Background: Shoulder horizontal abduction in the prone position (SHAP) has been reported as an effective exercise to strengthen the lower trapezius. However, the effects of pre-emptive scapular posterior tilt on scapular muscle activity and scapulohumeral movements during SHAP have not been examined. Objectives: To examine the effect of the addition of scapular posterior tilt on muscle activity of the trapezius and posterior deltoid, and scapular posterior tilt and shoulder horizontal abduction, during SHAP. Design: Cross-sectional study. Methods: Fifteen healthy male subjects performed two types of SHAP: general and modified SHAP (SHAP combined with pre-emptive scapular posterior tilt). To perform modified SHAP, pre-emptive scapular posterior tilt training was performed prior to the modified SHAP. Muscle activity of the middle and lower trapezius and posterior deltoid, and the amount of scapular posterior tilt and shoulder horizontal abduction, were measured during two types of SHAP. Results: Muscle activity of the lower trapezius and scapular posterior tilt was significantly increased during the modified SHAP, while muscle activity of the posterior deltoid and the amount of shoulder horizontal abduction were significantly decreased. However, the middle trapezius muscle activity did not change during the modified SHAP. Conclusion: The SHAP with pre-emptive scapular posterior tilt can be useful to strengthen the lower trapezius.

Background: Trunk flexor-extensor muscles’ co-activation and upright posture are important for spinal stability. Abdominal bracing and maximal expiration are being used as exercises to excel torso co-contraction. However, no study has on comparison of the effect of this exercise on multifidus in the upright sitting posture. Objectives: This study aims to verify the effectiveness of abdominal bracing and expiration maneuvers in lumbo-pelvic upright sitting. Design: Cross-sectional study. Methods: Eighteen healthy women were recruited for this study. The multifidus muscle thickness of all subjects was measured in three sitting conditions (lumbo-pelvic upright sitting, lumbo-pelvic upright sitting with abdominal bracing, and lumbo-pelvic upright sitting with maximum expiration) using ultrasound. One-way repeated measure analysis of variance was used for the evaluation. Results: Compared to lumbo-pelvic upright sitting, lumbo-pelvic upright sitting with abdominal bracing and lumbo-pelvic upright sitting with maximum expiration were associated with significantly increment of muscle thickness. There was no significant difference in muscle thickness between lumbo-pelvic upright sitting with abdominal bracing and lumbo-pelvic upright sitting with maximum expiration. Conclusion: Abdominal bracing and maximum expiration could be beneficial to increasing lumbar multifidus thickness in lumbo-pelvic upright sitting.

Background: Although studies have been conducted on muscle thickness and balance in trunk stabilization exercise and exercise using vibration props, studies on trunk stabilization exercise using active vibration for spinal alignment are still insufficient to draw a conclusion. Objectives: To investigate the effect of trunk stabilization exercise using active vibration on the spinal alignment in adult females. Design: A randomized controlled trial. Methods: Twenty-six adult females were randomly assigned to the experimental group (active vibration) and 13 control groups (active non-vibrating) and exercised three times a week for 8 weeks. Each group was measured for spinal alignment before exercise and 8 weeks after exercise. Spinal alignment, trunk imbalance, pelvic tilt, and pelvic torsion were measured using a spinal alignment analyzer. Results: Trunk imbalance was a significantly different depending on the time in the experimental group and the control group (P<.05). Pelvic tilt was a significant difference between the groups (P<.05). Also, pelvic tilt was a significantly different depending on the time in the experimental group (P<.05), but the control group showed no significant difference (P>.05). Pelvic torsion was no significant difference in both groups (P>.05). Conclusion: This study demonstrates that trunk stabilization exercise using active vibration has a positive effect on the alignment of the spine.

Background: Incorrect postures of adolescents caused by the use of smart devices have been noted as a factor causing spinal diseases. Objectives: To examine the effect of joint mobilization and stretching on Cobb’s angle and respiratory function in adolescent idiopathic scoliosis (AIS). Design: Cluster-randomized controlled trial. Methods: A total of 22 subjects with AIS were enrolled. They were allocated to two groups: the joint mobilization (n=11) and the stretching (n=11). All interventions were conducted for 30 minutes, three times a week for six weeks. Outcome measures were the Cobb’s angle and respiratory function. The Cobb’s angle and respiratory function measured using the X-ray and Micro- Quark. Results: Joint mobilization group showed significant differences in Cobb’s angle and respiratory function, but stretching group showed significant differences Cobb’s angle. The differences in peak expiratory flow (PEF) between the two groups were significant. Conclusion: This study proved that joint mobilization is a more effective intervention for AIS to improve Cobb’s angle and respiratory function, when compared to stretching.

