Acute effects of scapular mobilization in shoulder dysfunction: a double-blind randomized placebo-controlled trial.

OBJECTIVE: The aim of this study was to evaluate the initial effects of scapular mobilization (SM) on shoulder range of motion (ROM), scapular upward rotation, pain, and function. DESIGN: Pretest-posttest for 3 groups (SM, sham, and control). SETTING: A double-blinded, randomized, placebo-controlled trial was conducted to evaluate the initial effect of the SM at a sports physiotherapy clinic. PARTICIPANTS: 39 subjects (22 women, 17 men; mean age 54.30 +/- 14.16 y, age range 20-77 y). INTERVENTIONS: A visual analog scale, ROM, scapular upward rotation, and function were assessed before and just after SM. SM (n = 13) consisted of the application of superoinferior gliding, rotations, and distraction to the scapula. The sham (n = 13) condition replicated the treatment condition except for the hand positioning. The control group (n = 13) did not undergo any physiotherapy and rehabilitation program. MAIN OUTCOME MEASURES: Pain severity was assessed with a visual analog scale. Scapular upward rotation was measured with a baseline digital inclinometer. Constant Shoulder Score (CSS) was used to measure shoulder function. RESULTS: After SM, we found significant improvements for shoulder ROM, scapular upward rotation, and CSS between pretreatment and posttreatment compared with the sham and control groups. In the sham group, shoulder-ROM values increased or decreased for the shoulder and scapular upward rotation was not changed. Pain, ROM, and physical function of the shoulder were not significantly different in the sham group than in controls (P > .05). CONCLUSIONS: SM may be a useful manual therapy technique to apply to participants with a painful limitation of the shoulder. SM increases ROM and decreases pain intensity.

Effect of trunk-muscle fatigue and lactic acid accumulation on balance in healthy subjects.

OBJECTIVE: This study sought to determine the effects of trunk-muscle fatigue and blood lactic acid elevation on static and dynamic balance. INTERVENTION: Fatigue was induced by an isokinetic protocol, and static and dynamic balance were assessed during bilateral stance using a Kinesthetic Ability Trainer. Subjects participated in a fatigue protocol in which continuous concentric movements at 60 degrees/s were performed until the torque output for both trunk flexion and extension dropped below 25% of the calculated peak torque for 3 consecutive movements. MEASURES: Before and immediately after the fatigue protocol, blood lactic acid measurements and static- and dynamic-balance measurements were recorded. RESULTS: An increase in lactic acid levels was detected in all subjects. According to a dependent-samples t test, significant differences in balance and lactic acid values were found after the fatigue protocol. There was no correlation between lactic acid accumulation (change between prefatigue and postfatigue levels) and balance-score differences. CONCLUSION: Trunk-muscle fatigue has an adverse effect on static and dynamic balance.

Hemodynamic and lactic Acid responses to proprioceptive neuromuscular facilitation exercise.

The hemodynamic and metabolic responses to proprioceptive neuromuscular facilitation (PNF) exercise were examined in 32 male university students (aged 19-28 years). Ten repetitions of PNF exercises were applied to the subjects' dominant upper extremities in the following order: as an agonist pattern flexion, adduction and external rotation; and as an antagonist pattern extension, abduction and internal rotation. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), double product (DP), and blood lactate concentration (La) were determined before, immediately after, and at 1(st), 3(rd), and 5(th) minutes after PNF exercise. A one-way ANOVA with repeated measures indicated significant differences in HR, SBP, DBP, DP and La immediately after PNF exercise. HR increased from 81 (±10) to 108 (±15) b·min(-1) (p < 0.01), SBP increased from 117 (±10) to 125 (±11) mmHg (p < 0.01), DBP increased from 71 (±10) to 75 (±8) mmHg (p < 0.01), DP increased from 96 (±16) to 135 (±24) (p < 0.01), and La increased from 0.69 (±0.31) to 3.99 (±14.63) mmol·L(-1) (p < 0.01). Thus PNF exercise resulted in increased hemodynamic responses and blood lactate concentration that indicate a high strain on the cardiovascular system and anaerobic metabolism in healthy subjects. Key PointsPNF exercises resulted in increased hemodynamic responses.Repeated PNF exercises resulted in an increased blood lactate concentration.

Predictors of job satisfaction among physiotherapists in Turkey.

The aim of this study was to investigate the level of job satisfaction among physiotherapists, and to identify the best predictors of job satisfaction. A self-administrated questionnaire survey was conducted in September 2003. Data were collected from 198 physiotherapists in 13 health care settings (five university hospitals, seven government hospitals, and one municipality hospital) located in Ankara, Turkey. Respondents were asked to complete a 31-item job satisfaction questionnaire. The response rate was 79.8%. The percentage of satisfied physiotherapists was 45.5%. There were no significant satisfaction differences between genders or between age groups. There was a positive relationship between the global satisfaction and domain scores (all ps<0.01). Logistic regression analysis showed that the most important predictors of job satisfaction were: (1) Leadership (OR=1.03, 95% CI 1.01 to 1.06), (2) Interpersonal relationships (OR=1.03, 95% CI 1.00 to 1.05), (3) Advancement (OR=1.02, 95% CI 1.00 to 1.05), and (4) Salary (OR=1.02, 95% CI 1.00 to 1.04). Specific job satisfaction dimensions indicate that highest dissatisfaction levels occur in the area of salary and advancement. Areas of dissatisfaction are signals for change.