A Letter to the Editor on "Effect of Visual Biofeedback Obtained Using the Iowa Oral Performance Instrument on the Suprahyoid Muscle Activation Level During Effortful Swallowing Maneuver".

The author has provided an alternative biofeedback method to help maintain the effortful swallowing (ES) maneuver target effort to utilize a constantly high swallowing pressure. The author has identified ES with visual feedback (i.e. the Iowa Oral Performance Instrument (IOPI)) produced higher EMG activation levels than without. However, the author accepted higher activation levels as higher muscle force production, attributed the lower EMG activation levels in 4th set to fatigue, and did not consider other possibilities. As the author stated in the discussion "his/her method caused participants to focus more efforts to achieve the goal" in feedback condition and enhanced the participant's focus on the exercise plan. This situation, caused by the focus of attention, can be explained with the "constrained action hypothesis". Also, EMG levels are highly correlated to muscle force, but EMG does not directly measure the force produced. This causes some unpredictable factors that can influence the force but not the EMG data. To conclude, the increased EMG activity or the participants' negative feedback could be caused by the focus of attention, and future studies should consider this perspective.

Scapular muscle endurance may improve shooting performance in air pistol shooters.

BACKGROUND: In air pistol shooters, the number of studies evaluating the physical characteristics is very few. The purpose of this study was to examine the relationship of core, scapula, and shoulder girdle muscles endurance on performance in air pistol shooters and to determine the importance of the endurance parameters. METHODS: Twenty-eight male air pistol shooters were included. The Closed Kinetic Chain Upper Extremity Stability Test, Upper Quarter Y Balance Test, Prone Bridge Test, Side Bridge Endurance Test, and The Scapular Muscle Endurance Test were used to evaluate the endurance of shoulder girdle, core, and scapular muscles. The relationships between endurance and shooting performance parameters were investigated. RESULTS: A positive moderate correlation was found between the scapular muscle endurance test and the shooting performance (P=0.002 r=0.638). A significant regression equation was found for shooting scores (F(1.26)=11.975, P=0.02, R2=0.315). It was observed that the shooting score increased by 0.375 points for each unit increase of the Scapular Muscle Endurance Test. No statistically significant relationship was observed in other parameters (P>0.05). CONCLUSIONS: In this study, core and shoulder girdle muscle endurances were not associated with shooting performance. Scapular muscle endurance may contribute positively to shooting performance. An exercise program to increase scapular muscles endurance can be beneficial for the performance of shooters.

Effects of Different Frequencies of Physical Therapy Visits on Shoulder Function After Arthroscopic Rotator Cuff Repair.

OBJECTIVE: There is no consensus about the optimal frequency of patient visits during the rehabilitation program after arthroscopic rotator cuff repair (ARCR). This study aimed to investigate the short- and long-term effects of high-frequency (HF) and low-frequency (LF) visits of the patients in the first 12 weeks of rehabilitation after ARCR. METHODS: This was a quasi-randomized study with 2 parallel groups. Forty-seven patients with ARCR were included in 2 different patient visit frequency protocols (HF = 23, LF = 24) in 12 weeks of postoperative rehabilitation. Patients in the HF group visited the clinic twice a week, whereas patients in the LF group visited once every 2 weeks for the first 6 weeks and once a week for the following 6 weeks. Both groups performed the same exercise protocol. Outcome measurements were pain and range of motion measured at baseline; at the 3rd, 5th, 8th, 12th, and 24th weeks; and at 1-year follow-up. Shoulder function was assessed at the 12th and 24th weeks and at 1-year follow-up with an American Shoulder and Elbow Surgeons score. RESULTS: There was a significant group × time interaction in pain intensity during the activity between the groups. The activity pain intensity was higher in the LF group (4.2 points) at 8 weeks post surgery than in the HF group (2.7 points) (mean difference: 1.5 points, P < .05), whereas it was similar in both groups at other time periods. The interaction term was not significant between the groups for pain intensity during rest and night through the 1-year follow-up. No group × time interactions were observed in shoulder range of motion and American Shoulder and Elbow Surgeons score over the postoperative period. CONCLUSION: Both rehabilitation programs at different visit frequencies after ARCR showed similar clinical results in the long term. A supervised, controlled rehabilitation program with LF visits in the first 12 weeks after surgery can be sufficient to achieve optimal clinical results and reduce rehabilitation-related costs after ARCR. IMPACT: This study highlights that LF treatment protocols under the supervision of the therapist can be adopted after the arthroscopic rotator cuff repair to achieve successful results while decreasing the treatment costs. Physical therapists should plan the treatment sessions efficiently for the compliance of the patients to the exercise treatment. LAY SUMMARY: If you are a patient with arthroscopic rotator cuff repair, a supervised, controlled rehabilitation program with low-frequency visits in the first 12 weeks after surgery could help you achieve the best outcome and help lower the costs of rehabilitation. A total of 3 visits in the first 6 weeks might be sufficient (once every 2 weeks). More frequent visits (1-2 visits a week) should happen 6 to 12 weeks after the surgery.

