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Thesis (M App Sci in Physiotherapy) --University of South Australia, 1992

Thesis (MAppSc in Physiotherapy) -- University of South Australia

Thesis (MAppSc in Physiotherapy)--University of South Australia, 1995

Thesis (MSc.(Anatomy)--Faculty of Health Sciences)-University of Pretoria, 2007. / Includes bibliographical references.

M.Tech. (Chiropractic) / PURPOSE: The aim of the study was to compare the effectiveness of treating inter-scapular pain with either chiropractic adjustments delivered to the costovertebral joints, with ischaemic compression of the myofascial trigger points of the rhomboid muscles, or using a combination treatment protocol in order to determine which of the three treatment protocols was superior. DESIGN: This study was a comparative study consisting of three groups of ten participants each. Participants were between the ages of eighteen and forty-five and there was an equal male to female ratio. Prior to becoming a participant in this study individuals were assessed according to the inclusion and exclusion criteria. A McGill Pain Questionnaire, numerical pain rating scale, a clinical case history, full physical examination, a cervical regional examination were completed. The method of treatment for each participant was determined by random group allocation. Group 1 received chiropractic adjustments to the costovertebral joints, Group 2 received ischaemic compression to the myofascial trigger points of the rhomboid muscles. Group 3 received a combination treatment involving both chiropractic adjustments to the costovertebral joints together with ischaemic compression of the rhomboid trigger points. Subjective and objective readings were based on the above treatment protocols. All participants received a total of six treatments over a three week period. MEASUREMENTS: Subjective measurements were obtained by the Numerical Pain Rating Scale and the McGill Pain Questionnaire. Objective measurements were obtained using the hand-held pressure algometer. The data was collected on the first, fourth and seventh consultations. OUTCOME: With regards to the subjective readings, the results from the McGill Pain Questionnaire for the intragroup analysis indicated that the ischaemic compression group showed the greatest improvement over time (84.06%). No statistically significant differences were noted for the intergroup analysis. The intragroup analysis of the Numerical Pain Rating Scale indicated that the adjustment group showed the greatest improvement over time (78.70%). The intergroup analysis indicated that there were no statistically significant differences. With regards to the objective measurements, the intragroup analysis of the pressure algometer readings indicated that the ischaemic compression group showed the greatest improvement over time (35.44%). Once again, there were no statistically significant differences with the intergroup analysis. CONCLUSION: Based on the results of this study, it showed that all three treatment groups were effective in decreasing inter-scapular pain and disability. Although all three treatment protocols have shown to be effective, and have shown similar improvement, intergroup analysis indicates that statistically there is no treatment protocol that is seen to be more superior or more effective in treating inter-scapular pain.

By understanding the normal humeral and scapular kinematics during the kayak stroke, inferences about the relationship of kayaking technique and shoulder injury may be established. The purpose of this study was to describe scapular and humeral kinematics and to compare dominant versus non-dominant symmetry in healthy whitewater kayakers performing the forward stroke. Twenty-five competent whitewater kayakers (mean age: 34.1±9.4 years, mean height: 1.768±0.093 m, mean mass: 78.2±13.0 kg) underwent humeral and scapular kinematic assessment, using an electromagnetic tracking device, while kayaking on a kayak ergometer. Paired t-tests were used to determine symmetry. Scapular and humeral kinematic means and standard deviations at six time points during the kayak stroke were described. Scapular and humeral kinematics were shown to be similar upon bilateral comparison. The greatest potential for injury during the forward stroke may be at thrust paddle shaft vertical when the humerus is maximally elevated in internal rotation and adduction as subacromial structures may be mechanically impinged. The relationship between scapulohumeral kinematics related to injury at other time points are also described.

