Earticle

Background: This study aimed to investigate the effectiveness of lumbar stabilization exercises combined with the Mulligan Sustained Natural Apophyseal Glide (SNAG) technique on gait function and postural alignment in patients with chronic low back pain. Methods: A total of 30 chronic low back pain patients were randomly assigned to either an experimental group, which received lumbar stabilization exercises combined with the Mulligan SNAG technique, or a control group, which received lumbar stabilization exercises combined with physical agent therapy. The interventions were conducted for 6 weeks. Changes in gait parameters, foot pressure, and spinal alignment were measured before and after the intervention, and comparative analyses were performed between the groups. Results: The study results showed that the experimental group demonstrated statistically significant improvements in all gait parameters, including gait velocity, stride length, step width, and cadence, as well as in spinal alignment before and after the intervention (p<.05). In contrast, the control group showed statistically significant changes only in gait velocity and spinal alignment (p<.05). Specifically, for the Kyphotic Angle, a significant decrease was observed in the control group (p<.01). A comparison between the two groups revealed a statistically significant difference only in gait parameters (p<.05), indicating that the experimental group was superior in improving gait function. Conclusion: In conclusion, this study provides clinical evidence that combining the Mulligan SNAG technique with lumbar stabilization exercises should be preferentially considered for treating chronic low back pain patients aiming to improve their walking ability.

Background: This study aimed to examine the effects of combining the Graston technique and extracorporeal shockwave therapy (ESWT) on shoulder range of motion (ROM), pain, grip strength, and upper limb function in patients with adhesive capsulitis. Methods: Thirty-two patients diagnosed with adhesive capsulitis were randomly assigned to either an experimental group (n = 16) or a control group (n = 16). The experimental group performed the Graston technique for 10 minutes, followed by ESWT for 10 minutes (2,000 pulses), while the control group received only ESWT for 10 minutes. Both groups received treatment twice per week for four weeks. General physical therapy (hot pack for 15 minutes and electrical stimulation for 15 minutes) was given equally to both groups. Outcome measures included shoulder ROM (flexion, abduction, external rotation), pain assessed by the visual analog scale (VAS), grip strength, and upper limb function assessed by the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Pre- and post-intervention differences within groups were analyzed using paired t-tests, and between-group comparisons were analyzed using independent t-tests. Results: Both groups showed significant improvements in all outcome measures after the intervention (p < .001). The experimental group showed significantly greater improvements than the control group in ROM, VAS, grip strength, and QuickDASH scores (p < .001). Conclusion: The combined application of the Graston technique and ESWT was more effective than ESWT alone in improving joint mobility, reducing pain, enhancing grip strength, and improving upper limb function in patients with adhesive capsulitis. These results support the clinical utility of this combined approach for shoulder rehabilitation.

Background: The shoulder functions as a critical biomechanical link between the upper extremity and the trunk, providing both mobility and stability necessary for efficient functional movement. Adequate trunk stability is essential for optimal force transmission and coordinated muscle activation within the shoulder complex. Deficits in trunk stability may disrupt normal neuromuscular control, leading to altered activation patterns of scapular and glenohumeral muscles, reduced strength output, and the development of compensatory movement strategies. Despite its clinical importance, the influence of external trunk stabilization on shoulder muscle performance has not been fully clarified. Therefore, this study aimed to investigate the effects of different external trunk compression conditions on isometric shoulder rotator strength and scapular muscle activity in healthy young adults, with the goal of identifying the most effective trunk compression site. Methods: Twenty-eight healthy adults in their twenties voluntarily participated in this study. Isometric shoulder internal and external rotation strength was assessed under three experimental conditions: no trunk compression, pelvic compression only, and combined thoracic and pelvic compression. Surface electromyography was used to measure muscle activity of the upper trapezius, lower trapezius, serratus anterior, and middle deltoid during standardized isometric tasks. All measurements were performed in a controlled laboratory setting, and data were analyzed to compare differences across conditions. Results: Isometric shoulder internal and external rotational strength significantly increased with greater levels of external trunk support. Electromyographic analysis revealed significant differences in muscle activation among the three compression conditions (p < .01). Specifically, scapular stabilizing muscles demonstrated progressively increased activation as the number of compression sites increased, indicating enhanced neuromuscular engagement. Conclusion: External trunk compression effectively enhances shoulder rotational strength and facilitates increased activation of scapular stabilizing muscles. These findings suggest that improving trunk stability may optimize shoulder function during isometric tasks. Incorporating trunk stabilization strategies into rehabilitation programs may be beneficial for individuals with shoulder dysfunction, potentially improving clinical outcomes and functional performance.

