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123
PHYSICAL TREA MENTS
October 2014 . Volume 4 . Number 3
Elham Hajihosseini 1*, Aliasghar Norasteh 2, Ali Shamsi 3, Hassan Daneshmandi 2
1. Msc Student, Department of Sports Injuries, School of Sport Sciences, University of Guilan, Guilan, Iran.
2. Associate Professor, Department of Sports Injuries, School of Sport Sciences, University of Guilan, Guilan, Iran.
3. Assistant Professor, Department of Sports Injuries, School of Sport Sciences, University of Guilan, Guilan, Iran.
* Corresponding Author:
Elham Hajihosseini, MSc
Address: Department of Sports Injuries, School of Sport Sciences, University of Guilan, Guilan, Iran.
Phone:
+98 (936)0441429
Email: Hosseinielham1988@gmail.com
The Effects of Strengthening, Stretching and Comprehensive
Exercises on Forward Shoulder Posture Correction
Purpose: The forward shoulder (FS) is one of the most common deformities accounted for 60%
of shoulder abnormalities.This study aimed to investigate the effects of a 6-weekstrength training,
stretch training andcomprehensive training in patients with forward shoulder abnormalities.
Methods:This quasi-experimental study design Pre-posttest with control group. Forty females
students with excessive forward shoulder angle (FS>52) were chosen using purposive sampling
method. The average of age, weight, height and body mass index of the samples were 22.22±1.77
years, 61.22±1.90 kg, 161.85±2.55 cm, and 23.37±0.9kg.m2 respectively. The subjects were
randomly divided into 4 groups ( each 10 subjects), 3 experimental and 1 control groups. The rst
experimental group performed strength training, second group stretch training and third group
comprehensive training for 6 weeks. In this period, the control group did not receive any training.
We used photogrammetric method to measure the angle of the forward shoulder. Shoulder angle
changes of the subjects before and after 6 weeks were measured. Data were analyzed using
paired T-test, One-way analysis of variance and SPSS (21) (P≤0.05).
Results: According to study ndings, paired t-test results in the experimental group showed
that the forward shoulder angle of the subjects in corrective exercises signicantly decreased so
that after participating in 3 types of training program, strengthening(P=0.001, t=8.63), stretching
(P=0.001, t=6.78) and comprehensive (P=0.001, t=12.11), the angle dropped in the order of 6.10,
4.90 and 7.10 degrees. One-way analysis of variance (ANOVA) showed that there are signicant
differences (P=0.001) among the effects of different exercises on the forward shoulder angle.
Based on Tukey test results, the implementation of corrective exercises, strengthening (P=0.001),
stretching (P=0.001), and comprehensive (P=0.001) showed a signicant difference with the
control group. However, no signicant differences were observed among the groups of strength,
stretching and comprehensive trainings with each other.
Conclusion: The results demonstrated a signicant decrease in the angle of forward shoulder in
the experimental group. Therefore, using this program is recommended in subjects with these
deformity.
A B S T R A C T
Keywords:
Forward shoulder,
Strengthening training,
Stretching training,
Comprehensive training
1. Introduction
ith regard to the natural direction of the
body, the position of shoulders toward
the back spine has a crucial role in
having proper appearance and desired
physical condition [1]. Changes in scapula and shoulder
are related to each other. Any change in natural direc-
tion of scapula leads to change in local performance
and movement chain. When the distance of scapulas
becomes far or near to each other various physical posi-
tions such as Pigeon chest, forward shoulder posture,
W
Article info:
Received: 10 Feb. 2014
Accepted: 28 Jun. 2014
124
kyphosis, scoliosis, or scapular winging are reported
[2,3]. Some people believe that muscles that support
scapula have basic and important role in the position of
shoulders to each other. If the mentioned muscles lack
required power, many changes will be observed in that
region [4,5]. Natural performance of shoulder balances
the stability and movement ability of glenohumeral and
scapular thoracic joints and to the lesser amount acro-
mioclavicular joints. When the required movement or
stability in each joint encounters a difculty, shoulder
performance will be impaired [6,7,8].
Stature abnormalities have undesirable effects on the
perception of the body, particularly in young people [9,
10]. Changes in scapula posture and inappropriate po-
sition of shoulder and muscular imbalance around the
shoulder (for example imbalance of anterior and poste-
rior shoulder muscles) are important factors for shoulder
abnormality and chronic pain syndromes. Formation of
negative compatibilities and structural deformations in
peoples can be proportionate to their skill and move-
ment patterns [11].