Le but de ce travail est d’améliorer les techniques de mesure cinématique tridimensionnelle (3D) afin d’étudier les schémas cinématiques du complexe de l’épaule et du rachis cervical chez des sujets sains et pathologiques. La première partie de ce travail propose un rappel d’anatomie fonctionnelle, une revue de la littérature de la cinématique du complexe scapulo-huméral et une mise au point sur les techniques de mesure de ces deux complexes articulaires. La deuxième partie de ce travail a pour objectif d’évaluer à partir d’études cliniques originales : - la reproductibilité des techniques de mesure des rotations des complexes scapulo-huméral et cervical et d’en proposer une amélioration par une analyse simultanée des translations du barycentre de la scapula ainsi que par la mesure couplée des deux complexes articulaire. - les schémas cinématiques de la scapula dans différents modèles de pathologies ostéo-articulaires au cours de gestes analytiques et fonctionnels. En conclusion, ce travail de thèse met en évidence : une variabilité intra-individuelle dans la capacité à reproduire un mouvement à l’identique avec le membre supérieur et à conserver la même précision dans le repositionnement de la tête. - des mouvements de translation 3D de la scapula, dont certains de grande amplitude, associés aux rotations des mouvements de faible amplitude du rachis cervical associés aux mouvements du membre supérieur en faveur de son rôle proprioceptif. - des schémas cinématiques scapulaires spécifiques : - de la lésion neurologique en cas de scapula alata dynamique. - de la nature fonctionnelle de la tâche en cas de pathologies ostéo-articulaires communes / The aim of this work was to improve the methods of kinematic assessment of the shoulder complex and of the cervical spine in order to improve understanding of scapular and cervical spine kinematics in asymptomatic and symptomatic subjects. The first part of this work provides a reminder of functional anatomy, a literature review of the 3D kinematics of the shoulder complex and issues relating to measurement techniques of both articular complexes. The second part is based on original clinical studies assessing: - the reliability of the measurement techniques of the rotations of both articular complexes and their enhancement by addition of scapular translations and the coupled mobility of the cervical spine and shoulder complexes. - the patterns of scapular kinematic in different ostéo-articular pathologies In conclusion, this work highlights: - intra-individual variability in the ability to reproduce a movement with the upper arm and in the accuracy of repositioning the head . -3D scapular translations (some with large ranges) associated with scapular rotations. - small movements of the cervical spine associated with upper limb movements relating to the proprioceptive role of the cervical. - spine specific scapular kinematic patterns depending on: - neurological lesions in the case of dynamic scapula alata, - the type of movement in common osteo articular pathologies

Bakgrund:  Simning är en populär sport. De extrema repetitiva rörelserna som ingår i sporter med majoriteten av rörelserna över huvudet, som exempelvis simning, och otillräcklig stabilitet i axelleden resulterar ofta i överansträngning och skador. Ett vanligt syndrom är impingement och det har rapporterats att 40-91 % av alla simmare har eller upplever problem i axelleden eller de omkringliggande strukturerna. Syfte: Att undersöka om en intervention bestående av övningar för scapulas närliggande muskler i fyra veckor kan påverka upplevd smärta i axel och nacke hos unga simmare. Deltagare: Sexton unga simmare mellan åldrarna (13±2), bestående av (10 flickor och 6 pojkar) deltog. Alla deltagare utförde minst fyra simpass i veckan. Alla deltagare i studien upplever problematik i axel och/eller nacke. Metod: Deltagarna fick fylla i ett (SRQ-S) formulär och genomgå ett Beighton-test. Alla deltagare instruerades i fyra olika övningar, syftet med övningarna var att öka neuromuskulär kontroll och styrka i axelns stabiliserande muskler. Alla övningar skulle utföras innan träningspass, minst en gång om dagen, i fyra veckor. Efter fyra veckors interventionen fick deltagarna fylla i ett nytt (SRQ-S) formulär, den totala poängen innan och efter jämfördes. Resultat:  (SRQ-S) formulären resulterade i en signifikant skillnad (p=0,0005) mellan innan och efter interventionen. Majoriteten av deltagarna rapporterade ett högre välmående i axel och/eller nacke. Konklusion : Majoriteten av deltagarna upplevde minskad problematik i axel och/eller nacke efter fyra veckors interventionen. Det visar på att det finns ett samband mellan ökad axel stabilisering och minskad upplevd smärta i axel/nacke. Dock kan denna studie inte komma till en säker konklusion då vidare undersökning måste göras i detta område. / Background : Competitive swimming is a popular sport. The extreme repetitive motions that overhead-sports implies, like swimming, and inadequate stability in the shoulder joint often results in overexertions and injuries. A common condition is impingement syndrome and it has been reported that 40-91% of all swimmers have or experience problems in the shoulder joint or in the surrounding structures. Purpose : To investigate whether an intervention consisting of exercises for scapulas nearby muscles for four weeks can affect perceived distress in the shoulders and neck of young swimmers. Participants : Sixteen young swimmer between the age of (13±2), consisting of (10 females and 6 males) volunteered to participate. All the participants are performing at least four sessions of swimming a week. All the participants in the study are experiencing trouble in their neck or/and shoulders. Method : The participants had to fill in a (SRQ-S) form and do a Beighton-test. Participants were instructed in four different exercises, the purpose of the exercises were to increase neuromuscular control and strength in the shoulder stabilizing muscles. All exercise were to be performed before every session of swimming, at least once a day, for four weeks. After the four weeks of intervention the participants had to fill in a new (SRQ-S) form, the before and after score were compared. Results : The (SRQ-S) formulas resulted in a significant difference (p=0,0005) between before and after the intervention. The majority of the participants reported also a higher prosperous in their shoulder and/or neck area. Conclusion: The majority of the participant experienced less discomfort in their shoulder and neck area after the four weeks of intervention. There seems to be a relationship between increased shoulder stability and decrease in discomfort in the shoulder/neck. However this study can not come to a secure conclusion and further investigation has to be made in this area.

