Article

Effects of a stretching protocol for the pectoralis minor on muscle length, function, and scapular kinematics in individuals with and without shoulder pain

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Abstract

Study design: Parallel-group intervention with repeated measures. Introduction: Shortening of the pectoralis minor (PM) may contribute to alterations in scapular kinematics. Purpose of the study: To evaluate the effects of a stretching protocol on function, muscle length, and scapular kinematics in subjects with and without shoulder pain. Methods: A sample of 25 patients with shoulder pain and 25 healthy subjects with PM tightness performed a daily stretching protocol for 6 weeks. Outcome measures included Disabilities of the Arm, Shoulder, and Hand questionnaire, PM length, and scapular kinematics. Results: Disabilities of the Arm, Shoulder, and Hand scores decreased (P < .05) in the patient group at post-intervention. No differences (P > .05) were found for PM length in both groups. Scapular anterior tilt increased (P < .05) at 90° of flexion in the healthy group. Discussion: This study demonstrated that a daily home stretching protocol significantly decreases pain and improves function in subjects with shoulder pain. The mechanism responsible for these improvements does not appear directly related to PM muscle length or scapula kinematics, suggesting that other neuromuscular mechanisms are involved. Conclusion: The PM stretching protocol did not change the PM length or scapular kinematics in subjects with or without shoulder pain. However, pain and function of the upper limbs improved in patients with shoulder pain. Level of evidence: 2b.

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... 3D studies Scapular motion and position were measured in 8 studies using 3D tracking systems. 6,12,22,28,37,42,45,46 Four studies evaluated scapular motion in individuals with SIS, 6,28,42,46 of which 3 studies revealed significant effects of exercise on scapular motion. 6,42,46 However, evaluation of the risk of bias showed high risk of bias in 3 studies in terms of participant selection and blinding. ...
... The other 4 studies evaluated scapular motion in asymptomatic individuals. 12,22,37,45 Two studies reported significant effect of exercise on scapular motion. 12,45 On evaluation of their methodologic risk of bias, high risk was revealed in many aspects of bias assessment (Table II). ...
... Ten studies evaluated pain before and after exercise interventions. 3,6,28,29,32,[37][38][39]41,46 Four studies measured pain using the visual analog scale; in 3 of these studies, significant effects of therapeutic exercise on pain were reported. 3,6,29 Although Struyf et al 39 reported no change in resting pain after exercise therapy, they reported a significant reduction of pain during movement (P < .004) ...
Article
Background: Therapeutic exercise for scapular muscles is suggested to be effective in reducing shoulder pain in patients with rotator cuff disorders, whereas its effectiveness on scapular position and motion has remained unclear. Therefore, the aim of this systematic review was to investigate whether exercise therapy improves scapular position and motion in individuals with scapular dyskinesis. Methods: This study is a wide systematic review including any type of clinical trial in which the effect of any type of therapeutic exercise, including scapular muscle strengthening, stretching, and scapular stabilization exercise, is investigated in adult participants. Results: Twenty studies were included in this systematic review. Studies were categorized on the basis of the techniques they used to measure scapular position and motion and the included participants. Methodologic quality of the studies was assessed by the Cochrane tool of assessing the risk of bias. Eight studies used 3-dimensional techniques for measuring scapular motions. Among them, 5 studies showed significant effects of exercise on scapular motion, of which 3 studies investigated individuals with subacromial impingement syndrome (SIS). The other 12 studies used 2-dimensional measurement techniques, of which 8 studies reported significant effects of exercise on scapular position and motion both in SIS patients and in asymptomatic individuals. However, their methodologic quality was debatable. Therefore, there was conflicting evidence for the effect of exercise on scapular dyskinesis. Conclusion: There is a lack of evidence for beneficial effects of exercise in improving scapular position and motion in individuals with scapular dyskinesis. However, exercise is beneficial in reducing pain and disability in individuals with SIS.
... There are discrepancies in the literature regarding the measurement of the PM muscle length, which include participant positioning and the position of the scapula when PM length is measured (Borstad & Ludewig 2005;Ko et al. 2016;Morais & Cruz 2016;Struyf et al. 2012). In these studies, participants were positioned either in standing or in supine (Borstad 2006(Borstad , 2008Borstad & Ludewig 2005;Cools et al. 2010;Finley et al. 2017;Ko et al. 2016;Lee et al. 2015;Mackenzie et al. 2015;Rosa et al. 2016Rosa et al. , 2017Struyf et al. 2012Struyf et al. , 2014. In studies where PM length was measured in standing, the scapula could be in an anteriorly tilted position because of the influence of gravity on posture, thus demonstrating poor diagnostic accuracy and may provide inaccurate values for PM muscle length (Borstad 2006(Borstad , 2008Borstad & Ludewig 2005;Finley et al. 2017;Ko et al. 2016;Lee et al. 2015;Rosa et al. 2016Rosa et al. , 2017. ...
... In these studies, participants were positioned either in standing or in supine (Borstad 2006(Borstad , 2008Borstad & Ludewig 2005;Cools et al. 2010;Finley et al. 2017;Ko et al. 2016;Lee et al. 2015;Mackenzie et al. 2015;Rosa et al. 2016Rosa et al. , 2017Struyf et al. 2012Struyf et al. , 2014. In studies where PM length was measured in standing, the scapula could be in an anteriorly tilted position because of the influence of gravity on posture, thus demonstrating poor diagnostic accuracy and may provide inaccurate values for PM muscle length (Borstad 2006(Borstad , 2008Borstad & Ludewig 2005;Finley et al. 2017;Ko et al. 2016;Lee et al. 2015;Rosa et al. 2016Rosa et al. , 2017. ...
... The PMI values in the active posterior tilt position of the scapula of our study cannot be compared to other studies as no other study has compared the dominant and non-dominant sides in this position. Two studies that performed measurements with an active posterior tilt position of the scapula did not compare the dominant and non-dominant sides (Finley et al. 2017;Rosa et al. 2017). Similarly, the PMI values obtained in the passive posterior tilt position of the scapula in our study cannot be compared to other studies, as the only other study that performed measurements in the passive posterior tilt position again did not compare dominant and non-dominant sides (Finley 2017). ...
Article
Full-text available
Background: The pectoralis minor (PM) muscle is commonly regarded as a contributor to abnormal scapula positioning. Subsequently, the muscle length of the scapular stabilising muscles may be affected, as these muscles assume a lengthened position, which over time causes weakness. There are inconsistencies regarding PM muscle length values because of the different techniques and positions used when the length of the PM muscle is measured. Objective: To determine the PM muscle length in participants aged 18-24 using a Vernier® caliper and expressed as pectoralis minor index (PMI), with the scapula in three different positions. Method: The PM muscle length of 144 participants was measured with a Vernier® caliper (intraclass correlation coefficient 0.83-0.87). Measurements were made with the scapula in the resting position, in an active and a passive posterior tilt position. Results: Significant differences were observed in PMI between the resting scapula position - 10.04 (confidence interval, CI 9.93-10.14) and active posterior tilt - 10.19 (CI 10.09-10.30) (p < 0.001); the resting position - 10.04 (CI 9.93-10.14) and passive posterior tilt - 10.77 (10.66-10.87) (p < 0.001) and active - 10.19 (CI 10.09-10.30) and passive posterior tilt 10.77 (10.66-10.87) (p < 0.001). The dominant side had lower PMI values than the non-dominant side. Conclusion: The significant differences between the active and posterior tilt positions suggested that optimal muscle length of PM was affected by the inner range strength of the lower fibres of Trapezius. Clinical implications: It is important that in clinical practice not only the length of PM in scapular misalignment but also the strength of the antagonistic muscles is considered.
... Maintaining a forward shoulder posture and performing repetitive scapular movements involving anterior tilting and protraction of the scapula can result in adaptive shortness of the PM. This shortness is a potential mechanism underlying neck and shoulder pain syndrome (Morais & Cruz, 2016;Roland, 1986;Rosa, Borstad, Pogetti, & Camargo, 2017). Thus, PM stretching and relaxing can be a treatment strategy for symptomatic patients with shoulder disorders. ...
... The corner stretch is a frequently used exercise believed to slow the progression of PM shortness (Morais & Cruz, 2016;Mostafavifar, Wertz, & Borchers, 2012;Rosa et al., 2017). In their systematic review on stretching techniques for the PM, Morais and Cruz suggested that the efficacy of stretching techniques is determined by the force and duration applied (Morais & Cruz, 2016). ...
... Only woman included in Laudner's study (Laudner, Wenig, Selkow, Williams, & Post, 2015).The age range for the 6 trials was 18e50 years. The participants in 4 of the studies were all healthy adults without symptomatic shoulders, while those in the other 2 studies were workers with rounded-shoulder-posture (Han et al., 2015) and adults with shoulder pain (Rosa et al., 2017), respectively. In Viriyatharakij's study (Viriyatharakij, Chinkulprasert, Rakthim, Patumrat, & Ketruang, 2017), participants stretched the PM with active scapular retraction for 20 s (3 sets). ...
Article
Objective: Shortness of the pectoralis minor (PM) is a potential mechanism underlying shoulder impingement syndrome. Few studies have examined the effects of kinesiotaping and stretching exercise on PM length or index. This systematic review and network meta-analysis investigated the effects of stretching exercise and kinesiotaping on PM length and index in adults. Methods: This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomised controlled trials including adults with or without symptomatic shoulders were included. Heterogeneity between studies was assessed using I2 statistics, and publication bias was evaluated by constructing a funnel plot. Results: We extracted data from six randomised controlled trials that included 263 participants (age range: 18-50 years). Compared with usual care, kinesiotaping resulted in greater improvement in PM length (mean difference, 1.15 cm; 95% confidence interval [CI]: 0.20-2.10 cm). Compared with usual care and kinesiotaping, proprioceptive neuromuscular facilitation (PNF) stretching increased PMI significantly, with a mean difference of 1.40 (95% CI: 1.17-1.63) and 1.08 (95% CI: 0.29-1.87) cm, respectively. Conclusion: Compared with no intervention, kinesiotaping is beneficial for lengthening the PM. Intervention with static stretching alone has no effect on PM length. Compared with kinesiotaping alone and no intervention, PNF stretching increases PMI.
... Contrary to our hypotheses, our findings revealed no group differences in It has been suggested that decreased resting PMm length indicates a tight, or shortened PMm. 4,15 However, until now, no study has investigated whether resting PMm length was related to the magnitude of PMm elongation during active or passive movements. Although participants in our short and typical PMm length groups had different resting PMm lengths, the amount to which the PMm could be actively or passively lengthened with respect to resting length was not different between groups. ...
... Based on this finding it can be argued that utilizing resting PMm length alone to determine whether a stretching intervention is warranted is inappropriate. This may in part explain why a recent study by Rosa et al. 15 failed to find resting PMm length changes following a stretching program in individuals with short resting PMm length. It is possible that the PMm's in these individuals were not tight or shortened and therefore did not respond to the stretching program. ...
... In the current study data from a previous study 9 on 34 healthy individuals were used to derive cut points for defining the short (PMi < 8.9) and typical (8.9 ≤ PMi < 10.5) groups. The mean PMi value from this previous work 9 is in line with that reported by Struyf et al. 19 and Rosa et al. 15 but greater than that reported by Borstad and Ludewig 4 (Table 4). Assuming that researchers accurately palpated the coracoid process and fourth rib, we believe the strength of the relationship between height and PMm length could be a possible reason for mean PMi variability across studies. ...
Article
Background: Individuals with short resting pectoralis minor muscle length have been shown to have aberrant scapulothoracic motion when compared to individuals with long resting pectoralis minor muscle length. However, the degree to which the pectoralis minor muscle can be lengthened and whether or not scapulothoracic motion differs between individuals with short and typical resting pectoralis minor muscle length is unknown. Objectives: To determine if: (1) pectoralis minor muscle elongation (percent pectoralis minor muscle can be actively and passively lengthened beyond resting length), (2) pectoralis minor muscle percent length change during overhead reaching, and (3) scapulothoracic motion during overhead reaching differ between individuals with short and typical resting pectoralis minor muscle length. Design: Two group comparison. Methods: Thirty healthy individuals were placed into a short or typical resting pectoralis minor muscle length group. A caliper was used to measure resting pectoralis minor muscle length and pectoralis minor muscle length during active and passive muscle lengthening. An electromagnetic tracking system was used to measure pectoralis minor muscle length change as well as scapular, humeral, and trunk motion during several arm elevation tasks. Pectoralis minor muscle elongation and length change during arm elevation tasks were compared between groups using independent t-tests. Two-factor mixed-model analyses of variance were used to compare scapulothoracic motion at arm elevation angles of 30°, 60°, 90°, and 120°. Results: Pectoralis minor muscle elongation and pectoralis minor muscle length change during arm elevation did not differ between groups. Scapulothoracic motion did not differ between groups across arm elevation tasks. Conclusions: Although resting pectoralis minor muscle length differed between groups, pectoralis minor muscle lengthening and scapulothoracic motion were similar between participants with short and typical resting pectoralis minor muscle length. Additional studies are needed to better understand the role of pectoralis minor muscle elongation on scapulothoracic motion.
... Many factors such as age, gender, lack of muscle flexibility, strength asymmetry, sport year affect the occurrence of these injuries [3]. Among these factors; lack of muscle flexibility, especially inadequate pectoralis minor muscle length is responsible for making shoulder vulnerable to injury [4]. ...
... Repetitive use of the upper extremity for activities that protract and downwardly rotate the scapula may also contribute to adaptive shortening. PM's adaptive shortening leads to changes in the resting position of the scapula and altered scapular kinematics and these changes can cause imbalance between agonist and antagonist muscle strength of shoulder joint [4]. ...
... While the relationship between muscle shortness and sports injuries has been determined in the literature [4,8], there is no sufficient evidence regarding these injuries' mechanisms ...
