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.

Background: Sling exercises are frequently used for the rehabilitation process of patients with shoulder joint injuries, but research on the significant frequency intensity and appropriate treatment duration for sling exercises with local vibration stimulation is lacking. Objects: The aim of this study was to investigate the effects of sling exercise with vibration on shoulder range of motion (ROM), muscle strength, pain, and dysfunction in patients with a medical diagnosis of shoulder joint injury. Methods: Twenty-two patients were randomly assigned to the experiment and control groups. Six sling exercises with and without 50 ㎐ vibrations were applied in the experiment and control groups, respectively. Each exercise consisted of 3 sets of 5 repetitions performed for 6 weeks. The assessment tools used included shoulder joint range of motion, muscle strength, pain level, and shoulder pain and disability index for functional disability. We conducted re-evaluations before and 3 and 6 weeks after intervention. The changes in the measurement variables were analyzed and compared between the two groups. Results: The ROM of the external rotation of the shoulder joint had a significant interaction between the group and the measurement point (F=3.652, p<.05). In both groups, we found a significant increase in external rotation angle between the measurement points (p<.05). The flexor strength of the shoulder joint significant interaction between the group and the measurement point (F=4.247, p<.05). Both the experiment (p<.01) and control groups (p<.05) showed a significant increase in shoulder flexor strength at the measurement points. After 6 weeks of the interventions, both the groups showed significantly improved VAS (p<.01), SPADI (p<.01), and orthopedic tests (p<.01). However, there was no significant difference between the group and the measurement point in terms of the clinical outcomes observed. Conclusion: The sling exercise with local vibration of 50 ㎐ affected the external rotation of the shoulder range of motion and improved shoulder flexor strength in the patients with shoulder injuries. Therefore, we propose the use of the sling exercise intervention with vibration in the exercise rehabilitation of patients with shoulder joint injuries.

Background: High string instrument (violin, viola) players are at high risk for developing musculoskeletal problems. In particular, a higher prevalence of shoulder problems has been reported. However, evidence of the effectiveness of therapeutic exercise for musicians with this condition is lacking until now. Objects: This case series study investigated the effect of a specific exercise program on shoulder pain, dysfunction, and posture of professional orchestral high string musicians. Methods: Five professional orchestral high string players with shoulder pain participated in this study. A six-week specific exercise program focus on scapular stability for shoulder pain consisted of scapular muscle exercise. Physical examinations for pain and dysfunction, posture were performed, were identified among all subjects before starting the exercise program. Results: The results revealed that shoulder pain decreased by 67.86% and the effect of pain on instrument play decreased by 63.33%. The shoulder pain and disability Index and the performing arts module-quick disability of the arm, shoulder and hand scale decreased by 71.72% and 51.61% respectively. The exercise program improved function and posture. Conclusion: A specific exercise program for high string players was effective in managing shoulder pain. This case series is intended to provide empirical data on the effectiveness of an exercise program aimed at assessing the effect of exercise on pain, dysfunction, and posture of professional orchestra musicians associated with specific instrument groups.

