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.

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.

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.

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.

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.