Is Scapular Stabilization Exercise Effective for Managing Nonspecific Chronic Neck Pain?: A Systematic Review

Scapular stabilization is thought to have an important role in improving pain and dysfunction around the neck and shoulders, but evidence of this is lacking. We aim to systematically review the effect of a scapular stabilization exercise (SSE) on pain and dysfunction in patients with nonspecific chronic neck pain (NP). We searched the PubMed, EMBASE, CINAHL, and Cochrane Library databases using the terms (NP [MeSH] OR NP OR cervical pain OR neck ache OR cervicalgia) AND (scapular exercise OR periscapular exercise OR SSEs). We included suitable studies that met the study’s inclusion criteria. Among the 227 studies identified by our search strategy, a total of four (three randomized controlled studies and one prospective study) met the inclusion criteria. The SSE was intense. It included three sets of 10 repetitions. In most of the studies, the exercises were conducted 3 times per week. Most studies reported that the SSE improved pain and dysfunction in patients with nonspecific chronic NP; however, the reviewed articles did not use the same variables for measurement. Additionally, the sample size was small. Although several studies show that SSE might improve NP and dysfunction, the effects of SSE on pain and dysfunction in the neck region remain unclear because the number of studies was small. Further high-quality studies are necessary to identify the detailed effects of SSE in patients with NP.

Lumbar Extensor Muscle Size and Isometric Muscle Strength in Women with Symptomatic Lumbar Degenerative Diseases

STUDY DESIGN: A cross-sectional design. PURPOSE: To determine the characteristics of lumbar extensor muscle (LEM) size and isometric muscle strength and examine their correlations in women with lumbar degenerative diseases (LDDs). OVERVIEW OF LITERATURE: Many studies have evaluated the relationship between muscle size and strength, but the results have been controversial. METHODS: Seventy-four female patients (mean age, 66 years) who consecutively underwent posterior lumbar interbody fusion (L1–S1) were recruited. The cross-sectional area (CSA) of the back extensor muscles was measured between L1–2 to L5–S1, and the total sum of the CSAs at each disc level was calculated. Back extensor muscle strength was evaluated using a MedX lumbar extension machine. The Oswestry Disability Index (ODI, 0–100) and Visual Analog Scale (VAS, 0–10) of lower back pain were determined. RESULTS: The mean CSAs of the LEM at each level (L1/2–L5/S1) and the total sum were 34.3, 36.3, 35.1, 31.4, 21.9, and 156.2 cm2, respectively. The mean isometric strength at each angle (range, 0°–72°) was 32.5, 50.1, 72.0, 88.7, 100.7, 112.2, and 126.2 ft-lb, respectively. The mean ODI and VAS scores were 54.6 and 6.6, and the mean body weight and body mass index (BMI) were 59.9 kg and 24.9 kg/m2, respectively. The CSAs of the upper lumbar level (L1–4) and the total sum of the CSAs were associated with isometric strength, which was negatively correlated with patients’ age and ODI and positively associated with body weight and BMI, mainly at higher lumbar flexion angles (48°–72°). CONCLUSIONS: In women with LDD, LEM sizes of the upper lumbar levels (L1–4) were larger than those of the lower levels (L4–S1) and were positively associated with muscle strength. The upper lumbar levels in patients with LDDs appear to play a compensatory role when degenerative lesions are present in the lower lumbar levels.

Knee Muscle Strength after Revision Anterior Cruciate Ligament (ACL) Reconstruction: Comparison Primary ACL Reconstruction / 대한스포츠의학회지

The purpose of this study was to assess the knee strength and anterior laxity in between primary and revision anterior cruciate ligament (ACL) reconstruction. It was a cross-sectional study; 28 patients who had undergone revision ACL reconstruction and the another 30 patients who had primary ACL reconstruction once were compared each other which they all had been operated during the same period of season with the same technique in the same hospital. The isokinetic equipment was used to measure the main outcome for knee strength, and KT-2000 arthrometer was used for measuring anterior drawer test in 12 months post-reconstruction surgery. In the anterior drawer test, we found out that there were significantly differences between primary and revision ACL reconstruction groups (1.5±1.1 mm vs. 2.6±1.5 mm, p=0.001). There was no significant difference in the deficits of knee extensor and flexor muscle strength between primary and revision ACL reconstruction. Revision reconstruction groups have more laxity in anterior drawer than primary reconstruction groups. After revision ACL, the deficits of knee extensor and knee flexor muscle strength have no significantly difference from primary ACL reconstruction.

