Search Results (22)

This study aimed to describe and compare the serratus anterior (SA) and latissimus dorsi (LD) muscle activity during six hypopressive exercise (HE) positions performed in open and closed kinetic chains. While previous studies analyzed abdominal and pelvic muscle activity during HE, research on scapular stabilizers like SA and LD remains underreported. Twenty-five healthy adults (mean age, 42.9 ± 8.4 years; BMI, 22.1 ± 2.4 kg/m²) with prior HE experience performed three open and three closed-chain HE positions. Surface electromyography recorded bilateral SA and LD activity, normalized to maximum voluntary isometric contraction (MVIC). SA showed greater activation than LD across all positions, with moderate activation levels (20–40% MVIC), while LD activation remained mild (<20% MVIC). Significant differences were found across positions and kinetic chain conditions. SA activation was higher during closed-chain standing (W = 41; p < 0.001; r = −0.74) and kneeling (W = 9; p < 0.001; r = −0.94), while LD activity increased significantly in the seated closed-chain position (left LD: W = 26; p < 0.001; r = −0.84; right LD: W = 20; p < 0.001; r = −0.87). These findings suggest body and kinetic chain positioning influence scapular muscle recruitment during HE. Further research is warranted to determine clinical applications. Full article

Objective: The aim of the study was to evaluate the effect of postural stabilization exercises, in addition to cervical stabilization (CS), on the craniovertebral angle (CVA), pain, neck disability index (NDI), and quality of life in people with chronic neck pain. Methods: This study was performed on 60 women with chronic neck pain, aged 20–60 years, who were randomly divided into two groups. Individuals in the first group underwent CS exercises, in addition to scapular and lumbopelvic stabilization (SLPS) exercises, three times a week for 6 weeks. The individuals in the second group underwent only CS exercises for the same period. Moreover, stretching exercises and a 20 min hot pack were applied to the muscles around the neck of all patients. The CVA was measured using photogrammetry. The visual analog scale (VAS) was used to assess pain. The disability level was measured using the NDI. The Turkish version of the 36-Item Short-Form Health Survey (SF-36) was used to assess quality of life. The assessments were conducted before treatment, after treatment, and at the 2-month follow-up. To assess changes over time and between groups, a two-way repeated measures analysis of variance (ANOVA) was conducted. Results: Post-treatment measurements revealed significant differences favoring the SLPS group. The VAS and NDI scores were markedly lower in the SLPS group than in the CS group, both post-treatment (p < 0.001) and at follow-up (p < 0.001). The CVA was significantly greater in the SLPS group at both the post-treatment (p < 0.001) and follow-up (p < 0.001) assessments. However, in all sub-parameters except the SF-36 general health subscale, the SLPS group reported higher scores than the CS group post-treatment and at follow-up. Effect sizes for between-group comparisons ranged from moderate to very large (Cohen’s d = 0.65 to 2.31), and partial eta-squared (η²) values indicated moderate to large effect magnitudes (η² = 0.09 to 0.48), supporting the clinical relevance of the findings. Conclusion: In individuals with neck pain, including SLPS exercises in the treatment program, rather than just exercises for the cervical region, provides more positive results in terms of reducing disability and pain and increasing functionality. Clinical Trial Registration Number: NCT06578481. Full article