Background: Primary dysmenorrhea, a common menstrual pain condition, is influenced by hormonal changes, including excessive prostaglandin production, that may alter sensory processing and musculoskeletal function. These physiological changes may also affect functions including postural alignment, balance control, and body awareness. Although dysmenorrhea-related symptoms have been extensively studied, research evaluating posture, balance, and body awareness for correlations with menstrual phases or dysmenorrhea severity remains insufficient. We assessed postural alignment, balance, pain intensity, and body awareness according to the severity of primary dysmenorrhea in women with mild and severe primary dysmenorrhea. Methods: Twenty-nine women in their 20s were classified as having mild (n=14) or severe (n=15) dysmenorrhea using the modified Menstrual Distress Questionnaire. Postural alignment, static and dynamic balance, pain intensity, and body awareness were then assessed during pre-menstrual and menstrual phases. Comparisons were made within and between groups. Results: Both groups showed significant changes in postural alignment, staticㆍdynamic balance, and body awareness during menstruation compared to their pre-menstrual phase (p<.05). No significant differences were observed between groups in static/dynamic balance, pain intensity, or body awareness (p>.05). Change in pelvic tilt was significantly greater in the mild dysmenorrhea group (p<.05). Conclusion: Functional changes in posture, balance, and body awareness were observed during menstruation regardless of dysmenorrhea severity. These findings suggest clinical assessments and interventions should emphasize menstrual phase-related physiological changes rather than dysmenorrhea severity alone.

Background: Genu varum is associated with altered lower extremity alignment and abnormal mechanical loading on the knee joint, leading to secondary problems such as osteoarthritis, cartilage degeneration, and gait disturbances. Narrow squats, which increase quadriceps activation and improve knee alignment, and extracorporeal shockwave therapy (ESWT), known to improve muscle flexibility and tissue elasticity, have been suggested as effective interventions for genu varum. Despite this, the combined effects of narrow squat exercises and ESWT on the muscle function and lower extremity alignment have not been determined. Methods: Twenty-four adults with grade Ⅱ genu varum were assigned randomly to an experimental group (n=12) performing narrow squat exercises plus ESWT or a control group (n=12) performing narrow squat exercises plus hamstring stretching. The intervention was performed three times per week for four weeks, with gradually increasing intensity. The outcome measures included the knee extension range of motion (ROM), knee gap, and vastus medialis (VM) and vastus lateralis (VL) muscle thickness, assessed before and after the intervention. Data were analyzed using paired and independent t-tests. Results: Both groups showed significant improvements in the knee extension ROM, inter-knee distance, and VM and VL muscle thickness after the intervention (p<.05), but no significant differences were observed between the groups in any of the outcome measures (p>.05). Conclusion: ESWT combined with narrow squat exercise and hamstring stretching combined with narrow squat exercise effectively improved the knee ROM, muscle thickness, and inter-knee distance in adults with genu varum. Both interventions can be clinically useful strategies for correcting lower limb alignment and enhancing the muscle function in individuals with genu varum.

Background: This study conducted a comparative evaluation of the effects of combining pain neuroscience education (PNE) with cervical and scapular stabilization exercises in patients with cervical extension syndrome. The evaluation indicators included the visual analogue scale (VAS) score, Neck Disability Index (NDI) score, and Fear Avoidance Belief Questionnaire (FABQ) score. Methods: Thirty-six participants with cervical extension syndrome were randomly assigned to either a cervical and scapular stabilization exercise group (n=18) or a group that received cervical and scapular stabilization exercises combined with pain neuroscience education (n=18). Both groups participated in 50-minute sessions, three times per week for six weeks. Outcome measures included the visual analogue scale (VAS), Neck Disability Index (NDI), and Fear-Avoidance Beliefs Questionnaire (FABQ), which were assessed before and after the intervention. Results: The control and experimental groups showed significant improvements in the VAS scores, with a significant difference also observed between the two groups. The NDI scores decreased significantly in both groups after the exercise interventions, with a significant difference between the two groups. The FABQ scores also decreased significantly in both groups, with a significant difference observed between them. Conclusion: Cervical and scapular stabilization exercise combined with pain neuroscience education was more effective in reducing the VAS, NDI, and FABQ scores of patients with cervical extension syndrome than cervical and scapular stabilization exercise alone. Therefore, the combination of cervical and scapular stabilization exercises with pain neuroscience education can be used as a clinical intervention for the treatment and prevention of cervical extension syndrome.

Background: Chronic ankle instability (CAI) is common in young adults after recurrent ankle sprains and is associated with impaired proprioception, neuromuscular control, and balance. Conventional proprioceptive training is widely used, but visual biofeedback systems such as PhysioSensing, which provide real-time center of pressure feedback, may enhance training effects. This study compared PhysioSensing-based proprioceptive training with conventional ankle stability exercises in young adult males with functional ankle instability. Methods: Forty male university students were randomly assigned to a PhysioSensing-based proprioceptive training (PBP) group or a conventional ankle stability exercise (CAS) group. Both groups trained for 20 minutes, five times per week for four weeks. Outcomes included the Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM), Star Excursion Balance Test (SEBT), and Time-Based Lateral Balance Test (TBLT), assessed before and after the intervention. Results: Both groups showed significant improvements over time in CAIT, FAAM, SEBT, and TBLT scores (p<.05). Significant group × time interaction effects were observed for SEBT and TBLT (p<.01), indicating greater improvements in dynamic balance and lateral stability in the PBP group compared to the CAS group. Additionally, FAAM-Sport scores showed a significant interaction effect (p=.01), with the PBP group demonstrating superior improvements in sports-related ankle function. Conclusion: Both training programs improved ankle function and balance; however, PhysioSensing-based training produced superior gains in dynamic balance and lateral stability, suggesting that real-time visual biofeedback enhances neuromuscular control in CAI rehabilitation.