Positioning efficacy and comfort profile of shoulder support braces: A randomized repeated-measures study using three-dimensional kinematic analysis.

BACKGROUND: Shoulder bracing is very common in musculoskeletal rehabilitation. OBJECTIVE: In this study, the positioning efficacy of shoulder support braces was investigated by analyzing their three-dimensional kinematic properties, as well as their perceived comfort was investigated with user ratings. STUDY DESIGN: A randomized repeated-measures study. METHODS: Seventeen asymptomatic participants were included. Scapular, humeral, and thoracic kinematics for all participants were measured using an electromagnetic tracking device in 6 experiments in randomized order: no brace, neutral brace, abduction brace, internal rotation brace, 15-degree external rotation brace (ER15-B), and 30-degree external rotation brace (ER30-B). Also, comfort ratings were obtained during each session. RESULTS: Internal rotation brace achieved a mean of 29.34° of humerothoracic internal rotation while providing increased scapular internal rotation and upward rotation ( p < 0.05). Abduction brace achieved a mean of 45.39° of humerothoracic and 39.58° of glenohumeral elevation coupled with increased scapular upward rotation, posterior tilt, and humeral internal rotation ( p < 0.05). 30-Degree external rotation brace achieved a mean of 33.25° of glenohumeral external rotation and resulted in increased scapular external rotation, upward rotation, posterior tilt, and humeral external rotation ( p < 0.05). Abduction brace, internal rotation brace, ER15-B, and ER30-B moved the thoracic spine into a more axial rotation in the contralateral direction. Internal rotation brace, ER15-B, and ER30-B were rated more uncomfortable when compared with the no brace condition, with no significant differences observed among the braces. CONCLUSIONS: The positioning efficacy was enhanced when an abduction pillow and external rotation wedge were applied. Selection of commercially available shoulder support braces should involve consideration of whether it can achieve the desired position and orientation as well as its comfort profile.

Theraband Applications for Improved Upper Extremity Wall-Slide Exercises.

CONTEXT: The wall-slide exercise is commonly used in clinic and research settings. Theraband positioning variations for hip exercises have been investigated and used, but Theraband positioning variations for upper extremity wall-slide exercises, although not commonly used, have not been examined. OBJECTIVE: To evaluate the effect of different Theraband positions (elbow and wrist) on the activation of the scapular and shoulder muscles in wall-slide exercises and compare these variations with each other and with regular wall-slide exercises for the upper limbs. DESIGN: Descriptive laboratory study. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 20 participants (age = 23.8 ± 3 years, height = 176.5 ± 8.14 cm, mass = 75.3 ± 12.03 kg, body mass index = 24.23 ± 4.03) with healthy shoulders. INTERVENTION(S): Participants performed wall-slide exercises (regular and 2 variations: Theraband at the elbow and Theraband at the wrist) in randomized order. MAIN OUTCOME MEASURE(S): Surface electromyographic activity of the trapezius (upper trapezius [UT], middle trapezius [MT], and lower trapezius [LT]), infraspinatus, middle deltoid (MD), and serratus anterior (SA) muscles. RESULTS: Regular wall-slide exercises elicited low activity in the MD and moderate activity in the SA muscles (32% of maximal voluntary isometric contraction [MVIC] in the SA), whereas the Theraband-at-elbow and Theraband-at-wrist variations elicited low activity in the MT, LT, infraspinatus, and MD muscles and moderate activity in the SA muscle (46% and 34% of MVIC in the SA, respectively). The UT activation was absent to minimal (classified as 0% to 15% of MVIC) in all wall-slide exercise variations. The Theraband-at-wrist variation produced lower UT:MT, UT:LT, and UT:SA levels compared with the regular wall-slide exercise and Theraband-at-elbow variation. CONCLUSIONS: In shoulder rehabilitation, clinicians desiring to activate the scapular stabilization muscles should consider using the Theraband-at-wrist variation. Those seeking more shoulder-abduction activation and less scapular stabilization should consider using the Theraband-at-elbow variation of the upper extremity wall-slide exercise.

Responsiveness and Validity of Weight-Bearing Test for Measuring Loading Capacity in Patients With Triangular Fibrocartilage Complex Injury.

CONTEXT: Weight-bearing test (WBT) is a noninvasive quantitative test which has been used recently to determine loading capability of the individuals. The aim of this study was to strengthen the evidence for using the WBT test for measuring weight-bearing capacity of the upper-extremity with the specific objective of examining the internal and external responsiveness and concurrent validity of the test in patients with triangular fibrocartilage complex injury. DESIGN: Single-group repeated measures. METHODS: Internal responsiveness was assessed using effect size statistics. The correlation coefficient was used to examine external responsiveness by testing 5 hypotheses regarding predefined correlations between the changes in the measurements. Concurrent validity was evaluated by analyzing correlations between the WBT and other measurements. Thirty-one patients with triangular fibrocartilage complex injury were included for the analysis of the concurrent validity. Eighteen patients who completed all measurements at baseline and at 3-month follow-up enrolled for the responsiveness analysis. Measurements included the WBT, pain intensity, grip strength, and upper extremity functional level. RESULTS: The WBT test was able to detect statistically significant changes in weight-bearing capacity between baseline and follow-up (P = .0001). The effect size of the WBT was large. Three out of 5 hypotheses (60%) were confirmed, a good correlation was found between changes scores of the WBT and grip strength (r = .478; P < .05). There were significant correlations between the WBT and other measurements (r value range from -.401 to .742; P < .05). A higher correlation was found between the WBT and grip strength (r = .742; P = .0001). CONCLUSIONS: The responsiveness and concurrent validity of the WBT test confirmed that it is able to measure change in weight-bearing capacity in patients with triangular fibrocartilage complex injury.