Scapula plays various roles in facilitating the shoul-
der’s desired performance, as the anatomy and biome-
chanics of scapula have interactions with each other to
make efcient movement. Dynamic stability in scapular
thoracic joint depends on its muscular structure. When
the muscles are weak or tired, the scapular thoracic
rhythm will be deranged and shoulder performance
disorder will occur. These disorders can lead to micro-
trauma (little injuries) in shoulder muscles, capsule,
and ligament tissue, and eventually inammation [12].
The forward posture of shoulder is the front deviation
in shoulders, which is related to the scapula protraction
position and created by muscular imbalance between
the shortened small pectoral muscle and stretched mid-
dle trapezius muscle. Also, the rounded shoulders have
inuence on the position of upper trapezius and lower
trapezius muscles that will have inuence on shoulder
rotation negatively [12,13].
Generally, the skeletal malformations are caused by
genetic and congenital disorders, diseases and inju-
ries, type of sport, lack of movements, or inappropriate
movement patterns, inappropriate habits in sitting down
and standing up, body type, appearance condition and
age. These malformations have undesirable effects on
people’s mental, social, physiological, and movement
performance [14]. In a research that studied the postural
abnormalities of university students in Shiraz, the inci-
dence of round shouldered among the girls was more
than the boys, i.e., where 1.1% of boys had excessive
deformation, 7.8% had mean deformation and 91.1%
had normal posture, about 2.6% of girls had excessive
deformation, 44% mean deformation and 53.4% normal
posture [15].
Shoulders, which are rotated inward lead to shoulder
protraction and this condition reduces dorsal duct space
which put pressures over the neurovascular network. Fi-
nally, the person will be prone to the acromial impinge-
ment syndrome [16]. This abnormality can be the re-
sult of shoulder stretching ahead of anatomical position
because of excessive exercise, repetitive movements of
hands, strengthening or shortening of anterior muscles
of scapula such as serratus anterior muscles, pectoralis
minor, pectoralis major, and upper trapezius muscles.
Also, it may be due to weakening or elongation of the
muscles that pull the shoulder toward the front of the
spine such as middle and inferior trapezius, rhomboids,
and levator scapula muscles [17].
Continuous contraction for a long period of time, will
lead to shortening of the hardened muscle, elongation
or weakness of opposite posterior muscles group and
muscles damage [18]. Shoulder protraction may injure
the median nerve because when the shoulder has gone
away or abducted and other joints move, the movement
of nerve in the shoulder region will decrease. The move-
ment of scapula abduction or is retraction results in a
signicant decrease in isometric elevation of scapula
[19]. The above mentioned abnormality will be treated
and improved through various methods that include
hand treatments, postural retraining, using tapes and
orthosis, and exercise therapy. Among these, exercise
therapy or using the corrective and improving move-
ments is the common method in improving or treating
the forward shoulder abnormality.
In the current research the emphasis of strength train-
ing was on the weak muscles in this abnormality such
as inferior and mean trapezius, serratus anterior, rhom-
boids muscles, and the emphasis of stretching exercises
was on the shortened pectoral and inferior trapezius
muscles. In this regard, Lynch et. al studied the effect of
an exercise program on the amount of head and forward
shoulders angles. This program included stretching and
strengthening exercises and results of this research in-
dicate that performing this exercise program had posi-
tive effect in reduction the amount of head and forward
shoulder angles among the under study peoples [11].
Naja et al studied the effect of a stretching and
strengthening training program on the forward shoul-
der abnormality and the posture of scapula among the
l Elham Hajihosseini et al. l The Eects of Strengthening, Stretching and Comprehensive Exercises
125
PHYSICAL TREA MENTS
October 2014 . Volume 4 . Number 3
female students. Analyses of the data indicated that
amount of forward shoulder in the experimental group
signicantly decreased (about 12%) but no signicant
difference was observed in the control group; also the
distance between shoulders signicantly decreased
(about 9%) and no signicant difference was observed
in the control group [20].
Daneshmandi et al (2006) studied the effect of training
program on the scapula posture and position of forward
shoulder among 80 participants. They were classied
into 3 groups of abducted shoulder (more than 20 cm),
normal shoulder (17-19 cm) and retracted shoulder (less
than 17 cm). The Lateral Scapula Slide Test (LSST) is
used to determine the strength of the shoulder and sta-
bilizer muscles.