Presentation
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Problem Statement: In joint movement, agonist and antagonist muscle strength, as well as the length and the shortness of these muscles is an important parameter. Muscle shortness is one of the factor that responsible of sports injuries. Shoulder is one of the most injured joint in Judo. In this joint, determination of the relationship between muscle shortness and agonist-antagonist muscles strength will be effective to increase muscle strength, sportive performance and prevent sports injuries. Purpose of Study: This study was conducted to determine the relationship between pectoralis minor (PM) muscle length and shoulder internal(IR)/eksternal(ER) rotation isokinetic muscle strength in Judo athletes. Methods: The study included 80 (56 males, 24 female) professional Judo athletes aged between 14-25 (mean 17,31±2,51). Isokinetic muscle strength was assessed by ISOMED 2000® device. Pectoralis minor length was evaluated using a flexible tape measure in resting position. The assessments were made bilaterally. Findings and Results: There was a strong and statistically significant correlation between the PM length and the shoulder IR and ER peak torque values at both angular velocities and both sides (p <0,01). Conclusions and Recommendations: It was determined that the relationship between the length of the PM muscle and the internal and external rotator muscle strength of Judo athletes. Therefore, we think that by increasing shoulder muscle strength to enhance sportive performance, stretching exercises for PM muscle shortening should be added to training programs. Keywords: Isokinetic strength, Judo players, pektoralis minör length
... Many factors such as age, gender, lack of muscle flexibility, strength asymmetry and sport year affect the occurrence of these injuries [3]. Among these factors; lack of muscle flexibility, especially inadequate pectoralis minor muscle length is responsible for making shoulder vulnerable to injury [4]. ...
... Repetitive use of the upper extremity for activities that protract and downwardly rotate the scapula may also contribute to adaptive shortening. PM's adaptive shortening leads to changes in the resting position of the scapula and altered scapular kinematics and these changes can cause imbalance between agonist and antagonist muscle strength of shoulder joint [4]. ...
... While the relationship between muscle shortness and sports injuries has been determined in the literature [4,8], there is no sufficient evidence regarding these injuries' mechanisms ...
Article
Full-text available
Problem Statement: In joint movement, agonist and antagonist muscle strength, as well as the length and the shortness of these muscles is an important parameter. Muscle shortness is one of the factor that responsible of sports injuries. Shoulder is one of the most injured joint in Judo. In this joint, determination of the relationship between muscle shortness and agonist-antagonist muscles strength will be effective to increase muscle strength, sportive performance and prevent sports injuries. Purpose of Study: This study was conducted to determine the relationship between pectoralis minor (PM) muscle length and shoulder internal(IR)/external(ER) rotation isokinetic muscle strength in Judo athletes. Methods: The study included 80 (56 males, 24 female) professional Judo athletes aged between 14-25 (mean 17,31±2,51). Isokinetic muscle strength was assessed by ISOMED 2000 ® device. Pectoralis minor length was evaluated using a flexible tape measure in resting position. The assessments were made bilaterally. Findings and Results: There was a strong and statistically significant correlation between the PM length and the shoulder IR and ER peak torque values at both angular velocities and both sides (p <0,01). Conclusions and Recommendations: It was determined that the relationship between the length of the PM muscle and the internal and external rotator muscle strength of Judo athletes. Therefore, we think that by increasing shoulder muscle strength to enhance sportive performance, stretching exercises for PM muscle shortening should be added to training programs.
... 1,3 Unfortunately, adaptive shortening of this muscle can be common in overhead athletes 4,5 and nonathletes 2 alike. Pectoralis minor shortening has been associated with shoulder pain and pathology [6][7][8][9] and is therefore often targeted during preventative injury programs and various rehabilitation protocols. ...
... Several studies have shown that gross stretching of the pectoralis minor is not effective for correcting scapular kinematics, 9,10 but does result in increased muscle length 2,10 and elasticity. 11 These stretching techniques have focused on moving the coracoid process away from the rib cage 6,12-14 via glenohumeral horizontal abduction. ...
... 15 This tightness has been associated with shoulder pain and specific pathologies, such as subacromial impingement. [6][7][8][9] Therefore, techniques that can effectively lengthen this muscle may be beneficial in the prevention and treatment of such disorders. 6,9 The results of this study demonstrate that a self-myofascial release technique with motion is effective at acutely increasing glenohumeral flexion ROM, PML, and may possibly decrease forward scapular posture. ...
Article
Context: Tightness of the pectoralis minor is a common characteristic that has been associated with aberrant posture and shoulder pathology. Determining conservative treatment techniques for maintaining and lengthening this muscle is critical. Although some gross stretching techniques have been proven effective, there are currently no empirical data regarding the effectiveness of self-myofascial release for treating tightness of this muscle. Objective: To determine the acute effectiveness of a self-myofascial release with movement technique of the pectoralis minor for improving shoulder motion and posture among asymptomatic individuals. Design: Randomized controlled trial. Setting: Orthopedic rehabilitation clinic. Participants: A total of 21 physically active, college-aged individuals without shoulder pain volunteered to participate in this study. Main outcome measures: Glenohumeral internal rotation, external rotation, and flexion range of motion (ROM), pectoralis minor length, and forward scapular posture were measured in all participants. The intervention group received one application of a self-soft-tissue mobilization of the pectoralis minor with movement. The placebo group completed the same motions as the intervention group, but with minimal pressure applied to the xiphoid process. Separate analyses of covariance were used to determine differences between groups (P < .05). Results: Separate analyses of covariance showed that the self-mobilization group had significantly more flexion ROM, pectoralis minor length, and less forward scapular posture posttest than the placebo group. However, the difference in forward scapular posture may not be clinically significant. No differences were found between groups for external or internal rotation ROM. Conclusions: The results of this study indicate that an acute self-myofascial release with movement is effective for improving glenohumeral flexion ROM and pectoralis minor length, and may assist with forward scapular posture. Clinicians should consider this self-mobilization in the prevention and rehabilitation of pathologies associated with shortness of the pectoralis minor.
... Participants were required to have SIS symptoms for at least 3 months, defined as being positive for at least 3 of the following: [25][26][27][28][29][30][31] positive Neer, 32 Hawkins, 33 or Jobe tests, 34 pain with passive or isometric resisted shoulder ER, 30,35 and pain with active shoulder elevation. 36 Participants were required to have PCT, determined with the Low Flexion Test (LFT). ...
... Participants were required to have SIS symptoms for at least 3 months, defined as being positive for at least 3 of the following: [25][26][27][28][29][30][31] positive Neer, 32 Hawkins, 33 or Jobe tests, 34 pain with passive or isometric resisted shoulder ER, 30,35 and pain with active shoulder elevation. 36 Participants were required to have PCT, determined with the Low Flexion Test (LFT). ...
... The methods used to capture 3D scapular and humeral motion are described elsewhere. 8,9,30,49,50 Scapular IR/ER, upward/ downward rotation, and anterior/posterior tilt relative to the trunk were described using a YX'Z" Euler sequence. 51 Humeral plane of elevation, elevation angle, and IR/ER were described with a YX'Y" Euler sequence. ...
Article
Background Posterior capsule tightness (PCT) is associated with shoulder pain and altered shoulder kinematics, range of motion (ROM), external rotation (ER) strength, and pain sensitization. Objective To assess the effects of two interventions on shoulder kinematics, Shoulder Pain and Disability Index (SPADI) scores, ROM, strength, and pressure pain threshold (PPT) in individuals with PCT and shoulder impingement symptoms. Methods In this prospectively registered randomized controlled trial 59 individuals were randomized to either an Experimental Intervention Group (EIG, n=31) or a Control Intervention Group (CIG, n=28). The low flexion (LF) test was used to determine the presence of PCT. Shoulder kinematics, SPADI scores, internal rotation (IR) and ER ROM, ER strength, and PPT were measured pre- and post-treatment. Those in the EIG received an intervention specific to pain and PCT and those in the CIG received a non-specific intervention, both 4 weeks in duration. Results Individuals in the EIG demonstrated more scapular upward rotation (P=.03; mean difference (MD)=3.3°; 95% Confidence Interval (CI)=1.3°, 4.9°) and improved value on the LF test (P=.02; MD=4.6°; 95%CI=0.7°, 8.6°) than those in the CIG after treatment. Both groups presented less anterior (P<.01; MD=-0.7mm; 95%CI=-1.3mm, -0.2mm) and superior (P<.01; MD=-0.5mm; 95%CI=-0.9mm, -0.2mm) humeral translations, decreased SPADI score (P<.01; MD=-23.6; 95%CI=-28.7, -18.4), increased IR ROM (P<.01; MD=4.6°; 95%CI=1.8°, 7.8°) and PPTs for upper trapezius (P<.01; MD=60.1kPa; 95%CI=29.3kPa, 90.9kPa), infraspinatus (P=.04; MD=47.3kPa; 95%CI=2.1kPa, 92.5kPa), supraspinatus (P<.01; MD=63.7kPa; 95%CI=29.6kPa, 97.9kPa), and deltoid (P<.01; MD=40.9kPa; 95%CI=12.3kPa, 69.4kPa) after treatment. Conclusion The experimental intervention was more effective at improving PCT as measured through changes in the LF test. No benefit of the specific approach over the non-specific intervention was noted for the remaining variables.
... Our results show that in the short-term, addition of 'unilateral corner stretch' exercise does not result in a significant clinical benefit with respect to functional improvement or pain reduction in these participants. Based on biomechanical fundamentals, several investigations have established that loss of flexibility of the pectoralis minor alters the normal kinematics of the scapula (Michener et al., 2003;Borstad, 2006;Ludewig and Reynolds, 2009;Seitz et al., 2011;Ludewig and Braman, 2011;Rosa et al., 2017). Although the studies that support this association were conducted in a healthy, young population Ludewig, 2005, 2006;Borstad, 2008), several authors recommend including pectoralis minor stretching in the rehabilitation of participants with SPS (Ludewig and Reynolds, 2009;Phadke and Camargo, 2009;Ellenbecker and Cools, 2010;Ludewig and Braman, 2011;Seitz et al., 2011;Kibler et al., 2013;Cools et al., 2014). ...
... Although the studies that support this association were conducted in a healthy, young population Ludewig, 2005, 2006;Borstad, 2008), several authors recommend including pectoralis minor stretching in the rehabilitation of participants with SPS (Ludewig and Reynolds, 2009;Phadke and Camargo, 2009;Ellenbecker and Cools, 2010;Ludewig and Braman, 2011;Seitz et al., 2011;Kibler et al., 2013;Cools et al., 2014). Several studies that have included self-stretching exercises of the pectoralis minor in home treatment programs have shown a decrease in symptoms and functional improvement in participants with SPS (Wang et al., 1999;Ludewig and Borstad, 2003;McClure et al., 2004;Rosa et al., 2017). However, these positive clinical effects do not correlate with changes in the length of the pectoralis minor or scapular kinematics (McClure et al., 2004;Rosa et al., 2017). ...
... Several studies that have included self-stretching exercises of the pectoralis minor in home treatment programs have shown a decrease in symptoms and functional improvement in participants with SPS (Wang et al., 1999;Ludewig and Borstad, 2003;McClure et al., 2004;Rosa et al., 2017). However, these positive clinical effects do not correlate with changes in the length of the pectoralis minor or scapular kinematics (McClure et al., 2004;Rosa et al., 2017). Some randomized controlled trials have studied pectoralis minor stretching together with an exercise program and manual therapy for the treatment of participants with SPS. ...
Article
Background: Adaptive shortening of the pectoralis minor is one of the biomechanical mechanisms associated with subacromial pain syndrome (SPS). Objective: To compare the effects of an exercise program alone with an exercise program in combination with pectoralis minor stretching in participants with SPS. Design: Randomized controlled trial. Methods: Eighty adult participants with SPS were randomly allocated to two groups. The control group (n=40) received a 12-week specific exercise program and the intervention group (n=40) received the same program plus stretching exercises of the pectoralis minor muscle. The primary outcome measure was shoulder function assessed by a Constant−Murley questionnaire, and the secondary outcomes were the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, visual analog scale (VAS), and pectoralis minor resting length. Results: The present study shows no difference between the two interventions according to the Constant−Murley questionnaire (1.5 points; p=0.58), VAS at rest (0.2 cm; p=0.11), VAS at movement (0.5 cm; p=0.08), and pectoralis minor resting length (0.3 cm; p=0.06). The DASH questionnaire showed greater functional improvement in the control group (5.4 points; p=0.02). Finally, only pectoralis minor length index showed difference statistical significant in favor of intervention group (0.3%; p=0.04). Conclusion: In the short-term, the addition of a program of stretching exercises of the pectoralis minor does not provide significant clinical benefit with respect to functional improvement or pain reduction in participants with SPS.
... 8,10,41-43 A 5 • angular change in kinematics is considered to be similar to anatomical changes of the acromial slope in individuals with rotator cuff pathology. 8,10,[41][42][43][44] Based on calculations, 25 individuals were required per group. Individuals with symptoms of SIS were recruited using fliers posted in the local university setting, orthopedic clinics, and surrounding community, as well as through radio and digital media advertisements. ...
... Scapular kinematic and humeral translation data were captured and analyzed with the Flock of Birds (miniBird) hardware (Ascension Technology Corp, Burlington, VT, USA) integrated with the MotionMonitor software (Innovative Sports Training, Inc, Chicago, IL, USA). 9,10,42 The 3D position and orientation of 3 motion capture sensors were tracked simultaneously at a sampling rate of 100 Hz. Sensors were secured with double-sided adhesive tape and Transpore tape to the sternum and acromion and with a thermoplastic cuff to the distal humerus. ...
Article
Background: Posterior capsule tightness (PCT) and shoulder impingement syndrome (SIS) symptoms are both associated with altered shoulder biomechanics and impairments. However, their combined effect on kinematics, pain, range of motion (ROM), strength, and function remain unknown. Objective: The purpose of this study was to determine if the combination of PCT and SIS affects scapular and humeral kinematics, glenohumeral joint ROM, glenohumeral joint external rotation strength, pain, and function differently than does either factor (PCT or SIS) alone. Design: The design was a cross-sectional group comparison. Methods: Participants were placed into 1 of 4 groups based on the presence or absence of SIS and PCT: control group (n = 28), PCT group (n = 27), SIS group (n = 25), and SIS + PCT group (n = 25). Scapular kinematics and humeral translations were quantified with an electromagnetic motion capture system. Shoulder internal rotation and external rotation ROM, external rotation strength, and pain and Shoulder Pain and Disabilities Index scores were compared between groups with ANOVA. Results: The SIS group had greater scapular internal rotation (mean difference = 5.13°; 95% confidence interval [CI] = 1.53°-8.9°) and less humeral anterior translation (1.71 mm; 95% CI = 0.53-2.9 mm) than the other groups. Groups without PCT had greater internal rotation ROM (16.05°; 95% CI = 5.09°-28.28°). The SIS + PCT group had lower pain thresholds at the levator scapulae muscle (108.02 kPa; 95% CI = 30.15-185.88 kPa) and the highest Shoulder Pain and Disabilities Index score (∼ 44.52; 95% CI = 33.41-55.63). Limitations: These results may be limited to individuals with impingement symptoms and cannot be generalized to other shoulder conditions. Conclusions: Decreased ROM and lower pain thresholds were found in individuals with both impingement symptoms and PCT. However, the combination of factors did not influence scapular and humeral kinematics.
