Publications by authors named "Jiu-Jenq Lin"

59 Publications

Glenohumeral internal rotation deficit on pitching biomechanics and muscle activity.

Int J Sports Med 2021 Oct 12. Epub 2021 Oct 12.

School & Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.

To characterize the scapular pitching biomechanics in symptomatic GIRD pitchers (SG) compared to asymptomatic GIRD (ASG) and healthy pitchers. The scapular kinematics and associated muscle activities during pitching were recorded in 33 high school pitchers. Compared to healthy, GIRD pitchers had less scapular posterior tilt in each pitching event (average difference, AD = 14.4°, p < 0.01) and ASG demonstrated less scapular upward rotation at ball release (AD = 12.8°, p < 0.01) and greater muscle activity in the triceps brachii in the early-cocking phase (AD = 9.9%, p = 0.015) and in the serratus anterior in the late-cocking phase (AD = 30.8%, p < 0.01). Additionally, SG had less muscular activity on triceps brachii in the acceleration phase and serratus anterior in the cocking phase (AD = 37.8%, p = 0.016; AD = 15.5%, p < 0.01, respectively) compared to ASG. GIRD pitchers exhibited less scapular posterior tilt during pitching, which may cause impingement. Since tightness of the anterior shoulder is a common cause of inadequacy of posterior tilt during arm elevation, stretching exercise of the anterior shoulder is recommended. Given the inadequate recruitment during pitching in the GIRD pitchers, symptoms may develop following potential impingement.
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http://dx.doi.org/10.1055/a-1667-6080DOI Listing
October 2021

Physical activity and fitness in survivors of head and neck cancer.

Support Care Cancer 2021 Nov 17;29(11):6807-6817. Epub 2021 May 17.

School of Nursing, College of Medicine, National Taiwan University, No.1, Jen-Ai Rd., Sec. 1, Taipei City, 100, Taiwan.

Purpose: The purposes of the study were (1) to assess the physical activity (PA) status, muscle strength (MS), and flexibility of survivors of head and neck cancer (HNC) and compare these findings with normative data from national labor fitness measures; (2) to examine the differences among PA subgroups, as categorized using Godin's scores; and (3) to examine the association between stretching exercises and cervical range of motion (CROM).

Methods: A cross-sectional study with consecutive sampling was used to recruit HNC survivors from a medical center in Northern Taiwan who had completed either radiation therapy (RT) or multimodality treatments including RT within the current 5 years. The level of PA, daily function, fatigue, quality of life (QOL), MS (handgrip and hip flexor), BMI, and flexibility (CROM and fingertip-to-floor tests) of the participants were assessed.

Results: A total of 108 participants completed the assessments from 135 eligible patients (80% response rate). Although 60.2% reported engaging in PA, only 16.7% met WHO guidelines. Compared to subjects in the normative data, the survivors of HNC in this study had poorer handgrip strength, BMI, and CROM, but better forward flexion. The participants who were consistent with WHO PA guidelines reported less fatigue, better right hip flexor MS, and better QOL than those who did not engage in any PA.

Conclusion: Lack of sufficient PA and generally poorer fitness were found in study subjects. Longitudinal research to explore changes in fitness and barriers to PA compliance is strongly suggested to better enhance HNC patients' PA and fitness.
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http://dx.doi.org/10.1007/s00520-021-06192-yDOI Listing
November 2021

Effectiveness of low level laser therapy versus cryotherapy in cancer patients with oral mucositis: Systematic review and network meta-analysis.

Crit Rev Oncol Hematol 2021 Apr 11;160:103276. Epub 2021 Mar 11.

Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address:

Objective: The purpose of this network meta-analysis was to analyze the relative effects of low level laser therapy (LLLT) and/or cryotherapy in cancer patients with oral mucositis (OM).

Methods: This literature search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Physiotherapy Evidence Database (PEDro) up to 2020. Only randomized control trials which involved comparisons of groups receiving the interventions of combined cryotherapy and LLLT, LLLT, cryotherapy and usual care (the control group) in patients with cancer were eligible for inclusion. The effect sizes are presented as odds ratios for the occurrence of severe, moderate and none/mild OM. The mixed treatment comparison was conducted using generalized linear mixed models to analyze the direct and indirect comparisons of interventions. The critical appraisal was assessed using Cochrane Collaboration's tool. Heterogeneity between studies was assessed using I statistics, and publication bias was evaluated by constructing a funnel plot.