In addition, the Electromyography (EMG) method is
used to determine the Maximum Voluntary Contrac-
tion (MVC) of levator scapulae and trapezius, (2 main
muscles in scapula) before and after the training pro-
gram. Results indicated that this exercise program led
to change in the position of shoulders and reduction of
difference in the shoulders distance and improving the
forward shoulder in the practical group. Also, EMG
of selected muscles indicated signicant difference in
amount of muscles contraction before and after the ex-
ercise and training program [21].
Klumper et. al (2006) showed that performing stretch-
ing and strengthening exercises for 6 weeks decreases
the forward shoulder posture in professional swimmers
[22]. Wang et. al in their study on the inuence of stretch-
ing exercises for pectoral muscles and strengthening ex-
ercises for shoulder adductor and elevator muscles and
as well as glenohumeral external rotators among 20 sub-
jects with forward shoulder posture, found the increase
in horizontal abduction power and internal and external
rotation after exercise, also decrease in anterior devia-
tion and deformation of the spinal column as well as in-
crease in glenohumeral role in elevating the hand, while
the stable position of shoulder did not change, However
when the hand was abducted to 90 degree, the shoulder
showed less upward rotation and less upper movement
after the exercise program [23]. According to the re-
search, the results conrmed the inuence of stretching,
strengthening, mobilizing, and stabilizing in the muscle
groups improving the abnormalities.
In this study, the researcher in addition to separately
schedule stretching and strengthening exercises, pro-
vided a combination of these exercises in his training
and presented with different intensity, duration and
repetition to better improve the abnormalities. In the
previous studies, researchers programmed their own
improvement trainings on the basis of Kendall theory
and this led to less than expected effectiveness of these
programs. Now there are two questions: what is the
inuence of performing improvement exercises in the
form of stretching, strengthening, and comprehensive
exercises on the forward shoulder posture of female
university students, and which one is more effective?
Therefore, the current study aimed to compare the ef-
fects of these exercises on the forward shoulder posture
by proposing three types of training programs.
2. Materials and Methods
This quasi-experimental study design Pre-posttest with
control group. In the initial screening, out of approxi-
mately 600 people with postural see the side view, 82
people suspected were selected of having abnormalities
state simultaneously forward shoulder, forward head
and kyphosis. Regarding the use of intervention vari-
ables and subjects on the basis of inclusion and exclu-
sion criteria, the present study was a quasi-experimental
one. The participants in this research consisted of non-
athlete 20 to 25 years old female university students of
Guilan University.
Forty eligible persons were selected purposefully and
divided randomly into four groups (10 subjects in each
group) of stretching exercises, strengthening exercises,
comprehensive exercises and control group. The inclu-
sion criteria were having the abnormality of forward
shoulder more than 52 degree, 20-25 years age range,
no pain in scapula, back, neck or upper limb and also
the participants’ consent formto participate in research
[12,24].
• Exclusion criteria:
• Any variation and recent injury in shoulder
• Anyfracture that is related to shoulder
• Any nerve injuries
• Any type of treatment or surgery in lumbar spine,
back, neck or upper limbs
In the present study, the forward shoulder angle was
measured by taking photo from the body prole. This
method has a suitable repeatability and was used in sev-
eral studies; in this research the repeatability was (ICC=
0.92). [24]. To use this method, at rst 3 anatomic signs
of ear tragus, the right side acromion tubercle, and spi-
nous process of C7 vertebra must be determined and
126
landmarked. Then the subject was asked to stand at de-
termined place beside the wall (with 23 cm distance)
in such a manner that her left arm put toward the wall.
Then a photography tripod (a digital camera) is placed
at 265 cm distance from the wall and its height is ad-
justed at the level of the examinee’s right shoulder.
At that time the subject was asked to bend forward 3
times and raise her hands over her head 3 times and then
stand normally and relaxed and watched an imaginary
point on the opposite wall (the eyes were in the direction
of horizon). Then the examiner takes a photo from the
body prole after 5 seconds pause. Finally, the photo
was transferred into the computer and using AutoCAD
software, the joined line angle of c7 and acromion pro-
cess with vertical line (the forward shoulder angle) was
measured [24], (Figure 1).
