Search results for: modified posterior shoulder stretching exercises

Authors: Ozge Tahran, Sevgi Sevi Yesilyaprak

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Objective: The aim of the study was to investigate the effect of the Wilk’s modified two different stretching exercises on posterior shoulder tightness, pain, and dysfunction in patients with subacromial impingement syndrome (SIS). Method: This study was carried out on 67 patients who have more than 15° difference in shoulder internal rotation range of motion between two sides and had been diagnosed as SIS. Before treatment, all patients were randomly assigned into three groups. Standard physiotherapy programme was applied to the Group 3 (n=23), standard physiotherapy program with Wilk’s modified cross-body stretching exercises were applied to Group 1 (n=22), and standard physiotherapy program with Wilk’s modified sleeper stretching exercises were applied to Group 2 (n= 23). All the patients received 20 sessions of physiotherapy during 4 weeks, 5 days in a week by a physiotherapist. The patients continued their exercises at home at the weekends. Pain severity, shoulder rotation range of motion, posterior shoulder tightness, upper extremity functionality with Constant and Murley Score (CMS) and disability level with The Disabilities of the Arm, Shoulder and Hand Score (QuickDASH) were evaluated before and after physiotherapy programme. Results: Before treatment, demographic and anthropometric characteristics were similar in groups and there was no statistical difference (p > 0.05). It was determined that pain severity decreased, shoulder rotation range of motion, posterior shoulder tightness, upper extremity functionality, and disability were improved after physiotherapy in both groups (p < 0.05). Group 1 and 2 had better results in terms of reduction of pain severity during activity, increase in shoulder rotation range of motion, posterior shoulder mobility and upper extremity functionality and improvement in upper extremity disability, compared to Group 3 (p < 0.05). Conclusion: Modified posterior shoulder stretching exercises in addition to standard physiotherapy programme is more effective for reduction of pain during activity, to improve shoulder rotation range of motion, posterior shoulder mobility, and upper extremity functionality in patients with SIS compared to standard physiotherapy programme alone.

Keywords: modified posterior shoulder stretching exercises, posterior shoulder tightness, shoulder complex, subacromial impingement syndrome

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Authors: Mohammed Moustafa, Khaled Ayad, Waleed Reda

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Shoulder impingement syndrome is the most common disorder of the shoulder, resulting in functional loss and disability. Objective: This study was designed to compare between the effects of scapular muscle training versus rhythmic stabilization exercises in treatment of shoulder impingement syndrome. Methods: Thirty patients participated in this study; they were assigned randomly into two experimental groups. The first experimental group (A) consisted of 15 patients with a mean age (21.87±2.72) years; they received graduated rhythmic stabilization exercises and stretching of the posterior capsule. The second experimental group (B) consisted of 15 patients with a mean age (22.27±2.94) years; they received scapular muscle training exercises in addition to stretching of the posterior capsule. Treatment was given three times per week, every other day, for four consecutive weeks. Patients have been evaluated pretreatment and post treatment for shoulder pain severity and functional disability. Results: Both groups showed highly statistical significant reduction in pain severity and functional disability measured post-treatment when compared with their corresponding values in pretreatment assessment. Conclusion: Both of rhythmic stabilization exercises and scapular muscle training are effective interventions to reduce shoulder pain severity and functional disability.

Keywords: impingement syndrome, scapular exercises, rhythmic stabilization exercises, posterior capsule stretch

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Authors: Mohamed M. Mashaly, Ahmed M. F. El Shiwi

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Background: Shoulder impingement syndrome is an encroachment of subacromial tissues, rotator cuff, subacromial bursa, and the long head of the biceps tendon, as a result of narrowing of the subacromial space. Activities requiring repetitive or sustained use of the arms over head often predispose the rotator cuff tendon to injury. Purpose: To compare between Combined effect therapeutic exercises and Shockwave therapy versus therapeutic exercises and phonophoresis in the treatment of shoulder impingement syndrome. Methods: Thirty patients diagnosed as shoulder impingement syndrome stage II Neer classification due to mechanical causes. Patients were randomly distributed into two equal groups. The first group consisted of 15 patients with a mean age of (45.46+8.64) received therapeutic exercises (stretching exercise of posterior shoulder capsule and strengthening exercises of shoulder muscles) and shockwave therapy (6000 shocks, 2000/session, 3 sessions, 2 weeks apart, 0.22mJ/mm^2) years. The second group consisted of 15 patients with a mean age of 46.26 (+ 8.05) received same therapeutic exercises and phonophoresis (3 times per week, each other day, for 4 consecutive weeks). Patients were evaluated pretreatment and post treatment for shoulder pain severity, shoulder functional disability, shoulder flexion, abduction and internal rotation motions. Results: Patients of both groups showed significant improvement in all the measured variables. In between groups difference the shock wave group showed a significant improvement in all measured variables than phonophoresis group. Interpretation/Conclusion: Combined effect of therapeutic exercises and shock wave were more effective than therapeutic exercises and phonophoresis on decreasing shoulder pain severity, shoulder functional disability, increasing in shoulder flexion, abduction, internal rotation in patients with shoulder impingement syndrome.

Keywords: shoulder impingement syndrome, therapeutic exercises, shockwave, phonophoresis

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Authors: A-Reum Shin, Heon-Seock Cynn, Ji-Hyun Lee, Da-Eun Kim

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Round shoulder posture (RSP) is a position of scapular protraction and elevation, which may appear as scapular winging, and humeral internal rotation. Flexed posture (FP) may also affect RSP because FP is characterized by hyperkyphosis, forward head posture, and height reduction. The aim of this study was to investigate the effect of scapular posterior tilting exercise with prone trunk extension on round shoulder posture, activities of lower trapezius and serratus anterior, flexed posture, and thoracic erector spinae activity in subjects with round shoulder posture. Fifteen subjects with round shoulder posture were recruited in this study. Activities of lower trapezius, serratus anterior and thoracic erector spinae were measured during both scapular posterior tilting exercise and scapular posterior tilting exercise with prone trunk extension using electromyography, and round shoulder posture and flexed posture were measured immediately after each exercises using caliper. When the prone trunk extension was applied, the round shoulder posture and flexed posture significantly decreased, activities of lower trapezius and thoracic erector spinae significantly increased (p < 0.05) compared with the scapular posterior tilting exercise alone. There was no significant difference in serratus anterior activity between two exercises. Thus, prone trunk extension could be effective method to improve round shoulder posture during scapular posterior tilting exercise in subjects with round shoulder posture.