... Borstad and Ludewig (2005) found that a shortened pectoralis minor muscle may cause altered scapular kinematics of the shoulder which appeared to be similar to scapular kinematics of individuals with impingement symptoms in a non-athlete cohort. Conversely, Rosa, Borstad, Pogetti, and Camargo (2017) found that PML was not strongly correlated to scapular kinematics. It is important to consider that the above studies used non-athlete, heterogenous participants, making their findings less generalisable to our population of homogeneous amateur male cricketers. ...
... As such, the precise mechanism of how PML effects accuracy needs further investigation. However, it has been shown that stretching it may help with shoulder function even if the resting PML does not change (Rosa et al., 2017). ...
Article
Optimal throwing speed and accuracy is built on a complex interaction of multiple variables. Although strength and power has been associated with throwing speed in cricketers, the individual muscles that contribute to optimal function of the shoulder-complex has not been adequately explored in connection with throwing performance. Consequently, this study aimed to investigate the correlation between musculoskeletal variables and overhead throwing performance in cricketers. Thirty-two amateur male cricketers were tested using a battery of 16 tests (strength, flexibility, scapula positioning) as well as a throwing speed (TS) and a novel accuracy test (TA). Only two of the sixteen tests were correlated with throwing performance in the multiple regression analysis. Non-dominant hip abduction strength correlated positively with TS (p < 0.05): on average, a strength increase of 10 newtons (N) was associated with an increase in TS of 0.60 km/h (95% CI: 0.12-1.08). Non-dominant pectoralis minor length correlated positively with TA (p < 0.01): on average, a one-centimetre increase in the length correlated to an increase, of 0.633 points (95% CI: 0.225-1.041). This cross-sectional study demonstrated that from an array of musculoskeletal variables, only non-dominant hip abduction strength correlated with TS, while only non-dominant pectoralis minor length correlated with TA in amateur cricketers.
... In this position, one step forward was made, and stretching was performed by stretching the small pectoral muscle on the wall. 19 The exercise was maintained for 10 s in both left and right movements and repeated 10 times. Three sets were performed, and the resting time between each set was 30 s. ...
... These findings are consistent with those of the reduction in thoracic kyphosis by applying muscle strengthening in previous studies. 19,24 In the selfextension exercise group and the muscle energy technique group, the thoracic kyphosis significantly reduced, and the respiratory function significantly increased. Increased kyphosis angle causes the shortening of the pectoral muscles. ...
... 12 Shoulder dysfunction can be caused by various factors including a decreased pectoralis minor muscle (PMm) length, due to adaptive shortening or scapular dyskinesis (altered scapular motion and position). 13 Scapular dyskinesis and PMm length will be determined in this study as scapula performance plays a vital role in effective shoulder position, stability, movement and muscle performance during wheelchair activities. 14 The upper limbs are used as the primary mode of mobility and transfers, and as such, PWSCI who use manual wheelchairs are unable to rest their upper limbs in the presence of pain. 3 15 The inability to rest the upper limbs may force PWSCI to endure the pain while trying to participate with others. ...
... The PMm is measured in supine together with the participant's height (which will be measured using a tape measure). PMm length is expressed as Pectoralis Minor Index and is calculated as: (PMm length(cm) / height(cm) x 100) 13 Open access academic and clinical work conducted through the International Spinal Cord Society, Africa Spinal Cord Injury Network, Southern African Spinal Cord Association, South African Neurology Association, PainSA and 'Pain management' and 'Neurological rehabilitation' special interest groups of the South African Society of Physiotherapy. The researcher will contact the administrative staff of the abovementioned organisations to identify the potential experts. ...
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Introduction Approximately 80% of people with spinal cord injury experience clinically significant chronic pain. Pain (whether musculoskeletal or neuropathic) is consistently rated as one of the most difficult problems to manage and negatively affects the individual’s physical, psychological and social functioning and increases the risk of pain medication misuse and poor mental health. The aim of this study is to therefore determine the presence of pain and its impact on functioning and disability as well as to develop a framework for self-management of pain for South African manual wheelchair users with spinal cord injury. Methods and analysis Community-dwelling participants with spinal cord injury will be invited to participate in this three-phase study. Phase 1 will use a quantitative, correlational design to determine factors related to pain such as pectoralis minor length, scapular dyskinesis, wheelchair functioning, physical quality of life, community reintegration and pain medication misuse. Demographic determinants of pain such as age, gender, type of occupation, completeness of injury and neurological level of injury will also be investigated. Participants with pain identified in phase 1 will be invited to partake in a qualitative descriptive and contextually designed phase 2 to explore their lived experience of pain through in-depth interviews. The results of phases 1 and 2 will then be used with the assistance from experts to develop a framework for self-management of pain using a modified Delphi study. Data analysis will include descriptive and inferential statistics (quantitative data) and thematic content analysis (qualitative data). Ethics and dissemination Approval for this study is granted by the Faculty of Health Sciences Research Ethics Committee of the University of the Pretoria (approval number 125/2018). This study is registered with the South African National Health Research Database (reference GP201806005). This study’s findings will be shared in academic conferences and published in scientific peer-reviewed journals.
... 4 The Disabilities of the Arm, Shoulder, and Hand (DASH) is one of the questionnaires that has been widely used to assess individuals with SPS. [5][6][7][8][9] It measures symptoms and disabilities of the upper limbs 10 and has already been translated into several languages. [11][12][13][14] The DASH was found to present adequate reliability and validity and satisfactory responsiveness in individuals with SPS. ...
... There were no studies found that related the level of difficulty of the items with the ICF descriptors. Because the DASH is commonly used for assessing shoulder function in patients with SPS, [6][7][8][9]23 it is essential to evaluate how much and if the DASH questionnaire is adequate for this population. ...
Article
Objective The Disabilities of the Arm Shoulder and Hand (DASH) questionnaire is highly used to assess patients with symptoms of subacromial pain syndrome (SPS). No study has analyzed the DASH by using the Rasch model in these patients and related the level of difficulty of the items with the International Classification of Functioning Disability and Health (ICF) domains. The purpose of this study was to evaluate the measurement properties of the DASH in individuals with SPS and to describe which International Classification of Functioning, Disability and Health (ICF) components are influenced by SPS based on the DASH. Methods The full version of the DASH was used to assess upper limbs pain and function in individuals with SPS. Responses were assessed using the Rasch model. Items of the DASH were grouped according to the level of difficulty, and associated to the ICF domains in order to identify which is the most compromised aspect in these individuals. Results Reliability and internal consistency for the DASH were shown to be 0.93 and 0.95, respectively. Item 3 (“Turn a key”) was the easiest, and 25 (“Pain during specific activity”) the most difficult. Only item 30 (“Less capable/confident/useful”) resulted as an erratic item. Item 15 (“Put on a sweater”) showed differential functioning by age, and item 11 (“Carry a heavy object”) by sex. Seven items showed differential functioning related to the angular onset of pain during arm elevation. Sixty percent of the most difficult items belonged to the “Body function” domain of the ICF. Conclusion Although some psychometric properties of the DASH are adequate according to the Rasch model, adjustments to some items are necessary for individuals with SPS. Clinicians should be cautious when interpreting the DASH, especially in patients with the angular onset of pain above 120° of arm elevation. Impact The information contained in this study should be used by clinicians to interpret the results of the DASH when assessing individuals with SPS. The DASH may not be adequate to assess those with shoulder pain above 120 degrees of arm elevation. These results are not generalizable to other shoulder pathologies.
... As an impairment, scapular dyskinesis has been posited to be primarily the result of soft-tissue deficiencies, thus the treatment focus has centered on mobility and strength enhancement. [5][6][7][8]17,[41][42][43][44][45][46][47][48][49][50][51][52] However, various reports have noted that interventions directed at correcting these deficiencies, mostly manual therapy and therapeutic exercise, have little influence on the scapular motion itself. 48,49,52,53 There are several possible reasons for these findings. ...
... [5][6][7][8]17,[41][42][43][44][45][46][47][48][49][50][51][52] However, various reports have noted that interventions directed at correcting these deficiencies, mostly manual therapy and therapeutic exercise, have little influence on the scapular motion itself. 48,49,52,53 There are several possible reasons for these findings. ...
Article
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Scapular dyskinesis is a condition that is frequently observed clinically but not often understood. Too often it is viewed as a diagnosis which is not accurate because it is a physical impairment. This misclassification of dyskinesis has resulted in literature that simultaneously supports and refutes scapular dyskinesis as a relevant clinical entity as it relates to arm function. These conflicting views have not provided clear recommendations for optimal evaluation and treatment methods. The authors' experience and scholarship related to scapular function and dysfunction support that scapular dyskinesis is an impairment that has causative factors, that a pathoanatomical approach should not be the primary focus but should be considered as part of a comprehensive examination, that a qualitative examination for determining the presence or absence of a scapular contribution to shoulder dysfunction is currently the best option widely available to clinicians, and that rehabilitation approaches should be reconsidered where enhancing motor control becomes the primary focus rather than increasing strength.
... The clinical examination of patients with shoulder pain usually includes range of motion (ROM) and soft-tissue length or tension measurements to identify impair- ments treatable by physical therapists. The pectoralis minor (PM) muscle length can be one of these mea- sures because of the potential effect of its length on normal scapula kinematics (Borstad and Ludewig, 2005;Phadke, Camargo, and Ludewig, 2009) and on shoulder pain (Braun, Kokmeyer, and Millett, 2009;Castelein, Cagnie, Parlevliet, and Cools, 2016;Kibler and McMullen, 2003;Provencher et al., 2016;Rosa, Borstad, Pogetti, and Camargo, 2017). While the mechanisms contributing to shoulder pain need further clarification, a combination of soft-tissue and motor control alterations is proposed to explain the associa- tion between shoulder pain and altered scapula motion ( Ludewig and Reynolds, 2009;Phadke, Camargo, and Ludewig, 2009). ...
... The diagnosis of SIS was based on a clinical examination and self-reported history (Haik et al., 2014;Hegedus et al., 2012;Ludewig and Borstad, 2003;Rosa, Borstad, Pogetti, and Camargo, 2017). SIS was considered present when at least 3 of the following were positive ( Hegedus et al., 2012;Michener, Walsworth, Doukas, and Murphy, 2009): (1) Neer test (Neer, 1972); (2) (Alburquerque-Send?n, ...
Article
Background: There is evidence that pectoralis minor (PM) length influences scapula position and that scapula position relates to glenohumeral joint (GHJ) external rotation (ER) range of motion (ROM). Objectives: To explore the association between PM resting length and GHJ ER ROM in individuals with and without shoulder pain. The influence of GHJ ER ROM measurement position on this association was also evaluated. Design: Cross-Sectional. Methods: Fifty individuals (25 asymptomatic and 25 with shoulder pain) participated. PM resting length was measured using a tape measure with subjects standing, while GHJ ER ROM was quantified using a digital inclinometer with participants in both supine and seated positions. The same blinded investigator took all measurements. Results/findings: A significant negative correlation between PM resting length and GHJ ER ROM in the seated position was noted in the asymptomatic group (r = -0.41; p = 0.04), but not in the symptomatic group (r = -0.33; p = 0.11). A nonsignificant negative correlation was also demonstrated in the supine position for both groups (r ranged from -0.35 to -0.17; p > 0.05). There was a significant group x position interaction (F = 4.06; p = 0.04) with more GHJ ER ROM (6.80°) for asymptomatic group in the seated position. Conclusions: PM length is not strongly correlated with GHJ ER ROM in individuals with or without shoulder pain. However, the position in which GHJ ER ROM is measured influenced the motion in asymptomatic individuals.
... Based on anatomic landmarks representing the muscles origin and insertion, we evaluated the muscle resting length prestretching and poststretching but did not see differences in this measurement. 1 We also found no changes that exceeded the minimal detectable change 3 when PM length was measured in a position of scapular retraction. We agree with Ebaugh, Finley, and Goodstadt that although PM resting length did not change, it is certainly possible that extensibility was influenced through decreased tissue passive tension and resistance to lengthening and/or tolerance. ...
... The presence of a forward shoulder posture, reduced scapular upward rotation and alterations in electromyographic (EMG) activity of the scapular upward rotators muscles have been related to shoulder dysfunctions. 1,2 Interventions aiming to improve shoulder and scapula alignment by means of changing soft tissue properties around the shoulder, such as stretching of the pectoralis minor 3 and major and strengthening of the scapular upward rotators muscles, 4,5 have been proposed. However, the effects of these exercise programs on shoulder posture are contradictory. ...
Article
Background: Modifications of posture in a segment may influence the posture of adjacent and nonadjacent segments and muscular activity. The spine-shoulder and spine-pelvis relationships suggest that the pelvis may influence shoulder posture. Objective: To investigate the effect of the active reduction of the anterior pelvic tilt on shoulder and trunk posture during static standing posture and on the electromyographic activity of the scapular upward rotators during elevation and lowering of the arm. Methods: Thirty-one young adults were assessed in a relaxed standing position and a standing position with 30% active reduction of the anterior pelvic tilt. The pelvic tilt, trunk posture, and forward shoulder posture during the static standing posture and the electromyographic activity during elevation and lowering of the arm were assessed. Results: Paired t-tests indicated that the active reduction of the anterior pelvic tilt reduced the trunk extension (MD=1.09; 95%CI=-2.79 to -1.03). There were no effects on the forward shoulder posture (MD=0.09; 95%CI=-0.92 to 1.09). Repeated measures of analyses of variance indicated an increase in lower trapezius electromyographic activity (MD=3.6; 95%CI=1.28 to 5.92). There was a greater reduction in upper trapezius activity after pelvic tilt reduction during arm elevation (MD=1.52%; 95%CI=-2.79 to -0.25) compared to that during the lowering phase. There were no effects of pelvic tilt reduction on the electromyographic activity of the serratus anterior (MD=3.26; 95%CI=-3.36 to 9.87). Conclusion: The influence of pelvic posture on the trunk posture and lower trapezius activation should be considered when assessing or planning exercise for individuals with shoulder or trunk conditions.
... For any player of any age, shoulder mobility can be accomplished by including low-resistance actions, such as pushups, increased range of motion push-ups using a suspension trainer. Intervention studies have shown that self-administered standing stretches with the arm held abducted at 90°against a wall corner (6 wk; four 1-min stretches with 30-s rest intervals) can reduce muscle pain (62). Even one bout of stretching the pectoralis minor shoulder at maximal horizontal abduction and external rotation with arm elevation at 150°(10 intervals of 30 s of stretch, 10 s of rest) can increase external rotation, posterior tilt of the scapula, and decrease pectoralis muscle stiffness by 12.7% (61). ...
