The effect of muscle-biased manual therapy on shoulder kinematics, muscle performance, functional impairment, and pain in patients with frozen shoulder.

BACKGROUND: Frozen shoulder (FS) is characterized by restricted active and passive shoulder mobility and pain. PURPOSE: Compare the effect of muscle-biased manual therapy (MM) and regular physical therapy (RPT) in patients with FS. STUDY DESIGN: Pretest-post-test control group study design. METHODS: We recruited 34 patients with FS and compared the effect of 12-session MM and RPT. The outcome measures were scapular kinematics and muscle activation, scapular alignment, shoulder range of motion, and pain intensity. Two-way analysis of variance was used to examine the intervention effect with α = 0.05. RESULTS: Both programs resulted in similar improvements in pain and shoulder function. Compared to the RPT, MM resulted in increased posterior tilt (MM: 7.04°-16.09°, RPT: -2.50° to -4.37°; p = 0.002; ES = 0.261) and lower trapezius activation (MM: 260.61%-470.90%, RPT: 322.64%-313.33%; p = 0.033; ES = 0.134) during scaption, and increased posterior tilt (MM: 0.70°-15.16°, RPT: -9.66° to -6.44°; p = 0.007; ES = 0.205) during the hand-to-neck task. The MM group also showed increased GH backward elevation (MM: 37.18°-42.79°, RPT: 43.64°-40.83°; p = 0.004, ES = 0.237) and scapular downward rotation (MM: -2.48° to 6.80°, RPT: 1.93°-1.44°; p < 0.001; ES = 0.404) during the thumb-to-waist task, enhanced shoulder abduction (MM: 84.6°-102.3°, RPT: 85.1°-92.9°; p = 0.02; ES = 0.153), and improved scapular alignment (MM: 10.4-9.65 cm, RPT: 9.41-9.56 cm; p = 0.02; ES = 0.114). CONCLUSIONS: MM was superior to the RPT regarding scapular neuromuscular performance. Clinicians should consider adding muscle-biased treatment when treating FS.

The immediate effect of muscle release intervention on muscle activity and shoulder kinematics in patients with frozen shoulder: a cross-sectional, exploratory study.

BACKGROUND: Contractile tissue plays an important role in mobility deficits in frozen shoulder (FS). However, no study has assessed the effect of the muscle release technique on the muscle activation and kinematics in individuals with FS. The purposes of this study were to assess the differences in shoulder muscle activity and kinematics between the FS and asymptomatic groups; and to determine the immediate effects of muscle release intervention in the FS group. METHODS: Twenty patients with FS and 20 asymptomatic controls were recruited. The outcome measures included muscle activity of the upper and lower trapezius (UT and LT), infraspinatus (ISp), pectoralis major (PM), and teres major (TM), shoulder kinematics (humeral elevation, scapular posterior tilt (PT) and upward rotation (UR), shoulder mobility, and pain. Participants in the FS group received one-session of heat and manual muscle release. Measurements were obtained at baseline, and immediately after intervention. Multivariate analysis of variance was used for data analysis. The level of significance was set at α=0.05. RESULTS: Compared to the controls, the FS group revealed significantly decreased LT (difference =55.89%, P=0.001) and ISp muscle activity (difference =26.32%, P =0.043) during the scaption task, and increased PM activity (difference =6.31%, P =0.014) during the thumb to waist task. The FS group showed decreased humeral elevation, scapular PT, and UR (difference = 35.36°, 10.18°, 6.73° respectively, P <0.05). Muscle release intervention immediately decreased pain (VAS drop 1.7, P <0.001); improved muscle activity during scaption (UT: 12.68% increase, LT: 35.46% increase, P <0.05) and hand to neck (UT: 12.14% increase, LT: 34.04% increase, P <0.05) task; and increased peak humeral elevation and scapular PT during scaption (95.18°±15.83° to 98.24°±15.57°, P=0.034; 11.06°±3.94° to 14.36°±4.65°, P=0.002), and increased scapular PT during the hand to neck (9.47°±3.86° to 12.80°±8.33°, P=0.025) task. No statistical significance was found for other group comparisons or intervention effect. CONCLUSION: Patients with FS presented with altered shoulder muscle activity and kinematics, and one-session of heat and manual muscle release showed beneficial effects on shoulder muscle performance, kinematics, mobility, and pain. TRIAL REGISTRATION: Retrospectively registered on Jan 18, 2016 (ACTRN 12616000031460 ).