Purpose: This study examined the effects of sling-based lower limb complex exercise combined with foot intrinsic muscle exercise on pain and lower limb function of patello-femoral pain syndrome (PFPS). Methods: This study involved 30 PFPS participants at the C center in Daegu. The researcher randomly allocated 30 PFPS participants into an experimental group and a control group, with 15 individuals in each group. The experimental group performed a sling-based lower limb complex exercise combined with the foot intrinsic muscle exercise. The control group performed only sling-based lower limb complex exercise. After 4 weeks of intervention, the intervention effect was measured by the visual analog scale (VAS), the dynamic valgus angle (DVA), and the navicular drop test (NDT). All participants were evaluated before and after the intervention. Results: In the within-group comparison, both groups showed significant decreases in the VAS, improvements in the DVA and the NDT (p<.05). In the between-group comparison, the experimental group showed a greater decrease in the VAS than the control group (p<.05). In addition, the experimental group showed greater improvements in the DVA and the NDT than the control group (p<.05). Conclusion: Sling-based lower limb complex exercise combined with foot intrinsic muscle exercise resulted in a significant decrease in pain (VAS), and improvements in DVA and NDT in PFPS. These results are considered suitable for application as an intervention method in clinical practice, simultaneously controlling the knee, improving the function of the internal muscles of the foot, and stabilizing the hip joint, especially during activities requiring functional movement.

Purpose: This study compared the lower extremity muscle activation during conventional, wall, and reformer squats in order to guide exercise selection in clinical and rehabilitation settings. Methods: A total of 28 healthy adults in their 20s participated in this study. Surface electromyography was used to assess the activation of the biceps femoris, vastus lateralis, vastus medialis, and gluteus medius muscles. All participants performed conventional squat, wall squat, and reformer squat in a randomized order to minimize potential bias. The collected data were analyzed using one-way repeated measures analysis of variance (ANOVA) with Bonferroni post hoc testing, and the level of statistical significance was set at α = .05. Results: Significant differences in muscle activation were observed among the three squat conditions (p <.05). The conventional squat showed the highest muscle activation across all muscles, followed by the wall squat, whereas the reformer squat demonstrated the lowest activation. Specifically, the activation of the biceps femoris, vastus medialis, vastus lateralis, and gluteus medius were significantly higher during the conventional squat compared to the other two conditions. In addition, the vastus medialis to vastus lateralis ratio was significantly higher in conventional and wall squats than in reformer squats. Conclusion: The conventional squat appears to be the most effective exercise for maximizing lower extremity muscle activation. In contrast, the wall squat may serve as a useful transitional exercise, while the reformer squat may be beneficial during the early stages of rehabilitation by reducing joint loading. These findings may provide valuable guidance for clinicians when selecting appropriate squat exercises based on individual functional status and rehabilitation goals.

Purpose: This study examined the effects of high-intensity laser therapy (HILT) as a monotherapy on pain, knee function, and Borg Rating of Perceived Exertion (RPE) scores in a patient diagnosed with a meniscus tear Methods: A 64-year-old male patient was diagnosed with a meniscus tear, and a single-case A-B-A’ study design was applied. The study was conducted for six weeks and consisted of three phases: a one-week baseline phase (Phase A), a two-week intervention phase (Phase B), and a three-week follow-up phase (Phase A’). In the follow-up phase, after two weeks of observation, the final assessments were conducted during the last week. In the intervention phase, HILT was applied around the joint line of the affected knee three times per week (six times in total). The outcome measures included the Visual Analogue Scale (VAS), pressure pain threshold (PPT), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Borg Rating of Perceived Exertion (Borg RPE) scale. Results: Positive improvements were noted in all the outcome measures after HILT application. The VAS score was decreased by 5.5 points during movement and by 6.0 points in the standing position compared with the baseline, indicating significant pain relief. The PPT values increased at all measurement sites, with the most significant improvement observed in the quadriceps femoris muscle. The knee function was improved across all KOOS subdomains. In particular, the Quality of Life (QoL) showed the most significant change with a score of 18.7 points. The Borg RPE level decreased significantly from Borg 6 (‘Very hard’) at the baseline to Borg 1 (‘Very light’) post-intervention. In the follow-up phase (A’), although a regression pattern was observed in some outcome measures, significant improvements compared to the baseline were maintained, indicating the sustained effects of the intervention. Conclusion: HILT applied to a patient with a meniscus tear was effective in reducing pain and improving knee function. The therapeutic effects were maintained even after the intervention ended. Therefore, HILT can be used in clinical practice as a non-invasive conservative treatment for patients with meniscus tears.