Tender point examination with palpation in different shoulder pathologies: A retrospective study.

BACKGROUND: Shoulder pain is a common symptom for non-traumatic shoulder pathologies and affects 4.7-66.7% of entire population. Even with the latest technological advantages, palpation still is a cost and time efficient tool to evaluate the shoulder pathologies. Our aim was to investigate and compare palpation findings in different shoulder pathologies. METHOD: We used first assessments of impingement syndrome (IS) (n = 205), rotator cuff tear (RCT) (n = 185) and frozen shoulder (FS) (n = 210) patients who received treatment between 2010 and 2019 years. Two experienced physiotherapists palpated predefined points: long head of biceps brachii, pectoralis minor, lateral intermuscular septum, proximal tendons of extensor group. These points categorized into "proximal", "mid-proximal", "mid-distal", "distal", "irregular". We also grouped patients by their BMIs. RESULTS: We found RCT patients had higher BMI than IS and FS patients (p < 0.001, p = 0.001); more tender intermuscular septum points and night pain than IS patients (p = 0.001, p = 0.003) and more extensor group proximal tendon points than IS and FS patients (p < 0.001, p = 0.001). "No tenderness" group had lesser resting pain than distal group (p < 0.001) and lesser activity and night pain than middle-proximal, middle-distal, and distal groups (all ps < 0.002). Distal group had higher night pain than middle-proximal group (p = 0.003). Morbidly obese patients had higher night pain than normal and overweight patients (p = 0.003 and p = 0.009). CONCLUSIONS: Tender point distribution varies depending on the pathology with biceps brachii being the most common. RCT patients had higher night pain related to more distal tender points. Patients with higher night pain had increased tenderness in septum intermuscular and extensor muscles' proximal tendons.

Evaluation of work-related musculoskeletal problems in pediatric surgeons.

PURPOSE: Pediatric surgeons are exposed to intense work-related activities, depending on their profession, including residency training. This study aims to investigate the musculoskeletal symptoms and analyze the relationship between musculoskeletal symptoms and the demographics, physical activity levels, and body mass index (BMI) of pediatric surgeons. METHODS: A total of 82 pediatric surgeons (female, 20; male, 62) were included in this study. The musculoskeletal symptoms were determined using the Cornell Musculoskeletal Discomfort Questionnaire. The levels of physical activity were determined using the International Physical Activity Questionnaire. RESULTS: The mean age of the participants was 48.97 ± 8.894 years, the mean BMI was 26.72 ± 4.12 kg/m2, and the mean working time after acquiring their specialty was 18.65 ± 9.83 years. The average surgery counts per week were 15.22 ± 12.17. Pediatric surgeons mostly complained from lower back pain, upper back pain, neck pain, and right and left shoulder pain. Surgeons with higher BMI had higher pain scores and received more treatment sessions. CONCLUSIONS: Pediatric surgeons' complaints are related to their total numbers of surgery. Higher BMI and lower physical activity seem to be the major contributing factors for developing musculoskeletal symptoms. The study results indicated that surgeons should keep their BMI levels to the optimum and increase their physical activity levels.

The effects of hamstring training methods on muscle viscoelastic properties in healthy young individuals.

This study investigated the effects of hamstring training methods on the passive viscoelastic properties of hamstring and quadriceps muscles and the relationship of these properties to lower extremity power, hamstring flexibility, and agility. A total of forty healthy individuals were recruited for this study. Participants performed Nordic hamstring exercises (n = 14), hamstring curl exercises (n = 14), or received neuromuscular electrical stimulation (NMES; n = 13) for eight weeks. Measurements were taken both before and one week after the interventions of the viscoelastic properties of hamstring and quadriceps muscles, strength, flexibility, agility, and lower extremity power. Nordic hamstring exercises increased hamstring muscle elasticity while decreasing quadriceps and hamstring muscle stiffness; whereas leg curl exercises increased quadriceps and hamstring muscle stiffness while decreasing quadriceps muscle tone (P < .05). Both strengthening methods increased agility, hamstring flexibility, and vertical jump. NMES produced no noticeable effects. Eccentric and concentric training methods had inverse effects on both hamstring and quadriceps muscles' viscoelastic parameters, but had similar improvements on performance parameters. Since changes in viscoelastic parameters of muscle could affect musculotendinous systems' compliance, clinicians should consider viscoelastic properties over performance parameters, when prescribing concentric or eccentric exercises.