Article
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Lacrosse imposes multiple simultaneous physical demands during play including throwing and catching a ball while holding a crosse, running, cutting, and jumping. Often, these skills are completed while experiencing contact from another player leading to both on-and-off platform movements. Other motions include defensive blocking and pushing past defenders. Repetitive motions over sustained durations in practice or competition impart mechanical stresses to the shoulder or elbow joints, supportive muscles, and connective tissue. Preparation for lacrosse participation involves bilateral optimization of strength and durability of stabilizer muscles. Passing and shooting skills are encouraged to be equally effective on both sides; therefore, symmetric strength and flexibility are vital for prehabilitation and rehabilitation efforts. This article will: 1) provide insights on the upper-extremity musculoskeletal demands of lacrosse and related sports with similar throwing motion and 2) describe prehabilitation and rehabilitation methods that improve athlete durability and reduce likelihood of upper-extremity injury. Introduction Despite the rapid growth of lacrosse participation in developing players, appropriate prerehabilitation and rehabilitation training strategies to prepare these players are still in development. Lacrosse is a unique throwing sport, because it involves continuous upper-extremity use through carriage and play with a handheld crosse, physical contact (1), and high-speed lower-body motion. In this fast-paced game, athletes (10 for men, 12 for women) run distances up and down a field while carrying a ball, passing, shooting, or defending a goal or other defending other players with the crosse. Regulation game times range from 40 to 50 min, depending on the age and sex of the competitors.
... 15 Recently, pectoralis minor length and its shortening have received remarkable empirical attention, in terms of studies of its reliability, 16 its association with shoulder external rotation, 17 and as an outcome measure after a stretching programme in participants with shoulder pain. 18 However, differences between symptomatic groups and healthy controls were not calculated. To the best of our knowledge, differences in the Levator Scapulae Index (LSI) between symptomatic and control populations have not been determined yet. ...
Article
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Objective To determine the potential differences in both scapular positioning and scapular movement between the symptomatic and asymptomatic contralateral shoulder, in patients with unilateral subacromial pain syndrome (SAPS), and when compared with participants free of shoulder pain. Setting Three different primary care centres. Participants A sample of 73 patients with SAPS in their dominant arm was recruited, with a final sample size of 54 participants. Primary outcome measures The scapular upward rotation (SUR), the pectoralis minor and the levator scapulae muscles length tests were carried out. Results When symptomatic shoulders and controls were compared, an increased SUR at all positions (45°, 90° and 135°) was obtained in symptomatic shoulders (2/3,98/8,96°, respectively). These differences in SUR surpassed the minimal detectable change (MDC95) (0,91/1,55/2,83° at 45/90/135° of shoulder elevation). No differences were found in SUR between symptomatic and contralateral shoulders. No differences were found in either pectoralis minor or levator scapulae muscle length in all groups. Conclusions SUR was greater in patients with chronic SAPS compared with controls at different angles of shoulder elevation.
... The recent study examining the effects of selfstretching of the PMi for 6 weeks on scapular kinematics concluded that stretching did not change PMi length and scapular kinematics in individuals with and without shoulder pain. 27 Therefore, future study should evaluate the long-term effects of the therapist-applied PMi stretching on muscle stiffness and scapular motion. ...
Article
Background: Pectoralis minor tightness may be seen in individuals with scapular dyskinesis, and stretching is used for the treatment of altered scapular motion in sports and clinical fields. However, few researchers have reported on the effects of pectoralis minor stiffness on scapular motion during arm elevation. This study investigated whether an acute decrease of pectoralis minor stiffness after stretching changes the scapular motion during arm elevation. Methods: The study allocated 15 dominant and 15 nondominant upper limbs in healthy men as control and interventional limbs, respectively. In the intervention limb group, the shoulder was passively and horizontally abducted at 150° of elevation for 5 minutes to stretch the pectoralis minor muscle. Before and after stretching, an electromagnetic sensor was used to examine 3-dimensional scapular motion during abduction and scaption. Ultrasonic shear wave elastography was used to measure pectoralis minor stiffness before and immediately after stretching and after arm elevation. Results: In the interventional limb, pectoralis minor stiffness decreased by 3.2 kPa immediately after stretching and by 2.5 kPa after arm elevation. The maximal changes in scapular kinematics after stretching were 4.8° of external rotation and 3.3° of posterior tilt in abduction, and 4.5° of external rotation and 3.7° of posterior tilt in scaption. Upward rotation in abduction or scaption did not change. Conclusions: Stretching for the pectoralis minor muscle increases external rotation and posterior tilt of the scapula during arm elevation.
... However, when performed as part of a six-week home stretching program, there was no increase in pectoralis minor length in both healthy and symptomatic subjects. 1 Conversely, pectoralis minor stretching done in conjunction with a shoulder strengthening routine have led to improvements in posterior scapular tilting and forward shoulder position. 21,41 Care must be taken when selecting stretches for the pectoralis musculature to protect the anterior capsule in the overhead athlete. ...
Article
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Background In elite tennis players, musculoskeletal adaptations in the dominant upper extremity have been reported for range of motion, strength, and scapular biomechanics. In addition to scapular dysfunction, tightness and inflexibility of the pectoral musculature have been identified as risk factors for the development of overuse shoulder injury in overhead athletes. Hypothesis Differences in anterior shoulder position will be identified between the dominant and non-dominant extremity in elite tennis players. The purpose of this study was to examine bilateral differences in anterior shoulder posture measured using a double square in elite tennis players without shoulder injury. Study Design Descriptive Laboratory Study Methods Three hundred and six uninjured elite tennis players were measured in the supine position using a double square method to measure anterior shoulder position. The distance from the surface of the table to the anterior most position of the shoulder (in millimeters) was measured bilaterally and compared. A dependent t-test was used to test for significant differences in anterior shoulder position between the dominant and non-dominant extremity. Results One hundred thirty-three males and 173 females were included in this study with a mean age of 16.58 years. The mean difference between extremities indicates increased anterior shoulder positioning on the dominant shoulder of 7.65 mm in females, and 8.72 in males. Significantly greater (p<.001) anterior shoulder position measures were documented on the dominant shoulder as compared to the non-dominant shoulder. Conclusions The results of this study showed significantly (p<.001) greater anterior shoulder position on the dominant extremity of elite male and female tennis players. The differences of 7-8mm between extremities has clinical application for interpreting anterior shoulder position test results in this population. Level of Evidence 3
... The 3-D position and orientation of each sensor were tracked simultaneously at sampling rates of 100 Hz. These surface sensors positions were previously used (Habechian et al., 2014;Haik et al., 2014a;Ludewig and Cook, 2000;McClure et al., 2006;Rosa et al., 2017). ...
Article
Background: The Scapular Assistance Test was suggested to directly assess the influence of scapular motion on pain and indirectly measure the function of the scapular rotators. However, it is still not clear if individuals with a positive Scapular Assistance Test actually present changes in scapular motion and muscle strength. This study compared scapular kinematics and muscle strength between those with a positive Scapular Assistance Test and those with a negative Scapular Assistance Test. Methods: Fifty individuals with shoulder pain were randomly allocated to: positive (n = 25) or negative Scapular Assistance Test (n = 25) group. Scapular kinematics was measured during elevation and lowering of the arm. Strength of the serratus anterior and lower trapezius was also measured. Two-way analysis of variance was used to compare kinematics between groups. Unpaired Student's t-test and Mann-Whitney test were used to compare strength of serratus anterior and lower trapezius, respectively. Findings: There were no differences (P > 0.05) in scapular internal rotation and upward rotation between both groups. For scapular tilt, there was group main effect (P < 0.05) during elevation and lowering of the arm, whereas the positive Scapular Assistance Test group presented greater scapular anterior tilt. There was no difference (P > 0.05) in strength between groups. Interpretation: Individuals with a positive Scapular Assistance Test are more likely to present decreased scapular posterior tilt in those with shoulder pain. Strength of the scapular muscles seems to be same in those with a positive and a negative Scapular Assistance Test.
... For the healthy group, the scapular anterior tilt at 90° of flexion also increased significantly. The length of the pectoralis minor for both groups did not demonstrate any significant changes 49) . A previous study reported that there is a significant decrease in RSP through the application of pectoralis minor stretching exercises and scapular, posterior tilting exercises for individuals with RSP 16) . ...
Article
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[Purpose] The purpose of this study was to analyze the effects of pectoralis minor stretching and shoulder strengthening with an elastic band on balance and maximal shoulder muscle strength in young adults with rounded shoulder posture. [Subjects and Methods] Nineteen subjects with rounded shoulder posture were randomly divided into 2 groups: a shoulder stabilization exercise group and a stretching exercise group. The groups performed each exercise for 40 minutes, 3 times a week, for 4 weeks. Static balance (eyes open and closed), dynamic balance (the limits of stability in 4 directions) and shoulder muscle strength in 5 directions were measure before and after the exercises. [Results] The stretching exercise demonstrated a significant difference between the pre- and post-exercise in the static balance with eyes closed and extension and horizontal abduction strength while the stabilization exercise demonstrated significant difference in the left and right directions between the pre- and post-exercise of the dynamic balance and flexion strength. The stabilization exercise demonstrated significant differences shown in the flexion between the pre- and post-test. [Conclusion] The shoulder stabilization and stretching exercises improved the static balance, dynamic balance, and muscle strength.
... This group will perform stretching and strengthening exercises commonly used to treat individuals with shoulder pain (Appendix A, Supplementary data). 26,61 The self-stretching exercises will address the UT, 26 pectoralis minor, 25 and posterior shoulder. 62 Each stretch will consist of 3 repetitions of 30 s, with an interval of 30 s between repetitions. ...
Article
Background Scapular focused exercise interventions are frequently used to treat individuals with shoulder pain. However, evidence for changes in scapular motion after intervention is limited. Objective To compare the effects of scapular movement training versus standardized exercises for individuals with shoulder pain. Methods This will be a single-blinded randomized controlled trial. Sixty-four individuals with shoulder pain for at least 3 months, scapular dyskinesis, and a positive scapular assistance test will be randomly allocated to one of two groups: Scapular Movement Training (group 1) and Standardized Exercises (group 2). Group 1 will receive education about scapular position and movement, and be trained to modify the scapular movement pattern. Group 2 will perform stretching and strengthening exercises. Both groups will be treated twice a week for eight weeks. Three-dimensional scapular kinematics and muscle activity of the serratus anterior and upper, middle, and lower trapezius during elevation and lowering of the arm will be assessed at baseline and after 8 weeks of treatment. Pain intensity, function, fear avoidance beliefs, and kinesiophobia will be assessed at baseline and after 4 and 8 weeks of treatment, and 4 weeks after the end of treatment. Conclusions The results of this study may contribute to a better understanding of the efficacy of scapular focused treatments for individuals with shoulder pain. Clinical trial registration: NCT03528499
... ©Journal of Sports Science and Medicine (2021) 20, [17][18][19][20][21][22][23][24][25] movement and position of the scapula (i.e., scapular dyskinesis) (Kibler et al., 2013). Many previous studies have examined the effect of interventions lengthening the PMi on the rounded shoulder posture, scapular movement, and patient self-reported outcome (Gutierrez-Espinoza et al., 2019;Lee et al., 2015;Rosa et al., 2017;Wang et al., 1999), indicating that the stretching of PMi is significant in rehabilitation and sports settings. However, few studies have directly determined the muscle mechanical response of the PMi in resistance to stretching interventions. ...
Article
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Increased muscle stiffness of the pectoralis minor (PMi) could deteriorate shoulder function. Stretching is useful for maintaining and improving muscle stiffness in rehabilitation and sport practice. However, the acute and prolonged effect of stretching on the PMi muscle stiffness is unclear due to limited methodology for assessing individual muscle stiffness. Using shear wave elastography, we explored the responses of shear modulus to stretching in the PMi over time. The first experiment (n = 20) aimed to clarify the acute change in the shear modulus during stretching. The shear modulus was measured at intervals of 30 s × 10 sets. The second experiment (n = 16) aimed to observe and compare the prolonged effect of different durations of stretching on the shear modulus. Short and long stretching duration groups underwent 30s × 1 set and 30s × 10 sets, respectively. The assessments of shear modulus were conducted before, immediately after, and at 5, 10, and 15 min post-stretching. In experiment I, the shear modulus decreased immediately after a bout (30 s) of stretching (p < 0.001, change: -2.3 kPa, effect size: r = 0.72) and further decreased after 3 repetitions (i.e., 90 s) of stretching (p = 0.03, change: -1.0 kPa, effect size: r = 0.53). In experiment II, the change in the shear modulus after stretching was greater in the long duration group than in the short duration group (p = 0.013, group mean difference: -2.5 kPa, partial η2 = 0.36). The shear modulus of PMi decreased immediately after stretching, and stretching for a long duration was promising to maintain the decreased shear modulus. The acute and prolonged effects on the PMi shear modulus provide information relevant to minimum and persistent stretching time in rehabilitation and sport practice.
... Mobilization has been proven to be effective treatment technique for improving shoulder mobility and decreasing in pain through stimulation of type 2 mechanoreceptors and by inhibition of type 4 nociceptors [25]. Many studies stated that Stretching had positively affect on pain by decreasing muscle passive resistance, improving connective tissue extensibility and inuencing neural activation patterns [26]. Strengthening programme improves strength and upper limb function in HSP, Resistance training programme through various grades increases recruitment in the number of motor ring units as well as an increased rate and synchronization of ring [27]. ...
Article
Shoulder pain is a common complication of a stroke which can impede participation in rehabilitation and has been associated with poor outcomes. Low Level LASER Therapy (LLLT) is one of the adjunct treatments of choice with exercise therapy for shoulder rehabilitation in Physiotherapy. The objective of this study was to investigate the effect of LLLT on Hemiplegic Shoulder Pain (HSP) in reducing shoulder pain and improving upper limb function in post Stroke subjects. Prospective study design. 68 subjects with mean age of 53 years having a clinical diagnosis of Stroke with HSP were randomly allocated into two groups. In Group-A (n=34) subjects were treated with LLLT and standardized Rehabilitation Programme, where as in Group-B (n=34) subjects were treated with standardized Rehabilitation Programme. Participants were given interventions twice a week for 8 weeks. The outcomes of this intervention were measured by SPADI for pain, disability and FMA-UE for function. Statistical analysis of the data revealed that within group comparison both groups showed signicant improvement in all parameters, where as in between groups comparison Group-A showed better improvement compared to the Group-B. After 8 weeks of interventions both Group-A and Group-B showed signicant improvement in reducing pain and improving upper limb function. However LLLT along with Standardized Rehabilitation Programme showed more improvement when compared to the Standardised Rehabilitation Programme alone. Thus this study concludes that LLLT is a useful adjunct in HSPalong with rehabilitation
... Rosa ve ark. günlük germe protokolünün omuz ağrısı olan hastalarda ağrıyı önemli ölçüde azalttığını ve omuz ekleminin fonksiyonunu geliştirdiğini, ancak skapular kinematiğini değiştirmediğini belirtmişlerdir (17). McClure ve ark. ...
