Earticle

Purpose: This study investigated the effects of combined extracorporeal shock wave therapy (ESWT) and joint mobilization (JM) on acromiohumeral distance (AHD) and pressure pain threshold (PPT) in patients with shoulder impingement syndrome (SIS). Methods: Thirty patients with SIS were randomly assigned to an experimental group that received ESWT+JM (n=15) or a control group that performed shoulder stabilization exercises (n=15). The interventions were delivered three times weekly for four weeks. AHD was measured using ultrasonography and PPT using a digital algometer. Baseline homogeneity was confirmed for both AHD (p=0.587) and PPT (p=0.830). Statistical analyses included paired t-tests, independent t-tests, and two-way repeated measures ANOVA with partial eta squared (η²). Results: Both the experimental and control groups showed significant improvements in AHD (experimental: t = –4.314, p=0.001; control: t= –2.618, p = 0.020) and PPT (experimental: t = –6.236, p<0.001; control: t = –4.101, p=0.001). The post-intervention values were significantly higher in the experimental group for AHD (t=3.178, p=0.004) and PPT (t=2.560, p=0.016). ANOVA revealed significant time effects and group × time interactions for both AHD and PPT [time effects: (AHD: F=24.559, p<0.001, η²=0.467; PPT: F=55.709, p<0.001, η²=0.666); group × time interactions: (AHD: F=C6.811, p=0.004, η²=0.259; PPT: F=8.910, p=0.006, η²=0.241)]. Group effect was significant for AHD (F=4.009, p=0.047) but not for PPT (p=0.127). Conclusion: ESWT combined with JM produced superior improvements in AHD and PPT compared with stabilization exercise alone. Large interaction effects indicated complementary mechanisms, supporting this combined approach as an effective rehabilitation strategy for SIS.

Purpose: This study aimed to investigate the effects of taping-assisted rhythmic stabilization exercises on shoulder muscle activity and function in patients with shoulder impingement syndrome. Methods: Twenty patients diagnosed with shoulder impingement syndrome were randomly assigned to experimental (n=10) or control (n=10) groups. The experimental group underwent rhythmic stabilization exercises combined with taping, while the control group underwent general physical therapy for 30 min per session, three times a week, for six weeks. Muscle activities of the upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) were measured using surface electromyography, and shoulder function was assessed using the Oxford Shoulder Score (OSS) before and after the intervention. Results: After the intervention, the experimental group demonstrated a significant increase in SA muscle activity and shoulder function compared with the control group (p<.05). Within-group analysis revealed significant improvements in SA activity and OSS only in the experimental group (p<.01), whereas no significant changes were observed in UT or LT muscle activity in either group. Conclusion: Taping-assisted rhythmic stabilization exercise was found to be an effective intervention for enhancing selective muscle activation and shoulder function in patients with shoulder impingement syndrome. This combined approach may serve as a valuable clinical rehabilitation strategy to improve shoulder stability and functional recovery.

Purpose: This study aimed to investigate the effects of taping-assisted rhythmic stabilization exercises on shoulder muscle activity and function in patients with shoulder impingement syndrome. Methods: Twenty patients diagnosed with shoulder impingement syndrome were randomly assigned to experimental (n=10) or control (n=10) groups. The experimental group underwent rhythmic stabilization exercises combined with taping, while the control group underwent general physical therapy for 30 min per session, three times a week, for six weeks. Muscle activities of the upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) were measured using surface electromyography, and shoulder function was assessed using the Oxford Shoulder Score (OSS) before and after the intervention. Results: After the intervention, the experimental group demonstrated a significant increase in SA muscle activity and shoulder function compared with the control group (p<.05). Within-group analysis revealed significant improvements in SA activity and OSS only in the experimental group (p<.01), whereas no significant changes were observed in UT or LT muscle activity in either group. Conclusion: Taping-assisted rhythmic stabilization exercise was found to be an effective intervention for enhancing selective muscle activation and shoulder function in patients with shoulder impingement syndrome. This combined approach may serve as a valuable clinical rehabilitation strategy to improve shoulder stability and functional recovery.