Introduction: Spinal thrust manipulation has been found useful for improving pain and mobility in musculoskeletal conditions of the thoracic spine. This case report highlights the importance of incorporating high-velocity low-amplitude (HVLA) thrust manipulation to the mid-thoracic rib articulations in a patient experiencing thoracic spine pain associated with an acute onset of osteomyelitis at levels T7–T9. Detailed Case Description: A 49-year-old female who was recovering from osteomyelitis of the thoracic spine 4 months prior was referred to physical therapy by her neurosurgeon. Her osteomyelitis infection resulted in a bone-on-bone interaction between T7 and T9, resulting in significant thoracic spine pain. Severe restrictions in active range of motion (AROM) were found in extension and right and left rotation. At initial evaluation, the patient’s pain intensity score was 8/10 (NPRS, 0–10), the disability score was 46/50 (NDI, 0–50), and the patient-specific functional scale score was 3/10 (PSFS, 0–10). Initially, interventions included grades I-IV posterior to anterior (PA) mobilizations of the thoracic spine from levels T2 to T9, mobilization with movement of the thoracic spine for extension and rotation bilaterally, scapular stabilization, and thoracic mobility exercises. Treatment progressed to HVLA thrust manipulation techniques targeting the costotransverse articulations of ribs 2–9. Discussion: Following the initial eight treatment sessions over 4 weeks, minimal improvement was observed for pain (NPRS from 8/10 to 6/10), disability (NDI from 46/50 to 34/50), and thoracic extension AROM (13°). However, during visits 9–16, the addition of HVLA thrust manipulation targeting the costotransverse articulations resulted in significant improvements in pain, disability, and AROM. The patient was subsequently discharged after 16 visits and able to return to a full workday as a teacher without any thoracic pain or ROM restrictions. At the 6-month follow-up, the patient outcomes remained, and she was working with no restrictions. Conclusion: The addition of HVLA thrust manipulation targeting the mid-thoracic rib articulations to a program of non-thrust mobilization and exercise appeared useful for improving pain, disability, and range of motion in a patient recovering from osteomyelitis of the thoracic spine. Full article

This study involves 32 adults with upper cross syndrome (UCS). The experimental group was asked to perform scapular stabilization accompanied by breathing training (SBG). The comparison group was asked to perform scapular stabilization accompanied by thoracic exercises (STG). After four weeks of exercise, changes in the pressure pain threshold (PPT), respiration function, and lower chest expansion (LCE) were measured again. Methods: A two-way repeated-measures analysis of variance (ANOVA) was conducted to investigate the interaction between the measurement period and measurement group, as well as the intra-group effect throughout the measurement period. The statistical significance level was set at p < 0.05. Bonferroni post hoc corrections were used to analyze the intra-group differences before and after the effect of the interventions (α = 0.025). Results: A significant difference in within-group effect validation was found when comparing the time of change between the two groups before and after the intervention. There was no significant difference in the interaction effect depending on the time and group (p > 0.025). Conclusions: Scapular stabilization combined with breathing training or thoracic exercises effectively reduces pain and improves respiratory function in upper cross syndrome. Full article

Background/Objectives: Shoulder injuries are common in overhead sports like tennis due to repetitive unilateral movements that can lead to muscle imbalances. This study aimed to compare muscle recruitment and asymmetry during bilateral shoulder injury prevention exercises (performed with both arms simultaneously) in tennis players versus non-tennis athletes. Methods: Thirty-nine athletes (sixteen tennis players, twenty-three non-tennis athletes) performed two bilateral scapular retraction exercises at 45° and 90° shoulder abduction. Surface electromyography (sEMG) recorded the activation of the middle and lower trapezius. Root Mean Square (RMS), peak RMS and muscle symmetry indices were analyzed. Results: Tennis players showed significantly lower trapezius activation, especially during prone retraction at 90°. Muscle symmetry was slightly higher in tennis players at 90°, but asymmetry increased at 45°, suggesting angle-specific adaptations. Conclusions: Repetitive asymmetric loading in tennis may reduce the activation of scapular stabilizers and contribute to muscular imbalances. Including targeted bilateral exercises in training may help improve scapular muscle function and reduce injury risk in overhead athletes. Full article

Anteroinferior shoulder dislocations require surgical intervention when related to critical glenoid bone loss. Scapular spine bone blocks have emerged as a promising alternative to traditional bone augmentation techniques. However, limited data exist on their biomechanical stability when using different suture-based fixation techniques. This study aimed to evaluate primary stability and micromotion after glenoid augmentation using a scapular spine bone block. A total of 31 fresh-frozen human shoulder specimens underwent bone block augmentation. The specimens were randomized into three groups: double-screw fixation (DSF), single-suture bone block cerclage (SSBBC), and double-suture bone block cerclage (DSBBC). Biomechanical testing was conducted using cyclic loading (5000 cycles at 1 Hz) and micromotion was analyzed using an optical 3D measurement system. Statistical analysis showed that medial irreversible displacement was significantly greater in the SSBBC group compared to DSF (p = 0.0386), and no significant differences were found in anterior or inferior irreversible displacements. A significant difference was noted in posterior reversible displacement (p = 0.0035), while no differences were found in inferior or medial reversible displacements. Between DSF and DSBBC, no significant differences were found in irreversible or reversible displacements in any direction. DSBBC provided stability comparable to DSF while offering a viable metal-free alternative. In contrast, SSBBC displayed inferior biomechanical properties, raising concerns about its clinical reliability. Full article

Background and Objectives: Scapular muscles are crucial in controlling scapular movement, ensuring proper alignment, and preventing injuries during shoulder joint motion. The shoulder abduction angle is one of the most important factors when performing exercises to improve scapular movement control. The Pilates reformer arm work (AW) movement can be performed with different shoulder abduction angles. Therefore, this study analyzed the differences in scapular muscle activation depending on the shoulder abduction angle during the AW movement. Materials and Methods: Twenty-six healthy adult males performed the AW movement under four shoulder abduction angle conditions (0°, 90°, 135°, 160°). When performing the AW in the four conditions, surface electromyography analyzed the muscle activation of the upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), serratus anterior (SA), posterior deltoid (PD), and levator scapulae (LS), and the muscle activation ratios of the UT/LT, LS/LT, UT/SA, and LS/SA. Results: The UT, LT, and SA muscle activation increased proportionally with the increasing shoulder abduction angle (p < 0.001). The LT showed the highest muscle activity at the shoulder abduction angle of 135° (p < 0.001). The MT and PD showed the highest muscle activities at the shoulder abduction angle of 90° (p < 0.001). The muscle activity ratios of the UT/LT and LS/LT were the lowest at the shoulder abduction angles of 90° and 135° (p < 0.001). The muscle activity ratio between the UT/SA and LS/SA was the lowest at the 135° and 160° shoulder abduction angles (p < 0.001). Conclusions: Our findings highlight the impact of the shoulder abduction angle on scapular muscle activation, suggesting that different angles may be used to engage specific muscles during Pilates reformer arm work exercises selectively. This insight can guide exercise interventions for individuals aiming to improve their scapular control and stability. Full article

