• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.18 no.2
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• pp.49-55
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• 2012

Background: The purposes of this study were to: 1) investigate the relation between thoracic kyphosis, postural stiffness and thoracic rotation and 2) the intra-rater reliability of the measurement methods for thoracic kyphosis and rotation angle. Methods: Thirty-nine young adults (13 males, 26 females) participated in the study. Thoracic kyphosis was measured using a Flexicurve while standing in their usual relaxed posture and then in their maximally erector posture. Index of kyphosis (IK) measures taken in the relaxed and maximally erect positions were used to estimate postural stiffness. Thoracic rotation range of motion (ROM) was measured using universal goniometer and inclinometer in two positions. The association between the magnitude of the IK and thoracic stiffness and thoracic rotation ROM was also examined. Reliability was determined using intra-class correlation coefficients (ICC). Results: When measured from the mean relaxed IK (${\pm}SD$) was 7.42 (${\pm}1.47$) and mean erect IK was 4.92 (${\pm}1.63$) and mean IK ratio was 1.66 (${\pm}.65$). The relaxed IK was significantly correlated with the range of motion thoracic rotation in two positions (r=.503~580, p<.01). Conclusion: Thoracic kyphosis in relaxed position was associated with the range of motion thoracic rotation. Thoracic kyphosis measurement with the Flexicurve and range of motion 2 techniques of thoracic rotation showed good reliablity and may be a useful measurement tool in clinical practice.

• Physical Therapy Rehabilitation Science
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• v.6 no.2
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• pp.65-70
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• 2017

Objective: The purpose of this study was to examine the intertester reliability and validity of four nonradiologic measurements of thoracic spine rotation in healthy adults. Design: Descriptive laboratory study. Methods: This study was conducted on 20 male and 20 female university students aged between 19 and 26. To measure thoracic rotation, a goniometer, a bubble inclinometer, a dual inclinometer, and a smartphone application-clinometer were used. The measurement was performed twice for each device and the same measurement was performed by two examiners. The measurements were performed in the lumbar locked position. The arm in the direction of rotation was taken back and placed onto the back of the lumbar region. With right and left trunk rotation, the head was rotated together but remained in the center line so that the axial rotation was maintained. Both examiners performed the measuring procedures and directly handled the measuring instrument. All measurement results were recorded by the recorder. Results: The range of motion (ROM) of thoracic rotation in lumbar locked position for all four devices was 47 degrees. The intra-rater reliability estimates ranged from 0.738 to 0.906 (p<0.05). The inter-rater reliability estimates ranged from 0.736 to 0.853 (p<0.05). The goniometer, bubble inclinometer, dual inclinometer, and smartphone clinometer showed high validity (p<0.05). This result indicates that all four devices may be used by the same examiner and by other examiners obtaining follow-up measurement. Conclusions: The use of the goniometer, bubble inclinometer, dual inclinometer, and smartphone clinometer for measurements in the lumbar locked posture are reliable and valid nonradiologic measures of thoracic rotational ROM in healthy adults.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.19 no.2
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• pp.11-18
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• 2013

Background: The objective of this study was to compare the efficacies of thoracic self-mobilization and strengthening exercise in young adults with thoracic hyperkyphosis. Methods: The subjects were 30 young adults (11 males, 19 females) with thoracic hyperkyphosis. They were randomly assigned to one of three groups: thoracic self-mobilization, thoracic strengthening exercise, and control group. The thoracic self-mobilization group performed active dynamic exercises, which included thoracic extension and rotation in supine and standing positions. The strengthening exercise group performed resistance exercises involving the back extensor muscle, with an elastic band and dumbbells. The outcome measures were the thoracic kyphosis angle and forward head posture (craniovertebral angle [CVA] and cranial rotation angle [CRA]). Results: Compared with the baseline values, the thoracic kyphosis angle had decreased while the CVA had increased in both training groups (p<.05), but the CRA was significantly decreased in only the strengthening exercise group. Thoracic self mobilization reduced kyphosis and improved CVA, while thoracic strengthening exercise reduced kyphosis and improved CVA and CRA. Conclusion: This study suggests a promising exercise intervention that can improve posture in young adults with thoracic hyperkyphosis.

• Journal of International Academy of Physical Therapy Research
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• v.8 no.2
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• pp.1201-1205
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• 2017

The purpose of this case study was to investigate the effects of thoracic mobilization and manipulation on a patient with upper thoracic pain. The subject had been complaining of upper thoracic pain for the last 4 months. On the X-ray, T3 and T4 spinous process were located on the left side of the vertical axis. First, transverse mobilization was applied from left to right at the T3-T4 and then thoracic manipulation was performed. The intervention methods of mobilization and manipulation were based on the concept of Maitland manual therapy. The subject underwent a total of 20 sessions (five times per week for four weeks). The thoracic pain and vertebral rotation angle were measured to examine the effect of the intervention. The thoracic pain score decreased (from 4.0 to 1.5) and the angle of thoracic vertebral rotation decreased (from $70{\underline{\circ}}$ to $4.0{\underline{\circ}}$). These results suggest that applied mobilization and manipulation in patients with a primary complaint of thoracic pain decreasing the thoracic pain and vertebral rotation angle.

• Journal of the Korean Society of Physical Medicine
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• v.11 no.4
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• pp.1-9
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• 2016

PURPOSE: The aim of this study was to examine the effects of abdominal breathing and thoracic expansion exercises on craniovertebral and cranial rotation angles in patients with rotator cuff injury. METHODS: This study enrolled 19 patients with rotator cuff injury, and ten and nine of the patients were randomly placed in abdominal breathing and thoracic expansion exercise groups, respectively. After pain treatment in each group, breathing exercise was conducted thrice a week for four weeks. The patients were recorded by using a digital camera and Image J (version 1.46, National Institutes of Health, USA), an angle measurement program, was used to analyze changes in the craniovertebral angle, cranial rotation angle, and sagittal shoulder posture. RESULTS: Statistically significant differences in the craniovertebral angle were found in both the abdominal breathing and thoracic expansion exercise groups (p<.05). A significant difference in cranial rotation angle was found in the thoracic expansion exercise group only (p<.05). No statistically significant differences in sagittal shoulder posture were found in both groups (p>.05). CONCLUSION: Although abdominal breathing and thoracic expansion exercises did not effectively change sagittal shoulder posture, the exercises were effective in improving craniovertebral and cranial rotation angles. Therefore, abdominal breathing and thoracic expansion exercises are suggested as effective exercise programs for forward head posture.

• Korean Journal of Applied Biomechanics
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• v.20 no.2
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• pp.197-204
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• 2010

Scapular position and motion are essential for normal upper limb mobility; Further, the posture of patients with thoracic kyphosis is related to shoulder girdle function and disorder. The purpose of this study was to examine the effects of thoracic posture on the shoulder range of motion and on three-dimensional scapular kinematics. Thirty healthy subjects performed right-arm abduction along the frontal plane while standing in both erect and in slouched trunk posture. The scapular position and rotation, and shoulder and thoracic angles were recorded using a motion analysis system. The scapular upward rotation and internal rotation were significantly altered according to postural tatiges; however, scapular tilt was not affected. Shoulder angle was significantly decreased in the slouched posture as c rpared to tatt in the erect posture. Thus, a slouched posture(thoracic kyphosis) significantly affects the shoulder range of motion and scapular kinematics during shoulder abduction in the frontal plane.

• Physical Therapy Korea
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• v.26 no.4
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• pp.53-62
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• 2019

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 $120^{\circ}$ 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.