The Effect of Individualized Exercise Parameters Applied to Two Patients Recovering from Implanted Left Ventricular Assist Devices in Korea / 대한스포츠의학회지

Left ventricular assist devices (LVADs) are a treatment option for patients with severe chronic heart failure. These patients are referred to an inpatient cardiac rehabilitation after implantation to improve an aerobic capacity and quality of life (QOL). Several studies have reported that an exercise therapy, which is a component of cardiac rehabilitation, improves exercise capacity and QOL. The LVADs were implanted successfully in a destination therapy in two Korean patients, and these patients were enrolled in the cardiac rehabilitation. After an individualized intervention, they were discharged from improved exercise functional capacity and QOL. This is the first report showing a benefit of the individualized exercise therapy using different parameters after LVADs implantation in Korea.

Accuracy of Four Resting Metabolic Rate Predictive Equations in Obese Women / 대한스포츠의학회지

Calculating the estimated resting metabolic rate (RMR) in severely obese patients is useful, but there is controversy concerning the effectiveness of available predictive equations using body weight. This study compared the accuracy of four commonly used RMR predictive equations to measured RMR. We evaluated the efficacy of RMR equations against indirect calorimetry in forth female obese subjects. The subjects had their RMR measured by indirect calorimetry and compared to the most commonly used prediction equations (Harris-Benedict, Owen, and Mifflin-St Jeor, World Health Organization/Food and Agriculture Organization/United Nations University [WHO/FAU/UNU]). The results shows that Owen and Mifflin-St Jeor equations significantly under-estimated to our measured RMR. However, the WHO/FAO/UNU Equation was the most accurately predictive RMR values (1,543.6+/-110.3 vs. 1,484.3+/-218.3) compared to measured RMR. As based on data, we suggest that WHO/FAO/UNU equation and Harris-Benedicts equation would be most reasonable and useful for Korean obese women.

Gender Differences in Knee Laxity and Function after Anterior Cruciate Ligament Reconstruction / 대한스포츠의학회지

Anterior cruciate ligament (ACL) reconstruction is frequently performed to restore knee stability and function following ACL injury. Little is known about the outcome differences between man and women patients after anterior cruciate ligament reconstruction. Therefore, the purpose of the present study was compared between the genders after a minimum of 1 year following arthroscopic ACL reconstruction. Between 2012 and 2015, 30 men (mean age, 27.0+/-8.7 years) and 30 women (mean age, 25.3+/-7.2 years) who had undergone primary ACL reconstructions were recruited from Samsung Medical Centers. We assessed the knee laxity using the KT-2000 arthrometer, and subjective functional questionnaire was assessed with the Lysholm score and International Knee Documentation Committee (IKDC) subject score. Also we had measured the performance test which is single-leg hop test. As a result, no significant gender differences were found at knee laxity and knee Lyshlom and IKDC score. However, there is significantly difference between men and women with only single-leg hop test. Compared to male patients, female patients reported significantly less single-leg hop distance and less improvement 1 year after reconstruction. Subjective criteria failed to detect clinically significant differences in KT-2000 arthrometer, and subjective functional questionnaire result between men and women. However, we had found that women got less hop distance than men which means more safety functional test must be required before returning to sports.