본 연구는 경락마사지가 여성의 어깨 통증에 미치는 효과를 검증하기 위한 목적으로 수행되었다. 이를 위하여 여성 참가자들 45명을 비확률표본추출법 중 편의표본추출법(convenience sampling)과 판단표본추출법(judgemental sampling)에 의해 연구 대상 표본을 추출하였고, 참가자들는 S시에서 어깨 통증으로 인해 경락마사지 치료를 받는 45명의 여성들을 대상으로 주 2회 40분씩 총 16회의 경락마사지 처치를 하였다. 본 실험의 프로그램은 참가자 안정-경락마사지-경혈지압-경락마사지-참가자 안정의 순서로 이루어져 있으며 경락마사지에 적용한 경락은 12경락 중에서 수태음폐경(LU; Lung Meridian)과 수태양소장경(SI; Small Intestine Meridian)만을 처치하였다. 측정도구는 어깨 통증에 대한 주관적인 표현을 기록하는 사상척도(Visual Analog Scale; VAS)에 의한 통증평정지수를 3회에 걸쳐 측정하였으며, 5점 리커트 척도를 자기평가기입법에 의해 시행하였다. 이상의 연구방법을 통하여 경락마사지를 받은 여성의 어깨 통증 감소에 관한 영향력에 대하여 다음과 같은 결론을 얻게 되었다. 첫째, 참가자의 배경변인인 연령에 따른 어깨 통증의 감소효과를 알아보기 위하여 횡단면 분석에서는 모두 유의미한 차이가 나타났다. 둘째, 경락마사지 치료에 따른 참가자의 어깨 통증감소 효과를 알아보기 위하여 대응표본 T-test 통한 차이 검증에서도 모두 유의미한 차이가 나타났다. 셋째, 연령에 따른 어깨 통증감소의 차이를 알아보기 위하여 다변량분산분석(MANOVA) 검증을 실시한 결과 모두 11개의 항목 중에서 10개의 항목에서 유의한 차이가 나타났으며, 문항 6번의 편두통 관련 항목에서만 유의미한 차이가 나타나지 않았다. 이러한 연구의 결과를 통해 경락마사지가 여성의 어깨 통증 감소에 유의한 영향을 미치고 있다는 것을 알 수 있었으며 한의학과 결합된 치료방법인 경락마사지가 어깨 통증감소에 적합한 프로그램임을 확인할 수 있었다. 따라서 이러한 연구의 결과가 향후 여성의 어깨 통증 치료에 긍정적인 기초 자료를 제공할 것으로 기대한다.

The purpose of this study was to identify the immediate effects of Maitland joint mobilization with kinematic taping in subacromial impingement syndrome patients. The Maitland joint mobilization was applied glenohumeral joint. The mobilization was performed at the end of rage to Grade IV. After that, kinematic tape was attached to shoulder joint (supraspinatis, infraspinatis, and trapezius muscles). The intervention period was four days. The measurement was done five times. The shoulder pain, range of motion (flexion, abduction, and rotation of the shoulder joint), muscle tone and stiffness (upper trapezius and deltoid muscle) were measured. The shoulder pain decreased. The range of motion (ROM) was increased all flexion, abduction, and rotation of the shoulder joint. Muscle tone and stiffness were decreased, especially upper trapezius of those was greatly decreased. The findings of present study suggest that Maitland joint mobilization with kinematic taping is effective in decreasing pain, muscle tone and stiffness, and in increasing shoulder ROM in patients with subacromial impingement syndrome.

Background: Scapular posterior tilt (SPT) is important in the prevention of abnormal scapular movement and pain during elevation of the arm. However, previous studies have overlooked increased upper trapezius (UT) muscle activity interrupting the normal force couple of scapular motion and compensation of levator scapulae (LS) muscle activated simultaneously with UT during SPT exercise. Objects: The purpose of this study was to compare the effects of modified SPT with depression exercise versus SPT exercise on serratus anterior (SA), lower trapezius (LT), UT, and LS muscle activities and the clavicular tilt angle, in subjects with rounded shoulder posture (RSP) and myofascial pain in the UT muscle region. Methods: Eighteen subjects with RSP were recruited and randomly allocated to 2 groups; 9 in the SPT group and 9 in the SPT with depression group. All subjects met the specific RSP criteria and had myofascial pain of UT region. Depending on the allocated group, subjects performed the assigned SPT exercise and EMG data were recorded during the each exercise. Clavicular tilt angle was defined as the angle between the line joining the medial and lateral end of the clavicle and a horizontal line. Results: The SA muscle activity was significantly greater in SPT with depression than with SPT exercise (p<.05). The UT, LS muscle activity and the clavicular tilt angle was significantly lower in SPT with depression than with SPT exercise (p<.05). Conclusion: These findings were insightful because the potential risk of pain from overactivation of the UT and LS was considered, in contrast with SPT exercise. SPT with depression exercise can be implemented as an effective method to facilitate scapular muscle activity for stability and to prevent myofascial pain in the neck and shoulder.