• Physical Therapy Korea
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• v.26 no.3
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• pp.42-56
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• 2019

Background: Individuals with mechanical neck pain show biomechanical and neurophysiological changes, including cervical spine muscle weakness. As a result of deep muscle weakness, it causes stability disability and reduced upper thoracic spine mobility, which finally leads to functional movement restriction such as limited range of motion and dysfunction. Recent studies have shown that thoracic spine manipulation and mobilization could reduce symptoms of mechanical neck pain in patients. Objects: The purpose of this study was to investigate the effects of thoracic mobility exercise on cervicothoracic function, posture feature, and pain intensity in individuals with mechanical neck pain. Methods: The study subjects were 26 persons who were randomly assigned to the experimental (with thoracic mobility exercise) and control groups (without thoracic mobility exercise), with 13 subjects in each group. The cervicothoracic function (neck functional disability level and cervicothoracic range of motion), posture feature, and pain rating (using a quadrupled visual analogue scale [QVAS]) were measured before, after 3 weeks, and after 6 weeks. Results: Statistically significant group-by-time interactions were found with repeated analyses of variance for the Korean neck disability index (KNDI), all cervical range of motion (CROM), all thoracic range of motion (TROM), cranial rotation angle, sagittal shoulder posture (SSP), and QVAS (p<.05). All groups showed significant improvements from all times in all the evaluated methods. The KNDI, CROM, TROM of left rotation, and SSP in the experimental group showed significant improvements after 3 weeks, and the TROM of the right rotation and QVAS in the experimental group showed significant improvements after 6 weeks when compared with the control group. Conclusion: Thoracic mobility exercise during 6 weeks might be effective intervention to improve the functional level, posture feature, and QVAS pain rating for managing individuals with mechanical neck pain.

• PNF and Movement
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• v.15 no.3
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• pp.381-387
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• 2017

Purpose: Although some studies indicate that the Sorensen test may not be used to examine back muscles such as the erector spinae, alternatives to the back-extension test are rarely suggested. Therefore, the purpose of the present study was to investigate an effective way to stimulate the erector spinae muscles by adding a component of trunk rotation and lateral bending to general back extensions. Methods: A total of 18 healthy, physically active participants performed simple trunk extension, extension with trunk rotation, and extension with lateral bending. Surface electromyography responses of the latissimus dorsi, thoracic, and lumbar levels of the erector spinae; the gluteus maximus; and the biceps femoris muscles were investigated during these 3 conditions of modified back extension tests. Results: The simple trunk extension exercise caused significant increases in activity of the gluteus maximus and biceps femoris muscles as compared to the extension with rotation and lateral bending exercises. The extension with trunk rotation exercise showed significantly greater activation in the thoracic and lumbar levels of the erector spinae and in the latissimus dorsi as compared to the other exercises. The index measuring subjective difficulty was significantly lower in the simple trunk extension exercise as compared to the extension with trunk rotation and extension with lateral bending exercises. Conclusion: The present study suggests that extension with trunk rotation has the advantage of stimulating the para-spinal muscles, while simple trunk extension may not be adequate to selectively simulate the para-spinal muscles but may be appropriate for examining global trunk extensors.

• Korean Journal of Applied Biomechanics
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• v.23 no.4
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• pp.369-376
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• 2013

The purposes of this study were to assess dynamic stability toward pelvis-spine column distortion during running and to compare the typical three-dimensional angular kinematics of the trunk motion; cervical, thoracic, lumbar segment spine and the pelvis from the multi-segmental spine model between exercise group and non-exercise group. Subjects were recruited as exercise healthy women on regular basis (group A, n=10) and non-exercise idiopathic scoliosis women (group B, n=10). Data was collected by using a vicon motion capture system (MX-T40, UK). The pelvis, spine segments column and lower limbs analysiaed through the 3D kinematic angular ROM pattern. There were significant differences in the time-space variables, the rotation motion of knee joint in lower limbs and the pelvis variables; obliquity in side bending, inter/outer rotation in twisting during running leg movement. There were significant differences in the spinal column that is lower-lumbar, upper-lumbar, upper-thoracic, mid-upper thoracic, mid-lower thoracic, lower thoracic and cervical spine at inclination, lateral bending and twist rotation between group A and group B (<.05, <.01 and <.001). As a results, group B had more restrictive motion than group A in the spinal column and leg movement behaved like a 'shock absorber". And the number of asymmetry index (AI) showed that group B was much lager unbalance than group A. In conclusion, non-exercise group was known to much more influence the dynamic stability of equilibrium for bilateral balance. These finding suggested that dynamic stability aimed at increasing balance of the trunk ROM must involve methods and strategies intended to reduce left/right asymmetry and the exercise injury.