Characteristics of Back Muscle Strength in Patients with Scheduled for Lumbar Fusion Surgery due to Symptomatic Lumbar Degenerative Diseases

STUDY DESIGN: Cross sectional study. PURPOSE: To evaluate characteristics of back muscle strength in patients scheduled for lumbar fusion surgery. OVERVIEW OF LITERATURE: Little is known regarding muscle strength in patients with symptomatic lumbar degenerative diseases who require fusion surgery. METHODS: Consecutive 354 patients scheduled for posterior lumbar interbody fusion due to symptomatic degenerative diseases were approached for participation. 316 patients were enrolled. Before surgery, muscle strength was assessed by measuring maximal isometric extension strength at seven angular positions (0degrees, 12degrees, 24degrees, 36degrees, 48degrees, 60degrees, and 72degrees) and mean isometric strength was calculated. The Oswestry Disability Index (0-100) and visual analogue scale (0-100) for back pain were recorded. Muscle strength was compared according to gender, age ( or =70 years) and scheduled fusion level (short, or =3). RESULTS: Isometric strength was significantly decreased compared with previously reported results of healthy individuals, particularly at extension positions (0degrees-48degrees, p0.05). Isometric strengths showed significant, but weak, inverse correlations with age and Oswestry Disability Index (r<0.4, p<0.05). CONCLUSIONS: In patients with symptomatic lumbar degenerative diseases, back muscle strength significantly decreased, particularly at lumbar extension positions, and in females and older patients.

Exercise Therapy for an Older Patient With Left Ventricular Assist Device

A left ventricular assist device (LVAD) is a mechanical circulation support implanted for patients with end-stage heart failure. It may be used either as a bridge to cardiac transplantation or as a destination therapy. The health of a 75-year-old man with a medical history of systolic heart failure worsened. Therefore, he was recommended to have implanted a LVAD (Thoratec Corp.) as a destination therapy. After the surgery, he was enrolled in patient cardiac rehabilitation for the improvement of dyspnea and exercise capacity. In results, there is an improvement on his exercise capacity and quality of life. For the first time in Korea, we reported a benefit of exercise therapy after being implanted with a LVAD.

Change of Lumbar Isometric Extensor Strengths after Posterior Lumbar Interbody Fusion in Patients with Lumbar Degenerative Disease

STUDY DESIGN: Prospective cohort study. OBJECTIVES: This study was undertaken to examine changes in lumbar isometric extensor strength after posterior lumbar interbody fusion (PLIF) surgery. SUMMARY OF LITERATURE REVIEW: In most reports, the patients that have undergone PLIF surgery have been shown to have muscle weakness and atrophy. However, the research conducted regarding the changes in muscle strength throughout a follow up period is insufficient. MATERIALS AND METHODS: Forty-nine patients (mean age, 65 years (range, 45 to 77)), scheduled for posterior lumbar interbody fusion due to symptomatic degenerative diseases, were enrolled. Preoperatively and 3, 6, and 12 month after surgery, lumbar isometric extensor strength was assessed using a MedX instrument in 7 angular positions (0-72degrees). The mean isometric strength and rate of increase were calculated. Isometric strengths were compared according to patients' age ( or =70 years) and fusion level (short: or =3) and the respective relationships were analyzed. RESULTS: The mean isometric strength changed from 89.0 preoperatively to 85.3, 110.4, and 120.8 ft-lb at each follow-up, respectively. The rate of increase of strength was significantly greater at 0degrees(36.1 %) than at 72degrees(24.2 %) (p=0.019). Preoperative isometric strengths were similar in each age and fusion level group, but isometric strengths at the final follow-up were significantly lower in older patients and in the long level fusion group (p=0.002 and 0.043, respectively). Mean isometric strength at the last follow-up showed significant associations with age and fusion level (r=-0.431 and -0.317, p=0.002 and 0.030, respectively). CONCLUSION: After lumbar fusion surgery, back muscle strength slightly decreased until 3 months and then significantly increased. However, postoperative strength increases were lower in older patients and those in the long level (>3) fusion group. These results could be basic data for a rehabilitation program after lumbar fusion.