The program of special exercises for 6 weeks, 3 ses-
sions per week and each session of 30 to 70 minutes was
performed by the samples, under the supervision and
control of the examiner. Each training session includes
5-10 minutes warming up, strengthening, and stretching
exercises for 20– 50 minutes and cooling down for 5-10
minutes. The intensity of the exercises for the subject
was set on the basis of previous ndings and their toler-
ability threshold.
In this research, the stretching exercises, were per-
formed to stretch the shortened muscles of anterior part
of the body such as minor pectoralis and increase the
movement extent of scapula muscles (Figure 2). Each
session of training program was performed under the
direct supervision and control of examiner to be as-
sured of doing exercises correctly. In addition, all the
variables were measured with reliable tools and meth-
ods. Also during the performance process, the training
amount and volume (repetition, and duration) increased
gradually during 6 weeks training program and accord-
ing to the personal characteristics of each subject. The
subjects were asked to do the stretching movements to
the extent that feel stretch in their anterior pectoral part
(chest) (until the threshold of feeling pain).
Then they kept the mentioned position for 10 to 15
seconds. Afterwards, they return to the starting position
and after a pause proportionate with the keeping time,
repeat that movement. It must be mentioned that, the
time of keeping that position during 6 weeks of training
gradually increased from 10 to 15 seconds. The number
of repetition in each set gradually went up from 6 to 12.
The resting time between the sets was determined based
on the time of performing each set. [12, 21, 25].
In the rst exercise, the person was asked to lie on the
foam rolls in supine position and cross her hand over her
chest. Then, put her arm and elbow muscles in 90 de-
gree abduction and ection form and keep this position
for a minimum of 10 seconds (at the beginning of train-
ing) and maximum of 15 seconds (at the end of training)
without any resistance against the gravity until she felt
stretch in the anterior part of chest (to the threshold of
feeling pain). Then after a pause proportionate with the
time of keeping that position, the subjects were asked to
repeat that action or move again.
For the next movement, the person was asked tolie on
the foam in supine position and put her arm and elbow
muscles in 90 degree abduction and ection by the side
of body (starting position), then slowly made her elbows
near her body in parallel with the ground level and kept
this position for 10 to 15 seconds while the arms were
in external rotation and shoulders pressed on each other.
Finally, the method of performing Chin Tuck training
Table 1. Description of strengthening trainings (Thera Band) used in 6 week training program.
Training Performance method
Retracon of
shoulder
In the rst posion the subject stands, shoulders are abducted, elbows are in 90 degree econ and forearms are in horizontal
posion. Subjects put the training band between their hands and retracted their shoulders to each other by pulling it. The
subject must keep the rst posion of 90 degree for shoulders and elbows and then does a controlled return to the starng
posion. This training is performed to strengthen the retracng muscles of shoulder such as middle and inferior trapezius,
rhomboids and lassimus dorsi.
External rotaon
In the second training, the upper part of hand is placed in 90 degree abducon of shoulder and 90 degree econ of elbow. At
rst forearm has a horizontal posion and then changes into a vercal posion. Then the subject performs a controlled return
to reach the starng posion. The training band is xed in front of the subject approximately in the height of her waist to start
the training. This training is planned to strengthen the weakened muscles in scapular region such as middle trapezius, serratus
anterior, and rhomboids.
Flecon
In the next training the subject keeps her hands at 90-degree econ, elbows are completely straight and palms are down-
ward, shoulders bend about 180 degree against the resistance of training band and then performs a controlled return to the
starng posion. The training band is xed in front of the subject at the height about her waist to start training. This training is
performed to strengthen the inferior trapezius and serratus anterior muscles.
PHYSICAL TREA MENTS
l Elham Hajihosseini et al. l The Eects of Strengthening, Stretching and Comprehensive Exercises
127
PHYSICAL TREA MENTS
October 2014 . Volume 4 . Number 3
or exercise was in such a manner that the subjects were
asked to stand in a manner that their backs were against
the wall and their chin was downward and back in the
double chin form and kept this position for 10-15 sec-
onds. In the third training or exercise the person stood
in the corner of the wall in a manner that her arm and
elbow joints were in 90 degree abduction and ection
position, hands place at two sides of the wall corner. In
this position legs were placed in line with each other and
one of them was ahead of other one.
