Effect of adding diaphragmatic breathing to corrective exercises on kyphotic angle and diaphragmatic excursion in postmenopausal kyphotic women: A randomized controlled trial.

BACKGROUND: Age-related thoracic kyphosis can impair posture, diaphragmatic excursion, respiratory function, and overall quality of life (QoL). PURPOSE: This randomized controlled trial aimed to compare the effects of corrective exercises alone versus combined with diaphragmatic breathing exercises on thoracic kyphosis, diaphragmatic excursion, thoracic pain, and QoL in postmenopausal kyphotic women. METHODS: Forty postmenopausal women diagnosed with thoracic kyphosis were randomly divided into two groups. Group A received corrective exercises for 12 weeks (n = 20), while Group B received both diaphragmatic breathing exercises and corrective exercises for the same duration (n = 20). Primary outcome measures were thoracic kyphosis angle and diaphragmatic excursion, while secondary outcome measures were thoracic pain and QoL. Both groups were assessed pre- and post-intervention using a flexible curve ruler for the thoracic kyphosis angle, ultrasonography for the diaphragmatic excursion, the visual analog scale for thoracic pain, and the Arabic version of the QoL Questionnaire of the European Foundation for Osteoporosis for QoL. RESULTS: Both groups showed significant within-group improvements in all measures post-intervention (p < 0.05). Between-group comparisons post-intervention revealed no significant differences (p > 0.05) except for diaphragmatic excursion, where Group B showed significantly greater improvement (p < 0.05). CONCLUSIONS: A 12-week program of corrective exercises alone or combined with diaphragmatic breathing exercises significantly improved kyphosis angle, thoracic pain, and QoL in postmenopausal kyphotic women. The addition of diaphragmatic breathing exercises provided further benefits by increasing diaphragmatic excursion to a greater degree compared with corrective exercises alone.

Evaluation of the effect of corrective exercise intervention on musculoskeletal disorders, fatigue and working memory of office workers.

Objectives: The present study aimed to investigate the effect of corrective exercise intervention (corrective exercise reminding and training software) on musculoskeletal disorders (MSDs), fatigue, posture and working memory among office workers. Methods: A total of 66 office workers participated in the present study. Data collection was carried out using questionnaires (including the Nordic musculoskeletal questionnaire, multidimensional fatigue inventory and Borg rating scale), direct observations of work postures using rapid upper limb assessment (RULA) and rapid office strain assessment, and the n-back test. Results: There was a significant difference between the two groups (intervention and control) in terms of the severity of musculoskeletal discomfort after the intervention. There was a significant decrease in the mean score of trunk posture and the total RULA score in the intervention group after the intervention. The severity of perceived discomfort in all areas except the knee declined during the intervention. There was also a significant difference in physical and mental fatigue scores before and after the intervention. There was a significant difference in the accuracy score of office workers after the intervention compared to before the intervention. Conclusions: Overall, the results confirm the effectiveness of this low-cost, simple and easy-to-use ergonomic intervention.

The effect of saffron and corrective exercises on depression and quality of life in women with multiple sclerosis: A randomized controlled clinical trial.

Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system which causes various complications such as reduced ability to do daily activities, depression and early death of patients. The present study aimed to compare the effect of saffron and corrective exercises on depression and quality of life in women with MS. This randomized controlled clinical trial was conducted on 80 MS women for 12 weeks. Participants were selected through convenience sampling and allocated into four study groups (three intervention groups and one control group) using the stratified block randomization. The Expanded Disability Status Scale, Beck Depression Inventory and The Multiple Sclerosis Impact Scale were used to collect data at the start of the study and also at the end of the sixth and the twelfth weeks. At the end of the twelfth week, the depression mean scores in all experimental groups (saffron group, corrective exercises group, corrective exercises + saffron group) were significantly different compared to the control group (P < 0.05), and this difference in corrective exercises + saffron group was more than the others. Also, at the end of the twelfth week, the mean scores of the quality of life (both physical and mental dimensions) in all experimental groups were significantly different from the control group (P < 0.05). The saffron group in physical dimension and the corrective exercises + saffron group in psychological dimension showed a significant difference with other groups. Although each of the corrective exercises program and saffron consumption alone were effective in reducing depression and enhancing the quality of life in MS patients, the consequences will be more beneficial in case these two interventions are used together. Therefore, it is necessary to encourage MS patients to consume saffron supplement along with doing physical activities in caring and rehabilitation programs.

