The Combined Effect of the Trapezius Muscle Strengthening and Pectoralis Minor Muscle Stretching on Correcting the Rounded Shoulder Posture and Shoulder Flexion Range of Motion among Young Saudi Females: A Randomized Comparative Study.

BACKGROUND: The shortening of the pectoralis minor muscle (PMi-M) and weakening of the lower trapezius muscle (LTr-M) affect scapular movement, resulting in the development of a rounded shoulder posture and reduction in the shoulder flexion range of motion (SFROM). OBJECTIVE: This study evaluated the combined effect of LTr-M strengthening and PMi-M stretching on correcting the rounded shoulder postures and SFROM among young Saudi females. METHODS: This study was based on a two-arm parallel-group repeated measures randomized comparative design. A total of sixty female participants with rounded shoulder postures were recruited and randomly allocated into groups 1 and 2 (n = 30/group). Each group performed supervised PMi-M stretching; however, group 2 performed a combination of LTr-M strengthening and PMi-M stretching. The outcomes, including rounded shoulder posture and SFROM, were assessed using the pectoralis minor length test (PMLT) and universal goniometer. A repeated measure ANOVA was used to compare the differences within-group and between-group for the outcomes measures at one-week (baseline) pre-intervention, two weeks, and three -weeks post-intervention. The significance level was set at q > 2.00 and p < 0.05 for all respective statistical analyses. RESULTS: The within-group comparison revealed significant improvements (q > 2.00) in the outcomes of PMLT and SFROM when comparing their post-intervention scores to the baseline scores. The between-group comparison revealed a significant and an insignificant (q < 2.00) difference in the outcomes of PMLT and SFROM, respectively when comparing their scores at the second- and third-week post-intervention. Furthermore, the effect size of the intervention suggests an advantage of group 2 over group 1 in increasing the resting length of the PMi-M only among young Saudi females. CONCLUSIONS: The combined effect of LTr-M strengthening and PMi-M stretching was more beneficial than PMi-M stretching alone in correcting the rounded shoulder posture among young Saudi females by increasing PMi-M resting length. However, it could not yield a differential improvement in the SFROM outcome among them.

Effectiveness of deep cervical fascial manipulation and yoga postures on pain, function, and oculomotor control in patients with mechanical neck pain: study protocol of a pragmatic, parallel-group, randomized, controlled trial.

INTRODUCTION: Mechanical neck pain (MNP) is a commonly occurring musculoskeletal condition that is usually managed using electrical modalities, joint mobilization techniques, and therapeutic exercises, but has limited evidence of their efficacy. Pathology (densification) of the deep cervical fascia that occurs due to the increased viscosity of hyaluronic acid (HA) may induce neck pain and associated painful symptoms of the upper quarter region. Fascial manipulation (FM) and yoga poses are considered to reduce the thixotropy of the ground substances of the deep fascia and improve muscle function. The purpose of this study is to investigate the effect of FM and sequential yoga poses (SYP) when compared to the usual care on pain, function, and oculomotor control in MNP. METHODS: This FaCe-Man trial will recruit 160 patients with subacute and chronic mechanical neck pain diagnosed using predefined criteria. Participants will be randomized to either the intervention group or the usual care group, using a random allocation ratio of 1:1. Patients in the intervention group will receive FM (4 sessions in 4 weeks) and SYP (12 weeks) whereas the standard care group will receive cervical mobilization/ thoracic manipulation (4 sessions in 4 weeks) and therapeutic exercises (12 weeks). The primary outcome is the change in the numeric pain rating scale (NPRS). The secondary outcomes include changes in the patient-specific functional scale and oculomotor control, myofascial stiffness, fear-avoidance behavior questionnaire, and elbow extension range of motion during neurodynamics test 1. DISCUSSION: If found effective, FM along with SYP investigated in this trial can be considered as a treatment strategy in the management of mechanical neck pain. Considering the magnitude of the problem, and the pragmatic and patient-centered approach to be followed, it is worth investigating this trial. TRIAL REGISTRATION: ClinicalTrials.gov CTRI/2020/01/022934 . Registered on January 24, 2020 with ctri.nic.in. Clinical Trials Registry - India.