Then the subject was asked to bend the knee of her for-
ward leg and incline her body to forward. Finally, per-
forming Chin Tuck training was in this manner that the
subjects were asked that in position of sitting down on
a bench put their chin to the downward and in the form
double chin and kept that position for 10-15 seconds.
The aim of performing strengthening exercises was
to strengthen the weakened muscles such as inferior
and middle trapezius, rhomboids, and serratus anterior
(Table 1). To perform strengthening trainings the elastic
bands were used in 3 sets and 10 repetitions per week
(Figure 3) [25]. To performstrengthening trainings the
elastic bands were used in 3 sets and 10 repetitions per
week [17]. In the second week, the amount of strength-
ening trainings changed gradually in such a manner that
in every set, the number of repetitions increased to 15
and in the third week this number reached to 20 repeti-
tions in each set. In the fourth week and according to the
principle of overloadand regulating strengthening train-
ings, the repetitions reached to 10 times and in fth and
sixth weeks they reached to 20 repetitions [22].
Comprehensive trainings were performed in the form
of combination of stretching and strengthening train-
ings. After the end of the training program (for a period
of 6 weeks), the shoulder angle was measured again.
Control group was present all the time by the side of
experimental groups but they did not perform any exer-
cises. Finally, after collecting the research data, the de-
mographic information such as age, height, and weight
together with research variables, were analyzed through
descriptive and inferential statistics by SPSS software
version 21; Also paired t-test and 1-way variance analy-
sis were used to compare the obtained results among
groups from pre-test and post-test. The signicance
level of all variables was considered at 0.05.
3. Results
Tables 2, 3, and 4 present the obtained results. In Table
2 the general characteristics of subjects and descriptive
information of variables such as height, weight, body
mass index, and amount of forward shoulder in the stud-
ied groups are shown.
As Table 3 indicates, according to the mean difference
in pre-test and post-test, the amount of t and P value, all
3 exercises of strengthening, stretching, and comprehen-
sive training methods have signicant inuence on the
amount of decrease in forward shoulder angle. While no
signicant change was observed in the amount of aver-
age forward shoulder angle in the control group in the
post-test.
Results of paired t-test in the experimental groups in-
dicated that the forward shoulder angle among subjects
after performing improvement trainings has decreased
signicantly. As a result after participating in 3 types
of exercises of strengthening training (P=0.001, t=8.63),
stretching training (P=0.001, t=6.78), and comprehen-
sive training (P=0.001, t=12.11), the angle decreased by
6.10, 4.90, and 7.10 degrees, respectively (Table 3).
Analysis of paired variance (ANOVA) to study differ-
ence of forward shoulder amount between groups in-
dicated that there is a signicant difference (P=0.001)
between the effect of various trainings on the amount of
forward shoulder angle.
Table 2. General characteristics of the subjects and descriptive information of the research variables.
Standard deviaon± Mean
Control groupComprehensive groupStretching groupStrengthening groupVariable
2.07 ± 22.91.98± 22.81.8±22.11.08±21.5Age (year)
1.37 ± 161.312.13 ± 162.13.96 ± 162.12.28 ± 162.1Height (cm)
1.75 ± 60.802.09 ± 61.801.52 ± 61.12.3 ± 61.2Weight (kg)
0.85 ± 23.430.84 ±23.521.02± 23.260.96 ± 23.29
Body mass index (kg/
square meter)
PHYSICAL TREA MENTS
128
To compare the groups, the Tukey post-hoc test was
used. It was observed that there was a signicant rela-
tionship between the inuence of exercises (strengthen-
ing (P=0.001), stretching (P=0.001) and comprehensive
(p=0.001)) and the control group. Whereas no signi-
cant difference was observed among strengthening,
stretching and comprehensive training groups (Table 4).
4. Discussion
Forward shoulder is an abnormal position which is de-
ned by the distance between inferior angle of scapula
and spinous process of vertebra [12]. Abnormal changes
in muscle balance and strength, the time consequences
of using muscle, and joint movement disorder may in-
crease the internal rotation of scapula,decrease the pos-
terior tilt and upward rotation of scapula which leads
to forward shoulder and other shoulder injuries [26,27].