Effects of Corrective Exercises on Work-Related Musculoskeletal Disorders and Quality of Life in Surgical Residents: A Pilot, Quasi-Experimental Study.

PURPOSE: Work-related musculoskeletal disorders (WMSDs) are one of the most important reasons for absenteeism, high costs of health care and human injuries; the latter are very common in medical staff. The present study was designed to evaluate the effects of corrective exercises on quality of life and work-related musculoskeletal disorders in surgical residents. METHODS: In a quasi-experimental study with a one-group pretest-posttest design, we assessed the eligibility of 135 surgical assistants. All recruited participants performed corrective exercises and were followed for 12 months. The primary outcome of the study was any change in the surgical residents' work-related musculoskeletal disorders, which was assessed using the Nordic Musculoskeletal Questionnaire (NMQ) and the Numerical Pain Rating Scale (NPRS) prior to, and 3, 6, and 12 months after intervention. The secondary outcome was any change in the surgical residents' quality of life (QOL) score, which was assessed at baseline, 6 and 12 months after the intervention using the World Health Organization Quality of Life - BREF (WHOQOL-BREF) questionnaire. RESULTS: One hundred eligible surgical residents were enrolled, of whom 67 (67%) completed the study. At baseline the majority of the participants were female and >30 years of age. Fifty-five percent of them used analgesic drugs. The use of analgesic drugs per week fell by 14.7% from baseline to 12 months; the change was statistically significant (p = 0.042). The effect of corrective exercises on the intensity of pain in the shoulder (p = 0.002), hand/wrist (p = 0.001), upper back (p = 0.03), lower back (p = 0.02) and knee (p = 0.01) was significant. Corrective exercises also led to a significant rise in the quality-of-life score (p < 0.019). CONCLUSIONS: This study demonstrated the effectiveness of corrective exercises in reducing work-related musculoskeletal disorders and improving quality of life among surgical residents.

Corrective exercises administered online vs at the workplace for pain and function in the office workers with upper crossed syndrome: randomized controlled trial.

OBJECTIVE: To evaluate the effects of online-supervised versus workplace corrective exercises on neck-shoulder pain (NSP), sick leave, posture, workability, and muscular activity among office workers with the upper crossed syndrome (UCS). METHODS: We performed a parallel-group randomized control trial at Shahid Beheshti University, Tehran, Iran, assigning 36 office workers to online-supervised, workplace, and control groups (mean (SD) age 38.91 ± 3.87, 38.58 ± 7.34, 37.00 ± 8.12). Inclusion criteria were alignment alteration (forward head (≥ 45°), rounding shoulder (≥ 52°), rounding back (≥ 42°), and pain intensity ≥ 3 in neck and shoulder. The two intervention groups performed 8-week exercise program, while the control group continued usual activities. Primary (NSP and sick leave) and secondary outcomes [postural angles, workability, and muscular activity were measured by VAS, outcome evaluation questionnaire (OEQ), photogrammetry, workability index, and EMG, respectively, at the baseline and an 8-week follow-up]. RESULTS: ANCOVA results revealed improvements for the online-supervised group versus control for NSP (P = 0.007), postural angles (P = 0.000, P = 0.001, P = 0.005), workability (P = 0.048, P = 0.042), and upper trapezius activation (P = 0.024, P = 0.016), respectively. Using paired t tests, both intervention groups improved from baseline to follow-up for NSP (P = 0.000, P = 0.002), forward head posture (P = 0.000, P = 0.000), round shoulders (P = 0.001, P = 0.031), and round back (P = 0.034, P = 0.008), respectively. Related parameters of workability (P = 0.041, P = 0.038), upper trapezius (P = 0.005, P = 0.005, P = 0.022), and serratus anterior (P = 0.020, P = 0.015) changed only in the online-supervised group. CONCLUSION: Online-supervised corrective exercise seems to improve a range of parameters related to work performance. These findings are highly applicable in light of the ongoing COVID pandemic; many workers have to work from home.

