Influence of scapular position on cervical rotation range of motion.

STUDY DESIGN: Cross-sectional study, quasi-experimental design. OBJECTIVES: To compare the active cervical rotation range of motion (ROM) between healthy young subjects with a neutral vertical scapular alignment and subjects with scapular depression, and to examine the influence of modifying the vertical position of the scapulae on active cervical rotation ROM. BACKGROUND: Altered scapular alignment is proposed to be related to neck dysfunction and pain. Changes in the alignment of either the scapulae or the cervical spine can potentially influence the biomechanics of the other by altering the tension at the cervicoscapular muscles. METHODS AND MEASURES: Fifty-eight college age students with neutral vertical scapular alignment (NS group, n = 29) or depressed scapular alignment (DS group, n = 29) volunteered to participate in the study. Cervical rotation ROM was assessed using the CROM device in 2 conditions: condition 1, resting scapular position; condition 2, neutral vertical scapular position with forearms supported. RESULTS: The ANOVA revealed no significant group-by-condition interaction (F = 0.19, df = 1, P = .66). There was a significant main effect of condition (F = 47.16, df = 1, P<.001). For both groups, there was an increase in cervical rotation ROM in condition 2 when compared to condition 1 (mean +/- SD, 10.2 degrees +/- 3.1 degrees; 95% Cl: 4.1 degrees to 16.4 degrees). There was no main effect of group (F = .41, df = 1, P = .53). CONCLUSION: Our results suggest that in a young healthy population the vertical scapular alignment does not influence cervical rotation ROM. Supporting the upper limbs, however, results in a significant and similar increase in cervical rotation ROM for both groups.

Influence of scapular position on the pressure pain threshold of the upper trapezius muscle region.

A position of scapula depression will maintain the upper trapezius muscle region in a lengthened position, causing excessive strain. This strain could lead to peripheral nociceptive nerves sensitization in the affected area, changing the pressure pain threshold (PPT). Thus, people with a faulty alignment of scapular depression may have lower PPT levels in the upper trapezius region when compared to subjects with normal vertical scapular position. The purpose of this double-blind study was to assess the influence of scapular position on the PPT of the upper trapezius region in a young healthy population. Fifty two physical therapy students of the Catholic University of Minas Gerais-PUC-Minas, Brazil, with normal shoulder (NS group, n=26, 6 men and 20 women) or depressed shoulder (DS group, n=26, 6 men and 20 women) volunteered to participate in this study. An electronic pressure algometer was used to measure the PPT on the upper trapezius muscle region. The results showed a significant difference between groups, with the DS group (19.0+/-9.0 N/cm(2)) demonstrated lower mean PPT values when compared to NS group (26.1+/-9.6 N/cm(2)) (p<0.01). Our results showed that healthy young subjects with depressed scapula position had significant lower upper trapezius PPT values when compared to subjects with normal scapula position.

The immediate effect of passive scapular elevation on symptoms with active neck rotation in patients with neck pain.

OBJECTIVE: To examine the effect of elevating the scapulae on symptoms during neck rotation. METHODS: A retrospective analysis of clinical records was conducted. One physical therapist examined 46 patients with neck pain (30 women, 16 men; mean age 45.89+14.39 y) using a standardized examination. Patients had a long-standing history of neck pain with a moderate level of symptoms and disability. Reports of symptoms were obtained in 2 scapulae position conditions: a patient-preferred scapulae position and a passively elevated scapulae position. RESULTS: In the patient-preferred positions, 29 (63%) of the 46 patients reported an increase in symptoms with neck rotation in at least one direction. In the scapulae elevated position, a significant percentage of patients reported a decrease in symptoms with neck rotation, right (82%) and left (76%) (both comparisons, P

A comparison of serratus anterior muscle activation during a wall slide exercise and other traditional exercises.