Purpose: This study examined the current status of sports physical therapy in Korea and identified misalignment with international standards despite growing sports participation and injury-related rehabilitation needs. Korea lacks a clear legal framework, standardized curricula, and nationally recognized specialization routes for sports physical therapists, which limit professional autonomy and role-related clarity on the field. The purpose of this study was to analyze the structural limitations of Korean sports physical therapy in the legal, educational, and practice domains and to propose a comprehensive talent‑development strategy benchmarked against leading international systems. Methods: A literature review and comparative analysis were conducted on domestic regulations and training systems, alongside models from countries such as the United States, Australia, and the United Kingdom, focusing on degree structures, residency programs, specialization frameworks, and competency requirements. Results: Our findings revealed a persistent gap between the competencies required in real-world sports environments and the outcomes of current Korean undergraduate and graduate programs, combined with physician-dependent legal authorities, hospital-centered education, and non-official society-driven certifications. The deployment of sports physical therapists in professional, amateur, and community sports is limited, and their roles are often ambiguously defined. Conclusion: This study proposes a three-pillar reform strategy: establishing specialized graduate education and standardized post-professional residency or fellowship pathways; introducing a government-endorsed national specialty certification aligned with Sports Certified Specialist and Australian Physiotherapy Association models, linked to mandatory continuing education; and institutionalizing multidisciplinary collaboration with clearly defined scopes of practice and communication protocols. These reforms are expected to enhance the professional autonomy and international competitiveness of Korean sports physical therapists, while improving athlete safety, performance, and the quality of national sports and rehabilitation services.

Purpose: This study aimed to investigate the effects of functional electrical stimulation on the autonomic nervous system for improving swallowing function in patients with dysphagia. Methods: Seventeen patients hospitalized at Busan T Rehabilitation Hospital participated in this study; only those who voluntarily agreed to participate were included. All participants had dysphagia; nine had cerebral infarction and nine had cerebral hemorrhage, and were classified as stroke patients. Functional electrical stimulation for swallowing was performed using a Vitalstim electrical stimulation device (SME Inc., USA) for 30 min/day, five times a week. Autonomic nervous system activity was measured using a pulse-wave pulsoximeter (Ubioclip, Biosensecretive, ROK) before and after electrical stimulation. The analyzed variables included mean heart rate, low frequency (LF), high frequency (HF), LF/HF ratio, standard deviation of normal-to-normal intervals (SDNN), and root mean square of successive differences (RMSSD). All data were analyzed using paired t-tests. Results: There were no statistically significant differences before and after the intervention in the mean heart rate, LF, HF, LF/HF ratio, SDNN, and RMSSD among the 17 patients with dysphagia who received functional electrical stimulation therapy (p>.05). Conclusion: Functional electrical stimulation therapy administered by an occupational therapist did not affect the autonomic nervous system in patients with dysphagia, indicating that the intervention was safe. However, because the SDNN and RMSSD values decreased, occupational therapists should apply the treatment with caution. Further studies are required to establish safer treatment protocols for these conditions.

Purpose: This study aimed to compare the effects of deep cervical flexor (DCF) exercise alone and DCF exercise combined with laser-based sensorimotor training on balance, cervical motor control, and superficial neck muscle tone in older adults. Methods: Twenty-four older adults were randomly assigned to either a DCF-only control group (n=12) or a DCF plus laser-guided sensorimotor training group (n=12). Both groups performed DCF exercises three times per week for six weeks, while the experimental group additionally trained on laser-based head-movement tracking. Outcome measures included the Functional Gait Assessment (FGA), modified Clinical Test of Sensory Interaction on Balance (m-CTSIB), Cranio-Cervical Flexion Test (CCFT), and muscle tones of the upper trapezius (UT), levator scapulae (LS), and sternocleidomastoid muscles (SCM) assessed using Myoton PRO. Pre-post differences were analyzed using paired t-tests, and between-group comparisons were performed using analysis of covariance (ANCOVA), with baseline values as covariates. Results: Both groups showed significant improvements in FGA, m-CTSIB, and CCFT scores after the intervention (all p<.05). The experimental group demonstrated significantly greater improvements in FGA (p<.05) and CCFT (p<.01) compared to the control group. Although the m-CTSIB score increased significantly in both groups (p<.05), the between-group difference was not significant (p>.05). For muscle tone, the experimental group showed significant reductions in the UT (p<.01), LS (p<.001), and SCM (p<.05). In the control group, only the UT showed a significant reduction (p<.05), whereas the LS and SCM did not show significant changes (p>.05). In terms of muscle tone, between-group comparisons revealed a significant difference only in the UT, with the experimental group showing a greater reduction (p<.05). Conclusion: In older adults, combining DCF exercise with laser-based sensorimotor training is more effective than DCF exercise alone for enhancing gait-related balance and cervical motor control, and for reducing superficial neck muscle overactivation, particularly in the upper trapezius. This combined intervention may serve as a useful therapeutic approach for improving balance and reducing the risk of falls in the older population.