Keywords: flexed posture, prone trunk extension, round shoulder posture, scapular posterior tilting

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Authors: Gulsun Guven

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The aim of this study was to examine the acute effects of static stretching exercises on the flexibility and sprint performance in 10-12 years old inactive healthy girls. A total of 27 girls were randomly divided into control group (n=15) and stretching group (n=12) who performed static stretching. Sit and reach flexibility and 30-meter sprint pre-tests were performed for both groups. Static stretching exercises were performed three times, 30 sec. practice and 15 sec. rest for each leg only on five muscle by stretching group. The post-tests were performed in five minutes after static stretching exercise. Paired t-test was used to analyze differentiations among the group parameters. According to research results, there is a significant difference between pre-test and post-test flexibility (p < 0.05) and sprint test results (p < 0.01). As a conclusion of the study, static stretching exercises improve flexibility but decrease sprint performance in 10-12 years old inactive healthy girls.

Keywords: flexibility, inactive girl, sprint, static stretching

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Authors: Sahar Mohammadyari Ghareh Bolagh, Behnaz Seyedi Aghdam, Jalal Shamlou

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This study was done to compare the effects of sports massage and stretching along the cold on pain intensity in elite female volleyball players with trigger points in shoulder girdle region. This study was conducted on 32 female volleyball players with latent trigger points in shoulder girdle region. Patients were randomly assigned to three groups: sports massage (n=11) stretching along the cold (n=11) and control group (n=10). One session treatment program during 15 minutes was performed. Pain intensity with VAS + algometer was assessed before and after intervention and improved in both of massage and cold groups. After treatment there were no significant difference between two treatment groups (P < 0. 050). Results of present research showed sports massage and stretching along the cold were effective on pain intensity of myofascial trigger points.

Keywords: sports massage، stretching along the cold، pain intensity، trigger points, elite, volleyball players, shoulder girdle region

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Authors: Che Hsiu Chen, Kuo Wei Tseng, Zih Jian Huang, Hon Wen Cheng

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A typical warm-up contains both stretching exercises and jogging. The static stretching prior to training or competition may cause detrimental effects to athletic performance. However, it is unclear whether different types of dynamic stretching exercises had different acute effects on knee flexors stiffness, flexibility, and strength. The purpose of this study was to analyze the knee flexors stiffness, flexibility, and strength gains after dynamic straight leg raise (DSLR) and dynamic modified toe-touch (MTT) stretching. Sixteen healthy university active men (height 176.27 ± 4.03 cm; weight 72.27 ± 8.90 kg; age 22.09 ± 2.31 years). After 5 minutes (8km/h) of running subjects performed 2 randomly ordered stretching protocols: DSLR and MTT stretching protocols. There were a total of six, 30 seconds bouts of dynamic stretching (15 repetitions) with 30seconds rest between bouts. The outcome measures were maximal voluntary isokinetic concentric hamstring strength (60°/s), muscle flexibility test by passive straight leg raise (PSLR), active straight leg raise (ASLR), and muscle stiffness using ultrasound Acoustic Radiation Forced Impulse (ARFI) elastography before and immediately after stretching. The muscle stiffness and concentric strength decreased significantly (p < .05), the flexibility no significant change after DSLR protocol (p > .05). The concentric strength decreased significantly (p < .05), the flexibility and muscle stiffness no significant change after MTT protocol (p > .05), whereas no significant differences were found for the DSLR and MTT. Our findings suggest that dynamic stretching (30s x 6 bouts) resulted in change in muscle stiffness or may be induced slack in the musculotendinous unit thereby, reducing force production. Therefore, 30s x 6 bouts of dynamic stretching adversely affects efforts of hamstring muscle maximal concentric strength.

Keywords: sport injury, ultrasound, eccentric exercise, performance

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Authors: Mohamed Salaheldien Mohamed Alayat, Ahmed Mohamed Elsoudany, Roaa Abdulghani Sroge, Bayan Muteb Aldhahwani

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Background: Neck pain is a common illness that could affect individual’s daily activities. Class IV laser with longer wavelength can stimulate tissues and penetrate more than the classic low-level laser therapy. Objectives: The aim of the study was to investigate the efficacy of class IV diode laser in the treatment of patients with chronic neck pain (CNP). Methods: Fifty-two patients participated and completed the study. Their mean age (SD) was 50.7 (6.2). Patients were randomized into two groups and treated with laser plus exercise (laser + EX) group and placebo laser plus exercise (PL+EX) group. Treatment was performed by Class IV laser in two phases; scanning and trigger point phases. Scanning to the posterior neck and shoulder girdle region with 4 J/cm2 with a total energy of 300 J applied to 75 cm2 in 4 minutes and 16 seconds. Eight trigger points on the posterior neck area were treated by 4 J/cm2 and the time of application was in 30 seconds. Both groups received exercise two times per week for 4 weeks. Exercises included range of motion, isometric, stretching, isotonic resisted exercises to the cervical extensors, lateral bending and rotators muscles with postural correction exercises. The measured variables were pain level using visual analogue scale (VAS), and neck functional activity using neck disability index (NDI) score. Measurements were taken at baseline and after 4 weeks of treatment. The level of statistical significance was set as p < 0.05. Results: There were significant decreases in post-treatment VAS and NDI in both groups as compared to baseline values. Laser + EX effectively decreased VAS (mean difference -6.5, p = 0.01) and NDI scores after (mean difference -41.3, p = 0.01) 4 weeks of treatment compared to PL + EX. Conclusion: Class IV laser combined with exercise is effective treatment for patients with CNP as compared to PL + EX therapy. The combination of laser + EX effectively increased functional activity and reduced pain after 4 weeks of treatment.