Background: In reverse shoulder arthroplasty (RSA), the neck–shaft angle (NSA) has trended downward from 155° to 135° to reduce scapular notching, but concerns about instability persist. To assess superior–lateral stability, we developed the intraoperative two-hand lever test (2HLT). The primary objective was to evaluate the effectiveness of the 2HLT, analyze the learning curve in this first study reporting on the new Perform stem, and compare the liner characteristics of 155° and 135° systems. Methods: In a single-surgeon learning curve study, 81 RSA procedures with the new Perform stem (Stryker) were included. The outcomes included the 2HLT test applied in 65 cases, early dislocations, stem alignment, stem length, liner type/thickness, and complications. The early dislocation rate was compared to 167 prior Ascend Flex RSA procedures (Stryker). The liner characteristics of three 135° systems (Perform/Stryker, Univers/Arthrex, and Altivate/Enovis) were compared to traditional 155° Grammont systems (Delta Xtend/DePuy, Affinis Metal/Mathys, SMR 150/Lima, and Aequalis Reversed/Stryker), focusing on jump height (JH) and the liner stability ratio (LSR). Results: In 63% (31/49) of the cases, the 2HLT detected superior–lateral instability, necessitating a retentive 135° liner. The early dislocation rate in the Perform cohort was 4.9% (0% for retentive liners, 8% for standard liners) versus 0% in the Ascend Flex cohort. The mean effective NSA was 133° (127–144°) for short Perform stems and 135° (129–143°) for long stems. Long Perform stems significantly reduced varus outlier density below 132° and 130° (p = 0.006, 0.002). The 36 mm Perform 135° standard liner has a JH of 8.1 mm and an LSR of 152%, markedly lower than the Altivate (10.0 mm/202%) and Univers (9.7 mm/193%) and similar to traditional 155° Grammont liners (8.1–8.9 mm/147–152%). Perform retentive liners have LSR values of 185–219%, comparable to the established 135° design standard liners (195–202%). In the Perform cohort, early complications included four superior–lateral dislocations (all standard liners, LSR 147–152%) requiring four revisions. Conclusions: Perform standard liners have a lower LSR than the established 135° designs. Retentive Perform liners (LSR > 184%) are comparable to standard liners of established 135° designs and effectively mitigate instability. We recommend discontinuing non-retentive Perform standard liners (NSA 135°, LSR < 158%) due to the 63% superior–lateral instability rate detected with the novel 2HLT, necessitating retentive liners, the documented LSR-NSA implant mismatch, and an early clinical dislocation rate of up to 8%. Full article

Background/Objectives: Many patients evaluated by shoulder specialists suffer from intractable pain, neuropathy, and weakness. The pectoralis minor (PM) remains the only scapula muscle to receive lower trunk (C8-T1) input. We propose a novel syndrome: the Human Disharmony Loop. This model portrays how this unique PM innervation causes scapular dyskinesia, which deranges the anatomy of the upper limb girdle and produces a refractory symptom complex of pain, neuropathy, and weakness. We hypothesize that certain patients with historically intractable symptoms of the upper limb girdle may benefit from PM tenotomy. Methods: Ten patients of diverse etiologies presented with a similar constellation of complaints. The patients included a female athlete, a female with macromastia, a male bodybuilder, and patients with post-radiation breast cancer, post-operative shoulder arthroplasty, interscalene block injury, cervical spine disease, persistent impingement after rotator cuff repair, direct traction injury, and occupational disorder. All patients exhibited coracoid tenderness, scapula protraction with internal rotation and anterior tilt, and pain involving the neck, shoulder, and upper back. The patients demonstrated varying degrees of arm neuropathy, subacromial impingement, and occipital headaches. The patients failed all prior treatments by multiple subspecialists, including surgery. Each patient underwent isolated open PM tenotomy. Results: In all ten patients, PM tenotomy substantially reduced shoulder, upper back, and neck pain, cleared concomitant neuropathy, restored full motion, and eradicated occipital headaches. The response to surgery was rapid, dramatic, and durable. Conclusions: The unique asymmetric neurologic innervation to the sole ventral stabilizer of the scapula, the pectoralis minor, predisposes the human shoulder to neurologic and musculoskeletal imbalance. This produces the Human Disharmony Loop: a clinical syndrome spanning from the neck to the fingertips, with chronic pain, neuropathy, and weakness. These challenging patients may benefit dramatically from isolated PM tenotomy. Full article