Background: Patients after rotator cuff (RC) surgery experienced pain, weakness and limited of motion of the shoulder. Physical therapists have used heat therapy, electrotherapy, range of motion (ROM) exercise and other methods to treat patients after RC surgery. In addition, functional taping is also used to support joint movement and to increase shoulder joint stability. Objects: The purpose of this study was to determine the initial effects of functional taping using non-elastic tape on pain, strength and ROM of the shoulder following RC surgery. Methods: Forty-eight patients with who underwent RC surgery volunteered for this study. The subjects were randomly divided into an experimental group (EG, n1=25) and a control group (CG, n2=23). First, non-allergic tape was applied to the shoulder to prevent skin irritation. The EG applied functional taping using non-elastic tape and the CG applied sham taping using elastic tape. Assessment tools included the shoulder pain and disability index for functional activity score, visual analog scale for level of pain, shoulder muscle strength, hand grip strength and ROM testing. Results: Pain score in the both group significantly decreased (p<.05), and change in pain score of in the EG increased significantly than in the CG (p<.05). Shoulder strength and ROM in the both group significantly increased (p<.05). Especially external rotation and extension of the shoulder ROM in the EG increased significantly more than in the CG (p<.05), but the rate of change in the two groups showed no significant difference. Conclusion: These results suggest that functional taping using non-elastic tape was initially effective in decreasing pain score level in patients with RC surgery.

Background: Shoulder stabilization commonly involves two components: the glenohumeral stabilization exercise (GSE) and scapular stabilization exercise (SSE). Despite the fact that the shoulder stabilization has advantageous merit, to our knowledge, only a few studies have compared the superior of the GSE and the SSE. Objects: The purpose of this study was to assess the effects of GSE in patients with nonspecific shoulder pain. Methods: Thirty subjects with nonspecific shoulder pain were randomly divided into an experimental group and control group, each with 15 patients. The experimental group used an GSE, whereas the control group did SSE. All subjects were measured in shoulder stability, scapular symmetric alignment, pain, muscle power, and range of motion before and after the intervention. Results: GSE resulted in significantly better shoulder stability (p=.046, from 8.67±7.54 score to 13.93±9.40) in the experimental group compared with SSE in the control group. However, no significant effects were observed for scapular symmetric alignment including the angles of inferior scapular distance (p=.829) and inferior scapular height difference (p=.735), pain (p=.113), muscle power including shoulder flexion (p=.723) and abduction (p=.897) and range of motion including shoulder flexion (p=.853) and abduction (p=.472). Conclusion: These findings suggest that GSE may be more effective in increasing the shoulder stability than the SSE in patients with nonspecific shoulder pain, probably through a centralization effect on the shoulder mechanism.

Background: For the treatment of forward head posture (FHP) and forward shoulder posture, methods for strengthening scapular retractors and deep cervical flexors and stretching pectoralis and upper cervical extensors are generally used. No study has yet assessed whether suboccipital release (SR) followed by cranio-cervical flexion exercise (CCFE) (SR-CCFE) will result in a positive change in the shoulders and neck, showing a “downstream” effect. Objects: The purpose of this study was to investigate the immediate effects of SR-CCFE on craniovertebral angle (CVA), shoulder abduction range of motion (ROM), shoulder pain, and muscle activities of upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) and LT/UT and SA/UT muscle activity ratios during maximal shoulder abduction in subjects with FHP. Methods: In total, 19 subjects (7 males, 12 females) with FHP were recruited. The subject performed the fifth phase of CCFE immediately after receiving SR. CVA, shoulder abduction ROM, shoulder pain, muscle activities of UT, LT, and SA, and LT/UT and SA/UT muscle activity ratios during maximal shoulder abduction were measured immediately after SR-CCFE. A paired t-test and Wilcoxon signed-rank test were used to determine the significance of differences in scores between pre- and post-intervention in the same group. Results: The CVA (p<.001) and shoulder abduction ROM (p<.001) were increased significantly postversus pre-intervention. Shoulder pain was decreased significantly (p<.001), and LT (p<.05) and SA (p<.05) muscle activities were increased significantly post- versus pre-intervention. The LT/UT muscle activity ratio was increased significantly post- versus pre-intervention (p<.05). However, there was no significant change in UT muscle activity and SA/UT muscle activity ratio between pre- and post-intervention (p˃.05). Conclusion: SR-CCFE was an effective intervention to improve FHP and induce downstream effect from the neck to the trunk and shoulders in subjects with FHP.