Background: If there is a difference in leg length, the center of gravity shifts unilaterally toward the short leg, causing loss of balance and secondary postural imbalance, trunk muscle tone changes, gait abnormalities and pelvic imbalance. Objectives: To investigate effects of self exercise program on leg length, balance in adults with leg-length discrepancy. Design: Single blind randomized controlled trial. Methods: Twenty-eight participants were selected and divided into resistance exercise, flexibility exercise, and core exercise. Each exercise was performed for 40 minutes, 3 times a week for 6 weeks. Leg length and balance before and after exercise were measured and analyzed. Results: Following the interventions, resistance exercise group showed significant improvement in balance, but leg length difference did not show significant results. Flexibility exercise group showed significant improvement in leg length difference, but balance did not show significant results. Core exercise group showed significant improvement in leg length difference and balance. There was no significant difference in the comparison between the three groups. Conclusion: This study suggests that customized exercise according to the patient's level is beneficial to the patients.

Background: Backpacks are one of the most widely used accessories in modern society. However, previous studies have shown that carrying a backpack can cause various musculoskeletal problems. Objectives: To investigate the effects of a body-adhesive backpack on craniovertebral angle, sagittal shoulder angle and the muscle fatigue in the upper extremity. Design: Randomized cross-over design. Methods: For this study, 36 healthy university students participated in this study. The experiment was conducted three times using common backpack, and body-adhesive backpack condition. The angles of the cervical spine and shoulder joints of the subjects were calculated without the backpack. Electrodes were placed at upper trapezius, lower trapezius, rectus abdominis and erector spinae to check for muscle fatigue. Subjects carried a backpack and walked on a treadmill for 15 minutes at 4 km/h. The muscle fatigue signal was also measured while walking. After walking, the craniovertebral and sagittal shoulder angles were measured again while subjects carried backpack. Results: As a result of this study, body-adhesive backpack condition showed significant decrease and significant increase in craniovertebral angle and sagittal shoulder angle than common backpack (P<.05). Body-adhesive backpack condition showed significant decrease in upper trapezius, lower trapezius, erector spinae, and rectus abdominis when compared to a common backpack (P<.05). Conclusion: This study suggests that a body-adhesive backpack is more beneficial in correcting body posture than a common backpack.

Background: Repetitive damage to the ankle joint causes chronic ankle instability, and studies comparing the effects of exercise in open and closed chains as a treatment method are very rare. Objectives: To investigate the effects of open and closed kinetic exercises on muscle activity and dynamic balance of ankle joint in adults with chronic ankle instability. Design: Single-blind randomized controlled trial. Methods: The selected 30 subjects are randomly divided into open kinetic chain exercise experimental group (EGⅠ, n=10), closed kinetic chain exercise experimental group (EGⅡ, n=10), and stretching control group (CG, n=10). Open and closed kinetic exercises lasted 30 minutes three times a week for six weeks and stretching exercises performed four actions for 20 seconds and five sets. The measurement tools using surface electromyography to measure muscle activity in the ankle joint. The dynamic balance of the ankle was evaluated using the Y-Balance test. Results: Following the intervention, closed and open kinetic chain exercise group showed significant difference in tibialis anterior and gastrocnemius muscle activity and dynamic balance (P<.05). However, no significant difference in tibialis anterior and gastrocnemius muscle activity and dynamic balance between closed and open kinetic chain exercise group (P<.05). Conclusion: This study provides evidence that closed and open kinetic chain exercise can be presented as an effective exercise for the muscle activity of ankle muscle and dynamic balance of the subject with chronic ankle instability.

Background: Shoes cover the feet and ankle joints and come into contact with the ground directly during walking, and the shape of shoes is related to the muscle tone of the lower extremity muscles. However, no study has been conducted on the muscle tone of the lower extremity after wearing combat boots. Objectives: To compare and analyze the effects of walking in combat boots and in athletic shoes on muscle tone and stiffness, to identifying the effect of the characteristics of shoes on the muscle tone. Design: Randomized controlled trial. Methods: Thirty subjects were randomly divided into a combat boots group and an athletic shoes group, and interventions were implemented. Both groups walked for 30 minutes on a treadmill at 4.2 km/h. MyotonPRO was used to measure the muscle tone and stiffness of the lower extremity. The measuring sites were set to five muscles on both legs. Results: In the combat boots group, muscle tone and stiffness of the medial gastrocnemius on the dominant side, the muscle tone and stiffness of rectus femoris, and the muscle stiffness of hamstring on the non-dominant side significantly decreased after walking. In the athletic shoes group, there was no significant change in the muscle tone and stiffness. Conclusion: The results of this study can be used to inform the wearing combat boots while walking on a treadmill reduces the muscle tone and stiffness of the lower extremity compared to athletic shoes. It indicates that the restriction of joint movement occurring when wearing combat boots influences reducing muscle tone and stiffness.