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Amaç: Çalışmamızın amacı, subakromiyal sıkışma sendromu tanılı hastalarda konservatif fizyoterapiyle birlikte uygulanan video oyunları tabanlı egzersiz eğitiminin ağrı, fonksiyonellik ve eklem pozisyon hissi üzerine etkilerini araştırmaktır. Materyal ve metod: Çalışmaya subakromiyal sıkışma sendromu tanılı, 40-65 yaşları arasında, Neer klinik evrelemesine göre Evre II ve Evre III sınıflamasında olan olgular alındı. Çalışmaya dahil edilen 50 hasta randomize olarak iki gruba ayrıldı. İlk gruba (n=25) konservatif fizyoterapi ve video oyunları tabanlı egzersiz eğitimi, ikinci gruba (n=25) sadece konservatif fizyoterapi uygulandı. Her iki grup da 20 seans tedaviye alındı. Tedavi öncesi ve tedavi sonrası ağrı, eklem hareket açıklığı, ağrılı ark, kas kuvveti, eklem pozisyon hissi ve fonksiyonellik değerlendirildi. Bulgular: Her iki grupta da ağrı şiddetinde ve ağrılı ark değerlerinde azalma, eklem hareket açıklığı ve kas kuvveti değerlerinde artış, eklem pozisyon hissi deviasyonlarında azalma ve fonksiyonellik düzeyinde artış görüldü (p<0.05). Eklem hareket açıklığı değerleri, kas kuvveti, ağrılı ark değeri, fonksiyonellik puanı açılarından gruplar arası fark bulunmadı (p>0.05). Ağrı, horizontal adduksiyon kas kuvveti, eklem pozisyon hissi parametrelerinde fark bulundu (p<0.05). Sonuç: Çalışmamızın sonucunda konservatif fizyoterapi ile birlikte uygulanan video oyunları tabanlı egzersiz eğitiminin, sadece konservatif fizyoterapi uygulamasına göre ağrının azalması, eklem pozisyon hissinde artış ve fonksiyonellik düzeyinde artış açılarından fark sağladığı belirlendi. Bu nedenle, subakromiyal sıkışma sendromunda uygulanan konservatif fizyoterapinin video oyunları tabanlı egzersiz eğitimi ile desteklenebileceği görüşündeyiz. Abstract Background: The aim of our study was to investigate the effectiveness of video games-based exercise training in addition to conservative physiotherapy in terms of pain, functionality and joint position sense in patients with subacromial impingement syndrome. Materials and Methods: We included patients with subacromial impingement syndrome between 40-65 years of age in Stage II and III classification according to Neer. Fifty patients included in our study were randomly divided into two groups. Conservative physiotherapy plus video games-based exercise training was applied to the first group (n=25), while only conservative physioterapy was applied to the second group (n=25). Both groups were treated for 20 sessions. Pre and post-treatment pain, range of motion, painful arc, muscle strength, joint position sense, and functionality were evaluated. Results: In both groups, pain intensity and painful arc values were decreased, range of motion and muscle strength values were increased, joint position sense deviations decreased, functional level and quality of life were improved (p<0.05). There were no difference in terms of range of motion, muscle strength (flexion, extension, abduction, internal rotation, external rotation), painful arc, functionality scores (p>0.05). There were significant differences between groups in terms of pain, horizontal adduction muscle strength, joint position sense (p<0.05). Conclusion: The results of our study showed that the video games-based exercise training plus conservative physiotherapy was more effective in terms of reducing pain, increasing joint position sense and increasing the level of functionality than only conservative physiotherapy. Therefore, we think that patients' treatment should be supported by video games-based exercise training.
... Stretches performed either by the person themselves or by a practitioner are a common prescription for adults that spend a long time in sedentary positions, or for those presenting with hip pain (Cibulka et al., 2017), and shoulder pain. (Rosa et al., 2017) Sometimes these stretches can be done without regard of a person's bone integrity and whether or not they have osteoporosis. For adults without osteoporosis, practices such as yoga can be safe and provide relief to muscle tightness that is often associated with a sedentary lifestyle, reducing tightness around the hips and shoulders, or for recovery after activity (Henchoz et al., 2010;Henchoz & So, 2008). ...
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Background: The risks of end-range movements for people with osteoporosis, specifically at the hips and shoulder, are not well understood. Objectives: To synthesize literature on the safety of stretching for people with osteoporosis by searching: 1) biomechanical literature to determine how much force results from an end-range maneuverer and is required to fracture joint components (focusing on the hip joint) and 2) clinical literature to describe techniques used, populations studied, effects, and reported adverse events. Methods: We conducted two separate search strategies in PubMed, EMBASE, and Scopus (1955–2020). Results: 16 articles described either biomechanical or clinical effects of passive and active end ranges of the hip joint. The largest load in the hip, described in the literature was in a crescent lunge during yoga. The moment produced in a crescent lunge is much smaller than that of the tensile strength of osteoporotic bone, suggesting the crescent lunge movement could be considered safe. Clinically, no adverse events were reported in exercise, stretching or yoga interventions. Conclusion: This review found no evidence that end range movements of the hip are unsafe, but there is little evidence. No studies were identified that explored the risk of humeral fracture during end range stretches.
... The duration of each stretch was 15 seconds and 5 repetitions were done. Pectoralis stretch was done in supine while serratus anterior and posterior capsular stretching was done in side-lying 17,18 . Furthermore, subscapularis and infraspinatus facilitation was also done in a supine position, during subscapularis facilitation passive internal rotation was done, while during infraspinatus facilitation passive external rotation was performed 19 . ...
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Aim: To determine the additional effects of thoracic manipulation on shoulder pain, shoulder range of motion (ROM) and disability in combination with conventional physical therapy exercises for individuals with adhesive capsulitis. Materials: A parallel, randomized controlled clinical trial was conducted. 32 patients (16 in each group), aged between 40‑60 years from both genders having shoulder pain, clinically diagnosed with adhesive capsulitis (Stage II and III), along with thoracic spine hypo mobility were included. Patients were randomized into conventional physiotherapy group (A) and thoracic manipulation group (B). Clinical trial was continued for two weeks with three sessions per week and a follow up was done at the end of 3rd week. Visual analogue scale (VAS), shoulder range of motion (ROM) and Disabilities of Arm Shoulder and Hand (DASH) score were used for outcomes measurement. Results: Intragroup comparison for shoulder ROM, DASH and VAS scores shows a significant (p value=≤0.001) for both groups. Intergroup comparison for shoulder ROM was improved significantly on post-intervention (p value=≤0.001). While intergroup comparison of baseline to end value for VAS showed insignificant result (p value=0.373). Conclusion: Additional effects of thoracic manipulation to conventional physical therapy underwent a greater improvement regarding shoulder range of motions and disability. Conventional physical therapy exercises and a combination of thoracic manipulation to conventional physical therapy exercises are equally effective for decreasing shoulder pain. Keywords: Adhesive Capsulitis, Pain, Frozen shoulder, Physical Therapy, Rehabilitation
... Tightness of the pectoralis minor muscle, the posterior capsule and/or external rotators may lead to scapular dysfunction [37]. The unilateral pectoralis minor stretch is an efficient stretching method for this muscle [38] and may lead to less shoulder pain and improvement of function [39]. Stretching of the posterior shoulder structures with sleepers stretch and cross-body stretch can improve range of motion (ROM) and function [15,16]. ...
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Background There is no consensus on the best training regimen for subacromial impingement syndrome (SIS). Several have been suggested, but never tested. The purpose of the study is to compare a comprehensive supervised training regimen (STR) based on latest evidence including heavy slow resistance training with a validated home-based regimen (HTR). We hypothesized that the STR would be superior to the HTR. Methods Randomised control trial with blinded assessor. 126 consecutive patients with SIS were recruited and equally randomised to 12 weeks of either supervised training regimen (STR), or home-based training regimen (HTR). Primary outcomes were Constant Score (CS) and Shoulder Rating Questionnaire (SRQ) from baseline and 6 months after completed training. Results were analyzed according to intention-to treat principles. The study was retrospectively registered in ClinicalTrials.gov. Date of registration: 07/06/2021. Identification number: NCT04915430. Results CS improved by 22.7 points for the STR group and by 23,7 points for the HTR ( p = 0.0001). The SRQ improved by 17.7 and 18.1 points for the STR and the HTR groups respectively (p = 0.0001). The inter-group changes were non-significant. All secondary outcomes (passive and active range of motion, pain on impingement test, and resisted muscle tests) improved in both groups, without significant inter-group difference. Conclusion We found no significant difference between a comprehensive supervised training regimen including heavy training principles, and a home-based training program in patients with SIS.
... Grade I Pm syndrome is not commonly considered in their differential diagnosis by orthopedic surgeons, but it has been discussed in the past in the physical therapy literature [16], with several stretching protocols reported [15]. Sanchez-Sotelo has compared the Pm as a "hand controlling the scapular position through a joystick, the coracoid process" [17]. ...
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Purpose The term “ pectoralis minor syndrome ” refers to this constellation of symptoms that can occur when the pectoralis minor (Pm) is shortened and contracted. Release of the tendon of the Pm from the coracoid has been reported to provide substantial clinical improvement to patients presenting with pectoralis minor syndrome. The purpose of this study was (1) to describe the technique for endoscopic release of pectoralis minor tendon at the subdeltoid space, (2) to classify the pectoralis minor syndrome according to its severity and (3) and to report the short-term outcomes of this procedure in a consecutive series of patients diagnosed with pectoralis minor syndrome. Methods Endoscopic release of the pectoralis minor tendon was performed in a series of 10 patients presenting with pectoralis minor syndrome. There were six females and four males with a median age at the time of surgery of 42 (range from 20 to 58) years. Four shoulders were categorized as grade I (scapular dyskinesis), and six as grade II (intermittent brachial plexopathy). Shoulders were evaluated for pain, motion, satisfaction, subjective shoulder value (SSV), quick-DASH, ASES score, and complications. The mean follow-up time was 19 (range, 6 to 49) months. Results Arthroscopic release of the tendon of the Pm led to substantial resolution of pectoralis minor syndrome symptoms in all but one shoulder, which was considered a failure. Preoperatively, the median VAS for pain was 8.5 (range, 7–10) and the mean SSV was 20% (range, 10% - 50%). At most recent follow-up the mean VAS for pain was 1 (range, 0–6) and the mean SSV 80% (range, 50% - 90%). Before surgery, mean ASES and quick-DASH scores were 19.1 (range, 10–41.6) and 83.1 (range, 71 and 95.5) points respectively. At most recent follow-up, mean ASES and quick-DASH scores were 80.1 (range, 40–100) and 19.3 (range, 2.3–68) points respectively. No surgical complications occurred in any of the shoulder included in this study. Conclusions Endoscopic release of the tendon of the pectoralis minor from the coracoid improves pain, function and patient reported outcomes in the majority of patients presenting with the diagnosis of isolated pectoralis minor syndrome.
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Background Exercise is considered to be both essential and at the forefront of the management of rotator cuff-related shoulder pain (RCRSP). Despite this, many fail to substantially improve with exercise-based treatment. Hence, expanding the current knowledge about the possible mechanisms of exercise for RCRSP is critical. Objective To synthesise the range of mechanisms proposed for exercise in people with RCRSP. Design Scoping review Methods A systematic search of the Physiotherapy Evidence Database (PEDro) was conducted from inception to July 3, 2022. Two reviewers conducted the search and screening process and one reviewer extracted the data from each study. Randomised clinical trials using exercise for the management of RCRSP of any duration were included. The PEDro search terms used were “fitness training”, “strength training”, “stretching, mobilisation, manipulation, massage”, “upper arm, shoulder, or shoulder girdle”, “pain”, and “musculoskeletal”. Data were analysed using quantitative and qualitative approaches. Results 626 studies were identified and 110 were included in the review. Thirty-two unique mechanisms of exercise were suggested by clinical trialists, from which 4 themes emerged: 1) neuromuscular 2) tissue factors 3) neuro-endocrine-immune 4) psychological. Neuromuscular mechanisms were proposed most often (n = 156, 77%). Overall, biomedical mechanisms of exercise were proposed in 95% of cases. Conclusions The causal explanation for the beneficial effect of exercise for RCRSP in clinical research is dominated by biomedical mechanisms, despite a lack of supporting evidence. Future research should consider testing the mechanisms identified in this review using mediation analysis to progress knowledge on how exercise might work for RCRSP.
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Background: Muscle tightness is a complex ailment that affects quality of life in people who experience it. Muscle tightness is not clearly defined by National Library of Medicine, which creates confusion in clinical practice. Objectives: The purpose of this study was to identify the attributes of muscle tightness from expert clinicians' perception and develop a consensus definition from multidisciplinary perspectives. Methods: This non-intervention study employed semi-structured interviews using qualitative design. Twelve multidisciplinary expert clinicians participated in the study. Results: The results indicate that limited range of motion is a key feature of muscle tightness; however, there are six other attributes: loss of function, changes in muscle texture, change in sensation, asymmetry, pain, and contracted muscle state. These attributes are largely subjective and are inter-related. Discussion: The new definition captures the multiple domains of muscle tightness. Lack of a standardized tool is a challenge, particularly when subjective assessments require patients' input. Development of such a tool to measure muscle tightness is advocated.
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Study design: Clinical commentary. Introduction/purpose: Pain and movement are universally relevant phenomena that influence human experiences in readily observable ways. Improved understanding of pain-movement relationships can guide medical and rehabilitative approaches to recovery and decrease risk of dysfunctional long-term consequences of otherwise normal neuromuscular responses. Therefore, the overall intent of this article is to elucidate the relationships between pain and movement as they relate to clinical decision making. Conclusions: Motor output is highly adaptable, can be influenced by multiple mechanisms at various levels along the nervous system, and may vary between individuals despite similar diagnoses. Therefore, interventions need to be individualized and consider both the types of motor response observed (ie, whether the response is protective or maladaptive), and the patient's acute physical activity tolerance when prescribing exercise/movement.