The effect of static stretching exercises on hip range of motion, pain, and disability in patients with non-specific low back pain.

PURPOSE: The benefits of providing static stretching exercise targeting the hips in patients with non-specific Low Back Pain (NSLBP) are not well established. The objective of the study was to verify the effects of static stretching on function, pain and range of motion on patients with non-specific Low Back Pain (NSLBP). METHODS: Thirty females with NSLBP were randomly assigned to two control (n = 15) and experimental (n = 15) groups. The experimental group received 3 stretch practice sessions per week for a period of 8 weeks. The Oswestry low back pain Disability Questionnaire (ODI), visual analog scale (VAS), and passive hip range of motion (PROM) were employed before and after the intervention. RESULTS: The results of mixed model analysis of variance indicate that the group × time interactions was not significant (p > 0.05) for all measurement outcomes. However, there was a main effect for Time (ODI: p = 0.002, VAS: p = 0.001, PROM-R: p = 0.016, PROM-L: p = 0.001). Such that the ODI, VAS, PROM-R, and PROM-L were showed significant differences before and after the intervention in the experimental group. CONCLUSIONS: The results demonstrated a significant difference in PROM, pain, and disability after 8 weeks of stretching exercises in participants with NSLBP and limited hip extension. Therefore, it would be reasonable to infer that NSLBP might be partly related to hip flexors tightness.

Reliability of isokinetic tests of velocity- and contraction intensity-dependent plantar flexor mechanical properties.

"Flexibility" tests are traditionally performed voluntarily relaxed by rotating a joint slowly; however, functional activities are performed rapidly with voluntary/reflexive muscle activity. Here, we describe the reliabilities and differences in maximum ankle range of motion (ROMmax ) and plantar flexor mechanical properties at several velocities and levels of voluntary force from a new test protocol on a commercially available dynamometer. Fifteen participants had their ankle joint dorsiflexed at 5, 30, and 60° s-1 in two conditions: voluntarily relaxed and while producing 40% and 60% of maximal eccentric torque. Commonly reported variables describing ROMmax and resistance to stretch were subsequently calculated from torque and angle data. Absolute (coefficient of variation (CV%) and typical error) and relative (ICC2,1 ) reliabilities were determined across two testing days (≥72 h). ROMmax relative reliability was good in voluntarily relaxed tests at 30 and 60° s-1 and moderate at 5° s-1 , despite CVs ≤ 10% for all velocities. Tests performed with voluntary muscle activity were only reliable when performed at 5° s-1 , and ROMmax reliability was moderate and CV ≤ 8%. For most variables, the rank order of participants differed between the slow-velocity, relaxed test, and those performed at faster speeds or with voluntary activation, indicating different information. A person's flexibility status during voluntarily relaxed fast or active stretches tended to differ from their status in the traditional voluntarily relaxed, slow-velocity test. Thus, "flexibility" tests should be completed under conditions of different stretch velocity and levels of muscle force production, and clinicians and researchers should consider the slightly larger between-day variability from slow-velocity voluntarily relaxed tests.

The Addition of Active Stretching to Balance Strategy Exercise is the Most Effective as a Home-Based Exercise Program in Improving the Balance of the Elderly.

Background: The decreased balance in the elderly increases the risk of falling. An effective type of exercise is needed to improve balance for the elderly. Aims: The purpose of this study was to determine the difference in the effectiveness of adding active stretching with dynamic stretching to balance strategy exercise as a home-based exercise program in improving the balance for the elderly. Participants and Methods: This research was a randomized control trial. The participants were 36 elderly selected based on the inclusion and exclusion criteria, divided into three groups. Group 1 was given dynamic stretching exercises to balance strategy exercises, Group 2 was assigned active stretching exercises to balance strategy exercise, and Group 3 was given balance strategy exercise only as a control group. Each group was given different exercises three times a week for 6 weeks. The balance ability of the elderly is measured using a Berg balance scale (BBS). Results: The mean difference scores of BBS before and after exercise with paired sample t-test increased in both groups with P < 0.05. It means that all groups had a significant impact, where the highest different score is in Group 2. The one-way ANOVA test showed a significant difference in the average posttest BBS value between the groups. Furthermore, the data were analyzed by the LSD post hoc test, where the results showed that all groups have significant differences against other groups (P < 0.05), with the best group being Group 2. Conclusion: According to the results, the addition of active stretching exercise to the balance strategy exercise as a home-based exercise program is the most effective in improving balance for the elderly.