Results: Twenty-six randomized controlled trials with a total enrollment of 1830 cancer patients with OM were included. The outcome of none/mild OM is desirable, and odds ratios of more than 1 favor the intervention group. Moderate and severe OM are defined as adverse outcomes, and ORs less than 1 favor the intervention group. The treatment effects of the combined cryotherapy and LLLT were better than those of usual care for none/mild and severe OM (ORs = 106.23 [95% CI = 12.15 to 929.17] and 0.01 [95% CI = 0 to 0.57], respectively). Treatment effects with cryotherapy alone and LLLT alone were better than those with usual care for none/mild and severe OM (ORs = 3.13 [95%CI = 1.56 to 6.27]; ORs = 7.56 [95%CI = 3.84 to 14.88] and 0.25 [95%CI = 0.11 to 0.54]; ORs = 0.13 [95%CI = 0.07 to 0.24], respectively). Nevertheless, for patients with none/mild OM, treatment effects with combined use of cryotherapy and LLLT were better than those with only LLT or cryotherapy (ORs = 14.06 [95%CI = 1.79 to 110.30] and 33.95 [95%CI = 3.50 to 329.65], respectively). For patients with moderate OM, treatment effect did not reach statistical significance among comparisons. The limitations include the wide variability in treatment protocols and the non-uniform outcome measurements across the studies examined.

Conclusion: Compared with no intervention, the treatment effects of combined cryotherapy and LLLT, laser alone, and cryotherapy alone are beneficial for the reduction of severe OM. There is no difference in treatment effects among cryotherapy and/or LLLT intervention in cancer patients with moderate OM. Results of this study provide an implicative basis for LLLT and cryotherapy as viable interventions that can significantly improve severe OM.
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http://dx.doi.org/10.1016/j.critrevonc.2021.103276DOI Listing
April 2021

Clinical Factors Related to Improved Scapular Control After a Scapular Conscious Control Program in Symptomatic Overhead Athletes: Secondary Analysis of a Randomized Controlled Trial.

Orthop J Sports Med 2020 Nov 30;8(11):2325967120964600. Epub 2020 Nov 30.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.

Background: Predictive variables associated with the effects of a scapular conscious control program should be identified and used to guide rehabilitation programs.

Purpose: To determine whether potential factors are associated with the success of scapular muscle balance with an early control program in patients with subacromial pain and scapular dyskinesis.

Study Design: Case-control study; Level of evidence, 3.

Methods: A total of 38 amateur overhead athletes with subacromial pain and medial border prominence were recruited. They performed progressive conscious control of scapular orientation during 45° and 90° of arm elevation. Stepwise logistic regression and receiver operating characteristic curve were used to determine the optimal cutoff point of related factors for success or failure of the program. Potential factors including pain level during activity, pain duration, anterior/posterior shoulder flexibility, forward shoulder posture, posterior displacement of root of spine and inferior angle, scapular kinematics, and muscle activation before conscious control program were recorded as independent variables. Successful control defined as decreases of the upper trapezius/serratus anterior ratio in 2 consecutive trials of the 90° program or failure in the program was used as a dependent variable.

Results: Having a posterior displacement of the inferior angle of the scapula of ≤16.4 mm and scapular posterior tipping during arm elevation of ≤3.3° (collected before the control program) were associated with the success of the program ( = 0.286; < .05). Additionally, participants with each or both variables present at baseline had probabilities of success of 78% and 95%, respectively.

Conclusion: The value of scapular posterior displacement and posterior tilt should be considered before early scapular control program. Other factors related to the success of the program should be found due to the limited variance explained in the regression model.
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http://dx.doi.org/10.1177/2325967120964600DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708709PMC
November 2020

The immediate effects of a shoulder brace on muscle activity and scapular kinematics in subjects with shoulder impingement syndrome and rounded shoulder posture: A randomized crossover design.

Gait Posture 2020 06 4;79:162-169. Epub 2020 May 4.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan; Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan. Electronic address:

Background: Round shoulder posture (RSP) is one of the potential risks for shoulder impingement syndrome (SIS) due to alignment deviation of the scapula. Evidence on how the characteristics of a shoulder brace affecting the degree of RSP, shoulder kinematics, and associated muscle activity during movements is limited.

Research Question: The purposes of this study were (1) to compare the effects of a shoulder brace on clinical RSP measurements, muscle activities and scapular kinematics during arm movements in subjects with shoulder impingement syndrome (SIS) and RSP; and (2) to compare the effects of two configurations (parallel and diagonal) and two tensions (comfortable and forced tension) of the brace straps on muscle activities and scapular kinematics during arm movements in subjects with SIS and RSP.

Methods: Twenty-four participants (12 males; 12 females) with SIS and RSP were randomly assigned into 2 groups (comfortable then forced, and forced then comfortable) with 2 strap configurations in each tension condition. The pectoralis minor index (PMI), acromial distance (AD) and shoulder angle (SA) were used to assess the degree of RSP. Three-dimensional electromagnetic motion analysis and electromyography were used to record the scapular kinematics and muscle activity during arm movements.