STUDY DESIGN: Single-group repeated-measures design. OBJECTIVES: To investigate the ability of the wall slide exercise to activate the serratus anterior muscle (SA) at and above 90 degrees of humeral elevation. BACKGROUND: Strengthening of the SA is a critical component of rehabilitation for patients with shoulder impingement syndromes. Traditional SA exercises have included scapular protraction exercises such as the push-up plus. These exercises promote activation of the SA near 90 degrees of humeral elevation, but not in positions above 90 degrees where patients typically experience pain. METHODS AND MEASURES: Twenty healthy subjects were studied performing 3 exercises: (1) wall slide, (2) plus phase of a wall push-up plus, and (3) scapular plane shoulder elevation. Three-dimensional position of the thorax, scapula, and humerus and muscle activity from the SA, upper and lower trapezius, and latissimus dorsi were recorded. The magnitudes of activation for each muscle at 90 degrees, 120 degrees, and 140 degrees of humeral elevation were quantified from EMG records. Repeated-measures analyses of variance were used to determine the degree to which the different exercises activated the SA at the 3 humeral positions. RESULTS: The intensity of SA activity was not significantly different between the 3 exercises at 90 degrees of humeral elevation (P = .40). For the wall slide and scapular plane shoulder elevation exercises, SA activity increased with increasing humeral elevation angle (P = .001), with no significant differences between the 2 exercises (P = .36). CONCLUSION: The wall slide is an effective exercise to activate the SA muscle at and above 90 degrees of shoulder elevation. During this exercise, SA activation is not significantly different from SA activation during the push-up plus and scapular plane shoulder elevation, 2 exercises previously validated in the literature.

Trunk rotation-related impairments in people with low back pain who participated in 2 different types of leisure activities: a secondary analysis.

STUDY DESIGN: Cross-sectional, secondary analysis. OBJECTIVES: To examine whether there were differences in the numbers and types of impairments on examination between 2 groups of people with low back pain (LBP), those who participated in symmetric leisure activities and those who participated in asymmetric leisure activities. BACKGROUND: It has been proposed that people who repeatedly perform an activity that involves trunk movements and alignments in the same direction will develop strategies that are generalized to many activities. The repeated use of these strategies is proposed to contribute to impairments identifiable on examination and to LBP. METHODS AND MEASURES: Forty males and 40 females (mean +/- SD age, 41.4 +/- 13.9 years) with LBP who reported participation in either a symmetric or an asymmetric leisure activity participated in a standardized examination. Responses from 10 trunk-rotation-related impairment tests were analyzed using the Mann-Whitney U and chi-square statistics. RESULTS: Thirty people participated in asymmetric leisure activities and 50 people participated in symmetric leisure activities. The total number of rotation-related impairments was different for the 2 groups (U = 1112, P < .01). The asymmetric group displayed more total rotation-related impairments (median, 4.0; range, 7) than the symmetric group (median, 2.0; range, 6). A greater percentage of the asymmetric group displayed more impairments on 5 out of 10 individual tests, as compared to the symmetric group ( < or = .05 for all comparisons). CONCLUSIONS: Our results provide preliminary data to suggest that trunk-rotation-related impairments, identified on examination, may be related to the general type of movements and alignments used repeatedly by patients with LBP.

A specific exercise program and modification of postural alignment for treatment of cervicogenic headache: a case report.

STUDY DESIGN: Case report. OBJECTIVE: To describe an intervention approach consisting of a specific active-exercise program and modification of postural alignment for an individual with cervicogenic headache. BACKGROUND: The patient was a 46-year-old male with a 7-year history of cervicogenic headache. He reported constant symptoms with an average intensity of 5/10 on a visual analogue scale where 0 indicated no pain and 10 the worst pain imaginable. Average pain intensity in the week prior to the initial evaluation was 3/10 secondary to trigger point injections. The patient's headache symptoms worsened with activities that involved use of his arms and prolonged sitting. METHODS AND MEASURES: The patient was treated 7 times over a 3-month period. Impairments of alignment, muscle function, and movement of the cervical, scapulothoracic, and lumbar regions were identified. Outcome measurements included headache frequency, intensity, and the Neck Disability Index (NDI) questionnaire. Intervention included modification of alignment and movement during active cervical and upper extremity movements. The patient also received functional instructions focused on diminishing the effect of the weight of the upper extremities on the cervical spine. RESULTS: The patient reported a decrease in headache frequency and intensity (1 headache in 3 weeks, intensity 1/10) and a decrease in his NDI score from 31 (severe disability) to 11 (mild disability). The patient also demonstrated improvement in upper cervical joint mobility, cervical range of motion, scapular alignment, and scapulothoracic muscle strength. CONCLUSION: Interventions that included modification of alignment in the cervical, scapulothoracic, and lumbar region, along with instruction in a specific active-exercise program to address movement impairments in these 3 regions, appeared to have been successful in relieving headaches and improving function in this patient.