De acordo com o conceito de cadeia cinética, o controle da posição distal depende da estabilização dos segmentos proximais. Deste modo, a estabilização necessária para o controle e movimento dos membros superiores é proporcionada pelo tronco e pela pelve que servem como meio de transmissão de força e energia. O controle da postura e do movimento é realizado por mecanismos de feedback e feedforward definidos pela teoria do controle motor. O feedforward é descrito pelas atividades antecipatórias corporais a fim de neutralizar os efeitos perturbadores de determinada condição específica. O feedback é representado pelo uso do biofeedback (estímulo verbal, visual, auditivo ou cinestésico) com o objetivo de restaurar a coordenação e o controle muscular, e potencializar os mecanismos de feedforward muscular. Há poucas investigações de tais mecanismos de controle no complexo articular do ombro e estudos prévios demostram a influência de comandos verbais para a orientação escapular sobre os padrões de ativação muscular seletiva do ombro. Objetivo: verificar o efeito da instrução verbal para ativação consciente da musculatura abdominal, sobre a atividade dos músculos periescapulares em pacientes com sintomas da síndrome do impacto no ombro durante exercícios de força. Materiais e Métodos: 30 voluntários com condição dolorosa há pelo menos 4 semanas no ombro, de ambos os sexos ( 11 homens e 19 mulheres) com idade de 35 a 75 anos realizaram exercícios para o complexo sendo que o grupo controle apenas repetiu os exercícios já o outro grupo recebeu treinamento para adicionar a contração abdominal consciente referente a estímulo verbal e tátil durante os mesmos exercícios previamente realizados, assim o sinal eletromiográfico foi captado através do aparelho TrignoTM Wireless System (Delsys Inc. Boston, MA). Resultados: Durante os exercícios a comparação entre grupos com e sem instrução para contração abdominal no momento pré e pós apresentou diferença no modelo linear de efeitos mistos apenas para os músculos Trapézio Transverso durante o Full can (FC) para o lado sintomático (TE:0,92); Trapézio ascendente para o lado 10 sintomático durante (FC) (TE:-0,96) e para o lado assintomático durante External Rotation Kneeling (ERK) (TE:-0,81); já o Serrátil anterior quando exigido no exercício Knee Push (KP) o lado assintomático apresentou diferença entre os grupos (TE:-1,24) assim como no (ERK) com (TE: -2,09) para lado assintomático e no Wall Slide with Towel (WST) com (TE:1,03) também para o lado assintomático; Conclusão / According to the kinetic chain concept, the control of the distal position depends on the stabilization of the proximal segments. Thus, the stabilization necessary for the control and movement of the upper limbs is provided by the trunk and pelvis which serve as a means of transmitting force and energy. The control of posture and movement is performed by feedback and feedforward mechanisms defined by motor control theory. Feedforward is described by anticipatory body activities in order to counteract the disruptive effects of a particular condition. The feedback is represented by the use of biofeedback (verbal, visual, auditory or kinesthetic stimulus) with the objective of restoring coordination and muscular control, and potentiate the mechanisms of muscle feedforward. There are few investigations of such control mechanisms in the shoulder joint complex and previous studies demonstrate the influence of verbal commands on the scapular orientation on selective muscular activation patterns of the shoulder. Objective: To verify the effect of verbal instruction for conscious activation of the abdominal musculature on the activity of the periescapular muscles in patients with symptoms of shoulder impact syndrome during strength exercises. Materials and Methods: 30 volunteers with painful condition for at least 4 weeks on the shoulder, of both sexes (11 men and 19 women) aged 35 to 75 years performed exercises for the complex and the control group only repeated the exercises already the other group received training to add conscious abdominal contraction regarding verbal and tactile stimuli during the same exercises previously performed, so the electromyographic signal was captured through the TrignoTM Wireless System (Delsys Inc. Boston, MA). Results: During the exercises, the comparison between groups with and without instruction for abdominal contraction at the pre and post moments presented a difference in the linear mixed effects model only for Middle trapezoid muscles during Full can (FC) for the symptomatic side (TE: 0.92 ); trapeze lower to the symptomatic side during (FC) (TE: -0.96) and to the asymptomatic side during External Rotation Kneeling (TE: -0.81). The anterior serratus when required in the Knee Push exercise (KP), the asymptomatic side presented a difference between the groups (TE: -1.24) as well as in the (ERK) with (TE: -2.09) for asymptomatic side and Wall Slide with Towel (WST) with (TE: 1.03) also for the asymptomatic side; Conclusion: