Background: Cervical dysfunction is a common pathomechanical marker in individuals with forward head posture (FHP). To overcome the limitations of the isometric chin-tuck (ICT) exercise, dynamic neuromuscular stabilization (DNS), which emphasizes an entire spinal chain exercise, has recently shown promising clinical results.
Objects: Purpose of this study was to compare the immediate effects between ICT and DNS techniques.
Methods: 43 young subjects (mean age, 24.0±5.0 years) were recruited. Group of subjects with FHP were measured under baseline, ICT, and DNS conditions. Outcome measures included sitting height, longus colli (LC) and sternocleidomastoid (SCM) muscle thickness and LC/SCM thickness ratio. One-way repeated measures ANOVA was used to compare the continuous dependent variables among FHP, ICT, and DNS conditions at p<.016.
Results: Both ICT and DNS exercise conditions yielded significantly increased LC muscle thickness,
LC/SCM thickness ratio and sitting height than did FHP condition (p<.0001, respectively). Sitting height was significantly greater in DNS exercise than in the ICT exercise (p<.0001).
Conclusion: The present results demonstrated that sitting height was greater in the DNS exercise than in the ICT exercise, as well as both corrective postural training exercises were effective on LC/SCM muscle balance ratio when compared with the baseline FHP condition. Therefore, it is considered that DNS exercise can be the recommended exercise for people with FHP.
Background: In patients with lumbar spinal stenosis (LSS), lumbar flexion exercise (LFE) is considered a standard therapeutic exercise that widens the space between the spinal canal and intervertebral foramen. However, some researchers have reported that lumbar extension exercise (LEE) may improve lumbar pain and functional ability in patients with LSS. Although exercise intervention methods for patients with LSS have been widely applied in clinical settings, few studies have conducted comparative analysis of these exercise methods.
Objects: This study aimed to compare the effects of LFE, LEE, and lumbar flexion combined with lumbar flexion-extension exercise (LFEE) on pain, range of motion (ROM), pelvic tilt angle, and functional gait ability in patients with LSS.
Methods: A total of 30 patients with LSS, LFE (n1=10), LEE (n2=10), and LFEE (n3=10) were assigned to each of the three exercise groups. The numerical pain rating scale (NPRS), modified-modified schober test (MMST)-flexion, MMST-extension, pelvic tilt inclinometer, and 6-minute walking test (6MWT) were measured.
Results: After the intervention, statistically significant differences were observed in the NPRS (p=.043), MMST-flexion (p<.001), MMST-extension (p<.001), and 6MWT (p=.005) between groups. According to the post hoc test, the NPRS was statistically significant difference between the LFEE and LEE groups (p=.034). The MMST-flexion was statistically significantly different between the LFE and LEE (p=.000), LFE and LFEE (p=.001), and LEE and LFEE (p=.001) groups. The MMST-extension was statistically significantly different between the LFE and LEE (p<.001), LFE and LFEE (p=.002), and LEE and LFEE (p=.008) groups. The 6MWT was statistically significantly different between the LFE and LFEE (p=.042) and the LEE and LFEE (p=.004) groups.
Conclusion: This study suggested that LFEE was the most effective exercise for pain and functional gait ability in patients with LSS, LFE was the most effective exercise for lumbar flexion ROM, and LEE was the most effective exercise for lumbar extension ROM.
Background: The wall squat exercise has been recommended for strengthening of the lower extremity muscles with maintaining lumbar lordosis. Although squat has been studied to be related to lower extremity extensor strength, the relationship between wall squat and lower extremity extensor strength unclear. Because squat and wall squat are biomechanically different, study on the relationship is needed.
Objects: The purpose of this study was to determine the lower extremity extensor strength associated with wall squat performance.
Methods: 74 healthy volunteers were recruited to participate in this study. The volunteers were measured hip and knee extensors strength and then performed wall squat exercise for maximum count.
Results: We found significant relationships between wall squat performance and hip extensor strength normalized by body weight, knee extensor strength normalized by body weight and the composite value. In a regression analysis, hip extensor strength normalized by body weight explained 29% of the variation in wall squat performance in males and 35% in females.
Conclusion: These results demonstrate that hip extensor strength normalized by body weight is critical to wall squat performance in both sexes.
Background: The serratus anterior is one of the most important muscle for maintaining good scapular alignment in the shoulder joint. The pectoralis major and upper trapezius may also compensate for weak serratus anterior muscles. The push-up plus exercise has been identified as the optimal exercise for maximum activation of the serratus anterior.
Objects: The purpose of this study was to examine differences in surface electromyography (EMG) activity of upper trapezius, pectoralis major, and serratus anterior muscles during push-up plus exercises on variously angled surfaces in subjects with winged scapula.
Methods: Sixteen subjects with winged scapula (male=5, female=11) volunteered for this study. The subjects performed push-up plus exercise on four different tilt angles, namely 0˚, 30˚, 60˚, and 90˚. EMG activities in the serratus anterior, upper trapezius, and pectoralis major muscles during performance of push-up plus exercise were measured in all subjects. Data were processed from repeated measures one-way analysis of variance.
Results: There was significant difference in the muscle activity of the serratus anterior on the different surface angles (p＜.05). The results of the post-hoc analysis showed significantly greater serratus anterior muscle activity on a surface at a 0˚ angle than at others tilt angles (p＜.05). There was also significant difference in the ratio of serratus anterior to upper trapezius and serratus anterior to pectoralis major across the four surfaces (p＜.05), and post-hoc analysis showed significantly greater values on the 0˚ surface than on other tilts (p＜.05).
Conclusion: This study found that performing push-up plus exercises on a flat surface with 0˚ and 30˚ tilt angle achieves high activation of the serratus anterior muscle for selective strengthening. It can also take into account the sequential application, which is first performed at a 30˚ and at a 0˚ tilt angle for and effective but not excessive muscle activation.
Background: Obstacle training affects lower limb muscle activity, balance, reducing the risk of falls, and making gait more stable.
Objects: This study aimed to investigate the effects of aquatic and ground obstacle training on balance and muscle activity in patients with chronic stroke.
Methods: The study subjects included 30 patients with stroke, who were divided into aquatic (n1= 15) and ground (n2=15) groups. Groups underwent obstacle training three times per week, 30 min per session, for six weeks that went as follows: walking over sites with the paralyzed leg, stepping onto and down from a box step, and walking over obstacles with the non-paralyzed leg.
Results: The experimental results were obtained by comparing muscle activity. Activity of the rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius were significantly increased in the aquatic group (p<.05). Activity of the biceps femoris and tibialis anterior were significantly increased in the ground group (p<.05); however, the rectus femoris and gastrocnemius were not significantly different. In the comparison of maximal distance regarding the limits of stability, it was significantly increased on the non-affected side, affected side, and anterior and posterior distance in the aquatic group (p<.05). It was significantly increased in the non-affected side and anterior and posterior distance the ground group (p<.05); however, maximal distance on the affected side distance was not significantly different.
Conclusion: Gait training with aquatic and ground obstacles is effective for improving balance and gait ability of patients with stroke. However, it was more effective for the aquatic group than for the ground group.
Background: Whole body-electromyostimulation (WB-EMS) is widely used for the rehabilitation and recovery of patients with various neuromusculoskeletal disorders.
Objects: To objectively measure changes in lower extremity and abdominal muscles after sit-to-stand dynamic movement training using WB-EMS.
Methods: A total of 46 healthy adults (23 experimental and 23 control subjects) performed sit-to-stand exercise; the experimental group with WB-EMS, and the control group without WB-EMS. The muscle activity of the lower extremity, and the muscle thickness of the lower extremity and abdominal muscles were measured before and after the intervention.
Results: In terms of electromyographic activity, there was a significant interaction effect for the rectus femoris (RF) muscle (F=30.212, p=.000). With regards to ultrasonographic imaging, the muscle thickness of the RF muscle had a significant interaction effect at the muscle contraction ratio (F=8.071, p=.007). The deep abdominal muscles, such as the transverse abdominal (TrA) and internal oblique (IO) muscles, also showed significant interaction effects at the muscle contraction ratio (F=5.474, p=.024, F=24.151, p=.000, respectively)
Conclusion: These findings suggest that WB-EMS may help to improve the muscular activity of the RF muscle, and the muscle thickness of the RF muscle and deep muscles such as the TrA and IO muscles.
Background: Shoulder function is achieved by the coordinated movements of the scapula, humerus, and thoracic spine, and shoulder disorders can be associated with altered scapular kinematics. The trunk plays an important role as the kinematic chain during arm elevation.
Objects: The purpose of this study was to determine the effects of thoracic hyperkyphosis on scapular orientation and trunk motion.
Methods: Thirty-one subjects (15 in the ideal thorax group and 16 in the thoracic hyperkyphosis group) performed right-arm abduction and adduction movements in an unconstrained plane. The scapular orientation and trunk motion were recorded using a motion analysis system.
Results: Those subjects with thoracic hyperkyphosis displayed greater scapular posterior tilting at a 120˚ shoulder elevation, greater scapular internal rotation throughout the arm raising phase, and greater trunk axial rotation at the upper ranges of the shoulder elevation, compared to those subjects with an ideal thorax (p<.05).
Conclusion: Thoracic hyperkyphosis can cause scapular instability, greater trunk rotation and greater scapular posterior tilting, and may contribute to preventing the achievement of a full range of humeral abductions in an unconstrained plane.
Background: Both the rapid concentric and eccentric contractions during exercise repeatedly impose excessive stress on muscle tissue. The hamstring muscles are very susceptible to injury due to the tensile stress. Various interventions are currently being undertaken to prevent strain injury before exercise. Stretching is the most common method and is known to have a positive effect on flexibility and muscle performance. However, relatively few studies have investigated the potential negative factors of stretching.
Objects: The purpose of this study was to examine changes in pain following the different intensity of the stretching and types of physical stress.
Methods: The subjects were divided into three groups based on the intensity of stretching: 100% (S100), 75% (S75), and 50% (S50) of the measured force at the point of discomfort in static stretching and 100% (P100), 75% (P75), and 50% (P50) of the maximum voluntary isometric contraction in Proprioceptive Neuromuscular Facilitation (PNF) stretching. The pain individual subjects perceived after stretching was measured via a Visual Analog Scale (VAS) and compared between the groups
Results: Despite the decrease in the intensity of static stretching, no decrease in VAS value was observed. In PNF stretching, a significant decrease was observed at P50 compared to P100. S100 was significantly higher than P75 and P50.
Conclusion: Previous studies have shown that PNF has a superior or the same effect on flexibility in comparison with static stretching. This effect was maintained even in moderate intensity. PNF stretching performed under moderate rather than high intensive static stretching, which causes pain and discomfort, might be recommended in clinical settings.
Background: An excessive pronated foot is defined as a flattening or complete loss of the medial longitudinal arch. Excessive foot pronation is considered to have high risk factors of overuse injuries in the lower limb. Various treatments have been investigated in attempts to control excessive pronation.
Objects: This meta-analysis identifies the effects of an anti-pronation taping technique using different materials.
Methods: The electronic databases used include MEDLINE, the Physiotherapy Evidence Database (PEDro), Science Direct, the Korean Studies Information Service System (KISS), the Research Information Sharing Service (RISS), the Korea National Library, and the Korean Medical Database (studies published up to July 31, 2019). The database search used the following keywords: "foot drop" OR "foot arch" OR "foot pronation" OR "flat foot (pes planus)" AND "taping" OR "support." Eight eligible studies were analyzed to determine the effectiveness of anti-pronation taping in study and control groups.
Results: The overall random effect size (Hedges’ g) of the anti-pronation taping technique was 0.147 (95% confidence interval [CI]: -.214 to .509). When the effect (Hedges’ g) was compared by the type of tape material, rigid tape (RT; Lowdye taping) was .213 (95% CI: -.278 to .704) and kinesiotape (KT; arch support taping) was -.014 (95% CI: -.270 to .242). Based on this meta-analysis, it was not possible to identify the extent to which anti-pronation taping was effective in preventing navicular drop, improving balance, or changing foot pressure. Only three of the eight eligible studies applied KT on excessive pronated feet, and the outcome measure areas were different to those of the RT studies. The KT studies used EMG data, overall foot posture index (FPI) scores, and rear foot FPI scores. In contrast, the RT studies measured navicular heights, various foot angles, and foot pressure.
Conclusion: This review could not find any conclusive evidence about the effectiveness of any taping method for patients with pronated feet. Future studies are needed to develop the anti-pronation taping technique based on the clinical scientific evidence.