Movement system impairment-based categories for low back pain: stage 1 validation.

STUDY DESIGN: Cross-sectional study of patients with mechanical low back pain (MLBP). OBJECTIVE: To test the construct validity of 3 categories of a movement system impairment-based classification proposed for use with patients with MLBP. BACKGROUND: A pathoanatomic basis for directing treatment has not proven useful in a wide variety of patients with MLBP. In addition, there is a paucity of data describing the movement system impairments that characterize many of the pathoanatomically based MLBP diagnoses. Because of the mechanical nature of MLBP, a system based on groups of signs and symptoms relevant to conservative management needs to be developed. METHODS AND MEASURES: A movement system impairment-based classification was proposed that defined 5 categories of MLBP based on the findings from a standardized examination. Using the examination, 5 physical therapists examined a total of 188 patients with MLBP. A principal components analysis with an oblique rotation was conducted. Eigenvalues were plotted and a scree test was used to determine the number of factors to retain. A split-sample cross-validation procedure was conducted to verify the factor structure. RESULTS: Three factors were identified in both samples: 2 factors related to symptoms with lumbar rotation and lumbar extension alignments or movements, and 1 factor related to signs of lumbar rotation with different alignments and movements. CONCLUSION: Our results provide support for 3 factors related to 3 of the 5 proposed categories: lumbar rotation with extension, lumbar rotation, and lumbar extension. The existence of these 3 factors provides preliminary evidence for specific clusters of tests of alignment and movement impairments that could be used in classifying patients with MLBP into movement-system-related categories.

The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain: a preliminary report.

OBJECTIVE: To examine the effect on symptoms of modifying patient-preferred movements and alignments of the lumbar spine during patient examination. DESIGN: Repeated-measures study in which patients with low back pain (LBP) participated in a standardized examination that included tests of symptoms with various movements and positions. SETTING: Six university-affiliated outpatient physical therapy clinics and the local community. PARTICIPANTS: Five trained physical therapists examined a total of 185 patients (102 women, 83 men; mean age, 41.89+/-13.29 y) with LBP. The majority of patients had multiepisode, chronic LBP. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The examination included tests of symptoms with various alignments and movements in several different positions. Seven tests were designated as primary tests. Tests that increased symptoms were followed immediately by a secondary test in which (1) patient-preferred lumbar spine movement was modified or (2) the lumbar spine was positioned in a neutral alignment. Patients reported the effect of the secondary test on symptoms relative to their symptoms with the primary test. Three responses were possible: symptoms increased, remained the same, or decreased. RESULTS: Eighty-three percent of the patients reported an increase in symptoms with 1 or more of the 7 primary tests. Ninety-five percent who reported an increase in symptoms with at least 1 of the primary tests reported a decrease in symptoms with 1 or more of the 7 secondary tests. The majority of patients reported a decrease in symptoms when the spinal movement or alignment was modified for 6 of the 7 secondary tests. CONCLUSIONS: Modifying the symptom-provoking movements and alignments of the spine during symptom testing resulted in a decrease in symptoms for the majority of patients. Information about specific modifications that provide relief of LBP symptoms is important because it can be used to design a treatment program that focuses on training a patient to modify the same movements and alignments in their everyday activities.