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PURPOSE Spinal cord injuries cause a decrease in overall body function after spinal cord injury. The physical fitness of the spinal cord injured person varies greatly depending on the level of injury, physical activity, and the use of a wheelchair. Therefore, exercise prescription programs that take into account the type of disability of the spinal cord injuries will help improve physical fitness. The purpose of this study was to identify the physical characteristics of spinal cord injured people by examining previous studies and to suggest strategies for applying effective exercise programs. METHODS This study was conducted to investigate previous studies and to present the physical characteristics of spinal cord injuries according to spinal cord injury level, physical activity level and wheelchair use, and to determine the appropriate exercise test method and effective exercise prescription strategy. RESULTS This study suggested the exercise test method considering the physical characteristics of the spinal cord injured people and the NMES exercise program for the cardiorespiratory capacity enhancement exercise program and the NMES exercise program for the prevention of the lower extremity muscle activity. CONCLUSIONS The application of a customized exercise prescription program for spinal cord injuries would have a positive effect on the prevention of secondary complications due to spinal cord injury and improvement of the quality of life of people with spinal cord injury. Based on the results of this study, we expect that the scientific exercise prescription program will be applied to people with spinal cord injuries.
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Objective Our aim was to analyze whether shoulder pain is related to scapular upward rotation (SUR) or to the lengths of the pectoralis minor and levator scapulae muscles. Methods This cross-sectional, observational study was carried out in 3 primary-care centers; 54 individuals with chronic shoulder pain participated. Scapular upward rotation and the lengths of the pectoralis minor and levator scapulae muscles were assessed. Results The level of association was small between shoulder pain and function and (1) the lengths of the pectoralis minor ( r = 0.08, P = .93) and levator scapulae ( r = −0.01, P = .57) muscles and (2) SUR at 45° ( r = 0.17, P = .21), 90° ( r = 0.08, P = .57), and 135° ( r = 0.10, P = 0.45) of shoulder elevation. Conclusion The relationship was small between shoulder pain and function and (1) SUR (45°, 90°, and 135° of shoulder elevation) and (2) the lengths of the pectoralis minor and levator scapulae muscles. Thus, the use of SUR and pectoralis minor and levator scapulae lengths in shoulder assessment should be undertaken with caution. Other factors such as psychological factors, central/peripheral sensitization, and intrinsic properties of the tissue have to be taken into account.
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Objective: To assess the relationship of pectoralis minor muscle (PMm) length and extensibility to shoulder pain, shoulder girdle motion, and duration of manual wheelchair (MWC) use and compare differences in muscle length, muscle extensibility, peak humeral elevation and pain among groups based on duration of wheelchair use. Design: Cross-sectional cohort study; SETTING: Laboratory setting PARTICIPANTS: Twenty-two individuals with SCI who used a MWC for daily community and home mobility (18 males, mean age 41.7 years, duration wheelchair use = 14.6 years). Participants were stratified into groups based on duration of wheelchair use: < 5 years (n=6), 5-15 years (n=8), >15 years (n=8). Interventions: Not applicable; MAIN OUTCOME MEASURE(S): Clinical measures of PMm length and extensibility, shoulder girdle motion, and shoulder pain (Wheelchair Users Shoulder Pain Index). Results: Significant, high correlations were found among duration of wheelchair use, passive PMm length, passive PMm extensibility and peak humerothoracic elevation. Moderate correlation of peak humerothoracic elevation to pain was found. Individuals with >15 years wheelchair use have reduced PMm extensibility and reduced peak humerothoracic elevation compared to those with < 5 years duration of use. Conclusions: This is the first investigation to identify the association of reduced PMm extensibility with reduced shoulder girdle mobility, pain, and duration of wheelchair use in individuals with SCI.
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Background: Pectoralis minor adaptive shortening may change scapula resting position and scapular kinematics during arm elevation. A reliable and clinically feasible method for measuring pectoralis minor length will be useful for clinical decision making when evaluating and treating individuals with shoulder pain and dysfunction. Objectives: To evaluate intrarater, interrater, and between-day reliability of a pectoralis minor (PM) muscle length measurement in subjects with and without signs of shoulder impingement. Method: A convenience sample of 100 individuals (50 asymptomatic and 50 symptomatic) participated in this study. Intra- and interrater reliability of the measurement was estimated in 50 individuals (25 asymptomatic and 25 symptomatic), and between-day reliability of the measurement repeated over an interval of 7 days was estimated in an independent sample of 50 additional participants. Pectoralis minor length was measured using a flexible tape measure with subjects standing. Results: Intraclass correlation coefficients (ICC3,k) for intrarater and interrater reliability ranged from 0.86-0.97 and 0.95 for between-day reliability in both groups. Standard error of measurements (SEM) ranged from 0.30-0.42 cm, 0.70-0.84 cm, and 0.40-0.41 cm for intrarater, interrater, and between-day reliability, respectively, across the sample. The minimal detectable change (MDC) for between-day measurements ranged from 1.13-1.14 cm for both groups. Conclusions: In asymptomatic individuals and in those with signs of shoulder impingement, a single rater or pair of raters can measure pectoralis minor muscle length using a tape measure with very good reliability. This measurement can also be reliably used by the same rater over a seven day interval.
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Study Design Randomized controlled trial. Objective To evaluate the effects of an exercise protocol, with and without manual therapy (MT), on scapular kinematics, function, pain, and mechanical sensitivity in individuals with shoulder impingement syndrome (SIS). Background Stretching and strengthening exercises effectively decrease pain and disability in individuals with SIS. There is still conflicting evidence regarding the efficacy of adding MT to an exercise therapy regimen. Methods Forty-six patients were assigned to 1 of 2 groups, both groups receiving a 4-week intervention. The intervention for one group consisted of stretching and strengthening exercises. The other group received the same intervention supplemented by MT targeting the shoulder and cervical spine. All outcomes were measured pre- and post-intervention at 4 weeks. Outcome measures consisted of: scapular kinematics in the scapular and sagittal planes during arm elevation, pain assessed with a visual analogue scale, mechanical sensitivity assessed with pressure pain threshold, and function as determined through the DASH questionnaire. The study is registered at www.clinicaltrials.gov (NCT02035618). Results Independent of the intervention group, small, clinically irrelevant changes in scapular kinematics were observed post-intervention. A significant group x time interaction effect (P=.001) was found for scapular anterior tilt during elevation in the sagittal plane, with the exercises + manual therapy group increasing 3.0° (95%CI -1.5, 7.5) relative to baseline compared to a decrease of 0.3° (95%CI -4.2, 4.8) in the exercise only group. Pain, mechanical sensitivity, and the DASH score improved similarly for both groups by the end of the intervention period. Conclusion Adding MT to an exercise protocol did not enhance improvements in scapular kinematics, function, and pain in individuals with SIS. The noted improvements in pain and function are not likely explained by changes in scapular kinematics. Level of Evidence Therapy, Level 1B. J Orthop Sports Phys Ther, Epub 15 Oct 2015. doi:10.2519/jospt.2015.5939.
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To compare scapular posterior tilting exercise alone and scapular posterior tilting exercise after pectoralis minor (PM) stretching on the PM index (PMI), scapular anterior tilting index, scapular upward rotation angle, and scapular upward rotators' activity in subjects with a short PM. Fifteen subjects with a short PM participated in this study. The PMI, scapular anterior tilting index, and scapular upward rotation angle were measured after scapular posterior tilting exercise alone and scapular posterior tilting exercise after PM stretches. Scapular upward rotators' activities were collected during scapular posterior tilting exercise alone and scapular posterior tilting exercise after PM stretches. The PMI and scapular upward rotation angle, as well as the activity of the upper trapezius, lower trapezius, and serratus anterior muscles, were significantly greater for scapular posterior tilting exercise after PM stretching and the scapular anterior tilting index was significantly lower for scapular posterior tilting exercise after PM stretching than the scapular posterior tilting exercise alone. Scapular posterior tilting exercise after PM stretching in subjects with a short PM could be an effective method of modifying scapular alignment and scapular upward rotator activity. Copyright © 2015 Elsevier Ltd. All rights reserved.
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To determine the effects of scapular mobilization on function, pain, range of motion, and satisfaction in patients with subacromial impingement syndrome (SAIS). Randomized, double-blind, placebo-controlled clinical trial. University hospital clinics in Turkey. 66 participants (mean ± SD age 52.06 ± 3.71 y) with SAIS. Participants were randomized into 3 groups: scapular mobilization, sham scapular mobilization, and supervised exercise. Before the interventions transcutaneous electrical stimulation and hot pack were applied to all groups. Total intervention duration for all groups was 3 wk with a total of 9 treatment sessions. Shoulder function and pain intensity were primary outcome measures; range of motion and participant satisfaction were secondary outcome measures. Shoulder function was assessed with the short form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH). A visual analog scale was used to evaluate pain severity. Active range of motion was measured with a universal goniometer. A 7-point Likert scale was used to evaluate satisfaction. Outcome measurements were performed at baseline, before visits 5 and 10, 4 wk after visit 9, and 8 wk after visit 9. There was no group difference for DASH score (P = .75), pain at rest (P = .41), pain with activity (P = .45), pain at night (P = .74), and shoulder flexion (P = .65), external rotation (P = .63), and internal rotation (P = .19). There was a significant increase in shoulder motion and function and a significant decrease in pain across time when all groups were combined (P  .001). The level of satisfaction was not significantly different for any of the questions about participant satisfaction between all groups (P > .05). There was not a significant advantage of scapular mobilization for shoulder function, pain, range of motion, and satisfaction compared with sham or supervised-exercise groups in patients with SAIS.
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Study design: Randomized controlled trial with immediate follow-up. Objectives: To evaluate the immediate effects of a low-amplitude, high-velocity thrust thoracic spine manipulation (TSM) on pain and scapular kinematics during elevation and lowering of the arm in individuals with shoulder impingement syndrome (SIS). The secondary objective was to evaluate the immediate effects of TSM on scapular kinematics during elevation and lowering of the arm in individuals without symptoms. Background: Considering the regional interdependence among the shoulder and the thoracic and cervical spines, TSM may improve pain and function in individuals with SIS. Comparing individuals with SIS to those without shoulder pathology may provide information on the effects of TSM specifically in those with SIS. Methods: Fifty subjects (mean ± SD age, 31.8 ± 10.9 years) with SIS and 47 subjects (age, 25.8 ± 5.0 years) asymptomatic for shoulder dysfunction were randomly assigned to 1 of 2 interventions: TSM or a sham intervention. Scapular kinematics were analyzed during elevation and lowering of the arm in the sagittal plane, and a numeric pain rating scale was used to assess shoulder pain during arm movement at preintervention and postintervention. Results: For those in the SIS group, shoulder pain was reduced immediately after TSM and the sham intervention (mean ± SD preintervention, 2.9 ± 2.5; postintervention, 2.3 ± 2.5; P<.01; moderate effect size [Cohen d = 0.2]). Scapular internal rotation increased 0.5° ± 0.02° (P = .04; small effect size [Cohen d<0.1]) during elevation of the arm after TSM and sham intervention in the SIS group only. Subjects with and without SIS who received TSM and asymptomatic subjects who received the sham intervention had a significant increase (1.6° ± 2.7°) in scapular upward rotation postintervention (P<.05; small effect size [Cohen d<0.2]), which was not considered clinically significant. Scapular anterior tilt increased 1.0° ± 4.8° during elevation and lowering of the arm postmanipulation (P<.05; small effect size [Cohen d<0.2]) in the asymptomatic subjects who received TSM. Conclusion: Shoulder pain in individuals with SIS immediately decreased after a TSM. The observed changes in scapular kinematics following TSM were not considered clinically important. Level of evidence: Therapy, level 4. J Orthop Sports Phys Ther 2014;44(7):475-487. Epub 22 May 2014. doi:10.2519/jospt.2014.4760.
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Measuring the pectoralis minor muscle length (PML) is of clinical interest, as a short PML has been associated with a decrease of scapular posterior tilting and shoulder pain. However, as no reliability data are available at present, the objective of this study was to examine the inter- and intrarater reliability of the PML measurement in both subjects with and without shoulder impingement symptoms (SIS). Therefore, two assessors performed the PML measurement (3 times/shoulder) in 25 patients with SIS and 25 pain-free controls. Both assessors were blinded for each other's findings. For reliability testing, intra-class coefficients (ICCs; model 2,1) and standard errors of measurements were calculated. Intrarater reliability analysis resulted with ICCs ranging from 0.87 (Standard error of measurement (SEM) 0.21-0.27%) (symptomatic) to 0.93 (SEM 0.19-0.30%) (asymptomatic) in patients with SIS, representing excellent test-retest agreement. Healthy subjects presented with ICCs ranging from 0.76 (SEM 0.29-0.32%) (dominant side) to 0.87 (SEM 0.21-0.32%) (non-dominant side), representing good test-retest agreement. ICCs and SEMs on the symptomatic and asymptomatic side (0.48 and 0.46%; 0.56 and 0.61%) in SIS patients, and on the two sides (non-dominant; 0.47 and 0.45%, dominant; 0.53 and 0.38% respectively) in healthy subjects showed moderate interrater reliability and low dispersion of the measurement errors. We concluded that the PML measurement has good to excellent intrarater reliability and poor to moderate interrater reliability.
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Study design: Clinical measurement. Objective: To establish trial-to-trial within-day and between-day reliability, standard error of measurement, and minimal detectable change of scapular orientation during elevation and lowering of the arm, and with the arm relaxed at the side, in individuals with and without shoulder impingement. Background: Electromagnetic devices are commonly used to measure 3-D scapular kinematics during arm elevation in different conditions and for intervention studies. However, there is a lack of studies that evaluate within- and between-day reliability of these measurements. Methods: The subjects were allocated to either a control group or an impingement group. Kinematic data were collected using the Flock of Birds electromagnetic device during elevation and lowering of the arm in the sagittal plane on 2 different occasions, separated by 3 to 5 days. Forty-nine subjects were tested for within-day reliability. Forty-three subjects were reassessed for between-day reliability. Results: Intraclass correlation coefficients for within- and between-day assessment of scapular orientation during elevation and lowering of the arm in both groups ranged from 0.92 to 0.99 and from 0.54 to 0.88, respectively. Intraclass correlation coefficients for assessment of scapular orientation with the arms relaxed at the side in both groups ranged from 0.66 to 0.95. The standard error of measurement for between-day measurements ranged from 3.37° to 7.44° for both groups. The minimal detectable change for between-day measurements increased from 7.81° at the lower to 17.27° at the higher humerothoracic elevation angles. Conclusion: These results support the use of Flock of Birds to measure scapular orientations in subjects with and without impingement symptoms. The measurements showed excellent within-day reliability but were not highly reliable over time.