Background: The prolonged use of smartphones may lead to cervical posture deformities and other associated issues. Among these conditions, cervical extension type is one of the most commonly observed, characterized by increased cervical lordosis, forward head posture, and thoracic kyphosis. These biomechanical changes may lead to neck pain, a restricted range of motion (ROM), and heightened cervical muscle tone. The purpose of this study was to evaluate the impact of combining cervical stabilization exercises with either scapular stabilization or thoracic exercises on the mechanical properties of cervical muscles, the pressure pain threshold (PPT), and the ROM in individuals with cervical extension type. Methods: This study included 32 subjects with cervical extension type who were randomly divided into two groups: 16 subjects were placed in either the cervical and scapular stabilization exercises group (CSG) or the cervical stabilization with thoracic exercises group (CTG). After four weeks of exercise intervention, the following assessments were conducted: measurement of muscle tone, stiffness, and elasticity of the sternocleidomastoid (SCM) and upper trapezius (UT) muscles using Myoton PRO; evaluation of the PPT of the SCM and UT muscles using a pressure pain threshold meter; and assessment of cervical ROM (extension, flexion, and rotation) using motion analysis equipment. Results: Both groups showed significant differences in muscle tone, stiffness, elasticity, PPT, and cervical ROM (p < 0.05). The PPT of the UT muscle was significantly improved in the CSG compared to the CTG (p < 0.05). Conclusions: There were significant improvements in muscle tone, stiffness, elasticity, pain, and cervical ROM after exercise intervention in both groups of subjects with cervical extension. Cervical stabilization exercises, along with scapular stabilization, have better effects on improving UT muscle pain. Full article

Background and Objectives: The infraspinatus muscle is critical for shoulder stability and external rotation, yet achieving selective activation during exercises remains challenging. This study explores the effectiveness of a novel muscle architecture-based position (MABER) compared to traditional exercises in individuals with rounded shoulder posture. Materials and Methods: This prospective, cross-sectional study evaluated the selective activation of the infraspinatus during external rotation exercises in participants with rounded shoulder posture. Thirty-two participants (17 males and 15 females) were recruited. Electromyographic (EMG) activity of the middle trapezius, posterior deltoid, and infraspinatus muscles in the dominant limb was recorded during four exercise positions: standing external rotation (SER), side-lying external rotation (SDER), scapular plane external rotation (SPER), and MABER. Results: MABER produced the highest infraspinatus activity (p < 0.001), while the lowest activity was observed during SPER (p < 0.001). The SER position generated higher posterior deltoid activity compared to other positions (p < 0.001). The SDER position demonstrated the highest infraspinatus/posterior deltoid activity ratio (p < 0.001). Conclusions: The MABER position can be used as an effective exercise to strengthen the infraspinatus muscle. This study contributes to the literature by comparing MABER with traditional exercises and highlights its potential benefits for individuals with rounded shoulder posture. Full article

The purpose of this study was to compare the effects of a complex shoulder exercise program including respiratory training with those of a similar program including thorax-stabilization exercises on muscle activity and posture in individuals exhibiting scapular internal rotation. The subjects of this study were 32 adults with scapular internal rotation. The exercise group performed the complex shoulder exercise program with respiratory training (EG), while the control group performed the complex shoulder exercise program with thorax-stabilization exercises (CG). After 4 weeks of training, the changes in muscle activity and posture were measured. The differences between the two groups were assessed through comparative analysis using an independent t-test. The paired t-test revealed significant disparities in craniovertebral angle (CVA) and sagittal shoulder angle (SSA) posture between the measurements before and after the programs (p < 0.05). Additionally, the paired t-test indicated notable differences in muscle activity of the upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) muscles (p < 0.05). According to the findings, both intervention groups presented significant improvements in cervical and shoulder posture and muscle activity. Consequently, combination of the complex shoulder exercise program with either respiratory training or thorax-stabilization exercises had a favorable impact on posture and muscle activity among individuals exhibiting scapular internal rotation. Full article