Regular School Sport versus Dedicated Physical Activities for Body Posture-A Prospective Controlled Study Assessing the Sagittal Plane in 7-10-Year-Old Children.

Body posture develops during the growing period and can be documented using trunk photography. The study aims to evaluate the body posture in children aged 7-10 years undergoing a dedicated physical activities program versus regular school sport. A total of 400 children, randomly chosen from a cohort of 9300 participating in a local scoliosis screening program, were evaluated twice at a one-year interval. A total of 167 children were involved in regular school sport (control group), while 233 received both school sport and a dedicated physical activities program (intervention group). Standardized photographic habitual body posture examination was performed at enrollment (T0) and one-year after (T1). Sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), chest inclination (CI), and head protraction (HP) were measured. At T0, the body posture parameters did not differ between groups. At T1 in the controls, all five parameters tended to deteriorate (insignificant): SS p = 0.758, LL p = 0.38, TK p = 0.328, CI p = 0.081, and HP p = 0.106. At T1 in the intervention group, the SS decreased (p = 0.001), the LL tended to decrease (p = 0.0602), and the TK, CI, and HP remained unaltered. At T1, the SS and LL parameter differed between groups statistically (p = 0.0002 and p = 0.0064, respectively) and clinically (2.52° and 2.58°, respectively). In 7-10-year-old children, participation in dedicated physical activities tends to improve their body posture compared to regular school sport.

Online supervised versus workplace corrective exercises for upper crossed syndrome: a protocol for a randomized controlled trial.

BACKGROUND AND OBJECTIVE: Musculoskeletal disorders (MSDs) including upper crossed syndrome (UCS) are considered as the leading cause of work-related issues worldwide among office workers. Therefore, the present study aims to evaluate the effect of workplace-based versus online-supervised home-based corrective exercises among office workers with UCS. METHODS AND DESIGN: To this end, 45 subjects within the age range of 30-45 years are randomly assigned to three groups in the present parallel-group, randomized control trial using a pretest-posttest design. These groups include the subjects who receive online-supervised exercise and workplace exercise containing three sessions of intervention for 8 weeks and the control group receives no intervention while performing routine activities. The primary outcome variables are neck-shoulder pain (NSP) and consequent sick leave due to NSP, followed by alignment, workability, and the surface electromyography of upper, middle, and lower trapezius (UT, MT, and LT), sternocleidomastoid (SCM), and serratus anterior (SA) as the secondary variables. DISCUSSION: The present study seeks to assess the effect of workplace versus online-supervised corrective exercise interventions among 45 office workers suffering from UCS. It is expected to improve and reduce the related symptoms including postural malalignment and imbalance muscles after 8 weeks of corrective exercises. If effective, the findings may lead to adherence and work performance among the office workers, and individuals subjected to UCS can use the benefits of an online-supervised intervention. In addition, the findings may be useful in different workplaces as the evidence for employers to benefit from the reduction in the related costs and side effects of work-related neck/shoulder disorders including work disability, productivity loss, time expense, social insurance, work absenteeism, and treatment costs. Finally, clinicians and corrective exercise therapists can consider it as a clinical based-evidence intervention for their further actions. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20200729048249N1. Registered on 5 October 2020 ( https://en.irct.ir/user/trial/49992/view ).

The effect of core stability-based corrective exercises on gait parameters in elite soccer players diagnosed with Middle Crossed Syndrome.

BACKGROUND/AIMS: The aim of this study was to investigate the effect of eight weeks of core stability-based corrective exercises, on gait parameters in elite soccer players diagnosed with middle crossed syndrome. METHODS: 15 male elite soccer players (aged 18-28) were enrolled in a same-subject intervention trial to assess if the middle crossed syndrome could be influenced through core stability exercise. Core stability-based corrective exercises were completed 3 times per week for 8 weeks and changes in gait parameters (pre- and post- intervention) were measured. RESULTS: The results showed that most gait parameters including stride length (p = 0.025), gait speed (p = 0.023), number of strides (p = 0.007), length of shots (p = 0.003), and also soccer players' height (p = 0.011) improved significantly in post-intervention in comparison to pre-intervention. Stride width in post-intervention did not show changes in comparison with pre-intervention (p = 0.083). CONCLUSION: The results indicate the significant effectiveness of core stability-based corrective exercises on gait parameters in those with middle crossed syndrome. By doing corrective exercises based on core stability during the study period, gait parameters in the post-intervention surpass the results in the pre-intervention in most parameters. Therefore, it is proposed that corrective exercises based on core stability is a safe and useful method for improving function in those with middle crossed syndrome and it could be used as a therapy to help players identified with this finding. In this regard, it is suggested to researchers and coaches to correct imbalances in order to achieve better results in training programs.

The comparison of two corrective exercise approaches for hyperkyphosis and forward head posture: A quasi-experimental study.

BACKGROUND: Hyperkyphosis (HKP) and forward head posture (FHP) occur due to prolonged poor postures and repetitive activities. OBJECTIVE: The present study aimed to compare the effects of the National Academy of Sports Medicine (NASM) and Sahrmann corrective exercises on HKP and FHP correction. METHODS: This quasi-experimental study was conducted on 30 subjects with HKP and FHP, who were randomly assigned to the NASM (n= 15) and Sahrmann groups (n= 15). The ImageJ software and a spinal mouse device were used to measure FHP and HKP deformities, and neck and shoulder muscle strength, range of motion (ROM), and pulmonary function were assessed as the secondary outcomes before and after the eight-week intervention. RESULTS: FHP improved more significantly in the Sahrmann group compared to the NASM group (P< 0.05), while no significant difference was observed between the groups in HKP (P> 0.05). The improvement in the neck and shoulder muscle strength was more significant in the Sahrmann group compared to the NASM (P< 0.05), except for the neck flexors. In addition, the neck extension ROM enhanced more significantly in the Sahrmann group compared to the NASM group (P< 0.05). CONCLUSION: According to the results, the Sahrmann corrective exercises that focused on the correction of imbalanced muscle stiffness had more significant effects on the correction of FHP, neck and shoulder muscle strength and neck extension ROM.

Active straight leg raising (ASLR) competence improves with reverse-ASLR exercises and not repeating ASLR exercises.

In the Functional Movement Screen (FMS), a subgroup of those with a score of 1 due to limitations in the active straight leg raising (ASLR) but not in the passive straight leg raising is considered to have a stability or motor control dysfunction (SMCD). The FMS proposes the use of the movements in a reverse pattern to improve FMS scores. The aim of this study was to investigate whether the reverse pattern of the ASLR (reverse-ASLR) was more effective than repeating the ASLR to improve the FMS score in participants with the FMS ASLR score of 1 due to the SMCD (ASLR-1-SMCD). A two-armed randomized controlled trial was conducted in individuals with the ASLR-1-SMCD. The intervention was either the reverse-ASLR or the ASLR exercise on both sides at home for a month followed by a 1-month wait-and-see interval, wherein the primary outcome measure was the right FMS ASLR score. Forty participants were randomized to the ASLR exercise group (n=20) or the reverse-ASLR exercise group (n=20). The Fisher exact test demonstrated a statistically significant difference (P=0.020) in the proportion of those with FMS ASLR score improvement to a score of 2 (ASLR exercise group, one; reverse-ASLR exercise group, eight) at follow-up 1, but no significance (P=0.106) at follow-up 2 (ASLR exercise group, none; reverse-ASLR exercise group, four). This study indicated that the reverse-ASLR exercise was more effective than repeating the ASLR exercise in order to improve the ASLR score among individuals with the ASLR-1-SMCD.

Corrective Exercises or Ergonomic Principles for Workers with Low Back Pain.

INTRODUCTION: Work-related musculoskeletal disorders (WRMSD) are considered the main cause of occupational diseases. Health care workers, nursing assistants, and service forces that perform manual labor are the most vulnerable to musculoskeletal disorders, especially low back pain, due to the nature of their jobs. The purpose of this study was to compare the effectiveness of corrective exercise training to ergonomic principles training on low back pain in nursing assistants and service forces. METHODS: A nonrandomized clinical trial study was done on 75 staff (nursing assistants and service forces) with low back pain. The participants were divided into three groups: corrective exercise training, ergonomic principles training, and control group. Pain intensity and disability questionnaires were completed before and after 8 weeks of intervention by each group and analyzed. RESULTS: The mean intensity of pain after intervention in corrective exercises group (3.8 ± 1.5) was markedly less than the ergonomic group (4.7 ± 1.4) and control group (5.5 ± 1.7) (P = 0.001). The mean disability score after intervention in the corrective exercises group (17.3 ± 9.6) was significantly less than the ergonomic group (21.8 ± 12.6) and control group (25.3 ± 11.2) (P < 0.001). CONCLUSION: While corrective exercises training and ergonomic principles training both have a significant effect on reducing the severity of pain and disability caused by low back pain, corrective exercises training is more effective than ergonomic principle training.

The effectiveness of a comprehensive corrective exercises program and subsequent detraining on alignment, muscle activation, and movement pattern in men with upper crossed syndrome: protocol for a parallel-group randomized controlled trial.

BACKGROUND: Upper crossed syndrome (UCS) refers to specific altered muscle activation and changed movement patterns along with some postural deviations in the upper quarter of the body. This syndrome might contribute to the dysfunction of the cervicothoracic and glenohumeral joints. OBJECTIVES: The present study will aim to investigate the effectiveness of a comprehensive corrective exercises program (CCEP) and subsequent detraining on alignment, muscle activation and movement pattern in men with UCS. METHODS/DESIGN: This is a parallel-group randomized controlled trial. Participants will be 22 men aged 18 to 28 years who are suffering from UCS. Participants in the intervention group will conduct CCEP (three times a week for 8 weeks), followed by 4 weeks of detraining. The control group will do their daily activities. Participants will be randomized (1:1) into the intervention or the control group. The primary outcome will be upper trapezius activations. Secondary outcomes consist of electromyography of middle and lower trapezius and serratus anterior muscles, scapular dyskinesis test, forward head and shoulder angles, thoracic kyphosis angle, and neck flexion pattern test. DISCUSSION: We propose to evaluate the effectiveness of a randomized controlled trial of a CCEP in men with UCS on their alignment, selected muscle activations, and relevant movement patterns. Results from our trial may provide new insights into the effects of exercise not only on the alignment but also on muscle activation and movement patterns that are important outcomes for people with postural malalignments and, if successful, could assist therapists in evidence-based clinical decision-making. TRIAL REGISTRATION: Iranian Registry of Clinical Trials, IRCT20181004041232N1. Registered on 26 October 2018.

IMPLEMENTING A STANDARDIZED INTERVENTIONAL EXERCISE REGIMEN TO IMPROVE FUNCTIONAL MOVEMENTS IN FEMALE COLLEGIATE ATHLETES.

BACKGROUND: Interventional exercises have been developed to help athletes improve scores on the Functional Movement Screen™ (FMS™). However, there is a paucity of research on the effects of a similar program in female athletes, as well as the effects of a standardized corrective exercise regimen. The purpose of this study was to assess whether an in-season, standardized interventional exercise program improves FMS™ score asymmetry and the composite score of female collegiate athletes. STUDY DESIGN: Prospective, quasi-experimental, cohort study. METHODS: Forty-one (mean age 19.5 ± 1.2 years; body mass, 70.6 ± 11.5 kg ; height, 1.70 ± 0.083 m) NCAA Division III female soccer (n=10), softball (n=17), and basketball (n=14) players participated in this study. The athletes completed the FMS™ screens prior to their season, regularly participated in four in-season standardized corrective exercises throughout three to four month athletic seasons, and completed the FMS™ screens in the postseason. RESULTS: The average score of all athletes before the season was 15.52 ± 0.63 and 16.04 ± 0.72 after the season. While the mean score of soccer players increased from 14.80 ± 0.92 to 16.1 ± 1.52 and the mean score of softball players increased from 15.83 ± 1.89 to 16.72 ± 1.41 at the end of the season, the mean score of basketball players dropped from 15.93 ± 1.49 to 15.29 ± 1.59. Women's basketball players experienced a decrease in their composite FMS™ score ( x ¯ = -0.571, p<0.01), while women's soccer players ( x ¯ =+1.30, p<0.05) and softball players ( x ¯ =+1.12, p<0.05) experienced an increase in mean score 2.28 times and 1.96 times greater in magnitude than the decrease in basketball players' composite FMS™, respectively. Fewer total athletes demonstrated asymmetries at postseason testing, decreasing from 24 at preseason testing to 15 at postseason testing (p<0.01). Significant differences were not noted between athlete age and FMS™ scores (p>0.05). CONCLUSIONS: Standardized interventional programs during athletic teams' seasons may be used to help increase FMS™ scores and reduce asymmetry. Though more studies are warranted to address the negative effects of this standardized program in women's basketball players, this study demonstrated that the number of asymmetries significantly decreased from pre- to postseason among soccer and softball players, which may have implications for a higher resistance to injury. LEVELS OF EVIDENCE: 3.

Non-structural misalignments of body posture in the sagittal plane.

BACKGROUND: The physiological sagittal spinal curvature represents a typical feature of good body posture in the sagittal plane. The cervical and the lumbar spine are curved anteriorly (lordosis), while the thoracic segment is curved posteriorly (kyphosis). The pelvis is inclined anteriorly, and the lower limbs' joints remain in a neutral position. However, there are many deviations from the optimal body alignment.The aim of this paper is to present the most common types of non-structural misalignments of the body posture in the sagittal plane. MAIN BODY OF THE ABSTRACT: The most common types of non-structural misalignments of body posture in the sagittal plane are as follows: (1) lordotic, (2) kyphotic, (3) flat-back, and (4) sway-back postures. Each one may influence both the skeletal and the muscular system leading to the functional disturbance and an increased strain of the supporting structures. Usually, the disturbances localized within the muscles are analyzed in respect to their shortening or lengthening. However, according to suggestions presented in the literature, when the muscles responsible for maintaining good body posture (the so-called stabilizers) are not being stimulated to resist against gravity for an extended period of time, e.g., during prolonged sitting, their stabilizing function is disturbed by the hypoactivity reaction resulting in muscular weakness. The deficit of the locomotor system stability triggers a compensatory mechanism-the stabilizing function is overtaken by the so-called mobilizing muscles. However, as a side effect, such compensation leads to the increased activity of mobilizers (hyperactivity) and decreased flexibility, which may finally lead to the pathological chain of reaction within the musculoskeletal system. CONCLUSIONS: There exist four principal types of non-structural body posture misalignments in the sagittal plane: lordotic posture, kyphotic posture, flat-back posture, and sway-back posture. Each of them can disturb the physiological loading of the musculoskeletal system in a specific way, which may lead to a functional disorder.When planning postural corrective exercises, not only the analysis of muscles in respect to their shortening and lengthening but also their hypoactivity and hyperactivity should be considered.