This research focused on evaluating the shoulders po-
sition to determine the effect of three 6 week training
program on shoulder posture. Research results indicated
that performing strengthening trainings caused signi-
cant decrease of about 10% in forward shoulder angle,
performing stretching trainings caused signicant de-
crease of about 8%, and performing comprehensive
trainings caused 13% signicant decrease in forward
shoulder angle. According to the results of current re-
search, there is a signicant difference in performing
6 weeks strengthening, stretching, and comprehensive
trainings with control group.
However there were no signicant differences be-
tween strengthening, stretching and comprehensive
training groups with each other. Although the statistical
data indicated no signicant differences in training pro-
grams, statistical trend and response of comprehensive
training program were superior to others. Control of ef-
fective training factors in each one of training programs,
particularly in comprehensive trainings, probably non-
conformity of some factors which can lead to reduction
of accuracy and characteristics of each program cause
that effects of these 3 programs be similar to each other
and don’t create signicant differences in the case of
performance and results, its reason may be affected by
difference in type of mechanisms and exercises or train-
ings and amount of examinee’s physical tness.
Table 3. Comparing the mean difference of forward shoulder angle between pre-test and post-test (paired test).
PtMean dierence
Post-testPre-test
VariableExercise type
Mean
Standard
deviaon
Mean
Standard
deviaon
*0.0018.60.7150.303.956.43.05Forward shoulder angleStrengthening
*0.0016.70.7252.405.1257.303.37Forward shoulder angleStretching
*0.00112.110.5847.502.0654.62.46Forward shoulder angleComprehensive
0.1681.50.1357.703.2857.903.2Forward shoulder angleControl
*Signicance level (P≥ 0.05) PHYSICAL TREA MENTS
Table 4. Results of Tukey post-hoc test to compare changes of forward shoulder angle.
Group Mean dierences Mean standard error Signicance level
Strengthening- stretching -1.2 0.84 0.49
Strengthening- comprehensive 10.84 0.64
Strengthening-control -5.4 0.84 0.001*
Stretching- comprehensive 2.2 0.84 0.62
Stretching-control -4.2 0.84 0.001*
Comprehensive-control -6.4 0.84 0.001*
*Signicance level (P≥0.05) PHYSICAL TREA MENTS
l Elham Hajihosseini et al. l The Eects of Strengthening, Stretching and Comprehensive Exercises
129
PHYSICAL TREA MENTS
October 2014 . Volume 4 . Number 3
Uncontrollable factors in the present research, such as
daily activities, rest, kind of diet, personal habits, man-
ner of standing up, sitting down, and studying could be
the reason for lack of differences between 3 training
groups. As it was mentioned before, this lack of signi-
cant difference among 3 training protocols can be due
to the interference of unwanted and obtrusive variables.
It seems that, in future similar studies, with accessing
to more homogenized samples, changes in FITT (fre-
quency, intensity, time, and type) of each program and
higher control of the researcher, different results will be
obtained.
Also, although the present research cant not signi-
cantly show the difference between training methods,
the dominant statistical trend in combinational training
(7.10 degree) compared to two other groups of stretch-
ing (4.9 degree) and stretching (6.10 degree) could be
considered an important application point from opera-
tional and clinical viewpoint. It is evident that gener-
alization of this research results was in the under study
society area, that researcher was obliged to report and
analyze the existed data, so more information will be
dependent to the future researches.
Figure 1. Calculating the angles of forward shoulder by pho-
tography method [24].
PHYSICAL TREA MENTS
Figure 2. Stretching corrective and improving exercises program PHYSICAL TREA MENTS
130
According to the general principles of training pro-
grams for corrective and remedial actions, strengthen-
ing of weakened muscles leads to biomechanical move-
ment and obtaining appropriate direction of abnormal
parts. In fact stretching the shortened anterior shoulder
muscles (hypertrophy) together with strengthening the
weakened posterior muscles has signicant inuence on
improving the forward shoulder abnormality.
Furthermore, desirable effect of these training pro-
grams might be due to concurrent attention to the
changes in one-fth of upper part of body and con-
sidering the corrective and improvement trainings to
improve abnormalities related to the face. Results of
the present study conform to the results of researches
conducted by Klumper et al (2006), Lynch et al (2010),
Kotteswarn et al (2012), Harman et al (2005), Thigpen
et al (2009), Naja et al (2006), and Daneshmandi et
Figure 3. Strengthening corrective or improving exercises program PHYSICAL TREA MENTS
l Elham Hajihosseini et al. l The Eects of Strengthening, Stretching and Comprehensive Exercises
Figure 4. Average changes of forward shoulder angle in 4 research groups.