The Correlation of the Evaluation of Quality of Life Depends on Knee Strength after 1-Year an Anterior Cruciate Ligament Reconstruction / 대한스포츠의학회지

The life situation has been changed in patients who underwent anterior cruciate ligament (ACL) rupture and subsequent reconstruction. The main purpose of this study was to assess the quality of life (QOL) of patients with ACL reconstruction through Short-Form 36 (SF-36) survey. And secondary aim was to investigate a relationship between health-related QOL survey and the correlation of results with other clinical test. 70 patients (age, 32.0+/-11.7 years) with an after 1 year ACL reconstruction participated in this study. As clinical evaluations, the SF-36 Questionnaire was used for the QOL and isokinetic strength test was performed for the knee extensors and flexors. And the anterio tibial translation was measured by KT-2000. Spearman's correlation coefficient showed significant correlations between knee strength (extensor and flexor) deficit and SF-36 score including physical functioning, bodily pain, vitality, social function score (p0.05). In conclusion, the Knee strength is significantly associated with QOL. Therefore after ACL reconstruction, a speedy recovery of muscular strength will help to improve the QOL.

The Clinical Outcomes of Exercise Therapy for a Soccer Player with Stress Fracture of Superior Pubic Ramus / 대한스포츠의학회지

Stress fractures are common injuries that begin with repetitive and excessive stress on the bone. It is very rare that stress fracture was occurred in pubis superior ramus in athletics, and the report concerning the exercise therapy for this fracture was not sufficient in the literature. We report of a case of a 17-year-old male soccer player who suffered from left inguinal pain due to the stress fracture of pubis superior ramus. He was conducted an exercise program that consisted of muscle strength, stretching, aerobic and functional exercise for 2 months. After this intervention, all muscle strength was significantly improved (17%) compared to baseline data, and also flexibility and range of motion were improved. This case shows that exercise therapy considered the cause and cyclic formation of bone remodeling is benefit to improve the exercise performance for a soccer player with superior ramus stress fracture.

The Effects of Knee Pain on the Quadriceps Strength, Proprioception and Balance in Patients with Knee Osteoarthritis / 대한스포츠의학회지

The purpose of this study was to assess the effects of knee pain on the quadriceps strength, proprioception and balance in subjects with bilateral knee osteoarthritis and the correlation between muscle strength, proprioception, and balance in knee osteoarthritis patients with knee pain. The inclusion criteria were symptomatic and radiographic bilateral knee osteoarthritis (Kellgren-Lawrence grade > or =2), visual analogue scale difference of the both knees > or =2. Thirty three participants (32 women, 1 men: mean age, 59.18 years) underwent assessment of maximal voluntary contraction of quadriceps and hamstring muscles, knee proprioceptive acuity (measure passive joint reposition sense) and balance index using Biodex System 3 isokinetic dynamometer and Biodex balance System. In this study, the more pain knee had weaker quadriceps strength than less pain knee (p0.05). Poor proprioception was associated with low quadriceps strength and poor Medio-lateral Stability Index (p<0.05). Future studies needed to account the influence of pain on neuromuscular factors as well as attempt to further clarify the relationships between these factors.

Effects of Preoperative Quadriceps Strength on the Knee Functional Scores One Year after Anterior Cruciate Ligament Reconstruction / 대한스포츠의학회지

To identify how influence preoperative predictable factors for knee function after one year of anterior cruciate ligament reconstruction (ACLR). The purpose of this study is to investigate the relationship of preoperative quadriceps strength and post-operative knee function scores (Lysholm score and International Knee Documentation Committee [IKDC] score) after surgery. We extracted seventy-one subjects who underwent hamstring autograft reconstruction to evaluate randomly. Muscle strength deficits were measured with CSMI isokinetic dynamometer. One year after ACLR, we collected these scores from subjects completed. After identification of baseline independent variables between quadriceps muscle strength deficits and both Lysholm score and IKDC score, we examined that how relevant influence in these relationship with these factors by classifying quartile groups. We demonstrated that quadriceps muscles strength and knee function scores were identified as significant correlation. It was compared with quartile outcome in order to analyze that how different result comes out as a degree of deficit. As a result, the only Q1 group who indicated less quadriceps muscle strength deficit (within 23% deficits) effected to knee function scores after one year surgery. The less of quadriceps muscle strength deficit indicated before surgery, the better functional knee score level turns up. Therefore, the result verified that there are significantly positive influences between these relationships after one year of ACLR.

