목적 : 본 연구는 웨스턴 온타리오 어깨 불안정 지수(Western Ontario Shoulder Instability Index: WOSI)를 한국어로 번역하고 측정 속성을 조사하고자 하였다. 연구방법 : 번역은 번역과 역번역 과정을 포함하는 다수의 문헌에서 사용되고 있는 가이드라인에 따라 진행되었다. 연구대 상자는 한국어판 WOSI (K-WOSI)와 Quick Disabilities of the Arm, Shoulder and Hand for Koreans (K-QuickDASH) 검사를 수행하였으며, K-WOSI는 일정한 시간이 지난 후에 같은 대상자에게 반복 측정되었다. 연구자 는 측정결과를 활용하여 내적일치도, 검사·재검사 신뢰도, 동시타당도, 바닥 및 천장 효과를 분석하였다. 결과 : 16명의 환자가 연구에 참여하였으며, 총점 분석 시 내적일치도(Cronbach’s alpha = 0.97)와 검사·재검사 신뢰 도(Pearson’s r = 0.86, Intraclass Correlation Coefficient = 0.92)가 통계학적으로 유의하였다. 평가의 하위 영역 간의 신뢰도 분석 시에도 통계학적으로 유의한 결과가 확인되었다. 또한 K-WOSI와 K-QuickDASH의 상관성이 높았 으며(Pearson’s r = 0.88), K-WOSI의 바닥 및 천장 효과가 발생하지 않았다. 결론 : 본 연구에서 K-WOSI가 어깨가 불안정한 환자들의 삶의 질을 평가하는데 있어 신뢰도와 타당도가 높은 평가로 확 인되었다.

PURPOSES : In this study, the initial behaviors of shoulder concrete slabs and tiebars at the longitudinal construction joints between the shoulder JCP and mainline CRCP are investigated. METHODS : The strains of concrete and tiebars were measured at the longitudinal construction joint between the CRCP and JCP. Measurements were performed using data accumulated over a month after concrete placement. The contact conditions were investigated by comparing the strains at each location. RESULTS : The longitudinal construction joints between the shoulder JCP and mainline CRCP exhibited the composite behavior of bonding and friction, and a virtual neutral axis was formed inside the JCP. At the connection of the shoulder concrete, the strain and temperature of the concrete were inversely proportional. The tiebars connecting the CRCP and JCP exhibited different behaviors depending on the bonding conditions around the tiebars of the construction joints. In the presumed state in which the bonding condition was maintained, the concrete temperature and tiebar strain were directly proportional; however, the presumed state of the separation condition exhibited an inversely proportional relationship. In the 24-h behaviors of the tiebars, the effects of the horizontal and curling movements overlapped, and the strains of the measured tiebars increased at the minimum and maximum temperatures of the shoulder JCP. CONCLUSIONS : The strains in the tiebars and concrete slabs primarily depended on the boundary conditions (bonding and friction) of the longitudinal construction joint between the shoulder JCP and mainline CRCP.

Background: The external rotation (ER) exercise in performed at a 90° abduction of the shoulder joint is an effective to strengthen the infraspinatus. However, failure of the humeral head to control axial rotation during exercise can be increased the posterior deltoid over activity. Biofeedback training is an effective method of promoting motor learning and control it could look forward to activate the infraspinatus selectively by controlling the humeral head during exercise. Objects: The aim of this study was investigated that whether biofeedback for axial rotation was effective to activate selectively the infraspinatus during ER exercise. Methods: The 15 healthy males participated, and all subjects performed both ER exercise in a sitting position with shoulder abducted 90° under conditions with and without axial rotation biofeedback. Exercise was performed in a range of 90° ER, divided into three phases: concentric, isometric, and eccentric. The infraspinatus and posterior deltoid muscle activity were observed using surface electromyography. Results: Both infraspinatus activity (p < 0.01) and infraspinatus to posterior deltoid activity ratio (p = 0.01) were significantly higher with biofeedback however, posterior deltoid activity was significantly lower with biofeedback (p = 0.01). The infraspinatus muscle activity and muscle activity ratio were the highest in the isometric contraction type, and there were significant differences for all contraction types (p < 0.05). Whereas, the posterior deltoid activity was the lowest in the isometric contraction type, and showed a significant difference between isometric and other two contraction types (p < 0.05), but no significant different between concentric and eccentric contraction. Conclusion: Our results indicate that the axial rotation biofeedback during sitting ER exercise might be effective method to activating selective infraspinatus muscle and recommended to enhance the dynamic stability of the shoulder joint.