Obstacle course races (OCR) have experienced significant growth in recent years, with millions of participants worldwide. However, there is limited research on the specific physiological demands and injury prevention strategies required for these events. This study aimed to analyze the physiological responses and injury risks in participants of a 5 km (Sprint) and 13 km (Super) OCR. Sixty-eight participants were assessed for cortical arousal, leg strength, isometric handgrip strength, blood lactate, heart rate, blood oxygen saturation, body temperature, urine composition, spirometry values, hamstring flexibility, lower limb stability, foot biomechanics, and scapular kinematics, one hour before and immediately after the races. The results showed a significant decrease in leg strength (Sprint: r = −0.56, p < 0.01; Super: r = −0.54, p = 0.01) and urine pH (Sprint: r = −0.70, p = 0.03; Super: r = −0.67, p = 0.01) in both distances, with increases in urine colour, protein, and glucose (Sprint: p < 0.04). In the 13 km race, lower limb stability decreased significantly post-race (r = −0.53, p = 0.01). Positive correlations were found between performance and pre-race handgrip strength (Sprint: r = 0.71, p = 0.001; Super: r = 0.72, p = 0.01) and spirometry values (FVC, FEF 25–75%, FEV1) (Sprint: r = 0.52, p = 0.031; Super: r = 0.48, p = 0.035). Thermoregulation capacity, reflected in a higher pre-race body temperature and lower post-race body temperature, also correlated with improved performance (r = 0.49, p = 0.046). Injury risk increased post-race, with a significant decline in lower limb stability (p < 0.05). These findings highlight the importance of targeted training programs, focusing on grip strength, leg strength, respiratory muscle training, and hydration strategies to optimize performance and reduce injury risk in OCR athletes. Full article

In this study, we investigated the effect of regular walking and its combination with manual techniques/resistance exercise. The position of the shoulder girdle was assessed using the acromion-wall distance (AD). The intervention took place twice a week for 4 weeks. A total of 88 seniors over the age of 60 successfully completed the study. The results showed a statistically significant improvement of AD in the left shoulder within the group that underwent walking combined with resistance exercise. The remaining groups did not show any statistically significant change in AD. Background: The world population is rapidly aging; therefore, it is necessary to respond to this challenge in time. One of the typical involutional signs of old age is a hunched posture combined with a forward position of the shoulder girdle. This posture negatively impacts various bodily functions, postural stability, and strain on the musculoskeletal system. Objectives: We aimed to evaluate the effect of walking and walking combined with manual therapy/resistance exercise on scapular positioning in healthy elderly individuals. Methods: Participants of experimental groups underwent a 4-week training session that involved walking and manual techniques/resistance training applied 2x/week. Participants of the control group maintained their usual daily habits. Results: Our results showed statistically significant improvement in scapular positioning of the left shoulder in participants who underwent regular walking combined with resistance exercise training. Conclusions: These results suggest that regular walking combined with resistance training, when properly dosed, may beneficially influence scapular positioning in healthy elderly individuals. Full article

Muscle imbalances in the upper body can lead to ineffective movement patterns and potential injury. The purpose of this study was to investigate the muscle activity, impact, and muscle activation ratio of the serratus anterior (SA), upper trapezius (UT), lower trapezius (LT), and pectoralis major (PM) during the knee push-up plus (KPUP) exercise under various loads. Method: Electromyography assessed scapular muscle activity in 32 healthy adults (15 males, 17 females) during three KPUP variations. Results: PM and UT showed no significant activity differences across loads, whereas SA and LT did. SA activity was significantly higher in the weighted KPUP (WKPUP) 3 kg than that in KPUP and WKPUP 1 kg. LT activity was also significantly higher in WKPUP 3 kg compared to KPUP and WKPUP 1 kg, with KPUP showing higher activity than WKPUP 1 kg. PM/SA ratios remained consistent across loads, while UT/LT ratios varied significantly, being notably lower at 3 kg compared to 0 kg and 1 kg. Similarly, UT/SA ratios differed significantly among loads, being notably lower at 3 kg and 1 kg compared to 0 kg. Conclusion: WKPUP with 3 kg demonstrated significantly higher SA and LT activity compared to KPUP and WKPUP 1 kg. The lowest UT/LT ratio was observed during the WKPUP 3 kg, suggesting its effectiveness for optimizing muscle activation balance during KPUP exercises. These findings may inform the development of exercise protocols aimed at improving scapular stabilization. Full article