• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.24 no.2
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• pp.29-36
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• 2018

Background: The purpose of this study was to investigate the effect of leg lift difference on serratus and upper trapezius when exercising in a scapula in a prone position, a typical waist stabilization exercise for subjects with a winged scapula. Method: Twenty normal adults and 20 subjects with winged scapula participated in the experiment. The surface EMG recordings were obtained from external oblique muscle and internal oblique muscle during scapula protraction exercise. The presence or absence of winging of the shoulder bone was measured using an electronic digital caliper for the distance the medial border of the scapula is lifted to the rear. In prostrate pier movement posture in both groups, both legs supporting, dominant leg lifting, and non-dominant leg lifting including the scapula protraction were conducted respectively. Results: In the results of comparison between the two groups, the dominant external oblique muscle and the non-dominant internal oblique muscle tended to increase according to the difference of the leg lifting of normal people. In the winged scapula group, internal oblique muscle showed increased muscle activity more than external oblique muscle. Conclusion: It was most effective to exercise with lifting the same position leg for strengthening the same external oblique muscle, and the opposite internal oblique muscle. Also, it is effective to exercise in prone pier movement posture for trunk stability. In addition, internal oblique muscle shows increased muscle activity in subjects with winged scapula. Therefore, appropriate adjustment of external oblique muscle and internal oblique muscle may have a positive effect on scapula dysfunction for trunk stability.

• Physical Therapy Korea
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• v.25 no.3
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• pp.39-50
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• 2018

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.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.30 no.2
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• pp.1-12
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• 2024

Background: This study aimed to determine the effects of pectoralis minor stretching, lower trapezius strengthening exercise with serratus anterior strengthening exercise to find an effective therapeutic exercise for alignment, shoulder range of motion, muscle imbalance of rounded shoulder patient. Methods: This study targeted on a total of 28 male subjects, aged 20s and 30s, and randomly divided the subjects into each group, with 14 subjects each. The experimental group performed pectoralis minor stretching, lower trapezius strengthening exercise, and serratus anterior strengthening exercise, while the control group performed pectoralis minor stretching and lower trapezius strengthening exercise. Results: both group showed an increase in active range of motion for shoulder flexion, a muscle activity of the serratus anterior muscle and the lower trapezius muscle, a decrease in muscle activity of the upper trapezius muscle, and a significant improvement in scapular alignment after the intervention. In the comparison between group, the experimental group showed greater increased shoulder joint flexion range of motion, serratus anterior muscle activity, and decreased upper trapezius muscle activity than the control group. Conclusion: Performing serratus anterior strengthening exercises with pectoralis minor stretching and lower trapezius strengthening exercises is effective for improving the active range of motion in shoulder joint flexion and muscle imbalance

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.11 no.2
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• pp.71-82
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• 2005

The couple force of the scapular stabilizers for upward rotation that include the upper and lower trapezius, serratus anterior muscles is essential to maintain the stability of shoulder joint. But if there is an imbalance of these muscles, it would occur many problems of shoulder joint. A push-up plus exercise with an unstable support is used in order to increase the muscle activity and stimulate the proprioception of shoulder joint. The purpose of this study was to compare the muscle activity of upper and lower trapezius, serratus anterior muscles and to determine which exercise is more effective when subjects perform push-up plus exercise in the stable support and unstable support. 15 healthy subjects and 15 painful subjects with injury of shoulder joint participated in this study. Surface electromyography data were collected during plus phase of push-up plus exercise. The types of push-up plus exercise were composed of three conditions. Stable type is subjects performed the push-up plus exercise on the fixed support and unstable type 1 is on the sling without shaking and unstable type 2 is on the sling with shaking by tester's manual. The upper and lower trapezius activities of injured group were higher than uninjured group at three measure conditions, but serratus anterior activities were not. The UT/SA ratio of injured group was higher than uninjured group at three measure conditions. The serratus anterior activities were most high at unstable 2 measure in both groups. The UT/SA ratio was most low at unstable 2 measure condition in injured group only. The present result revealed that push-up plus exercise in the unstable support with shaking which took most high serratus anterior activities and most low of UT/SA ratio is optimal cure method that can improve the imbalance of the scapular stabilizer.