Comparison of Two Static Stretching Procedures on Hip Adductor Flexibility and Strength.

It has been shown that acute static stretching (SS) may increase flexibility, improve performance and reduce the risk of muscle strains, but may also result in decreased maximal force output. Literature review revealed little research had specifically been done on the most effective ways to stretch the hip adductor muscles. The purpose was to determine the effects that an acute bout of SS (active vs passive) has on hip adductor flexibility and maintenance of strength. Randomized cross-over study using a 3 × 2 (Condition X Time) repeated measures ANOVA statistical design. Forty healthy and physically active subjects (20 male and 20 female) that screened positive for limited flexibility in hip adductor range of motion (ROM) participated. Following a warm-up, baseline maximal voluntary isometric contraction (MVC) and peak static ROM tests were administered. On separate days subjects randomly performed either 60 seconds of passive SS, active SS, or a time-matched control protocol before post measures were recorded for MVC and ROM. There was a significant time effect (p<0.001) that revealed both types of SS and control resulted in increased ROM pre-to-post (passive = 1.0; active = 1.1; control = 0.6 degrees) with no between condition differences (p=0.171). Neither type of SS resulted in reduced strength. Both methods minimally increased hip adductor flexibility without a decrease in force output. This suggests that individuals do not need to avoid SS for the hip adductors prior to engaging in physical activity for fear of a strength decrement.

Stretch imposed on active muscle elicits positive adaptations in strain risk factors and exercise-induced muscle damage.

INTRODUCTION: Stretching highly-contracted plantar flexor muscles (isokinetic eccentric contractions) results in beneficial adaptations in muscle strain risk factors; however its effects in other muscle groups, and on architectural characteristics and exercise-induced muscle damage (EIMD), are unknown. METHODS: The influence of a 6-week knee extensor training program was studied in 26 volunteers (13 control; 13 experimental). Before and after the training program, passive and maximal isometric and eccentric knee extensor moments and range of motion (ROM) were recorded on an isokinetic dynamometer with simultaneous ultrasound imaging of vastus lateralis (VL). On a separate day, EIMD markers (creatine kinase [CK], delayed onset muscle soreness [DOMS]) were measured before and 24 hours after a 20-minute downhill run. The 6-week training program was performed twice-weekly where five sets of 12 stretches (3 seconds per stretch) were imposed on maximally contracted knee extensor muscles. RESULTS: Significant (P < 0.05) increases in eccentric (29.5%) and isometric (17.4%) moments, ROM (5.2°), stretch tolerance (55.4%), elastic energy storage (73.0%), VL thickness (7.8%), pennation angle (9.0%), and tendon stiffness (8.7%) occurred. No change (P > 0.05) in passive muscle-tendon stiffness (-9.4%) or resting fascicle length (-0.7%) occurred. The downhill run resulted in substantial DOMS and significant increase in CK concentration before the training program (107.6%); however, DOMS was eliminated from the knee extensors and a significantly smaller increase in CK (-70.0%) occurred post-training. CONCLUSION: Positive adaptations in functional and physiological variables confirm that imposing stretch on maximally contracted muscle provides beneficial adaptations likely to mitigate EIMD and injury risk and enhance functional performance.

Global Active Stretching (SGA®) Practice for Judo Practitioners' Physical Performance Enhancement.