Keywords: chronic neck pain, class IV laser, exercises, neck disability index, visual analogue scale

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Authors: Lingling Li, Peng Zhao, Runze Guan, Alice Jones, Tao Yu

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Background: Shoulder pain and weakness are associated with complex pathologies and often precludes weightlifters from participation in training. The role and mode of exercise training in weightlifters with shoulder pathology remains unclear. Objectives: This case report described an exercise program in management of an elite weightlifter with primary complaint of right shoulder pain and weakness. Methods: A 22-year-old weightlifter presented with 2-year duration of right shoulder pain and weakness which was worsened by routine weightlifting training, and symptoms were not relieved with steroid injection, manual therapy nor usual physiotherapy. There was a limitation in all active range of motion especially horizontal extension (13ᵒ) and external rotation (41ᵒ) with pain intensity at 4/10 and 10/10 (numeric pain rating score) respectively. Muscle weakness was most significant at supraspinatus and teres minor, 38% and 27% respectively compared to his left shoulder (hand-held dynamometry, Micro FET2). An exercise training program focusing on improving mobility was designed for this athlete following a comprehensive physical assessment. Exercises included specific stretching, muscle activating and scapular stability training; once per day, and for 60 minutes each session. All exercises were completed under instruction as pain allowed. Quantitative assessment was conducted at the end of each week for 3 weeks. Outcomes: After the program, the athlete was pain-free in all movements except the O’Brien active compression internal rotation test, the pain was however reduced from 10/10 to 3/10. The horizontal extension and external rotation range increased to 79ᵒ to 120ᵒ respectively, and strength of all rotator cuff muscles returned to normal. At 1-month follow up, the athlete was totally pain-free and had returned to normal function and weightlifting training activities. The outcomes sustained through 6-month and one year. Conclusion: This case report supports the use of a mobility-focused exercise program for management of shoulder pain and weakness in an elite weightlifter athlete.

Keywords: exercise training, mobility, rehabilitation, shoulder pain, weightlifting

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Authors: Esther Liyanage, Indrajith Liyanage, Masih Khan

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Neck pain has become a common epidemiological problem. One of the reasons for this is a sedentary way of life, connected with using a personal computer during all daily activities. Work place and work duration has not been properly adapted to the personal physical conditions of these employees. During 1990’s the importance of workstation design and work methods, or ergonomics on health was brought to the forefront of public attention. Ergonomics is the application of scientific information concerning humans to the design of objects. Ergonomic intervention results in improvement of working posture and a decrease in prevalence of musculoskeletal symptoms. Stretching and resistance exercises to the neck are easy to do, when performed 1-2 times daily reduce discomfort and ease neck stiffness. This study is aimed at finding if ergonomics with exercises to the neck prove beneficial to reduce neck pain in Computer Professionals. The outcomes measures used were: Oswestry neck disability index and VAS score for pain. 100 subjects satisfying the inclusion criteria were included in the study. Results: Ergonomic intervention along with isometric neck exercises and stretching proved to reduce neck pain and disability among computer professionals.

Keywords: ergonomics, neck pain, neck exercises, physiotherapy for neck pain

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Authors: Sumit Kanwar, Manisha Chand, Gregory Gilot

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Background: Septic arthritis of the shoulder has infrequently been discussed. Focus on infection of the untouched shoulder has not heretofore been described. We present four patients with glenohumeral septic arthritis. Methods: Case 1: A 59 year old male with left shoulder pain in the anterior, posterior and superior aspects. Case 2: A 60 year old male with fever, chills, and generalized muscle aches. Case 3: A 70 year old male with right shoulder pain about the anterior and posterior aspects. Case 4: A 55 year old male with global right shoulder pain, swelling, and limited ROM. Results: In case 1, the left shoulder was affected. Physical examination, swelling was notable, there was global tenderness with a painful range of motion (ROM). The lab values indicated an erythrocyte sedimentation rate (ESR) of 96, and a C-reactive protein (CRP) of 304.30. Imaging studies were performed and MRI indicated a high suspicion for an abscess with osteomyelitis of the humeral head. Our second case’s left arm was affected. He had swelling, global tenderness and painful ROM. His ESR was 38, CRP was 14.9. X-ray showed severe arthritis. Case 3 differed with the right arm being affected. Again, global tenderness and painful ROM was observed. His ESR was 94, and CRP was 10.6. X-ray displayed an eroded glenoid space. Our fourth case’s right shoulder was affected. He had global tenderness and painful, limited ROM. ESR was 108 and CRP was 2.4. X-ray was non-significant. Discussion: Monoarticular septic arthritis of the virgin glenohumeral joint is seldom diagnosed in clinical practice. Common denominators include elevated ESR, painful, limited ROM, and involvement of the dominant arm. The male population is more frequently affected with an average age of 57. Septic arthritis is managed with incision and drainage or needle aspiration of synovial fluid supplemented with 3-6 weeks of intravenous antibiotics. Due to better irrigation and joint visualization, arthroscopy is preferred. Open surgical drainage may be indicated if the above methods fail. Conclusion: If a middle-aged male presents with vague anterior or posterior shoulder pain, elevated inflammatory markers and a low grade fever, an x-ray should be performed. If this displays degenerative joint disease, the complete further workup with advanced imaging, such as an MRI, CT scan, or an ultrasound. If these imaging modalities display anterior space joint effusion with soft tissue involvement, we can suspect septic arthritis of the untouched glenohumeral joint and surgery is indicated.

Keywords: glenohumeral joint, identification, infection, septic arthritis, shoulder

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Authors: Javier A. Maldonado E., Duvert A. Puentes T., Diego F. Villegas B.

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The SLAP lesion (Superior Labral Anterior to Posterior) involves the labrum, causing pain and mobility problems in the glenohumeral joint. This injury is common in athletes practicing sports that requires throwing or those who receive traumatic impacts on the shoulder area. This paper determines the biomechanical behavior of soft tissues of the glenohumeral joint when type II SLAP lesion is present. This pathology is characterized for a tear in the superior labrum which is simulated in a 3D model of the shoulder joint. A 3D model of the glenohumeral joint was obtained using the free software Slice. Then, a Finite Element analysis was done using a general purpose software which simulates a compression test with external rotation. First, a validation was done assuming a healthy joint shoulder with a previous study. Once the initial model was validated, a lesion of the labrum built using a CAD software and the same test was done again. The results obtained were stress and strain distribution of the synovial capsule and the injured labrum. ANOVA was done for the healthy and injured glenohumeral joint finding significant differences between them. This study will help orthopedic surgeons to know the biomechanics involving this type of lesion and also the other surrounding structures affected by loading the injured joint.

Keywords: biomechanics, computational model, finite elements, glenohumeral joint, superior labral anterior to posterior lesion

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Authors: Babak Mirzashahi, Arvin Najafi, Pejman Mansouri, Mahmoud Farzan

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Background: The most effective treatment of posterior cruciate ligament (PCL) tears and the consequence of untreated PCL injuries remain controversial. Objectives: The aim of this study is to assess outcomes of fixation of tibial posterior cruciate ligament (PCL) avulsion fractures via a modified technique. Patients and Methods: From January, 2009 to March, 2012, there were 45 cases of PCL tibial avulsion fractures that were referred to our hospital and were managed through a modified open posterior approach. Fixation of Tibial PCL avulsion fractures were fixed by means of a lag screw and washer placed through our modified open posterior approach. Range of motion was begun on the first postoperative day. Clinical stability, range of motion, gastrocnemius muscle strength, radiographic investigation, and patient’s overall quality of life was analyzed at final follow up visit. Results: The average of overall musculoskeletal functional evaluation scores was 15 (range 3–35). All patients achieved union of their fracture and had clinically stable knees at the latest follow-up. The mean preoperative Lysholm score for 15 knees was 62 ± 8 (range, 50-75); the mean postoperative Lysholm score was 92± 7 (range, 75-101). A significant difference in Lysholm scores between preoperative and final follow-up evaluations was found (P < .05). At first-year follow-up, 42 (93%) patients revealed a difference of less than 10 mm in thigh circumference between their injured and healthy knees. Conclusions: The management of displaced large PCL avulsion fractures with placement of a cancellous lag screw with washer by means of the modified open posterior approach leads to satisfactory clinical, radiographic, and functional results and reduces the operation time and less blood loss. Level of evidence: IV.

Keywords: posterior cruciate ligament, tibial fracture, lysholm knee score, patient outcome assessment

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Authors: Andrej Kocjan

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Introduction: Mobility has been shown to play an important role of health and quality of life among older adults. Falls, which are often related to decreased mobility, as well as to neuromuscular deficits, represent the most common injury among older adults. Fall risk has been shown to increase with reduced lower extremity flexibility. The aim of the paper is to assess the importance of flexibility training on joint range of motion and functional performance among elderly population. Methods: We performed literature research on PubMed and evaluated articles published until 2000. The articles found in the search strategy were also added. The population of interest included older adults (≥ 65 years of age). Results: Flexibility training programs still represent an important part of several rehabilitation programs. Static stretching and proprioceptive neuromuscular facilitation are the most frequently used techniques to improve the length of the muscle-tendon complex. Although the effectiveness of type of stretching seems to be related to age and gender, static stretching is a more appropriate technique to enhance shoulder, hip, and ankle range of motion in older adults. Stretching should be performed in multiple sets with holds of more than 60 seconds for a single muscle group. Conclusion: The literature suggests that flexibility training is an effective method to increase joint range of motion in older adults. In the light of increased functional outcome, activities such as strengthening, balance, and aerobic exercises should be incorporated into a training program for older people. Due to relatively little published literature, it is still not possible to prescribe detailed recommendations regarding flexibility training for older adults.

Keywords: elderly, exercise, flexibility, falls

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Authors: Isabella Schwartz, Ori Safran, Naama Karniel, Michal Abel, Adina Berko, Martin Seyres, Tamir Tsoar, Sigal Portnoy

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Virtual Reality allows to manipulate the patient’s perception, thereby providing a motivational addition to real-time biofeedback exercises. We aimed to test the effect of manipulated virtual kinematic intervention on measures of active and passive Range of Motion (ROM), pain, and disability level in individuals with traumatic stiff shoulder. In a double-blinded study, patients with stiff shoulder following proximal humerus fracture and non-operative treatment were randomly divided into a non-manipulated feedback group (NM-group; N=6) and a manipulated feedback group (M-group; N=7). The shoulder ROM, pain, and the Disabilities of the Arm, Shoulder and Hand (DASH) scores were tested at baseline and after the 6 sessions, during which the subjects performed shoulder flexion and abduction in front of a graphic visualization of the shoulder angle. The biofeedback provided to the NM-group was the actual shoulder angle and the feedback provided to the M-group was manipulated so that 10° were constantly subtracted from the actual angle detected by the motion capture system. The M-group showed greater improvement in the active flexion ROM, with median and interquartile range of 197.1 (140.5-425.0) compared to 142.5 (139.1-151.3) for the NM-group (p=.046). Also, the M-group showed greater improvement in the DASH scores, with median and interquartile range of 67.7 (52.8-86.2) compared to 89.7 (83.8-98.3) for the NM-group (p=.022). Manipulated intervention is beneficial in individuals with traumatic stiff shoulder and should be further tested for other populations with orthopedic injuries.

Keywords: virtual reality, biofeedback, shoulder pain, range of motion

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Authors: Saif Al-Qaisi, Alif Saba

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Normalization of electromyography (EMG) data in ergonomics research is a prerequisite for interpreting the data. Normalizing accounts for variability in the data due to differences in participants’ physical characteristics, electrode placement protocols, time of day, and other nuisance factors. Typically, normalized data is reported as a percentage of the muscle’s isometric maximum voluntary contraction (%MVC). Various MVC techniques have been recommended in the literature for normalizing EMG activity of back muscles. This research tests and compares the recommended MVC techniques in the literature for three back muscles commonly used in ergonomics research, which are the lumbar erector spinae (LES), latissimus dorsi (LD), and thoracic erector spinae (TES). Six healthy males from a university population participated in this research. Five different MVC exercises were compared for each muscle using the Tringo wireless EMG system (Delsys Inc.). Since the LES and TES share similar functions in controlling trunk movements, their MVC exercises were the same, which included trunk extension at -60°, trunk extension at 0°, trunk extension while standing, hip extension, and the arch test. The MVC exercises identified in the literature for the LD were chest-supported shoulder extension, prone shoulder extension, lat-pull down, internal shoulder rotation, and abducted shoulder flexion. The maximum EMG signal was recorded during each MVC trial, and then the averages were computed across participants. A one-way analysis of variance (ANOVA) was utilized to determine the effect of MVC technique on muscle activity. Post-hoc analyses were performed using the Tukey test. The MVC technique effect was statistically significant for each of the muscles (p < 0.05); however, a larger sample of participants was needed to detect significant differences in the Tukey tests. The arch test was associated with the highest EMG average at the LES, and also it resulted in the maximum EMG activity more often than the other techniques (three out of six participants). For the TES, trunk extension at 0° was associated with the largest EMG average, and it resulted in the maximum EMG activity the most often (three out of six participants). For the LD, participants obtained their maximum EMG either from chest-supported shoulder extension (three out of six participants) or prone shoulder extension (three out of six participants). Chest-supported shoulder extension, however, had a larger average than prone shoulder extension (0.263 and 0.240, respectively). Although all the aforementioned techniques were superior in their averages, they did not always result in the maximum EMG activity. If an accurate estimate of the true MVC is desired, more than one technique may have to be performed. This research provides additional MVC techniques for each muscle that may elicit the maximum EMG activity.

Keywords: electromyography, maximum voluntary contraction, normalization, physical ergonomics

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Authors: Yi Tse Wang, Che Hsiu Chen, Zih Jian Huang, Hon Wen Cheng

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Stretching treatments enhanced flexibility. On the other hand, decreases in hamstrings strength have been reported after stretching, especially with static stretching or passive stretching. Stretching has been shown to be more effective than static stretching to improve muscle performance, but a clear consensus for the effect of dynamic stretching on muscle performance has not been achieved. The purpose of this study was to compare the acute effect of a dynamic stretching, static stretching and eccentric exercise protocol on hamstrings stiffness, flexibility and muscle strength. Forty-five healthy active men (height 179.9 cm; weight 71.5 kg; age 22.5 years) were participated in 3 randomly ordered testing sessions: dynamic stretching (DS), active static stretching (ASS), and passive static stretching (PSS). All the stretch were performed 30 seconds and repeated 6 times. There was a 30-second interval between repetitions. The outcome measures were isokinetic concentric contraction (60°/s), eccentric contraction (30°/s) peak torque, muscle flexibility after stretching. The results showed that the muscle flexibility (3.6%, 3.9% and 1.59%, respectively) increased significantly after DS, PSS and ASS. Hamstring isokinetic concentric peak torque (-6.4%, -8.0% and -5.8%, respectively) and eccentric peak torque (-5.8%, -4.5% and -5.4%, respectively) decreased significantly after DS, PSS and ASS. Hence, although the stretching protocols improve hamstrings flexibility immediately, reduced hamstring muscle eccentric and concentric peak torque.

Keywords: hamstrings injury, warm-up, muscle performance, muscle stretching

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Authors: Orawan Vichiansan, J. Kraipoj, K.Phandech, P. Sirasaporn

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Generally, frozen shoulder will improve over time, although it may take a long time up to year. The symptoms of frozen shoulder present by pain around shoulder and consequently limit range of motions. The effect of frozen shoulder leads to limit activities daily living life and high medical care cost. Physiotherapy is well known treatment for frozen shoulder but there was no data about the treatment of physiotherapy in frozen shoulder and length of follow up. Thus the aim of this study was to investigate physiotherapy program for frozen shoulder on range of motion and length of follow up. A retrospective study design was conducted. 469 medical records of patients with frozen shoulder were reviewed. These frozen shoulders were treated at physiotherapy unit, department of Rehabilitation last 3 years (January, 2014- December, 2016). The data consist of range of motions and length of follow up was recorded. The medical record of 183 males and 286 females with average aged 57.82±12.32 years were reviewed in this study. There was a statistically significant increase in shoulder flexion [mean difference 30.24 with 95%CI were [24.37-36.12], shoulder abduction [mean difference 34.93 with 95%CI were 27.8-42.0], shoulder internal rotation [mean difference 17.25 with 95%CI were 12.55-21.95] and shoulder external rotation [mean difference 17.71 with 95%CI were [13.07-22.36] respectively. In addition, the length of follow up averaged 84 days. In summary, the retrospective study show physiotherapy program likely to be benefit for patients with frozen shoulder in term of range of motion and short length of follow up.