• PNF and Movement
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• v.16 no.1
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• pp.27-32
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• 2018

Purpose: This study examined changes in gait speed and stride length after an intervention involving simultaneous scapular and pelvic patterns of proprioceptive neuromuscular facilitation in a hemiplegic patient. Methods: A 58-year-old woman with left hemiplegia who had complained of slowness of gait speed and weakness of leg strength took part in an intervention involving scapular postdepression patterns on the affected side and pelvic postdepression patterns on the nonaffected side. The intervention was performed with the patient lying on her left side, in a half kneeling position, and in a standing posture. Rhythmic initiation was used for teaching the movements to the patient and improvement of kinesthesia, and a combination of isotonic was employed for increasing strength and irradiation of the scapula and pelvic movement. The intervention took place for 30 min. It was implemented twice a day, 5 days a week, for 3 weeks. After three repetitions, the average time taken to complete the 10-m walk test (10 MWT), in addition to stride length, was measured to determine gait speed. Results: After the 3-week program, the patient's performance in the 10 MWT improved from 21.7sec to 17.1sec, and her stride length improved from 31.4cm to 38.7cm. Conclusion: The results showed that trunk movement exercise, especially coordinative movements of the scapula and pelvis can improve gait speed and stride length by increasing trunk stability and mobility. A combination of pelvic and scapular patterns can facilitate trunk rotation, thereby improving gait speed and stride length.

• Journal of International Academy of Physical Therapy Research
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• v.4 no.2
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• pp.573-587
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• 2013

The purpose of this study was conducted in order to analyze the effects of the manual intervention and self-corrective exercise models of general coordinative manipulation(GCM) on the balance restoration of spine & extremities joints with distortions and mal-alignment areas. The subjects were the members who visited GCM Musculoskeletal Prevent Exercise Center from March 1 2012 to December 31 2013 because of spine & extremities joints distortion and mal-alignments, poor posture, and body type correction. All subjects were diagnosed with the four types of the GBT diagnosis. And according to the standards of the mobility vs stability types of the upper & lower body, they were classified into Group 1(40 persons) and Group 2(24 persons). For every other day for three times a week, GCM intervention models were applied to all subjects for four weeks, adding up to 12 times in total. Then the balance restoration effects were re-evaluated with the same methods. The results are as follows. 1) Balance restoration effects of VASdp(Visual analysis scale pain & discomfort) and ER(Equilibrium reaction: ER) came out higher in GCM body type(GBT) II III IV of Group 1. 2) In case of balance restoration effects in Moire and postural evaluation areas, Group 1 was higher and cervical and scapular girdle were higher in Group 2. The balance restoration of the four GBT types was significant in all regions(p<.05), and the scapular girdle came out as high in the order of GBTII IV I. 3) In case of thoracic-lumbar scoliosis and head rotation facial asymmetric cervical scoliosis ribcage forward, the balance restoration effects of the upper body postural evaluation areas came out the highest in Group 1 and Group 2, respectively. The balance restoration effects of the four GBT types were significant in all regions(p<.05), and came out the highest in lumbar scoliosis GBTIII I, ribcage forward and thoracic scoliosis GBTII IV. 4) The balance restoration effects of the lower body postural evaluation areas came out higher in Group 1 and Group 2 for pelvis girdle deviation patella high umbilicus tilt and hallux valgus foot longitudinal arch: FLA patella direction, respectively. The balance restoration effects of the four GBT types were significant in all regions(p<.05), and came out the highest in pelvis girdle deviation GBTIII I and patella high-direction GBTIV II I. 5) The balance restoration effects between the same GBT came out significant (p<.05) in all evaluation areas and items. The conclusions of this study was the manual intervention and self-corrective exercise models of the GCM about the mal-alignment of the spine & extremities joints across the whole body indicated high balance restoration effects(p<.05) in spine & extremities joints in all evaluation areas.

• Journal of the Korean Society of Physical Medicine
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• v.13 no.3
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• pp.75-80
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• 2018

PURPOSE: Scapular stability is very important to arm function during activities of daily living. The push-up plus exercise is commonly used to stabilize the shoulder muscles. In the present study, we designed an elastic shoulder band (ESB) that could be used with the push-up plus exercise and studied muscle activities of the serratus anterior (SA) and the lower and the upper trapezius (LT and UT) on stable and unstable support. METHODS: Fifteen healthy people participated in this study. Three muscles were investigated using surface EMG with and without the ESB on stable and unstable support. All subjects performed each trial three times for 7 seconds per set and rested for 30 seconds. Repeated one-way ANOVA was used for statistical analyses. RESULTS: The EMG activity of the SA was significantly different during the push-up plus exercise on stable support with the ESB compared with that on unstable support without the ESB (p<.05). However, there were no differences in the activities of UT and LT on stable and unstable support (p>.05). CONCLUSION: The ESB was effective for the activity of SA during the push-up plus exercise on stable support; therefore, it has the potential for use by people during push-up plus exercises. However, further studies are required to investigate the rehabilitation tools for patients with shoulder instability.