Background: The Trunk Stabilization Exercise and Respiratory Muscle Exercise may help address the complex biomechanical and neuromuscular issues that contribute to shoulder joint disorders and can help improve patient outcomes in terms of pain relief, range of motion, and functional ability. Objectives: To investigated the effects of conventional physical therapy, trunk stabilization exercise, and respiratory muscle exercise, on the Range of Motion (ROM), ULF and balance in patients with shoulder joint disorder. Design: A randomized controlled trial. Methods: This study randomly allocated 18 subjects to the control group, 19 to the trunk stabilization exercise group, and 19 to the respiratory muscle exercise group, while all interventions were performed five times a week for four weeks. The result measurement involved the ROM, the upper limb function test (ULT), and balance tests. Results: The respiratory muscles exercise group indicated significant improvement in ROM and balance tests than the trunk stabilization exercise group and control group. Conclusion: The respiratory muscle exercise is a more effective way to improve ROM and balance ability than trunk stabilization exercise for patients with shoulder joint disorder.

Background: Individuals with scapular winging have a weak serratus anterior (SA) muscle, and to compensate, the pectoralis major (PM) and upper trapezius (UT) muscles excessively activate, which can cause upper extremity dysfunction. This study aimed to compare the effects of isometric horizontal abduction (IHA) on SA, PM, and UT muscle activity, as well as the SA/PM and SA/UT muscle activity ratios during knee push-up plus (KPP) at 90° and 120° of shoulder flexion. Objects: This study aimed to compare the effects of IHA on SA, PM, and UT muscle activity, as well as the SA/PM and SA/UT muscle activity ratios during KPP at 90° and 120° of shoulder flexion. Methods: This study, conducted at a university research laboratory, included 20 individuals with scapular winging. Participants performed KPP with and without IHA at 90° (KPP90) and 120° (KPP120) of shoulder flexion. SA, PM, and UT muscle activity were measured using surface electromyography. Results: PM activity in KPP90 with IHA was significantly lower than KPP90 and in KPP120 was significantly lower than KPP90. UT activity was significantly greater with IHA than without IHA and at 120° than 90° of shoulder flexion. SA/PM muscle activity ratio was significantly higher in KPP90 with IHA than without IHA and in KPP120 than in KPP90. SA/UT muscle activity ratio was significantly lower with IHA than without IHA. Conclusion: KPP90 with IHA and KPP120 are effective exercises to reduce PM activity and increase SA/PM muscle activity ratio. However, applying IHA in KPP90 also reduces SA/UT muscle activity ratio, implying that it would be preferable to apply KPP120 in individuals overusing their UT muscles.

Background: Studies using Smovey and Vibration foam rollers are mostly conducted with normal adults, breast cancer patients, and athletes. However, there are not many studies applied to stroke patients to date. Objectives: The purpose of this study is to investigate the effect of vibration exercise on the range of motion of the shoulder and knee joints in stroke patients. Design: A randomized controlled trial. Methods: A total of 36 stroke patients, with 12 in the Smovey and Vibration foam roller group (SVG), 12 in the Smovey and Non-Vibration foam roller group (SNVG), and 12 in the control group (CG) were randomly assigned to exercise three times a week for 6 weeks. The range of motion of the shoulder and knee joints was measured for each group before and after 6 weeks of exercise. For joint range of motion, shoulder flexion and extension and knee flexion and extension were measured using BPMpro. Results: In terms of the difference in time, the flexion and extension of the shoulder and the flexion and extension of the knee on the paretic side were significant in the SVG and SNVG. The CG was not significant. Shoulder flexion and extension and knee flexion and extension on the unaffected side were all insignificant. The differences between each group were significant between the SVG and the CG and the SNVG and the CG. SVG and SNVG were not significant. Conclusion: It was found that vibration exercise had a positive effect on the range of motion of the shoulder and knee joints. Therefore, it is thought that vibration exercise can be provided as a clinical intervention method for shoulder and knee range of motion.

Background: Posterior capsule tightness (PCT), commonly seen in overhead athletes, is a soft tissue adaptation that is also noted in non-throwers. PCT is associated with scapular and humeral kinematic alterations, significant restriction of shoulder internal rotation (IR) range of motion (ROM), and significant scapular anterior tilting. Sleeper and cross-body stretches (CBS) are suggested for PCT and IR deficits, and have been modified since introduction. A novel modified sleeper stretch (NMSS) was designed in this study to prevent the risk of anterior translation of the humeral head. Though the effects of posterior shoulder stretching exercise have been widely studies, to the best of our knowledge, no previous studies have investigated the effectiveness of posterior shoulder exercises in decreasing scapular anterior tilting. Objects: To compare the immediate effects of two posterior shoulder stretching exercises (NMSS and CBS) on scapular anterior tilting and shoulder IR ROM. Methods: Thirty-two subjects with anteriorly tilted scapula and IR deficits [mean age: 24.3 ± 2.5 years; 15 males and 17 females] participated in this study. Subjects were randomly assigned to either the NMSS or CBS groups. Scapular anterior tilting (at rest and at shoulder 60° active IR) and shoulder IR ROM were measured before and immediately after intervention. Results: Scapular anterior tilting significantly decreased, while the shoulder IR ROM significantly increased in both groups. However, there was no significant group-by-time interaction effect or significant difference between the groups. Conclusion: Both stretching exercises were effective in restoring shoulder IR ROM and decreasing scapular anterior tilting.

Background: This study was carried out to determine whether non-face-to-face physical therapy would have similar exercise effects to face-to-face physical therapy. Hence, we developed an approach for patients, unable to visit hospitals due to circumstances such as the COVID-19 pandemic, to conduct physical therapy comfortably at home. Objects: This study aimed to compare the effects of a face-to-face and a non-face-to-face physical therapy treatment on improving a rounded shoulder posture. Methods: The participants with rounded shoulders were randomly divided into a face-toface group (n = 15) and a non-face-to-face group (n = 15), and each group performed exercises for four weeks. The exercise program consisted of the bare hands exercise, Thera-Band exercise, and foam roller exercise. The participants in the face-to-face group came to a designated place to perform their exercises, and those in the non-face-to-face group performed the exercises at their own home using Google Meet (Google). Acromial height, total scapular distance (TSD), shoulder pain and dysfunction index (SPADI), and pectoralis minor thickness were measured. Data analysis was performed using the R Statistical Software (R Core Team), and a normality test was performed using the Shapiro-Wilk test. Results: There were no significant differences between the face-to-face and the non-face-toface groups (p > 0.05). When comparing the differences before and after the exercises, both the face-to-face and the non-face-to-face groups showed significant differences in acromial height, SPADI, and pectoralis minor thickness (p < 0.05), and both groups showed no significant difference in TSD before and after the exercises (p > 0.05). Conclusion: The results of this study support the results of previous studies reporting that shoulder stabilization exercise and pectoralis minor stretching training improves round shoulders. In addition, this study revealed that both the face-to-face and the non-face-to-face physical therapy treatments had therapeutic effects.

Background: Several factors contribute to shoulder pain, including abnormal neck posture, repeated use of the upper limbs, work involving raising the upper limbs above the head, and the effects of vibration. However, previous study has reported that constant vibration exposure could impact improvement of the stability on joints related with muscle recruitment and activation. For this difference reason, we need to verify for the complex study of relationship with repetitive upper limb movements, poor head posture, and constant vibration exposure. Objects: Our study was made to investigate the influence of vibration exposure on the shoulder muscle activity during forward-head and over-head tasks with isometric shoulder flexion. Methods: In a total of 22 healthy subjects, surface electromyography (EMG) data were collected from shoulder muscles (upper/lower trapezius, serratus anterior, and lumbar erector spinae) on tasks (neutral-head task [NHT], forward-head task [FHT], and over-head task [OHT]) with and without vibration exposure. Results: In all tasks, the EMG data of the upper trapezius and serratus anterior significantly increased with vibration exposure (p < 0.05). Furthermore, the EMG data of the lumbar erector spinae significantly increased with vibration exposure in the NHT and FHT (p < 0.05). Conclusion: We suggest that continuous vibration exposure during the use of hand-held tools in the tasks could be associated with harmful effects in the workplace. Lastly, we clinically need to examine the guidelines regarding the optimal posture and vibration exposure.

PURPOSE: 본 연구의 목적은 둥근어깨자세(round shoulder posture)와 전방머리자세 (forward head posture)에 따라 폐활량 측정과 산소포화도 및 횡격막 움직임 크기의 상관관계를 알아보는 것이다. METHODS: 연구의 대상은 만성 심장질환 및 호흡기 질환을 가지고 있거나, 정신적, 인지적 장애가 있는 자, 척추옆굽음증(scoliosis)이 있는 자, 목과 갈비뼈 손상이나 수술 병력이 없는 50명의 자원한 사람으로 선정되었습니다. 통계분석은 피어슨(Pearson)의 상관분석을 실시한다. RESULTS:둥근어깨자세는 FVC,FEV1,FEV1/FVC%,PEF 에 대해 양의 상관계수를 보이고 이중 PEF가 가장 상관성이 높았다(p<.05). 횡격막 움직임의 크기(DMD)에 대해서도 양의 상관계수를 보였다. 그러나 TAD(table acromion distance)와는 음의 상관관계를, SPO2는 PM/C7~acro, TAD(table acromion distance) 둘다 음의 상관관계가 나타났다(P>.05). 전방머리자세는 CVA와 CRA 모두 FVC,FEV1,FEV1/FVC, PEF 비율에 대해 유의한 상관관계가 없다(p>.05). CRA와 DMD에는 유의한 차이가 있는 음의 상관관계가 나타났지만(p<.05), CVA와 DMD에는 유의한 상관관계가 발견되지 않았다. 또한 CVA와 CRA 모두 SPO2에 대해 유의한 상관관계가 없다(p>.05). CONLUSION: 결론적으로 전방머리자세의 각도와 둥근어깨 자세에 따라 폐활량과 횡격막 움직임에 영향을 미친다는 것을 확인 할 수 있었다. 하지만 좀더 많은 인원과 대상자들의 경직된 자세에 대해 제한할 방법을 추가적으로 찾을 필요가 있다.

Background: The rounded shoulder posture (RSP) causes the protraction, downward rotation, and anterior tilt of the scapula. Many studies reported that various interventions for the RSP could be helpful for RSP correction. However, no study has reported on the effect of an orthosis on the RSP. Objectives: To investigate the effect of an orthosis on the RSP in comparison with kinesio taping in 32 participants with RSP. Design: Quasi-experimental study. Methods: Thirty-two participants with RSP were randomly assigned into the kinesio taping group (n=15) and orthosis group (n=17). Kinesio taping was applied as follows: 1) both sides of the spine in a vertical direction from C7 to T12. 2) Both sides of the spine in an oblique direction from the coracoid process of the scapula through the acromion to the T12. Orthosis was tried on, and a pull adjustment strap was used to correct the RSP for each participant. Results: Both groups showed significant differences in the height of the acromion to the ground, forward head angle, forward shoulder angle, visual analog scale, and neck disability index within each group. However, no significant differences in all measurements were observed between the two groups. Conclusion: Orthosis for the RSP with exercise would improve the correction of the RSP as much as kinesio taping.

Background: The serratus anterior (SA) muscle prevents scapular winging (SW) by stabilizing the medial border of the scapula during arm movement. The upper trapezius (UT) and lower trapezius (LT) muscles may compensate for the weak SA muscle in individuals with SW during shoulder flexion. However, there is no study to examine whether compensation by UT and LT occurs in individuals with SW. Objects: This study compared the muscle activities of UT, LT, and SA as well as the SA/UT activity ratio between individuals with and without SW during shoulder flexion with load. Methods: This study recruited 27 participants with SW (n = 14) and without SW (n = 13). Electromyography data of the SA, UT, and LT muscles and SA/UT activity ratio were recorded and analyzed during shoulder flexion with 25% load of the maximal shoulder flexion force. Independent t-test was used to compare the UT, LT, and SA muscle activities and SA/UT ratio between the groups with and without SW; statistical significance was set at α of 0.05. Results: SA activity was significantly lesser in the group with SW than in the group without SW. However, there were no significant differences in the UT and LT activities and SA/UT activity ratio between the two groups. Conclusion: The SA activity was lesser in the group with SW than in the group without SW with 25% load of the maximal shoulder flexion force, but there was no compensatory muscle activity of the UT and LT observed. Therefore, further studies are warranted to clarify the compensatory strategy of scapular stabilization in individuals with SW during shoulder flexion under other heavy load conditions.

Background: Shoulder external rotation exercises are commonly used to improve the stabilizing ability of the infraspinatus. However, during exercise, excessive activation of the posterior deltoid compared to the infraspinatus causes the humeral head to move anteriorly in an abnormal position. Many researchers have emphasized selective activation of the infraspinatus during shoulder external rotation exercise. Objects: This study aims to delineate the optimal exercise method for selective activation of infraspinatus by investigating the muscle activities of the infraspinatus and posterior deltoid according to the four shoulder exercise methods and two forearm positions. Methods: Thirty healthy individuals participated in this study. The participants were instructed to perform shoulder external rotation exercises following four exercise methods: sitting external rotation (SIER); standing external rotation at 90° abduction (STER); prone external rotation at 90° abduction (PRER); side-lying external rotation (SLER), and two forearm positions (neutral, supinated). The electromyography (EMG) signal amplitude was measured during each exercise. Surface EMG signals were recorded from the posterior deltoid, infraspinatus, and biceps brachii. Results: EMG results of the infraspinatus and posterior deltoid in PRER, were significantly higher than that of the other exercises (p < 0.01). The EMG ratio (infraspinatus/posterior deltoid) in SIER was significantly higher than that of the other exercises. EMG activation of the posterior deltoid in SIER, PRER, and SLER was significantly higher in neutral than in supinated (p < 0.01). Furthermore, the EMG of the infraspinatus in SIER was significantly higher in neutral than in supinated (p < 0.01). The EMG ratio (infraspinatus/ posterior deltoid) in SIER was significantly higher in neutral than in supinated (p < 0.05.) Contrarily EMG ratios in PRER and SLER were significantly higher in supinated than in neutral (p < 0.05). Conclusion: The results show that clinicians should consider these exercise methods and forearm positions when planning shoulder external rotation exercises for optimal shoulder rehabilitation.

Purpose: 본 연구의 목적은 본 연구의 목적은 2주간의 회전근개의 강화운동이 회전근개의 근육 두께, 견봉하 공간, 어깨 불안정성에 미치는 영향을 알아보고자 하는 것이다. Methods: 근골격계 질환이 없는 대상자 35명을 대상으로 수행하였으며, 횡격막 호흡을 하는 그룹과 횡격막 호흡을 하지 않는 그룹으로 나누었으며, 두 그룹 모두 필라테스를 수행하였다. 실험에 사용한 기기로는 Ultrasonography(US), Pulmonary function tests(FEV1 / FVC), Bioeletic Impedance Analysis, Sit and reach test를 사용하였다. 근골격계 질환이 없는 대상자 20명이 실험에 참여하였다. 근력 강화 운동은 2주 동안 주 5세트, 총 50세트 실시하였으며, 운동은 풀캔, 빈캔, 외회전 운동으로 진행하였다. 초음파를 이용하여 극상근과 극하근의 근육 두께와 견봉하 공간의 변화를 확인하였다. CSMI는 가시위근과 가시아래근의 근력을 평가하는 데 사용되었다. 정규성 검증을 실시한 후, 반복측정분산분석 (repeated measures of ANOVA)를 사용하여 운동 전, 1주후, 2주후를 비교하였다. 사후 분석을 위해 Fisher’s LSD를 실시하였다. Results: 근력의 비교에서 운동 2주 후 측정 시 내회전에서 유의한 차이가 있었다 (P <0.05). 외회전에서는 유의한 차이가 없었다 (P >0.05). 근육두께에서는 가시위근과 가시아래근의 근육 두께는 유의한 차이가 없었다 (P >0.05). 또한 봉우리밑 공간에서도 유의한 차이가 없었다 (P >0.05). Conlusion: 결론적으로, 빈캔 운동과 풀캔 운동, 측면 외회전 운동은 어깨관절 안쪽돌림의 근력 강화에 긍정적인 효과가 있었다

Background: Patients who underwent rotator cuff repair (RCR) require management to control pain and prevent re tear and stiffness. Thoracic mobilization has been applied for the improvement of vertebra and shoulder movements and pain reduction. Also, core stability exercise is an intervention necessary for rehabilitation after shoulder surgery. Objectives: To examine the short term benefits of thoracic mobilization and core stability exercise for patients after RCR. Design: Randomized controlled trial with multi arm parallel group and single blind assessor. Methods: 30 participants after RCR were recruited. Participants were categorized into conventional physical therapy (CPT) group, thoracic mobilization (TM) group, and core stability exercise (CSE) group according to the randomization program. Each treatment, transcutaneous electrical nerve stimuli (TENS), TM, and CSE was applied to each group. 3 physical therapists only conducted evaluations; VAS (visual analogue scale), ROM (range of motion), and Korean version of Shoulder Pain and Disability Index (SPADI). Results: VAS and SPADI were statistically reduced, and ROM was statistically improved in all 3 groups. In between three group comparisons of changes in outcome variables, there was not a significant difference in VAS, but there was a significant difference in ROM and SPADI. In the post hoc test, ROM and SPADI showed a significant difference in TM and CSE compared to CPT. Conclusion: TM according to Maitland concept and CSE had beneficial effects compared to CPT in patients after RCR.