This study aimed to compare the characteristics of breast cancer surgery and shoulder surgery patients on the shoulder range of motion (ROM), degree of pain and dysfunction, and scapular position. This study was carried out with a total of 90 women: a breast cancer surgery group (BS, n1=30), a shoulder surgery group (SS, n2=30) and a control group (n3=30). Shoulder ROM, the Quadruple Visual Analogue Scale (QVAS), the Shoulder Pain and Disability Index (SPADI), and the Scapular Index (SI) were used to assess shoulder function. Statistical analyses were performed using a one-way analysis of variance, crosstab test, and independent sample t-test. Post-hoc testing was carried out with Bonferroni test. There were significant differences in shoulder ROM when the BS and the SS were compared with the control group. However, there was no significant difference in ROM between the BS and SS. Furthermore, there was a significant difference in shoulder pain between both surgery groups, and there was greater shoulder dysfunction in the SS than in the BS. There was also a significant difference in upper extremity posture when the BS and the SS were compared to the control group. Finally, there was no significant difference in upper extremity posture between the BS and the SS. This study compared shoulder ROM, pain, dysfunction, and upper extremity postures between the BS and SS. While there were no significant differences in shoulder ROM, pain, and upper extremity posture between both surgery groups, the level of dysfunction was found to be significantly different. Therefore, health professionals managing for breast cancer surgery or shoulder surgery patients should consider these outcomes.

The aim of this study was to compare the activity of the upper trapezius (UT) and serratus anterior (SA) and ratio of UT to SA during shoulder elevations. Ten subjects with UT pain (UTP) and 13 subjects without UTP participated in this study. Subjects with a UTP of over five in a pain intensity visual analogue scale (0-10 ㎝) for more than 2 months and latent myofascial trigger points (MTrPs) in the UT muscle were included in the UTP group. Electromyography (EMG) data of UT and SA at 1st and 10th elevations were analyzed. Two-way repeated analyses of variance were used to compare the EMG activity of UT and SA and the ratio of UT to SA during shoulder elevations between groups with and without UTP. There was a significant increase in UT/SA ratio in the group with UTP compared to the group without UTP (p=.01). The activity of UT and SA measured at the 10th elevation was significantly greater than that in the first elevation (p<.05). The activity of SA was significantly greater in the group without UTP than the group with UTP (p=.03). However, there was no significant difference between groups with and without UTP in terms of UT activity (p=.28). These results indicate that UTP may have relevance to the increased muscle activity ratio of UT to SA during shoulder elevations.

The purpose of this study was to examine the influences of chronic shoulder pain on the muscle tone in trunk muscles. The study's subjects were 40 men and women in their 30 to 50s, which were divided into two groups. A chronic shoulder pain group consisted of 20 subjects who had been diagnosed with chronic shoulder pain by doctors, and a painless group consisted of 20 subjects who had experienced no such pain. An analysis was performed using electromyography on the muscle tone in the rectus abdominalis, external oblique, internal oblique, and erector spinae muscles under the same conditions between the two groups. The analysis results were as follows. The chronic shoulder pain group exhibited an overall high level of trunk muscle tone than the painless group, along with a statistically significant difference in the rectus abdominalis(p<.05). Moreover, the chronic shoulder pain group showed differences in the trunk muscle tone depending on the affected side. The chronic left shoulder pain group yielded higher levels of muscle tone in the right-side trunk muscles. In particular, the group revealed statistically significant differences in the rectus abdominalis and internal oblique(p<.05). The chronic right shoulder pain group exhibited higher levels of muscle tone in the left-side trunk muscles with a statistically significant difference in the internal oblique(p<.05). The above results suggested that chronic shoulder pain influences increases in the muscle tone in the trunk muscles on the opposite side to the affected shoulder.