The Effects of Knee Pain on the Quadriceps Strength, Proprioception and Balance in Patients with Knee Osteoarthritis / 대한스포츠의학회지

The purpose of this study was to assess the effects of knee pain on the quadriceps strength, proprioception and balance in subjects with bilateral knee osteoarthritis and the correlation between muscle strength, proprioception, and balance in knee osteoarthritis patients with knee pain. The inclusion criteria were symptomatic and radiographic bilateral knee osteoarthritis (Kellgren-Lawrence grade > or =2), visual analogue scale difference of the both knees > or =2. Thirty three participants (32 women, 1 men: mean age, 59.18 years) underwent assessment of maximal voluntary contraction of quadriceps and hamstring muscles, knee proprioceptive acuity (measure passive joint reposition sense) and balance index using Biodex System 3 isokinetic dynamometer and Biodex balance System. In this study, the more pain knee had weaker quadriceps strength than less pain knee (p0.05). Poor proprioception was associated with low quadriceps strength and poor Medio-lateral Stability Index (p<0.05). Future studies needed to account the influence of pain on neuromuscular factors as well as attempt to further clarify the relationships between these factors.

Effects of Preoperative Quadriceps Strength on the Knee Functional Scores One Year after Anterior Cruciate Ligament Reconstruction / 대한스포츠의학회지

To identify how influence preoperative predictable factors for knee function after one year of anterior cruciate ligament reconstruction (ACLR). The purpose of this study is to investigate the relationship of preoperative quadriceps strength and post-operative knee function scores (Lysholm score and International Knee Documentation Committee [IKDC] score) after surgery. We extracted seventy-one subjects who underwent hamstring autograft reconstruction to evaluate randomly. Muscle strength deficits were measured with CSMI isokinetic dynamometer. One year after ACLR, we collected these scores from subjects completed. After identification of baseline independent variables between quadriceps muscle strength deficits and both Lysholm score and IKDC score, we examined that how relevant influence in these relationship with these factors by classifying quartile groups. We demonstrated that quadriceps muscles strength and knee function scores were identified as significant correlation. It was compared with quartile outcome in order to analyze that how different result comes out as a degree of deficit. As a result, the only Q1 group who indicated less quadriceps muscle strength deficit (within 23% deficits) effected to knee function scores after one year surgery. The less of quadriceps muscle strength deficit indicated before surgery, the better functional knee score level turns up. Therefore, the result verified that there are significantly positive influences between these relationships after one year of ACLR.

Perception of Balance Training and Evaluation / 대한스포츠의학회지

The purpose of this study was to survey the athletic trainers' recognition, need and evaluation for balance training and to investigate training and evaluation methods in the actual implementation. One hundred fifty trainers were participated in the survey. The study questionnaire of 24 encompassed five separated issues; basic characteristics of trainers, awareness and the need for balance, balance assessment and training content, assessment and training equipment, and education and need. Balance training were recognized as simple balance training in 20.7% of trainers, and as proprioception in 64.9%. Trainers with high needs of balance training were 69.4%. The percentage of trainers with protocol of balance training were 73.9%, and the trainers with complex equipments including software and hardware were 66.7%. Trainers with needs of education for training protocol, theoretical education for balance, and training equipment were 79.3%, 56.8%, and 63.1%. The results showed that educations for concept of balance training and sports injury rehabilitation, and research opportunities had to be provided to athlete trainers. We think that the results of this study can help athlete trainers to apply high-quality sports rehabilitation for athletes.

Proprioceptive and Strength Comparison of Remnant Preserved versus Conventional Anterior Cruciate Ligament Reconstruction / 대한스포츠의학회지