Purpose: This study investigated the effects of squat exercises performed under different levels of support surface stability on lower limb muscle architecture in individuals with subacute stroke. Specifically, this study aimed to compare the changes in muscle thickness and pennation angle of the paretic tibialis anterior and medial gastrocnemius muscles between stable and unstable support surface conditions. Methods: Twenty-six individuals with subacute stroke were randomly allocated to either the unstable surface group (n=13) or stable surface group (n=13). Both groups participated in a 4-week intervention consisting of conventional rehabilitation combined with a standardized squat exercise program performed five times per week. The squat depth (approximately 60° knee flexion) and movement speed were controlled using a goniometer and metronome. The muscle thicknesses of the tibialis anterior and medial gastrocnemius, as well as the pennation angle of the medial gastrocnemius were assessed using rehabilitative ultrasound imaging before and after the intervention. Within-group changes were analyzed using paired t-tests and between-group differences in change scores were examined using independent t-tests. Results: Both groups demonstrated significant increases in tibialis anterior thickness, medial gastrocnemius thickness, and medial gastrocnemius pennation angle after the intervention (p<.01). However, the unstable-surface group showed significantly greater improvements in all outcome variables than the stable-surface group (p<.05), indicating larger structural adaptations of the paretic lower limb muscles under unstable support surface conditions. Conclusions: Squat exercises performed on an unstable support surface induced greater increases in the muscle thickness and pennation angle of the paretic lower limb than those performed on a stable surface. These findings suggest that incorporating unstable support surfaces into squat training may provide additional benefits in promoting neuromuscular and structural adaptations in individuals with subacute stroke. Further studies are required to examine whether these architectural changes translate into functional improvements.

Purpose: This study aimed to compare the rectus abdominis (RA) muscle thickness between normal and obese body mass index (BMI) groups and to examine the association between BMI and RA thickness in healthy adults in their 20s. Methods: Thirty healthy adults aged 20–29 years participated in this cross-sectional study. Participants were classified into a normal-BMI group (18.5–22.9 kg/m², n=15) or an obese-BMI group (≥25.0 kg/m², n=15) according to the Asia–Pacific BMI criteria. Individuals classified as overweight (23.0–24.9 kg/m²) were excluded to ensure clear group separation. The RA thickness was measured using B-mode ultrasonography with a linear transducer positioned 2 cm above the umbilicus in the supine position. Three measurements were obtained at the same site, and the mean values were analyzed. Group differences were assessed using an independent t-test, and Pearson’s correlation analysis was performed to examine the relationship between BMI and RA thickness. An analysis of covariance was conducted to control for the potential effects of sex and height. Results: The RA thickness was significantly greater in the obese-BMI group than in the normal-BMI group (p<.001). A strong positive correlation was observed between BMI and RA thickness in all participants (r=.71, p<.001). After adjusting for sex and height, the difference in the RA thickness between the BMI groups remained statistically significant. Conclusions: A higher BMI was independently associated with increased RA thickness in healthy young adults. Ultrasonographic assessment of the RA thickness may serve as a clinically meaningful indicator of abdominal muscle characteristics related to body composition.

Purpose: This study examined the effects of extracorporeal shock wave therapy (ESWT) on the athletic performance of soccer players with chronic ankle instability (CAI). Methods: Thirty male soccer players were randomly assigned to an ESWT group (n=15) or a control group that received neuromuscular electrical stimulation (NMES) (n=15). Performance was assessed using the Vertical Jump Test, Star Excursion Balance Test, and 20-m Sprint Test. Results: The ESWT group showed significantly greater improvements in vertical jump height, balance, and sprint speed than the NMES group (p<0.05). Conclusion: ESWT effectively enhanced the athletic performance of soccer players with CAI by improving strength, balance, and sprinting ability. However, further studies are required to confirm the long-term efficacy of this treatment.

Purpose: This study aimed to investigate the effects of half-lunges with visual feedback and axial shortening on the psoas muscle thickness. Methods: This study included 20 healthy adults (20 men; mean age, 22.1 years) and used a repeated-measures design. All participants performed two types of motion (axial shortening and half-lunge with visual feedback) during respiratory muscle training. The psoas muscle thickness (at rest and during contraction) during the two motions was measured using ultrasonography. Results: Significant pre- and post-test changes in the psoas muscle thickness were observed in both groups (p<.05). However, a significant difference between the two motions was observed only in the normal group (p<.05) and not in the lengthened group (p<.05). Conclusion: The results of this study are significant as they confirm the effectiveness of half-lunges with visual feedback in selectively increasing the contraction of the psoas major muscle, regardless of the length of the iliopsoas muscle. This finding underscores the potential of half-lunges with visual feedback as an effective intervention for improving movement control dysfunction in the extension direction of the hip joint by limiting the uncontrolled movement of the adjacent joint.