The purpose of this study was to investigate the most effective and comprehensible method for the assessment of resting scapular position (RSP) and pain level (PL) in unilateral shoulder pain (USP). Fifty volunteers with USP were involved in the study. Resting scapular assessments of the patients' pain sides (PS) and non-pain sides (NPS) were evaluated. The assessment tools for RSP are: 1) sternal notch (SN) to coracoid process (CP) distance 2) 3rd thoracic spinous process (T3S) to posterolateral angle of acromion (PLA) distance 3) scapular index 4) 8th thoracic spinous process (T8S) to inferior angle of scapular (IAS) distance 5) supine measurement of pectoralis minor (PM) distance 6) standing PM distance 7) PM index (PMI) and 8) PM pain. The paired t-test was used to compare PS and NPS in RSP. Pearson correlation analysis was used to confer a relationship between the PL and RSP. The results of this study indicated that: 1) all the variables between the PS and NPS for RSP were statistically significant(p<.05) and 2) the PMI showed the strongest relationship in the correlation analysis between RSP and PL(p<.05, r=.37). Therefore, it can be concluded that there is a relationship between PMI and PL and it is suggested that an assessment tool using PMI to diagnose shoulder pain would be clinically effective.

A single subject experimental design (alternating treatment design) was used to compare the effects of only ultrasound and ultrasound combined with stretching of the joint capsule on the ROM increase and pain reduction in patients with frozen shoulder. Two subjects were included in each group. In the only ultrasound treatment sessions, ultrasound was applied at the pain point of the shoulder joint in supine position. In the ultrasound combined with stretching treatment sessions, ultrasound was applied at the pain point of the shoulder joint positioned in external rotation and abduction in sitting position. Only ultrasound treatment and ultrasound combined with stretching treatment were alternately performed on each patient. Pain and disability was measured by shoulder pain and disability index (SPADI), and range of motion (ROM) was measured by scratch test. The results of this study showed that ultrasound combined with stretching treatment were more effective than only ultrasound treatment in ROM increase and pain reduction. However, disability score was not significantly different.

A single subject experimental design (alternating treatment design) was used to compare the effects of Mulligan method and electrotherapy on the pain and limitation of range of motion in patients with frozen shoulder. In the Mulligan method sessions, the physiotherapist performed a posterior and caudal glide on the patient while the patient was performing shoulder flexion and abduction. In the electrotherapy sessions, the patient received ultrasound and interference current treatments. Mulligan method and electrotherapy were alternately performed on each patient. Pain was measured by visual analogue scale (VAS) and range of motion (ROM) was measured by modified finger ladder. The results showed that both Mulligan method and electrotherapy were effective in pain reduce and ROM increase, but Mulligan method was superior to electrotherapy in ROM increase while electrotherapy was superior to Mulligan method in pain reduce.

이 연구는 동결견 진단을 받은 환자 14명을 대상으로 하였다. 이들에게 한국전통 정골요법(이하 KTO)을 적용하여 병증의 완화가 실제 이루어 졌는지에 대한 연구를 진행 하였으며 자발적 방문을 한 환자로 구성이 되었다. 또한 약 6개월 이상의 통증을 호소하는 만성질환자를 대상으로 연구 되었다. 연구 결과 KTO를 적용 한 그룹의 경우 통증 수치가 감소되었다. KTO를 적용하지 않은 그룹의 경우 통증감소가 적었다. 이러한 결과들을 토대로 동결견 환자에게 한국전통정골요법이 미치는 효과는 유효하다라고 사료되며 정확한 적용을 위한 통일적 모델링과 효과가 증대 될 수 있는다른 치료 및 요법과의 병행이 필요 하다고 판단된다. 동결견 환자에게 한국전통정골요법을 적용하면 견관절의 운동범위 증가와 통증의 감소를 가져 올 수 있다. 그것은 발병의 원인이 너무 광범위하고 치료 방법도 정확하지 않은 현재의상황에 많은 도움이 될 것이다.