Keywords: frozen shoulder, physiotherapy, range of motions, length of follow up

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Authors: Didem Venus Yildiz, Murat Hocaoglu, Murat Dursun, Taner Akkan

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The shoulder joint is a more complex structure than the hip or knee joints. In addition to the overall complexity of the shoulder joint, two different factors influence the insufficient outcome of shoulder replacement: the shoulder prosthesis design is far from fully developed and it is difficult to place these shoulder prosthesis due to shoulder anatomy. The glenohumeral joint is the most complex joint of the human shoulder. There are various treatments for shoulder failures such as total shoulder arthroplasty, reverse total shoulder arthroplasty. Due to its reverse design than normal shoulder anatomy, reverse total shoulder arthroplasty has different physiological and biomechanical properties. Post-operative achievement of this arthroplasty is depend on improved design of reverse total shoulder prosthesis. Designation achievement can be increased by several biomechanical and computational analysis. In this study, data of human both shoulders with right side fracture was collected by 3D Computer Tomography (CT) machine in dicom format. This data transferred to 3D medical image processing software (Mimics Materilise, Leuven, Belgium) to reconstruct patient’s left and right shoulders’ bones geometry. Provided 3D geometry model of the fractured shoulder was used to constitute of reverse total shoulder prosthesis by 3-matic software. Finite element (FE) analysis was conducted for comparison of intact shoulder and prosthetic shoulder in terms of stress distribution and displacements. Body weight physiological reaction force of 800 N loads was applied. Resultant values of FE analysis was compared for both shoulders. The analysis of the performance of the reverse shoulder prosthesis could enhance the knowledge of the prosthetic design.

Keywords: reverse shoulder prosthesis, biomechanics, finite element analysis, 3D printing

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Authors: Elnaz Sabzehparvar, Pouya Rabiei, Houman Rezaei

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Few studies have been conducted about the effects of compound exercises emphasizing local stability and global stabilization subsystems on the performance of athletes. The present research aimed to study the effect of 6 weeks of compound exercises emphasizing local and global stability on the dynamic balance of elite male Taekwondo athletes. Twenty-seven elite male Taekwondo athletes (with a mean age, mass, and height of 24.4 ± 4.9 years, 75.7 ± 15.1kg, and 181.4 ± 7.8 cm, respectively) were assigned to two groups of control (n=12) and exercise (n=15). 6 weeks of compound exercises in 2 local and global phases. The first phase included activation exercises which were done separately and locally for 3 weeks. Then, integrative exercises specific to the global stabilization subsystems (longitudinal-depth, posterior oblique and anterior, and lateral) was carried out for next 3 weeks. The dynamic balance of subjects was measured in the pre-test and post-test using the Y Balance Test (YBT). After 6 weeks of compound exercises, scores of the YBT in the exercise group showed a significant improvement in all three anterior (p=0.035), posterolateral (p=0.017) and medial (p=0.001) directions in the post-test compared to the control group (p ≤ 0.05 for all comparisons). The findings of the present study suggested that compound exercises focusing on muscle as separate units and then as interdependent chains (muscular subsystems) can significantly increase YBT on elite male Taekwondo athletes in all three directions.

Keywords: Taekwondo, compound exercises, local and global stability, muscular subsystems

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Authors: Karima Abdel Aty Hassan Mohamed, Manal Mohamed Ismail, Mona Hassan Gamal Eldein, Ahmed Hassan Hussein, Abdel Aziz Mohamed Elsingerg

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Background: Patellofemoral pain (PFP) is a common musculoskeletal pain condition, especially in females. Decreased hip muscle strength has been implicated as a contributing factor, yet the relationships between pain, hip muscle strength and function are not known. Objective: The purpose of this study is to investigate the effects of strengthening hip abductors and lateral rotators on pain intensity, function and hip abductor and hip lateral rotator eccentric and concentric torques in patients with PFPS. Methods: Thirty patients had participated in this study; they were assigned into two experimental groups. With age ranged for eighty to thirty five years. Group A consisted of 15 patients (11females and 4 males) with mean age 20.8 (±2.73) years, received closed kinetic chain exercises program, stretching exercises for tight lower extremity soft tissues, and hip strengthening exercises .Group B consisted of 15 patients (12 females and 3 males) with mean age 21.2(±3.27) years, received closed kinetic chain exercises program and stretching exercises for tight lower extremity soft tissues. Treatment was given 2-3times/week, for 6 weeks. Patients were evaluated pre and post treatment for their pain severity, function of knee joint, hip abductors and external rotators concentric/eccentric peak torque. Result: the results revealed that there were significant differences in pain and function between both groups, while there was improvement for all values for both group. Conclusion: Six weeks rehabilitation program focusing on knee strengthening exercises either supplemented by hip strengthening exercises or not effective in improving function, reducing pain and improving hip muscles torque in patients with PFPS. However, adding hip abduction and lateral rotation strengthening exercises seem to reduce pain and improve function more efficiently.

Keywords: patellofemoral pain syndrome, hip muscles, rehabilitation, isokinetic

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Authors: Kasra Afsahi, Maryam Soheilifar, S. Hossein Hosseini

Abstract:

Background: There is growing evidence that Cerebral Vascular Accident (CVA) can be a consequence of Covid-19 infection. Understanding novel treatment approaches are important in optimizing patient outcomes. Case: This case explores the use of Virtual Reality (VR) in the treatment of a 23-year-old COVID-positive female presenting with left hemiparesis in August 2020. Imaging showed right globus pallidus, thalamus, and internal capsule ischemic stroke. Conventional rehabilitation was started two weeks later, with virtual reality (VR) included. This game-based virtual reality (VR) technology developed for stroke patients was based on upper extremity exercises and functions for stroke. Physical examination showed left hemiparesis with muscle strength 3/5 in the upper extremity and 4/5 in the lower extremity. The range of motion of the shoulder was 90-100 degrees. The speech exam showed a mild decrease in fluency. Mild lower lip dynamic asymmetry was seen. Babinski was positive on the left. Gait speed was decreased (75 steps per minute). Intervention: Our game-based VR system was developed based on upper extremity physiotherapy exercises for post-stroke patients to increase the active, voluntary movement of the upper extremity joints and improve the function. The conventional program was initiated with active exercises, shoulder sanding for joint ROMs, walking shoulder, shoulder wheel, and combination movements of the shoulder, elbow, and wrist joints, alternative flexion-extension, pronation-supination movements, Pegboard and Purdo pegboard exercises. Also, fine movements included smart gloves, biofeedback, finger ladder, and writing. The difficulty of the game increased at each stage of the practice with progress in patient performances. Outcome: After 6 weeks of treatment, gait and speech were normal and upper extremity strength was improved to near normal status. No adverse effects were noted. Conclusion: This case suggests that VR is a useful tool in the treatment of a patient with covid-19 related CVA. The safety of newly developed instruments for such cases provides new approaches to improve the therapeutic outcomes and prognosis as well as increased satisfaction rate among patients.

Keywords: covid-19, stroke, virtual reality, rehabilitation

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Authors: Seema Saini, Nidhi Chandra, Tushar Palekar

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Objective: To determine the effect of Passive pectoralis minor muscle stretching on scapular kinematics in individuals with scapular dyskinesia. Design: A randomized controlled study was conducted in Pune. The sample size was 30 subjects, which were randomly allocated to either Group A, the experimental group in which passive pectoralis minor stretch was given, or Group B, the control group, in which conventional exercises were given for 3 days a week over 4 weeks. Pre and Post treatment readings of the outcome measures, pectoralis minor length, scapular upward rotation, and lateral scapular slide test were recorded. Results: The results obtained prove a significant difference between pre and post mean values of pectoralis minor length in group A (pre 21.91, post 22.87) and in group B (pre 23.55 post 23.99); scapular upward rotation in group A (pre 49.95, post 50.61) and group B (pre 52.64, post 53.51); lateral scapular slide test at 0° abduction in group A (pre 6.613, post 6.14) and group B (pre 6.84, post 6.22); lateral scapular slide test at 45° abduction in group A (pre 7.14 and post 7.12) and group B (pre 8.18, post 7.53). With an inter-group analysis, it was found that mean of pectoralis minor length, scapular upward rotation, and LSST at 0° abduction in group A was significant than group B (p<0.05). Conclusion: Passive pectoralis minor stretching along with conventional strengthening exercises was shown to be more effective in improving scapular kinematics among patients with scapular dyskinesia.

Keywords: scapulohumeral rhythm, scapular upward rotation, rounded shoulders, scapular strengthening

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Authors: M. J. Pourvaghar, Sh. Khoshemehry

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Adopting inappropriate body posture during addiction can cause muscular and skeletal deformities. This study is aimed at investigating the effects of a program of the selected corrective exercises on the kyphosis of addicted male patients. Materials and methods: This was a quasi-experimental study. This study has been carried out using the semi-experimental method. The subjects of the present study included 104 addicted men between 25 to 45 years of age. In 2014, these men were referred to one of the NA (Narcotic Anonymous) centres in Kashan in 2015. A total of 24 people suffering from drug withdrawal, who had abnormal kyphosis, were purposefully selected as a sample. The sample was randomly divided into two groups, experimental and control; each group consisted of 12 people. The experimental group participated in a training program for 12 weeks consisting of three 60 minute sessions per week. That includes strengthening, stretching and PNF exercises (deep stretching of the muscle). The control group did no exercise or corrective activity. The Kolmogorov-Smirnov test was used to assess normal distribution of data; and a paired t-test and covariance analysis test were used to assess the effectiveness of the exercises, with a significance level of P≤0.05 by using SPSS18. The results showed that three months of the selected corrective exercises had a significant effect (P≤ 0.005) on the correction of the kyphosis of the addicted male patients after three months of rehabilitation (drug withdrawal) in the experimental group, while there was no significant difference recorded in the control group (P≥0.05). The results show that exercise and corrective activities can be used as non-invasive and non-pharmacological methods to rehabilitate kyphosis abnormalities after drug withdrawal and treatment for addiction.

Keywords: kyphosis, exercise-rehabilitation, addict, addiction

Procedia PDF Downloads 252

Authors: Narupon Kunbootsri, P. Sirasaporn

Abstract:

Frozen shoulder is a common problem present by pain and limit range of motion. The prevalence of frozen shoulder showed 18-31% of population. The effect of frozen shoulder lead to limit activities daily living life, high medical care cost and so on. Physiotherapy is one of the treatments for frozen shoulder but there was no data about the treatment of physiotherapy. Moreover, it is question about onset of symptom relate to physiotherapy program and obtaining physical modalities and delayed start physiotherapy program lead to delayed improvement. Thus the aim of this study was to investigate physiotherapy program for frozen shoulder relate to onset of symptom, range of motion and obtaining physical modalities. A retrospective study design was conducted. 182 medical records of patients with frozen shoulder were reviewed. These frozen shoulders were treated at physiotherapy unit, department of Rehabilitation last 3 years (January, 2014- December, 2016). The data consist of onset of symptom, range of motion and obtaining physical modalities were recorded. There was a statistically significant increase in shoulder flexion [mean difference 38.88 with 95%CI were [16.00-61.77], shoulder abduction [mean difference 48.47 with 95%CI were 16.07-90.59], shoulder internal rotation [mean difference 22.36 with 95%CI were 2.81-37.18] and shoulder external rotation [mean difference 32.12 with 95%CI were [(-2.47)-(46.91)]. In addition, the onset of symptom was 76.42±46.90 days. And the physical modalities used frequently were hot pack 14.8% and ultrasound diathermy 13.7%. In conclusion, the physiotherapy program including, hot pack and ultrasound diathermy seem to be useful for frozen shoulder. But onset of symptom is too long to start physiotherapy programs.