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Study design: Prospective, single-group observational design. Objectives: To determine the minimal clinically important difference (MCID) for the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure and its shortened version (QuickDASH) in patients with upper-limb musculoskeletal disorders, using a triangulation of distribution- and anchor-based approaches. Background: Meaningful threshold change values of outcome tools are crucial for the clinical decision-making process. Methods: The DASH and QuickDASH were administered to 255 patients (mean ± SD age, 49 ± 15 years; 156 women) before and after a physical therapy program. The external anchor administered after the program was a 7-point global rating of change scale. Results: The test-retest reliability of the DASH and QuickDASH was high (intraclass correlation coefficient model 2,1 = 0.93 and 0.91, respectively; n = 30). The minimum detectable change at the 90% confidence level was 10.81 points for the DASH and 12.85 points for the QuickDASH. After triangulation of these results with those of the mean-change approach and receiver-operating-characteristic-curve analysis, the following MCID values were selected: 10.83 points for the DASH (sensitivity, 82%; specificity, 74%) and 15.91 points for the QuickDASH (sensitivity, 79%; specificity, 75%). After treatment, the MCID threshold was reached/surpassed by 61% of subjects using the DASH and 57% using the QuickDASH. Conclusion: The MCID values from this study for the DASH (10.83 points) and the QuickDASH (15.91 points) could represent the lower boundary for a range of MCID values (reasonably useful for different populations and contextual characteristics). The upper boundary may be represented by the 15 points for the DASH and 20 points for the QuickDASH proposed by the DASH website.
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Background Complaints of arm, neck and shoulder are a major health problem in Western societies and a huge economic burden due to sickness absence and health-care costs. In 2003 the 12-month prevalence’s in the Netherlands were estimated at 31.4% for neck pain, 30.3% for shoulder pain, and 17.5% for wrist and hand pain. Research data suggest that these complaints are increasingly common among university students. The aims of the present study are to provide insight into the prevalence of complaints of arm, neck or shoulder in a university population, to evaluate the clinical course of these complaints and to identify prognostic factors which influence this course. Methods The present study is designed as a prospective cohort study, in which a cross-sectional survey is embedded. A self-administered cross-sectional survey will be conducted to gain insight into the prevalence of complaints of arm, neck or shoulder among university students and staff, and to identify persons who are eligible for follow up in the prognostic cohort study. Patients with a new complaint of pain and discomfort in neck and upper extremities between 18–65 years will be asked to participate in the prognostic cohort study. At baseline, after 6, 12, 26 and 52 weeks individual patient data will be collected by means of digitized self-administered questionnaires. The following putative prognostic determinants will be investigated: socio-demographic factors, work-related factors, complaint characteristics, physical activity and psychosocial factors. The primary outcome is subjective recovery. Secondary outcomes are functional limitations of the arm, neck, shoulder and hand, and complaint severity during the previous week. Discussion To our knowledge, this is the first prognostic study on the course of complaints of arm, neck or shoulder that is conducted within a university population. Moreover, there are hardly any studies that have estimated the prevalence of these complaints among university students. The results of this study can be used for patient education and management decisions, as well as for the development of interventions. Moreover, identification of high risk groups in the population is needed to generate hypotheses or explanations of health differences and for the design of prevention programs.
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The purpose of this clinical trial is to compare the effectiveness of a scapular-focused treatment with a control therapy in patients with shoulder impingement syndrome. Therefore, a randomized clinical trial with a blinded assessor was used in 22 patients with shoulder impingement syndrome. The primary outcome measures included self-reported shoulder disability and pain. Next, patients were evaluated regarding scapular positioning and shoulder muscle strength. The scapular-focused treatment included stretching and scapular motor control training. The control therapy included stretching, muscle friction, and eccentric rotator cuff training. Main outcome measures were the shoulder disability questionnaire, diagnostic tests for shoulder impingement syndrome, clinical tests for scapular positioning, shoulder pain (visual analog scale; VAS), and muscle strength. A large clinically important treatment effect in favor of scapular motor control training was found in self-reported disability (Cohen's d = 0.93, p = 0.025), and a moderate to large clinically important improvement in pain during the Neer test, Hawkins test, and empty can test (Cohen's d 0.76, 1.04, and 0.92, respectively). In addition, the experimental group demonstrated a moderate (Cohen's d = 0.67) improvement in self-experienced pain at rest (VAS), whereas the control group did not change. The effects were maintained at three months follow-up.
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Objective: Evidence for effective management of shoulder impingement is limited. The present study aimed to quantify the clinical, neurophysiological, and biomechanical effects of a scapular motor control retraining for young individuals with shoulder impingement signs. Method: Sixteen adults with shoulder impingement signs (mean age 22 ± 1.6 years) underwent the intervention and 16 healthy participants (24.8 ± 3.1years) provided reference data. Shoulder function and pain were assessed using the Shoulder Pain and Disability Index (SPADI) and other questionnaires. Electromyography (EMG) and 3-dimensional motion analysis was used to record muscle activation and kinematic data during arm elevation to 90° and lowering in 3 planes. Patients were assessed pre and post a 10-week motor control based intervention, utilizing scapular orientation retraining. Results: Pre-intervention, patients reported pain and reduced function compared to the healthy participants (SPADI in patients 20 ± 9.2; healthy 0 ± 0). Post-intervention, the SPADI scores reduced significantly (P < .001) by a mean of 10 points (±4). EMG showed delayed onset and early termination of serratus anterior and lower trapezius muscle activity pre-intervention, which improved significantly post-intervention (P < .05). Pre-intervention, patients exhibited on average 4.6-7.4° less posterior tilt, which was significantly lower in 2 arm elevation planes (P < .05) than healthy participants. Post-intervention, upward rotation and posterior tilt increased significantly (P < .05) during 2 arm movements, approaching the healthy values. Conclusion: A 10-week motor control intervention for shoulder impingement increased function and reduced pain. Recovery mechanisms were indicated by changes in muscle recruitment and scapular kinematics. The efficacy of the intervention requires further examined in a randomized control trial.
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To update our previously published systematic review and meta-analysis by subjecting the literature on shoulder physical examination (ShPE) to careful analysis in order to determine each tests clinical utility. This review is an update of previous work, therefore the terms in the Medline and CINAHL search strategies remained the same with the exception that the search was confined to the dates November, 2006 through to February, 2012. The previous study dates were 1966 - October, 2006. Further, the original search was expanded, without date restrictions, to include two new databases: EMBASE and the Cochrane Library. The Quality Assessment of Diagnostic Accuracy Studies, version 2 (QUADAS 2) tool was used to critique the quality of each new paper. Where appropriate, data from the prior review and this review were combined to perform meta-analysis using the updated hierarchical summary receiver operating characteristic and bivariate models. Since the publication of the 2008 review, 32 additional studies were identified and critiqued. For subacromial impingement, the meta-analysis revealed that the pooled sensitivity and specificity for the Neer test was 72% and 60%, respectively, for the Hawkins-Kennedy test was 79% and 59%, respectively, and for the painful arc was 53% and 76%, respectively. Also from the meta-analysis, regarding superior labral anterior to posterior (SLAP) tears, the test with the best sensitivity (52%) was the relocation test; the test with the best specificity (95%) was Yergason's test; and the test with the best positive likelihood ratio (2.81) was the compression-rotation test. Regarding new (to this series of reviews) ShPE tests, where meta-analysis was not possible because of lack of sufficient studies or heterogeneity between studies, there are some individual tests that warrant further investigation. A highly specific test (specificity >80%, LR+ ≥ 5.0) from a low bias study is the passive distraction test for a SLAP lesion. This test may rule in a SLAP lesion when positive. A sensitive test (sensitivity >80%, LR- ≤ 0.20) of note is the shoulder shrug sign, for stiffness-related disorders (osteoarthritis and adhesive capsulitis) as well as rotator cuff tendinopathy. There are six additional tests with higher sensitivities, specificities, or both but caution is urged since all of these tests have been studied only once and more than one ShPE test (ie, active compression, biceps load II) has been introduced with great diagnostic statistics only to have further research fail to replicate the results of the original authors. The belly-off and modified belly press tests for subscapularis tendinopathy, bony apprehension test for bony instability, olecranon-manubrium percussion test for bony abnormality, passive compression for a SLAP lesion, and the lateral Jobe test for rotator cuff tear give reason for optimism since they demonstrated both high sensitivities and specificities reported in low bias studies. Finally, one additional test was studied in two separate papers. The dynamic labral shear may be sensitive for SLAP lesions but, when modified, be diagnostic of labral tears generally. Based on data from the original 2008 review and this update, the use of any single ShPE test to make a pathognomonic diagnosis cannot be unequivocally recommended. There exist some promising tests but their properties must be confirmed in more than one study. Combinations of ShPE tests provide better accuracy, but marginally so. These findings seem to provide support for stressing a comprehensive clinical examination including history and physical examination. However, there is a great need for large, prospective, well-designed studies that examine the diagnostic accuracy of the many aspects of the clinical examination and what combinations of these aspects are useful in differentially diagnosing pathologies of the shoulder.
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This paper describes the development of an evaluative outcome measure for patients with upper extremity musculoskeletal conditions. The goal is to produce a brief, self-administered measure of symptoms and functional status, with a focus on physical function, to be used by clinicians in daily practice and as a research tool. This is a joint initiative of the American Academy of Orthopedic Surgeons (AAOS), the Council of Musculoskeletal Specialty Societies (COMSS), and the Institute for Work and Health (Toronto, Ontario).Our approach is consistent with previously described strategies for scale development. In Stage 1, Item Generation, a group of methodologists and clinical experts reviewed 13 outcome measurement scales currently in use and generated a list of 821 items. In Stage 2a, Initial Item Reduction, these 821 items were reduced to 78 items using various strategies including removal of items which were generic, repetitive, not reflective of disability, or not relevant to the upper extremity or to one of the targeted concepts of symptoms and functional status. Items not highly endorsed in a survey of content experts were also eliminated. Stage 2b, Further Item Reduction, will be based on results of field testing in which patients complete the 78-item questionnaire. This field testing, which is currently underway in 20 centers in the United States, Canada, and Australia, will generate the final format and content of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Future work includes plants for validity and reliability testing. © 1996 Wiley-Liss, Inc.
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Conservative treatments have been proposed for people with shoulder impingement syndrome (SIS), such as strengthening of the rotator cuff and scapular muscles and stretching of the soft tissues of the shoulder. However, there is a lack of studies analyzing the effectiveness of eccentric training in the treatment of SIS. To evaluate the effects of eccentric training for shoulder abductors on pain, function, and isokinetic performance during concentric and eccentric abduction of the shoulder in subjects with SIS. Twenty subjects (7 females, 34.2 SD 10.2 years, 1.7 SD 0.1 m, 78.0 SD 16.3 kg) with unilateral SIS completed the study protocol. Bilateral isokinetic eccentric training at 60º/s for shoulder abductors was performed for six consecutive weeks, twice a week, on alternate days. For each training day, three sets of 10 repetitions were performed with a 3-minute rest period between the sets for each side. The range of motion trained was 60° (ranging from 80° to 20°). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate functional status and symptoms of the upper limbs. Peak torque, total work and acceleration time were measured during concentric and eccentric abduction of the arm at 60º/s and 180º/s using an isokinetic dynamometer. DASH scores, peak torque, total work and acceleration time improved (p<0.05) after the period of intervention. This study suggests that isokinetic eccentric training for shoulder abductors improves physical function of the upper limbs in subjects with SIS.
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Stretching is a common activity used by athletes, older adults, rehabilitation patients, and anyone participating in a fitness program. While the benefits of stretching are known, controversy remains about the best type of stretching for a particular goal or outcome. The purpose of this clinical commentary is to discuss the current concepts of muscle stretching interventions and summarize the evidence related to stretching as used in both exercise and rehabilitation.
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Case series. Few studies have defined the dosage and specific techniques of manual therapy and exercise for rehabilitation for patients with subacromial impingement syndrome. This case series describes a standardized treatment program for subacromial impingement syndrome and the time course and outcomes over a 12-week period. Ten patients (age range, 19-70 years) with subacromial impingement syndrome defined by inclusion and exclusion criteria were treated with a standardized protocol for 10 visits over 6 to 8 weeks. The protocol included a 3-phase progressive strengthening program, manual stretching, thrust and nonthrust manipulation to the shoulder and spine, patient education, activity modification, and a daily home exercise program of stretching and strengthening. Patients completed a history and measures of impairments and functional disability at 2, 4, 6, and 12 weeks. Treatment success was defined as both a 50% improvement on the Disabilities of the Arm, Shoulder, and Hand (DASH) score and a global rating of change of at least "moderately better." At 6 weeks, 6 of 10 patients had a successful (mean +/- SD) DASH outcome score (initial, 33.9 +/- 16.2; 6 weeks, 8.1 +/- 9.2). At 12 weeks, 8 of 10 patients had a successful DASH outcome score (initial, 33.1 +/- 14; 12 weeks, 8.3 +/- 6.4). As a group, the largest improvement was in the first 2 weeks. The most common impairments for all 10 patients were rotator cuff and trapezius muscle weakness (10 of 10 patients), limited shoulder internal rotation motion (8 of 10 patients), and reduced kyphosis of the midthoracic area (7 of 10 patients). A program aimed at strengthening rotator cuff and scapular muscles, with stretching and manual therapy aimed at thoracic spine and the posterior and inferior soft-tissue structures of the glenohumeral joint appeared to be successful in the majority of patients. This case series describes a comprehensive impairment-based treatment which resulted in symptomatic and functional improvement in 8 of 10 patients in 6 to 12 weeks. Therapy, level 4.
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Descriptive study, cross-sectional design. Tennis requires repetitive overhead movement patterns that can lead to upper extremity injury. The scapula plays a vital role in injury-free playing. Scapular dysfunction has been associated with shoulder injury in the overhead athlete. The purpose of this study was to describe variables regarding scapular position, muscle strength and flexibility in young elite tennis players. Thirty-five adolescent Swedish elite tennis players (19 boys, aged 13.6 (+/-1.4) years, 16 girls, aged 12.6 (+/-1.3) years), selected on the basis of their national ranking, underwent a clinical screening protocol consisting of: scapular upward rotation at several angles of arm elevation; isometric scapular muscle strength; and anthropometric measurement of pectoralis minor (PM) length. The players showed significantly more scapular upward rotation on their dominant side (p<0.001). For both genders, upper trapezius (p=0.003) and serratus anterior (p=0.01) strength was significantly greater on the dominant side, whereas middle and lower trapezius strength showed no side differences. PM was shorter on the dominant side (p<0.001), and in the female players (p=0.006) compared with the boys. These results indicate some sports-related adaptations of young tennis players on their dominant side at the scapulothoracic level to exposure to their sport. These data may assist the clinician in the prevention and rehabilitation of sport-specific injuries in adolescent tennis players.
