom modification within the kinesiopathological model of pain, (2) symptom modification in clinical practice, and (3) potential commonality in seemingly divergent models of clinical practice. J Orthop Sports Phys Ther 2018;48(6):430-435. doi:10.2519/jospt.2018.0608.
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Feijen S, Kuppens K, Tate A, Baert I, Struyf T, Struyf F. Intra- and interrater reliability of the 'lumbar-locked thoracic rotation test' in competitive swimmers ages 10 through 18 years. Phys Ther Sport 2018; 32:140-144. [PMID: 29793122 DOI: 10.1016/j.ptsp.2018.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/19/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Measuring thoracic spine mobility can be of interest to competitive swimmers as it has been associated with shoulder girdle function and scapular position in subjects with and without shoulder pain. At present, no reliability data of thoracic spine mobility measurements are available in the swimming population. This study aims to evaluate the within-session intra- and interrater reliability of the "lumbar-locked rotation test" for thoracic spine rotation in competitive swimmers aged 10 to 18 years. This reliability study is part of a larger prospective cohort study investigating potential risk factors for the development of shoulder pain in competitive swimmers. DESIGN Within-session, intra- and inter-rater reliability. SETTING Competitive swimming clubs in Belgium. PARTICIPANTS 21 competitive swimmers. MAIN OUTCOME MEASURES Intra- and inter-rater reliability of the lumbar-locked thoracic rotation test. RESULTS Intraclass correlation coefficients (ICCs) ranged from 0.91 (95% CI 0.78 to 0.96) to 0.96 (0.89-0.98) for intra-rater reliability. Results for inter-rater reliability ranged from 0.89 (0.72-0.95) to 0.86 (0.65-0.94) respectively for right and left thoracic rotation. CONCLUSION Results suggest good to excellent reliability of the lumbar-locked thoracic rotation test, indicating this test can be used reliably in clinical practice.
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Affiliation(s)
- Stef Feijen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Kevin Kuppens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Angela Tate
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA
| | - Isabel Baert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Thomas Struyf
- Healthcare-associated Infections & Antimicrobial Resistance, Scientific Institute of Public Health, Brussels, Belgium
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium.
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Thoracic manual therapy is not more effective than placebo thoracic manual therapy in patients with shoulder dysfunctions: A systematic review with meta-analysis. Musculoskelet Sci Pract 2018; 33:1-10. [PMID: 29055216 DOI: 10.1016/j.msksp.2017.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Manual treatments targeting different regions (shoulder, cervical spine, thoracic spine, ribs) have been studied to deal with patients complaining of shoulder pain. Thoracic manual treatments seem able to produce beneficial effects on this group of patients. However, it is not clear whether the patient improvement is a consequence of thoracic manual therapy or a placebo effect. OBJECTIVES To compare the efficacy of thoracic manual therapy and placebo thoracic manual treatment for patients with shoulder dysfunction. METHODS Electronic databases (MEDLINE, CENTRAL, PEDro, CINAHL, WoS, EMBASE, ERIC) were searched through November 2016. Randomized Controlled Trials assessing pain, mobility and function were selected. The Cochrane bias estimation tool was applied. Outcome results were either extracted or computed from raw data. Meta-analysis was performed for outcomes with low heterogeneity. RESULTS Four studies were included in the review. The methodology of the included studies was generally good except for one study that was rated as high risk of bias. Meta-analysis showed no significant effect for "pain at present" (SMD -0.02; 95% CI: -0.35, 0.32) and "pain during movement" (SMD -0.12; 95% CI: -0.45, 0.21). CONCLUSION There is very low to low quality of evidence that a single session of thoracic manual therapy is not more effective than a single session of placebo thoracic manual therapy in patients with shoulder dysfunction at immediate post-treatment.
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Sahrmann S, Azevedo DC, Dillen LV. Diagnosis and treatment of movement system impairment syndromes. Braz J Phys Ther 2017; 21:391-399. [PMID: 29097026 PMCID: PMC5693453 DOI: 10.1016/j.bjpt.2017.08.001] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 08/30/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Diagnoses and treatments based on movement system impairment syndromes were developed to guide physical therapy treatment. OBJECTIVES This masterclass aims to describe the concepts on that are the basis of the syndromes and treatment and to provide the current research on movement system impairment syndromes. RESULTS The conceptual basis of the movement system impairment syndromes is that sustained alignment in a non-ideal position and repeated movements in a specific direction are thought to be associated with several musculoskeletal conditions. Classification into movement system impairment syndromes and treatment has been described for all body regions. The classification involves interpreting data from standardized tests of alignments and movements. Treatment is based on correcting the impaired alignment and movement patterns as well as correcting the tissue adaptations associated with the impaired alignment and movement patterns. The reliability and validity of movement system impairment syndromes have been partially tested. Although several case reports involving treatment using the movement system impairment syndromes concept have been published, efficacy of treatment based on movement system impairment syndromes has not been tested in randomized controlled trials, except in people with chronic low back pain.