Adjunct Non-Elastic Hip Taping Improves Gait Stability in Cane-Assisted Individuals with Chronic Stroke: A Randomized Controlled Trial.

Cane-assisted individuals with chronic stroke may perform with an abnormal gait pattern. One of the important factors of gait training for cane-assisted individuals is inducing improvement in lower limb muscle activity of the paretic side. Non-elastic taping on the hip may be used as an adjunct therapy for improving gait. The objective of this study was to investigate effects of non-elastic hip taping combined with exercise on gait in cane-assisted individuals with chronic stroke. This study is a single-blinded, randomized controlled trial. A total of 21 cane-assisted ambulators with chronic stroke were enrolled. Participants in both groups received a therapeutic exercise program, with the experimental and control groups having adjunct non-elastic taping and sham taping on the hip, respectively. The gait, Berg Balance Scale, 6-min walk test, and Fall Efficacy Scale-International were measured at pre-intervention, post-intervention, and 1-month follow-up. The experimental group resulted in significantly better performance in double-support time compared with the control group. Furthermore, the experimental group showed a significant improvement in double-support time and spatial symmetry at post-intervention and 1-month follow-up compared with pre-intervention. This study demonstrated that non-elastic hip taping combined with exercise could improve gait stability in cane-assisted ambulators. Non-elastic hip taping would be a useful adjunct to rehabilitation strategies for individuals with chronic stroke.

Immediate effect of hip taping on balance and walking ability in cane-dependent ambulators with chronic stroke: a randomized controlled trial.

BACKGROUND: Previous studies showed that cane-dependent post-stroke ambulators have poor balance and gait performance. Adhesive taping on the hip may be used as a therapeutic modality for improving range of motion and muscle activity in individuals with stroke. AIM: The objective of this study was to investigate the immediate effect of the hip extensor and abductor taping on balance and walking ability in cane-dependent ambulators with chronic stroke. DESIGN: This study was a single-blinded, randomized controlled trial. SETTING: Outpatients from a hospital rehabilitation department. POPULATION: Twenty-eight cane-dependent ambulators with chronic stroke were recruited. METHODS: Participants were randomized into either the control group with sham tape (N.=14) or experimental group with non-elastic tape (N.=14). The Berg Balance Scale, gait speed, 6-minute walk test, and Fall Efficacy Scale were measured with and without taping. RESULTS: After taping, participants in the experimental group showed significant improvement in the Berg Balance Scale, gait speed, and 6-minute walk test. Furthermore, experimental group showed significant improvement in the Berg Balance Scale and 6-minute walk test compared with sham taping control group. CONCLUSIONS: Non-elastic tape could immediately improve balance, gait speed, and endurance in cane-dependent ambulators with chronic stroke. CLINICAL REHABILITATION IMPACT: Non-elastic tape may be a useful adjunct to current rehabilitation strategies for individuals with chronic stroke.

Dual-task-related gait changes in individuals with stroke.

Many daily activities require people to complete a motor task while walking. The purpose of this study was to analyze subjects' ability to perform motor tasks while walking. Subjects were classified into three different groups. The first group included 15 full community ambulators post-stroke. The second group included 15 least limited community ambulators post-stroke. The final group included 15 age-matched healthy subjects. Gait performance was measured under three different conditions: (1) preferred walking (single task); (2) walking buttoning up (buttoning task); (3) walking while carrying a tray with glasses (tray-carrying task). Gait velocity, cadence, stride time, stride length, temporal and spatial symmetry indices were examined with the GAITRite system. Our results showed that there were no significant differences between full community ambulators and control subjects for all gait variables. However, there were significant differences in dual-task-related gait decrement between the full community ambulators and control subjects. There were also significant differences in dual-task-related gait decrement between least limited community ambulators and control subjects. The findings of this study suggest that subjects with stroke including the full community ambulators have difficulty performing two motor tasks concurrently.