Background: Few comparative studies have been conducted on strengthening the anterior and posterior muscles of the trunk via lumbar stabilization exercises. Objectives: To compare the effects of forward leaning exercise and supine bridging exercise in stability exercise. Design: Randomized controlled clinical trial (single blind). Methods: Thirty subjects with spondylolisthesis were participated in this study. Fifteen subjects performed the bridging exercises and fifteen subjects performed the forward leaning exercises. Each exercise was held for ten seconds per repetition, and four repetitions were considered one sub-session. A total of four sub-sessions were performed in one full exercise session. The full exercise session required thirty minutes, including rest time. Trunk strength and range of motion and Oswestry disability index were measured. Results: Two weeks later, trunk flexion strength and trunk extension range of motion were significantly increased in the forward leaning exercise group than in the supine bridging group, trunk extension strength were significantly increased in the supine bridging exercise group than in the forward leaning group. After two weeks, the pain score was significantly lower in the forward leaning exercise group than in the supine bridging group. Conclusion: This study has shown that stabilization exercises are effective in increasing range of motion and strength in spondylolisthesis subjects. It was especially confirmed that the method of strengthening the anterior muscles of the trunk is more effective than the standard stabilization exercise method.

Background: The myofascial release technique is known to be an effective technique for increasing posterior fascia flexibility in short hamstring syndrome (SHS) subjects. But therapeutic mechanism of myofascial relaxation remains unclear. Recently, the theory of autonomic nervous system domination has been raised, however, a proper study to test the theory has not been conducted. Objectives: To investigate whether the application of the myofascial release technique can induce changes in the autonomic nervous system and affect the secretion of stress hormones and myofascial relaxation. Design: Quasi-experimental study. Methods: Twenty-four subjects with SHS were randomly divided into two groups. In the experimental group, the suboccipital muscle inhibition (SMI) technique was applied to the subjects for 4 min in supine position, and in the control group, the subjects were lying in the supine position only. A forward flexion distance (FFD) was conducted, blood pressure, heart rate, and cortisol levels were measured before and after the intervention and 30 min after intervention to determine myofascial relaxation and stress hormone levels. The evaluation was conducted separately in blind by an evaluator. Results: A FFD decreased in the experimental group, no change in cortisol was observed. On the contrary, a decrease in cortisol appeared in the control group after 30 minutes. Conclusion: The myofascial release technique is an effective treatment to increase the range of motion through posterior superior myofascial chain, but there is no evidence that myofascial release technique can control the autonomic nervous system.

Background: Thera-Band, Narrow squats, Kinesiology taping helps in the reduction of loading on the knee joints. Despite the fact that the varus knee negatively affects the alignment of the lower extremities, most of the studies have analyzed each independently. Objectives: To investigate the effects of a complex exercise program consisting of elastic band exercises and squat exercises on the distance between the inner knees and balance in young adults with genu varum. Design: A cluster randomized controlled trial. Methods: The complex exercise group performed resistance exercises using an elastic band. The taping group used kinesiology tape on the vastus lateralis and biceps femoris. To select those to be included in the study, we measured the distance between the knees using digital Vernier calipers and to measure the balance ability, we used a balance training system. The data were analyzed with the independent t-test and paired t-test. Results: The study indicated a significant difference in the distance between the knees between the two groups, but no significant differences in the dynamic balance between the groups. Also, the static balance comparison between the groups according to the intervention method included the trace length, C90 area, C90 angle and velocity. There were no significant differences in the static balance between the groups. In addition, the complex exercise program was more effective than taping. Conclusion: The results of this study demonstrate that the complex exercise program and taping decrease the between both the knee and increase the balance.

Background: Patients with low back pain (LBP) experience misalignments in the center of pressure (COP) and muscle imbalances due to frequent onesided posture adjustments to avoid pain. Objectives: To identify the effects of Squat Exercises with Vertical Whole-Body Vibration on the Center of Pressure and Trunk Muscle Activity. Design: Randomized controlled trial. Methods: Thirty LBP patients with an imbalance in the COP were sampled and randomly assigned to an experimental group of 15 patients who under went an intervention involving squat exercises with vertical WBV and a control group of 15 patients who were treated via a walking intervention. As pretests before the interventions, the subjects’ COP was identified by measuring their stability index (ST), and erector spinae, rectus abdominis, transverse abdominis, gluteus medius muscle activity was analyzed by determining the % reference voluntary contraction (%RVC) value using surface electromyography while sit to stand. After four weeks, a post test was conducted to remeasure the same variables using the same methods. Results: Statistically significant differences were found in the ST (P<.01) and trunk muscle (P<.05, P<.001) in the experimental group before and after the intervention. In terms of the differences between the left- and right-side (RL) muscle activity, only the transverse abdominis (TrA) and gluteus medius (GM) exhibited statistically significant increase (P<.05). A comparison of the groups showed statistically significant differences in the TrA with respect to muscle activity (P<.05) and in the RLTrA and RLGM in terms ofthe difference between left- and right-side muscle activity (P<.01). Conclusion: Squat exercises with vertical WBV produced effective changes in the COP of patients with LBP by reducing muscle imbalances through the delivery of a uniform force. In particular, strengthening the TrA and reducing an imbalance in the GM were determined to be important factors in improving the COP.