PHYSICAL TREA MENTS
Control
Strengthening
Stretching
Combinational
131
PHYSICAL TREA MENTS
October 2014 . Volume 4 . Number 3
al (2006). Klumper concluded that stretching of the
anterior soft tissue of shoulder, internal rotator and ad-
ductor muscles, and strengthening of shoulder posterior
muscles including external and abductor rotators can
decrease the forward shoulder position among athletic
swimmers [22].
Kotteswarn et al studied the effect of stretching and
strengthening of shoulder muscles in shoulder protrac-
tion of persons with abducted shoulder position and
indicated that stretching of abducting muscles and
strengthening of retracting muscles and external rota-
tors of shoulder were effective in decreasing the shoul-
der protraction [12].
Lynch et al studied the inuence of an 8 week peri-
od training program on the amount of forward shoul-
der angle among 28 professional swimmers who were
17-23 years old [11]. This program was a combination
of stretching and strengthening program that was per-
formed 3 times a week. Results of this research indi-
cated that performing this training program had posi-
tive effect on reducing the amount of forward head and
shoulder angle among the studied persons; in such a
manner that the mean of forward head angle of peoples
in the training group decreases from 11.29 degree in
pre-test to 7.11 degree in post-test.
Also the average of forward shoulder angle among the
training group decreased from 9.62 in pre-test to 8.39
degree in the post-test. Naja et al (2012) indicated
that a period of training program would strengthen the
weakened muscles in the posterior part of shoulder and
stretch the shortened muscles in the anterior part of
shoulder. Also on the basis of the research results, the
average of forward shoulder in post-test was recorded
1.46 cm less than its average in pre-test which indicated
that the training program has led to a signicant de-
crease in forward shoulder of about 12% (P≥0.05) [20].
Besides, planning and performing an exact and pur-
poseful program of corrective and improving move-
ments of stretching, strengthening and comprehensive
trainings for scapula and elbow joint performed regu-
larly and under direct supervision and control of exam-
iner, can have desirable effects in decreasing the angle
of forward shoulder. On the basis of Vladimir Janda’s
chain reaction theory and modeling from Braugher’s
gear mechanism in spinal column, the comprehensive
improvement trainings are planned and performed by
the examiner [25, 26, 28].
In the combinational training program in addition to
improvement of forward shoulder abnormality, the
forward head and kyphosis abnormalities are studied
simultaneously and regarding the fact that these 3 ab-
normalities are related to each other and appearance of
each of them can be the reason of others’ appearance,
researcher tries to improve these 3 abnormalities at the
same time. The weak posture of shoulder and muscular
imbalance around it are important factors for forward
shoulder abnormality and chronic pain syndrome. This
research differed with previous researches in reducing
the time of study from 8-10 weeks to 6 weeks as differ-
ent researches concluded that a 6 weeks period of train-
ing program has desired effects and positive inuence
on improving the abnormality [12, 22, 28].
Another difference was in the sex of subjects and their
number in this research when all subjects were female
and their number in each training group were 10 persons
and also it examined how much effective the postural
suggestions were. While in the previous researches,
this fact was not considered and studied. Also in this
research we have used different trainings and exercised
with various intensities and times of training; these ex-
ercises consisted of strengthening, stretching, and com-
prehensive and mobilizing trainings.
It seems that lack of exercise leads to weakening of the
stabilizer muscles and muscles between the scapula as
well as atrophy of scapular muscles and consequently
dissymmetry of scapula and forward shoulder abnor-
mality. Therefore, this part needs enough strengthen-
ing of weakened muscles and stretching of shortened
muscles. Regarding the results of present research and
based upon desired effectiveness of improvement train-
ings in decreasing the forward shoulder angle, we sug-
gest that researchers and experts apply the improvement
training programs used in this research by observing the
mentioned principles.
Based on the present results, performing trainings in
this research, particularly the combinational and com-
prehensive trainings is a suitable, scientic, and safe
method to correct the forward shoulder position.
Acknowledgments
Finally, we thank and appreciate all the subjects who
participated in this research and also Guilan University
that provided the opportunity to do our research.
132
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l Elham Hajihosseini et al. l The Eects of Strengthening, Stretching and Comprehensive Exercises