• Physical Therapy Korea
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• v.31 no.1
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• pp.55-62
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• 2024

Background: The serratus anterior (SA) is a muscle that performs protraction of the scapulothoracic joint and plays a role in stabilizing the scapula. Imbalances or weaknesses in SA activation are associated with a variety of shoulder dysfunctions, making selective SA strengthening important for rehabilitation. Objects: We aimed to compare the muscle activation of the pectoralis major (PM), SA, external oblique (EO), and internal oblique (IO) during the push-up plus (PUP) exercise with isometric hip adduction (HA) and abdominal drawing-in maneuver (ADIM). Methods: Nineteen healthy male participants performed three PUP exercises: standard PUP, PUP with ADIM, and PUP with HA. Surface electromyography was used to measure and analyze the muscle activity for PM, SA, EO, and IO. Results: PUP with HA showed the lowest PM activity and highest SA activity, and no significant difference was observed between PUP and PUP with ADIM. PUP with ADIM showed significantly the highest EO and IO activity, followed by PUP with HA and PUP. Additionally, PUP with HA showed the lowest PM/SA ratio, and no significant difference was noted between PUP and PUP with ADIM. Conclusion: PUP with HA was able to show high SA muscle activity while reducing PM muscle activity. In addition, PUP with HA can lead to higher EO and IO muscle activity than standard PUP. This exercise could be used as a practical exercise method to selectively strengthen SA and improve scapular muscle stability during early shoulder rehabilitation.

• Journal of the Korea Convergence Society
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• v.9 no.2
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• pp.341-347
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• 2018

The purpose of this study is to examine the change to the muscle activity from the serratus anterior(SA) of 5th and 7th, upper trapezius(UT), middle trapezius(MT) lower trapezius (LT), and pectoralis major(PM) when push-up plus exercise(PUP) is performed in four postures. 25 healthy, young participants performed various PUP convergence exercise(general posture, $90^{\circ}$, $120^{\circ}$ and BOSU). The muscle activity of the shoulder stability muscles was measured using a surface EMG analysis system during various PUP convergence exercise. One-way repeated-measure of ANOVA was conducted to comparison the activity of each muscle. There was significant difference in SA7, PM, UT, and MT (p <.05) during various PUP. The muscle activity of SA7 had a significance difference between PUP and $90^{\circ}PUP$ or BOSUPUP respectively (p <.05). The muscle activity of PM had a significance difference between $90^{\circ}PUP$ and PUP or BOSUPUP (p <.05). The muscle activity of UT had a significance differnce between $90^{\circ}PUP$ and PUP or BOSUPUP (p <.05). The muscle activity of MT had a significance differnce between $90^{\circ}PUP$ and PUP and also significantly difference PUP and $120^{\circ}PUP$(p <.05). These results suggest that general PUP can be a useful to improve to scapular stabilizer muscle in who has no shoulder dysfunction.

• Journal of the Korean Society of Physical Medicine
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• v.13 no.3
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• pp.49-60
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• 2018

PURPOSE: This study was conducted to investigate the intervention effect obtained by applying an ICF tool to improve the dressing in a patient with rotator cuff syndrome to schematize the problems and approaching with PNF to solve the problems. METHODS: The subject of this study was a 44-year-old patient who underwent surgery after complete right rotator cuff tear. To treat his symptoms, the processes of clinical practice were implemented in the order of examination, assessment, diagnosis, prognosis, intervention, and outcome. During examination, patient information was collected using the ICF core set. In the assessment, the problems were schematized, and an ICF assessment sheet was used to identify the interaction of the problems. The diagnosis was made by clearly describing the causal relationship derived from the assessment in ICF terms. To solve the problems, the intervention was given in the order of indirect, direct, and task based on the philosophy of PNF. To evaluate the outcome, the differences before and after the intervention were compared. Additionally, the comparison for the ICF qualifier is presented with the ICF evaluation display. RESULTS: The results of the study showed clinical advantages in shoulder strength, eccentric control, range of motion, scapular stability, and shoulder pain. Overall, our patient with rotator cuff syndrome showed improvement in dressing and undressing activity in response to the PNF strategy. CONCLUSION: Application of the PNF intervention strategy after complete rotator cuff tear would have a positive effect on patient upper extremity function.