In order to analyze the Global Active Stretching (SGA®) practice on the physical performance enhancement in judo-practitioner competitors, 12 male athletes from Judo Federation of Sergipe (Federação Sergipana de Judô), were divided into two groups: Experimental Group (EG) and Control Group (CG). For 10 weeks, the EG practiced SGA® self-postures and the CG practiced assorted calisthenic exercises. All of them were submitted to a variety of tests (before and after): handgrip strength, flexibility, upper limbs' muscle power, isometric pull-up force, lower limbs' muscle power (squat-jump - SJ and countermovement jump - CMJ) and Tokui Waza test. Due to the small number of people in the sample, the data were considered non-parametric and then we applied the Wilcoxon test using the software R version 3.3.2 (R Development Core Team, Austria). The effect size was calculated and considered statistically significant the values p ≤ 0.05. Concerning the results, the EG statistical differences were highlighted in flexibility, upper limbs' muscle power and lower limbs' muscle power (CMJ), with a gain of 3.00 ± (1.09) cm, 0,42 ± (0,51) m and 2.49 ± (0.63) cm, respectively. The CG only presented statistical difference in the lower limbs' test (CMJ), with a gain of 0,55 ± 2,28 cm. Thus, the main results pointed out statistical differences before and after in the EG in the flexibility, upper limbs and lower limbs' muscle power (CMJ), with a gain of 3.00 ± 1.09 cm, 0.42 ± 0.51 m 2.49 ± 0.63 cm, respectively. On the other hand, the CG presented a statistical difference only the lower limbs' CMJ test, with a gain of 0.55 ± 2.28 cm. The regular 10-week practice of SGA® self-postures increased judoka practitioners' posterior chain flexibility and vertical jumping (CMJ) performance.

To Evaluate the Effectiveness of TBTS - A Novel Device to do Self-Stretching of Gastroc-Soleus Muscle in Patients with Equinus Deformity.

INTRODUCTION: Various methods have been used for management of equinus deformity. However, stretching gastroc-soleus muscle and achilles tendon is a difficult task. It is labour intensive, which makes the provision of treatment difficult for many patients. AIM: To study the effectiveness of Tension Bar Tendon Stretch (TBTS) compared to conventional stretching in patients with equinus deformity in terms of improvement in equinus angle and spasticity. MATERIALS AND METHODS: A prospective randomised case control study was done on 16 patients of both the sexes in the age group four years to 56 years. Patients were stratified based on presence or absence of spasticity. Patients were further randomly allotted to the study or control group. Study group received stretching with TBTS in addition to the conventional rehabilitation programme. Patients were assessed in terms of improvement in equinus deformity and spasticity (modified Ashworth scale). These indices were measured at 0 month (pre-treatment), 1 month (post-treatment), and 6 months (follow up). RESULTS: Equinus deformity in patients with spastic equinus changed from 22.4° to 12° in study group while in control group change was from 21° to 17°. The difference was statistically significant with p-value of 0.001. Non-spastic (post accidental) changed from 30° to 15° in study group while in control group change was from 31° to 23° with p-value of 0.001. Modified Ashworth Score (MAS) was assessed only in spastic equinus, while in study group MAS changed from 2.8 to 1.5 and MAS change was 2.6 to 2 in control group; this difference after six months of therapy was statistically significant with a p-value of 0.001. CONCLUSION: TBTS can be an effective tool in rehabilitation of patients having equinus deformity; it provides an effective and patient controlled stretching and no need for a physical therapist. TBTS is a novel but simple instrument that can be made locally by the patient or the family.

Immediate effect of passive and active stretching on hamstrings flexibility: a single-blinded randomized control trial.

[Purpose] This study compared the efficacy of passive and active stretching techniques on hamstring flexibility. [Subjects] Fifty-four healthy young subjects were randomly assigned to one of three groups (2 treatment groups and 1 control group). [Methods] Subjects in the passive stretching group had their knees extended by an examiner while lying supine 90° of hip flexion. In the same position, subjects in the active stretching group extended their knees. The groups performed 3 sets of the assigned stretch, with each stretch held for 10 seconds at the point where tightness in the hamstring muscles was felt. Subjects in the control group did not perform stretching. Before and immediately after stretching, hamstring flexibility was assessed by a blinded assessor, using the active knee-extension test. [Results] After stretching, there was a significant improvement in the hamstring flexibilities of the active and passive stretching groups compared with the control group. Furthermore, the passive stretching group showed significantly greater improvement in hamstring flexibility than the active stretching group. [Conclusion] Improvement in hamstring flexibility measured by the active knee-extension test was achieved by both stretching techniques; however, passive stretching was more effective than active stretching at achieving an immediate increase in hamstring flexibility.