Purpose: This narrative review examined the physiological mechanisms and clinical effectiveness of manual therapy, exercise therapy, adjunctive modalities, multimodal programs, and neurofeedback interventions in adults with tension-type headaches (TTH). Methods: We systematically searched PubMed, DBpia, KISS, and Google Scholar for studies published between January 2015 and April 2025. Eligible studies included adult TTH populations, physiotherapeutic interventions, and clinical outcomes, such as headache intensity, frequency, disability, and quality of life. Four independent reviewers screened, evaluated, and extracted the data. Fourteen studies met the criteria and data were synthesized according to intervention category. Results: Randomized controlled trials and systematic reviews consistently demonstrated that manual therapy, such as suboccipital inhibition, joint mobilization, soft tissue mobilization, and neural techniques, reduced headache intensity and pressure pain sensitivity. Exercise therapy, including deep cervical flexor training and postural stabilization, decreased headache frequency and improved functional measures. Adjunctive and multimodal approaches (TENS, AVE, relaxation, and biofeedback) further supported reductions in the headache burden, with improvements in disability indices (HDI, HIT-6) and quality of life (SF-12/36). TENS demonstrated enhanced effects when combined with physiotherapy, whereas AVE facilitated β-band suppression, α-band enhancement, and autonomic stabilization (HRV, skin conductance, skin temperature). Infra-low-frequency neurofeedback resulted in session-wise reductions in headache probability (~8% per session, p<.001) and strengthened corticolimbic connectivity. Evidence quality varied because of heterogeneity and short follow-up durations. Conclusion: Physiotherapy for TTH is clinically effective, and multimodal strategies offer superior and sustained outcomes. Integrating peripheral regulation (manual or exercise therapy) with central modulation (neurofeedback) is a synergistic and theoretically grounded treatment strategy. Future studies should standardize neurofeedback protocols and incorporate long-term follow-up to reinforce the evidence for central–peripheral integrated management.

Purpose: This study aimed to analyze the biomechanical effects of two types of manual-handling equipment commonly used in industrial settings by comparing muscle activation levels during pushing, pulling, and lifting tasks. Methods: Twenty-eight healthy adults participated in this study. Each participant performed pushing, pulling, and lifting tasks while transporting a 20-kg load using two types of manual handling equipment: one with a short handle (SH) and one with a long and adjustable handle (LH). Surface electromyography (EMG) was used to measure changes in trunk and lower limb muscle activation under identical experimental conditions. Results: LH consistently produced lower erector spinae (T7) activation than SH across all tasks. Soleus activation during pulling was significantly lower in the LH group than in the SH group. Trunk muscles showed higher activation during lifting than during pushing or pulling, regardless of handle type, whereas lower limb muscles demonstrated the greatest activation during pulling tasks. Conclusion: This study demonstrated that manual-handling equipment with an extended and adjustable handle significantly reduced muscle activation in users compared with conventional equipment. This finding provides fundamental evidence that biomechanical and ergonomic equipment can reduce musculoskeletal stress during industrial tasks, potentially contributing to the prevention of work-related musculoskeletal disorders.

Purpose: This study aimed to empirically assess how the provident effect on shoulder muscle activity and stabilization varies depending on the range of physical application (upper body vs. whole body) of vibration to the quadruped position. Methods: Twenty healthy adult female Pilates students without shoulder pain or musculoskeletal disorders were recruited and divided into the upper-body (n=10) and whole-body (n=10) vibration groups. Pre- and post-exercise shoulder muscle activity (EMG) and shoulder stabilization tests (ROM, MMT, and YBT) were performed. Two-way analysis of variance (ANOVA) was performed to determine the differences in the effects of vibration application between groups. Results: Vibrations applied in the quadruped position exerted a statistically significant impact on shoulder muscle activity. The upper-body vibration group showed substantially greater improvement than the whole-body vibration group. Conclusion: This study confirmed that the magnitude of improvements due to different extents of musculature exposed to vibrations were distinct. Both the upper and whole-body vibration groups experienced significant improvement, with the upper-body vibration group experiencing greater shoulder muscle improvement than the whole-body vibration group.