Reconstruction of the anterior cruciate ligament (ACL) restores knee stability. The remnant preserving technique was developed to preserve mechanoreceptor function, promote revasularzation and facilitate ligamentation. The purpose of this study was to analyze the clinical results of ACL reconstruction with remnant preserving. Between October in 2008 and September in 2009, 40 patients underwent ACL reconstruction using auto graft-hamstring tendon. On the basis of the ACL's condition patients were divided into 2 groups. In the trial group (preserved remnant group, PRG; n=20), there were 20 males with an average age of 26.2 years. In the control group (no remnant group, NRG; n=20) were 20 males with an average of age 27.1 years. We measured concentric peak torque of the knee extensors and flexors at 60degrees/s and 180degrees/s on an Isokinetic dynamometry. Proprioceptive functions have been assessed using Joint position sense and threshold to detection of passive motion. Dynamic postural stability was measured as a stability index in the anterior-posterior and medial-lateral planes with the Biodex Stability System. All tests were measured post-operative 1year. We found significant difference between the PRG and NRG for Joint position sense at 15degrees (2.40degrees+/-1.00degrees vs. 3.36degrees+/-0.95degrees; p=0.0145) and threshold to detect passive motion at 45degrees (2.02degrees+/-0.59degrees vs. 3.12degrees+/-0.94degrees; p=0.0213). But, we found no significant difference between the groups for the test results of the dynamic postural stability and knee strength. Therefore, preservation of the remnant ACL reconstruction is helpful in preserving the proprioception and function to stabilize the knee.

Present and future of sports medicine

No abstract available.

Sports Injury Surveillance during Summer Asian Games 2010 in Guangzhou / 대한스포츠의학회지

The purpose of this study was to do the surveillance study of sports injuries which were suffered to National players of South Korea Team during the summer Asian Games 2010 in Guangzhou. All medical staffs of Korea Delegation were asked to report all sports injuries newly incurred during the Games on injury report form, and the physicians made clinical diagnoses of the injuries. Total 725 injuries (430 athletes) were reported, and 288 injuries (209 athletes) were newly incurred: 68 injuries (58 athletes) were recurrent with previous history, resulting in total incidence rate: 45.5 injuries/1000 athlete exposures (AE) (95% confidence interval [CI]: 40.1-50.6 injuries/1000 AE) and incidence proportion: 26% (95% CI: 23-29). The new injury was highest in athletics (n=37, 12.8%), hockey (n=26, 9.0%), and basketball (n=23, 8.0%). While 162 injuries (56.2%) were incurred during practice, 126 injuries (43.8%) were incurred in competition. The most frequent diagnoses were lateral ankle ligament sprain (n=28, 9.7%, 95% CI: 6.3-13.1), calf muscle cramp (n=23, 95% CI: 4.9-11.1), and hamstring strain (n=22, 95% CI: 4.6-10.7). The relapsed injury was highest in athletics (n=16, 23.5%), basketball (n=6, 8.8%), and wrestling (n=5, 7.4%). While 50 injuries (73.5%) were recurred during practice, 18 injuries (26.5%) were recurred in competition. The most frequent diagnoses of relapsed injury were calf muscle cramp (n=11, 16.2%, 95% CI: 7.4-25.0), low back strain (n=6, 8.8%, 95% CI: 2.1-15.6), and hamstring strain (n=6, 8.8%, 95% CI: 2.1-15.6). Our data indicated incidence rates, incidence proportions, characteristics and frequent diagnoses of acute and recurrent sports injuries during the games, therefore these results could provide relevant information for the sports injury prevention at elite level.

Orthopedic disease and sports medicine related to lower limbs

In this study, the cause, diagnosis, and treatment of common lower limb injuries during the sports activities were presented. Sports injuries of the lower limbs are the most common injuries in the sports medicine field due to the high level of use of the lower limbs during sports activities. The common causes of leg injuries in athletes are traumatic force over the critical limit of normal tissue, repetitive microtrauma, and overuse. Common hip and pelvis problems encountered by the authors include trochanteric bursitis, snapping hip syndrome, and labral tears. The anterior and posterior cruciate ligaments, medial and lateral collateral ligaments, and meniscus have been most frequently involved in sports injuries affecting the knees. Lateral ankle sprain represents one of common injuries in the athletic population. Common overuse injuries are tendinopathies, stress fractures, chronic exertional compartment syndrome, and shin splints. Athletic activity provides a variety of positive benefits to participants' health. To safely continue those activities, an injury prevention program focusing on injuries that may occur in specific sports activities is recommended for participants. Early diagnosis and proper treatment are also important in promoting prompt recovery and preventing secondary injuries.