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OBJECTIVE: The purpose of this manuscript is to review current knowledge of how muscle activation and force production contribute to shoulder kinematics in healthy subjects and persons with shoulder impingement. RESULTS: The middle and lower serratus anterior muscles produce scapular upward rotation, posterior tilting, and external rotation. Upper trapezius produces clavicular elevation and retraction. The middle trapezius is primarily a medial stabilizer of the scapula. The lower trapezius assists in medial stabilization and upward rotation of the scapula. The pectoralis minor is aligned to resist normal rotations of the scapula during arm elevation. The rotator cuff is critical to stabilization and prevention of excess superior translation of the humeral head, as well as production of glenohumeral external rotation during arm elevation. Alterations in activation amplitude or timing have been identified across various investigations of subjects with shoulder impingement as compared to healthy controls. These include decreased activation of the middle or lower serratus anterior and rotator cuff, delayed activation of middle and lower trapezius, and increased activation of the upper trapezius and middle deltoid in impingement subjects. In addition, subjects with a short resting length of the pectoralis minor exhibit altered scapular kinematic patterns similar to those found in persons with shoulder impingement. CONCLUSION: These normal muscle functional capabilities and alterations in patient populations should be considered when planning exercise approaches for the rehabilitation of these patients.
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Stretching is commonly practiced before sports participation; however, effects on subsequent performance and injury prevention are not well understood. There is an abundance of literature demonstrating that a single bout of stretching acutely impairs muscle strength, with a lesser effect on power. The extent to which these effects are apparent when stretching is combined with other aspects of a pre-participation warm-up, such as practice drills and low intensity dynamic exercises, is not known. With respect to the effect of pre-participation stretching on injury prevention a limited number of studies of varying quality have shown mixed results. A general consensus is that stretching in addition to warm-up does not affect the incidence of overuse injuries. There is evidence that pre-participation stretching reduces the incidence of muscle strains but there is clearly a need for further work. Future prospective randomized studies should use stretching interventions that are effective at decreasing passive resistance to stretch and assess effects on subsequent injury incidence in sports with a high prevalence of muscle strains.
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This study evaluated the effectiveness of a rehabilitation program performed during working hours on function and pain in workers with subacromial impingement syndrome. Fourteen male workers (31.93 +/- 5.86 years) in the school supply industry were assessed. The duration of their shoulder pain was 28.50 +/- 33.64 months, and their amount of time in this industry was 9.07 +/- 3.68 years. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire evaluated function of the upper limbs. The Mc Gill Pain Questionnaire quantified the pain by the number of words chosen and the pain rating index (PRI). Subjects completed an 8-week rehabilitation program, twice a week, consisting of cryotherapy, strengthening, and stretching exercises. Subjects' outcome data were collected pre- and post-intervention. The results showed that DASH scores improved (p<0.05) and the number of words chosen and PRI decreased (p<0.05) on the McGill Pain Questionnaire at post-intervention. Results should be interpreted cautiously, considering the lack of a control group in the investigation. In conclusion, it is suggested that an intervention program consisting of cryotherapy, strengthening, and stretching applied during working hours and twice a week may be effective to decrease pain and physical impairment in male workers with subacromial impingement syndrome.
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Myofibrillogenesis in striated muscles is a highly complex process that depends on the coordinated assembly and integration of a large number of contractile, cytoskeletal, and signaling proteins into regular arrays, the sarcomeres. It is also associated with the stereotypical assembly of the sarcoplasmic reticulum and the transverse tubules around each sarcomere. Three giant, muscle-specific proteins, titin (3-4 MDa), nebulin (600-800 kDa), and obscurin (approximately 720-900 kDa), have been proposed to play important roles in the assembly and stabilization of sarcomeres. There is a large amount of data showing that each of these molecules interacts with several to many different protein ligands, regulating their activity and localizing them to particular sites within or surrounding sarcomeres. Consistent with this, mutations in each of these proteins have been linked to skeletal and cardiac myopathies or to muscular dystrophies. The evidence that any of them plays a role as a "molecular template," "molecular blueprint," or "molecular ruler" is less definitive, however. Here we review the structure and function of titin, nebulin, and obscurin, with the literature supporting a role for them as scaffolding molecules and the contradictory evidence regarding their roles as molecular guides in sarcomerogenesis.
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Stretch is commonly prescribed as part of physical rehabilitation in pain management programs, yet little is known about its effectiveness. A randomized controlled trial was conducted to investigate the effects of a 3-week stretch program on muscle extensibility and stretch tolerance in patients with chronic musculoskeletal pain. A within-subject design was used, with one leg of each participant randomly allocated to an experimental (stretch) condition and the other leg randomly allocated to a control (no-stretch) condition. Thirty adults with pain of musculoskeletal origin persisting for at least 3 months were recruited from patients enrolled in a multidisciplinary pain management program at a hospital in Sydney, Australia. The hamstring muscles of the experimental leg were stretched daily for 1 minute over 3 weeks; the control leg was not stretched. This intervention was embedded within a pain management program and supervised by physical therapists. Primary outcomes were muscle extensibility and stretch tolerance, which were reflected by passive hip flexion angles measured with standardized and nonstandardized torques, respectively. Initial measurements were taken before the first stretch on day 1, and final measurements were taken 1 to 2 days after the last stretch. A blinded assessor was used for testing. Stretch did not increase muscle extensibility (mean between-group difference in hip flexion was 1 degrees , 95% confidence interval=-2 degrees to 4 degrees ), but it did improve stretch tolerance (mean between-group difference in hip flexion was 8 degrees , 95% confidence interval=5 degrees to 10 degrees ). Three weeks of stretch increases tolerance to the discomfort associated with stretch but does not change muscle extensibility in patients with chronic musculoskeletal pain.
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Lengthening of the pectoralis minor muscle (PMi) during passive shoulder motions and the effect of stretching techniques for this muscle are unclear. The purposes of this study were: (1) to investigate the amount and pattern of the lengthening between passive shoulder motions and (2) to determine which stretching technique effected the greatest change in PMi length. Nine fresh cadaveric transthoracic specimens were used. Lengthening in the lateral and medial fiber group of the PMi was directly measured during 3 passive shoulder motions (flexion, scaption, and external rotation at 90 degrees of abduction) and 3 stretching techniques (scapular retraction at 0 degrees and 30 degrees of flexion and horizontal abduction) for this muscle. The measurement was conducted by using a precise displacement sensor. Although the length of the PMi linearly increased during all shoulder motions, lengthening during flexion and scaption was steeper and significantly larger than that during external rotation at 90 degrees of abduction. For the stretching techniques, scapular retraction at 30 degrees of flexion and horizontal abduction stretched the PMi more than scapular retraction at 0 degrees of flexion. In comparison with lengthening at 150 degrees of flexion, scapular retraction at 30 degrees of flexion significantly stretched the medial fiber group of the muscle. The extensive lengthening of the PMi is necessary during shoulder motions, especially flexion and scaption. Scapular retraction at 30 degrees of flexion makes the greatest change in PMi length. This study suggests the importance of the PMi in shoulder motion and provides anatomical and biomechanical evidence that might guide appropriate selection of stretching techniques.
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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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There is a growing body of literature associating abnormal scapular positions and motions, and, to a lesser degree, clavicular kinematics with a variety of shoulder pathologies. The purpose of this manuscript is to (1) review the normal kinematics of the scapula and clavicle during arm elevation, (2) review the evidence for abnormal scapular and clavicular kinematics in glenohumeral joint pathologies, (3) review potential biomechanical implications and mechanisms of these kinematic alterations, and (4) relate these biomechanical factors to considerations in the patient management process for these disorders. There is evidence of scapular kinematic alterations associated with shoulder impingement, rotator cuff tendinopathy, rotator cuff tears, glenohumeral instability, adhesive capsulitis, and stiff shoulders. There is also evidence for altered muscle activation in these patient populations, particularly, reduced serratus anterior and increased upper trapezius activation. Scapular kinematic alterations similar to those found in patient populations have been identified in subjects with a short rest length of the pectoralis minor, tight soft-tissue structures in the posterior shoulder region, excessive thoracic kyphosis, or with flexed thoracic postures. This suggests that attention to these factors is warranted in the clinical evaluation and treatment of these patients. The available evidence in clinical trials supports the use of therapeutic exercise in rehabilitating these patients, while further gains in effectiveness should continue to be pursued.
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Background: Conservative treatments have been proposed for people with shoulder impingement syndrome (SIS), such as strengthening of the rotator cuff and scapular muscles and stretching of the soft tissues of the shoulder. However, there is a lack of studies analyzing the effectiveness of eccentric training in the treatment of SIS. Objectives: To evaluate the effects of eccentric training for shoulder abductors on pain, function, and isokinetic performance during concentric and eccentric abduction of the shoulder in subjects with SIS. Methods: Twenty subjects (7 females, 34.2 SD 10.2 years, 1.7 SD 0.1 m, 78.0 SD 16.3 kg) with unilateral SIS completed the study protocol. Bilateral isokinetic eccentric training at 60o/s for shoulder abductors was performed for six consecutive weeks, twice a week, on alternate days. For each training day, three sets of 10 repetitions were performed with a 3-minute rest period between the sets for each side. The range of motion trained was 60° (ranging from 80° to 20°). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate functional status and symptoms of the upper limbs. Peak torque, total work and acceleration time were measured during concentric and eccentric abduction of the arm at 60o/s and 180o/s using an isokinetic dynamometer. Results: DASH scores, peak torque, total work and acceleration time improved (p<0.05) after the period of intervention. Conclusions: This study suggests that isokinetic eccentric training for shoulder abductors improves physical function of the upper limbs in subjects with SIS.
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Study Design: Two-group mixed-model analysis of covariance and correlation analysis. Objectives: To determine whether differences in humeral translations exist between patients with shoulder impingement symptoms and an asymptomatic comparison group, and if so, to determine if shoulder range-of-motion (ROM) measures are associated with abnormal translations. Background: Abnormal translations of the humeral head are believed to reduce the available subacromial space and to contribute to the development or progression of shoulder impingement symptoms. These abnormal translations have also been theorized to be related to tightness of the posterior capsule and decreased shoulder ROM. Methods and Measures: Three-dimensional humeral translations were tracked in symptomatic construction workers and an asymptomatic comparison group while elevating the arm in the scapular plane under no-load, 2.3-kg, and 4.6-kg hand-load conditions. Between-group comparisons were made across 3 phases of motion (30degrees-60degrees, 60degrees-90degrees, and 90degrees-120degrees) and the association between humeral translations and cross-body adduction and shoulder internal rotation ROM measures were determined by Pearson correlation analysis. Results: Persons with shoulder symptoms demonstrated small but significant changes in anterior-posterior translations of the humerus. These changes for the 90degrees-120degrees phase of humeral elevation were moderately negatively associated with available cross-body adduction ROM. Conclusions: The identified kinematic deviations are consistent with possible reductions of the subacromial space. Further study of relationships between posterior capsule tightness, rotator cuff function, and abnormal humeral translations is warranted to better delineate underlying kinematic mechanisms that may contribute to shoulder impingement symptoms and to refine rehabilitation techniques.
Article
Pectoralis minor adaptive shortening in healthy individuals is associated with altered scapular kinematics similar to the alterations demonstrated in individuals with subacromial impingement. This associative relationship suggests that stretching of the pectoralis minor may improve scapular kinematics and assist in the management of shoulder impingement. Several stretches for the pectoralis minor are used clinically, although it is not known which stretch optimally lengthens the muscle. The purpose of this analysis was to compare the mean length change for 3 pectoralis minor stretches. Fifty subjects without shoulder pathology were examined for the change in length of the pectoralis minor during 3 separate stretches by use of an electromagnetic motion-capture system. The stretches analyzed were a unilateral self stretch, a supine manual stretch, and a sitting manual stretch. Each stretch was significantly different from the other two (df, 2/98; F ratio, 39.09; P < .00001), with the unilateral self stretch demonstrating the greatest length change (2.24 cm), followed by the supine manual stretch (1.69 cm) and the sitting manual stretch (0.77 cm). Knowledge of the most effective method of elongating the pectoralis minor muscle may improve clinical decision making when targeting this anterior scapulothoracic muscle as part of intervention for or prevention of shoulder impingement.
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On shoulder examination, asymmetric scapular posture is often associated to abnormalities of the shoulder complex joint. However, shoulder asymmetries may also be related to adaptations to sports practice. The overhead throwing motion is a highly repetitive skilled motion performed at high velocities. Due to overuse of the dominant overhead-throwing shoulder, athletes may develop some kind of overhead throwing shoulder adaptation pattern that possibly includes scapular asymmetry at the resting position. To quantify the asymmetry between dominant and non-dominant resting scapular posture in 3 groups of healthy subjects (volleyball players, team-handball players and a control group). Bilateral 3D scapular kinematics with the arm at rest was measured using a 6 degrees-of-freedom electromagnetic tracking device. In handball athletes, the dominant scapula was more in internal rotation and anteriorly tilted than in volleyball players. Between athletes and non-athletes groups, the dominant scapula was more anteriorly tilted in the athletes. Clinicians should be aware that some degree of scapular asymmetry may be normal in some athletes. It should not be considered automatically as a pathological sign but rather an adaptation to sports practice and extensive use of upper limb.
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Fe3(PO4)2, sarcopside, displays unusual magnetic properties which have been investigated using time-of-flight powder neutron diffraction and magnetic susceptibility measurements. The structure contains chains of three edge-shared FeO6 octahedra with two inequivalent iron sites, the central M(1) site possessing a fairly regular symmetry and smaller volume compared with the two distorted M(2) sites of the terminal octahedra. In the absence of an applied field, the compound orders antiferromagnetically, with the M(2) sites in each chain having opposite spin directions along the [100] direction, leaving the central M(1) cation frustrated with no net spin. Under applied magnetic fields of < 0.7 T, two magnetic phase transitions are observed, a field-induced ferrimagnetic–antiferromagnetic transition at 38(1) K and an antiferromagnetic–paramagnetic transition at 44(1) K. At fields > 0.7 T, only the bicritical transition from ferrimagnetic to paramagnetic is observed at 44(1) K.