The effect of training in an interactive dynamic stander on ankle dorsiflexion and gross motor function in children with cerebral palsy.

OBJECTIVE: To study the effect of active stretching of ankle plantarflexors using an interactive dynamic stander in children with cerebral palsy (CP). METHODS: Six children in Gross Motor Function Classification System classes I-III, aged 4-10 years, trained intensive active dorsiflexion in an interactive dynamic stander using ankle movement to play custom computer games following a 10-week control period. Gross Motor Function Measure Item Set, gait performance and passive and active dorsiflexion with extended and flexed knee were chosen as outcome parameters. RESULTS: Median active and passive ankle dorsiflexion increased significantly (5 and 10 degrees, respectively) with extended knee. There was a small but clinically significant increase in gross motor function. The intervention had no effect on temporospatial gait parameters. CONCLUSION: In spite of the low number of participants, these results may indicate that intensive active stretching in an interactive dynamic stander could be an effective new conservative clinical treatment of ankle plantarflexor contracture in children with CP.

Reeducação Postural Global: uma revisão da literatura / Global Postural Re-education: a literature review

CONTEXTUALIZAÇÃO: O método de Reeducação Postural Global (RPG) tem sido utilizado na clínica com relatos de benefícios para a prevenção e recuperação de disfunções musculoesqueléticas. Após duas décadas de aplicação, estudos têm verificado sua eficácia no tratamento de diferentes condições clínicas e ele tem sido comparado com outros recursos fisioterapêuticos. Entretanto, são poucos os estudos voltados à comprovação dos princípios defendidos pelo autor do método, o que torna frágeis as argumentações em favor dele. OBJETIVO: Realizar, com base na literatura científica, uma análise crítica dos efeitos da intervenção fisioterapêutica utilizando o método RPG. MÉTODOS: Pesquisaram-se as bases de dados Medline, SciELO, LILACS e PeDRO, de 2000 a 2010, considerando os unitermos: RPG, alongamento global e alongamento ativo. RESULTADOS: Foram encontrados 25 estudos, sendo 13 relacionados ao método RPG e oito aos alongamentos global e ativo, além de três livros e uma tese. Após análise, 20 referências foram utilizadas. CONCLUSÕES: Parte dos estudos aponta que o método RPG é mais efetivo, enquanto outros mostram resultados similares a outros métodos de intervenção fisioterapêutica. Estudos indicam benefícios do método na melhora da força muscular respiratória, expansibilidade torácica, mobilidade toracoabdominal e da pressão respiratória máxima, além de reduzir a dor, a perda de urina em mulheres incontinentes, melhorar a flexibilidade, a atividade eletromiográfica nas disfunções temporomandibulares e a estabilidade postural em alterações ortopédicas de membros inferiores. Limitações metodológicas observadas sugerem a necessidade de maior rigor em futuras pesquisas.

BACKGROUND: The Global Postural Re-education (GPR) method has been widely used in clinical practice, with reported benefits for prevention and rehabilitation of musculoskeletal dysfunctions. In parallel with almost two decades of clinical implementation, research studies have tested and verified the effectiveness of GPR in treating different clinical conditions and have also compared this method with other physical therapy resources. However, few studies focused on the verification of the principles of mechanisms of action defended by the author of the method making the arguments in favor of the method weak. OBJECTIVE: To perform a critical systematic review of the effects of physical therapy intervention that use the GPR method. METHODS: We searched Medline, SciELO, LILACS and PeDRO, from 2000 to 2010, considering the key words: Global Postural Re-education, global and active stretching. RESULTS: We found 25 studies, 13 about GPR and 8 about global and active stretching in addition to three books and a thesis. After analysis, 20 references were included. CONCLUSIONS: Some of the studies indicated that the GPR method was more effective than other physical therapy interventions, while others demonstrated similar results of GPR when compared to other physical therapy interventions. Studies showed benefits of the GPR in improving the respiratory muscle strength, chest expansion, maximal respiratory pressure and in reducing pain, loss of urine in incontinent women, increasing flexibility, the electromyographic activity in temporomandibular disorders and postural stability in lower limb orthopedic alterations. Methodological limitations observed suggest the need for greater rigor in future research.