Keywords: frozen shoulder, range of motions, onset of symptom, physiotherapy, physical modality

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Authors: Tarek Aly

Abstract:

The shoulder is the most mobile joint whose stability requires the interaction of both dynamic and static stabilizers. Its wide range of movement predisposes to a high susceptibility to dislocation, accounting for nearly 50% of all dislocations. This trauma typically results in ligament injury (e.g., labral tear, capsular strain) or bony fracture (e.g., loss of glenoid or humeral head bone), which frequently causes recurrent instability. Patients with significant glenoid defects may require Latarjet procedure, which involves transferring the coracoid to the antero-inferior glenoid rim. In spite of outstanding results, 15 to 30% of cases suffer complications. In this article, we discuss the diagnosis of recurrent shoulder instability, the surgical technique and various complications of Latarjet procedure.

Keywords: recurrent, anterior gleno-humeral instability, latarjet, unstable shoulder

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Authors: Levan Nadareishvili, Roland Bakuradze, Barbara Kilosanidze, Nona Topuridze, Liana Sharashidze, Ineza Pavlenishvili

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Some regularities of formation of a new structural state of the thermoplastic polymers-gradually oriented (stretched) state (GOS) are discussed. Transition into GOS is realized by the graded oriented stretching-by action of inhomogeneous mechanical field on the isotropic linear polymers or by zonal stretching that is implemented on a standard tensile-testing machine with using a specially designed zone stretching device (ZSD). Both technical approaches (especially zonal stretching method) allows to manage the such quantitative parameters of gradually oriented polymers as a range of change in relative elongation/orientation degree, length of this change and profile (linear, hyperbolic, parabolic, logarithmic, etc.). Uniaxial graded stretching method should be considered as an effective technological solution to create polymer materials with a predetermined gradient of physical properties.

Keywords: controlled graded stretching, gradually oriented state, linear polymers, zone stretching device

Procedia PDF Downloads 394

Authors: S. Abbasi, M. R. Hadian, M. Abdolvahab, M. Jalili, S. H. Jalaei

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Background: Rehabilitation treatments have significant role in reducing the disabilities of Cerebro Vascular Accident (CVA). Due to great role of upper limb in the function of individuals particularly in Activity of Daily Living and the effect of stability of shoulder girdle on hand function, the aim of this study was to study the effects of Progressive Resistive Exercise on shoulder extensor and abductor muscles isometric strengths in adult hemiplegic. Methods: 17 adult hemiplegics patients (50-70 yrs., mean 60/52, SD7/22); with RT side dominancy and 6 months after stroke, participated in this study. All procedures were approved by ethical committee of TUMS and written consents were also taken. Patients were familiarized with the procedure and shoulder extensor and abductor muscles isometric strengths were measured by dynamometer. Results: according to result to our study, shoulder extensor and abductor muscles isometric strengths showed Significant differences between mean scores of pre and post intervention (P<0/05). Progressive Resistive Exercise improved 34% shoulder extensor muscles isometric strength and 27% shoulder abductor muscle isometric strength. Conclusion: Results of our research showed that progressive resistive exercise approach is a useful method for increasing the isometric strength of shoulder extensor and abductor muscles. Therefore, it might be concluded that improvement of strength of shoulder muscles could result in stability in shoulder girdle and consequently might effect on hand function in hemiplegic patients.

Keywords: shoulder extensor muscles isometric strength, shoulder abductor muscles isometric strength, hemiplegic, physical therapy

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Authors: Shuyi Wu, Chuang Li, Quanshui Zheng, Luping Xu

Abstract:

Stretching and snipping DNA molecule by microfluidic has important application value in gene analysis by lab on a chip. Movement, deformation and fragmenting of DNA in microfluidic are typical fluid-solid coupling problems. An efficient and common simulation system for researching the movement, deformation and fragmenting of DNA by microfluidic has not been well developed. In our study, Brownian dynamics-finite element method (BD-FEM) is used to simulate the dynamic process of stretching and fragmenting DNA by contraction flow. The shape and parameters of micro-channels are changed to optimize the stretching and fragmenting properties of DNA. Our results indicate that strain rate, resulting from contraction microchannel, is the main control parameter for stretching and fragmenting DNA. There is good consistency between the simulation data and previous experimental result about the single DNA molecule behavior and averaged fragmenting properties in this study. BD-FEM method is an efficient calculating tool to research stretching and fragmenting behavior of single DNA molecule and optimize microfluidic devices for manipulating, stretching and fragmenting DNA.

Keywords: fragmenting, DNA, microfluidic, optimize.

Procedia PDF Downloads 292

Authors: Amany Mohamed, Alaa Balbaa, Magdoline Mishel

Abstract:

Background: Pain in the neck or scapular region is one of the most frequent symptoms in cervical radiculopathy, which is commonly caused by degenerative process in the spine. Purpose: To determine the effect of scapular stabilization exercises in the treatment of chronic neck pain regarding pain and disability and limitation in the range of motion. Patients and Methods: Thirty male and female patients with chronic neck pain were involved. Aged between 30-50 years old. They were randomly assigned into two groups. In group (A), patients received physical therapy program in the form of infrared, transcutaneous electrical nerve stimulation (TENS), Stretching and cervical stabilization exercises. In group (B), patients received scapular stabilization exercises in addition to the same physical therapy program. Treatment was given 3 times a week for 4 weeks. Range of motion of the cervical spine, range of motion of the scapula, neck pain and disability were assessed before and after treatment. Results: There was significant improvement in both groups (A and B) in cervical range of motion, pain and disability. Group (B) showed more significant improvement than group (A) in cervical range of motion and pain and disability. There was no significant improvement in both groups in scapular range of motion. Conclusion: Scapular stabilization exercises should be used as an integral part in the rehabilitation program

Keywords: Neck pain, neck stabilization exercise, scapular stabilization exercise, chronic neck pain

Procedia PDF Downloads 264