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Affiliation(s)
- Shirley Sahrmann
- Washington University School of Medicine, Program in Physical Therapy, St. Louis, USA.
| | - Daniel C Azevedo
- Universidade Cidade de São Paulo (UNICID), Masters and Doctoral Programs in Physical Therapy, São Paulo, SP, Brazil; Pontifícia Universidade Católica de Minas Gerais (PUC-MG), Departamento de Fisioterapia, Belo Horizonte, MG, Brazil
| | - Linda Van Dillen
- Washington University School of Medicine, Program in Physical Therapy, St. Louis, USA
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Land H, Gordon S, Watt K. Reply to the letter to the Editor regarding 'Clinical assessment of subacromial shoulder impingement - Which factors differ from the asymptomatic population?'. Musculoskelet Sci Pract 2017; 29:e14-e15. [PMID: 28396212 DOI: 10.1016/j.msksp.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Helen Land
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia.
| | - Susan Gordon
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia.
| | - Kerrianne Watt
- College of Public Health, Medical & Vet Sciences, James Cook University, Townsville, Queensland, Australia.
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Ge W, Bennett TK, Oller JC. Should high-power posing be integrated in physical therapy? J Phys Ther Sci 2017; 29:697-701. [PMID: 28533612 PMCID: PMC5430275 DOI: 10.1589/jpts.29.697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 01/10/2017] [Indexed: 11/30/2022] Open
Abstract
[Purpose] Postural assessment and correction is a common approach in patient management
to decrease symptoms and improve function for patients. The purpose of this study was to
determine the effects of high-power posing on muscle strength and pain threshold.
[Subjects and Methods] Thirty-one subjects, 16 females and 15 males, mean age 28.9 (SD
10.8) years old, were recruited through a convenience sampling on the university campus.
The research design was a randomized controlled trial. In the experimental group, the
subjects were instructed to stand in a high-power posture. In the control group, the
subjects were instructed to stand in a low-power posture. Grip strength and pain threshold
measurements were conducted before and after the postural intervention. [Results] The grip
strength changed by −3.4 (−3.7, 0.3) % and 1.7 (−3.6, 5.3) % for the experimental and
control groups, respectively. The pain threshold changed by 0.6 (−9.9, 10.4) % and 15.1
(−9.3, 24.4) % for the experimental and control groups, respectively. However, both
changes were not significant as all the 95% CIs included 0. [Conclusions] The data did not
show significant benefits of high-power posing in increasing grip strength and pain
threshold compared to low-power posing.
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Affiliation(s)
- Weiqing Ge
- Department of Physical Therapy, Youngstown State University, USA
| | - Teale K Bennett
- Department of Physical Therapy, Youngstown State University, USA
| | - Jeremy C Oller
- Department of Physical Therapy, Youngstown State University, USA
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Lewis JS, McCreesh K, Barratt E, Hegedus EJ, Sim J. Inter-rater reliability of the Shoulder Symptom Modification Procedure in people with shoulder pain. BMJ Open Sport Exerc Med 2016; 2:e000181. [PMID: 27900200 PMCID: PMC5125418 DOI: 10.1136/bmjsem-2016-000181] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 12/04/2022] Open
Abstract
Background Musculoskeletal conditions involving the shoulder are common and, because of the importance of the upper limb and hand in daily function, symptoms in this region are commonly associated with functional impairment in athletic and non-athletic populations. Deriving a definitive diagnosis as to the cause of shoulder symptoms is fraught with difficulty. Limitations have been recognised for imaging and for orthopaedic special tests. 1 solution is to partially base management on the response to tests aimed at reducing the severity of the patient's perception of symptoms. 1 (of many) such tests is the Shoulder Symptom Modification Procedure (SSMP). The reliability of this procedure is unknown. Methods 37 clinician participants independently watched the videos of 11 patient participants undergoing the SSMP and recorded each patient's response as improved (partially or completely), no change or worse. Inter-rater reliability was assessed by Krippendorff's α, which ranges from 0 to 1. Results Krippendorff's α was found to range from 0.762 to 1.000, indicating moderate to substantial reliability. In addition, short (3-hour) and longer (1-day) durations of training were associated with similar levels of reliability across the techniques. Conclusions Deriving a definitive structural diagnosis for a person presenting with a musculoskeletal condition involving the shoulder is difficult. The findings of the present study suggest that the SSMP demonstrates a high level of reliability. More research is needed to better understand the relevance of such procedures. Trial registration number ISRCTN95412360.
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Affiliation(s)
- Jeremy S Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK; Department of Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Karen McCreesh
- Department of Clinical Therapies , University of Limerick , Limerick , Ireland
| | - Eva Barratt
- Department of Clinical Therapies , University of Limerick , Limerick , Ireland
| | - Eric J Hegedus
- Department of Physical Therapy , Congdon School of Health Sciences, High Point University , High Point, North Carolina , USA
| | - Julius Sim
- Institute for Primary Care and Health Sciences, Keele University , Stoke-on-Trent , UK
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