Results: All clinical measurements with the brace were significantly improved (p < 0.05). Under forced tension, muscle activities were higher with the diagonal configuration than with the parallel configuration in the lower trapezius (LT) (1.2-2.3% MVIC, p < 0.05) and serratus anterior (SA) (2.3% MVIC, p = 0.015). For upward rotation and posterior tilting of the scapula, the diagonal configuration was larger than the parallel configuration (1.5°, p = 0.038; 0.4°-0.5°, p < 0.05, respectively).

Significance: Different characteristics of the straps of the shoulder brace could alter muscle activity and scapular kinematics at different angles during arm movement. Based on the clinical treatment preference, the application of a shoulder brace with a diagonal configuration and forced tension is suggested for SIS and RSP subjects.
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http://dx.doi.org/10.1016/j.gaitpost.2020.04.028DOI Listing
June 2020

Measurement of scapular prominence in symptomatic dyskinesis using a novel scapulometer: reliability and the relationship to shoulder dysfunction.

J Shoulder Elbow Surg 2020 Sep 1;29(9):1852-1858. Epub 2020 Apr 1.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan. Electronic address:

Background: No previous studies have investigated whether the extent of scapular dyskinesis is associated with shoulder dysfunction. This study aimed (1) to establish the reliability of a scapulometer in patients with shoulder pain and (2) to investigate the related factors associated with shoulder dysfunction.

Methods: One hundred participants with symptomatic scapular dyskinesis were recruited. Twenty-one participants were involved in the reliability study to test the intrarater and inter-rater reliabilities of the scapulometer in patients with shoulder pain. After demographic data and self-reported Flexilevel Scale of Shoulder Function (FLEX-SF) scores were recorded, all participants were measured with a scapulometer to determine the posterior displacement of the root of the spine (ROS) and the inferior angle (IFA) of the scapula from the thorax. Next, the participants performed 5 trials of bilateral scapular plane elevation for scapular kinematics and electromyographic (EMG) data collection. Stepwise multiple linear regressions were used to determine the relationships between self-reported FLEX-SF scores and potential factors. In addition to scapular displacement, pain level, scapular kinematics, and EMG data were included as independent variables.

Results: The intrarater and inter-rater reliabilities of the scapulometer were excellent (intraclass correlation coefficient [ICC] = 0.93-0.97) and moderate to good (ICC = 0.74-0.81), respectively. The Bland-Altman plots showed no systematic bias between raters in the ROS and IFA measurements. Final stepwise multiple regression models showed that more ROS distance, higher serratus anterior activity, and lower pain level during arm elevation were associated with higher shoulder function (total R = 0.253).

Conclusion: The reliability of the scapulometer in patients with shoulder pain is moderate to excellent. Scapular dyskinesis may be a compensatory strategy to avoid shoulder pain and improve shoulder function.
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http://dx.doi.org/10.1016/j.jse.2020.01.069DOI Listing
September 2020

Single-Session Video and Electromyography Feedback in Overhead Athletes With Scapular Dyskinesis and Impingement Syndrome.

J Athl Train 2020 Mar 26;55(3):265-273. Epub 2019 Dec 26.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University.

Context: Subacromial impingement syndrome (SIS) is associated with scapular dyskinesis, or imbalanced scapular muscle activity. Evidence has shown that feedback can improve scapular control in patients with SIS. However, it is unknown whether real-time video feedback or electromyography (EMG) biofeedback is optimal for improving scapular kinematics and muscle activity during a functional task.

Objective: To compare the effects of video and EMG feedback sessions on absolute muscle activity (upper trapezius [UT], lower trapezius [LT], serratus anterior), muscle balance ratios (UT/LT, UT/serratus anterior), and scapular kinematics (anterior-posterior tilt, external-internal rotation, upward rotation) in SIS participants during arm elevation and lowering.

Design: Randomized controlled clinical trial.

Setting: Research laboratory.

Patients Or Other Participants: Overhead athletes who were diagnosed with SIS and who also exhibited scapular dyskinesis (N = 41).

Main Outcome Measure(s): Three-dimensional kinematics and EMG were recorded before and after feedback training.

Results: Lower trapezius muscle activity increased (4.2%-18%, < .011) and UT/LT decreased (0.56-1.17, < .013) in the EMG biofeedback training group as compared with those in the video feedback training group. Scapular upward rotation during arm elevation was higher in the video group than in the EMG group after feedback training (2.3°, = .024).

Conclusions: The EMG biofeedback improved muscle control and video feedback improved the correction of scapular upward rotation in patients with SIS.

Trial Registration Number: ClinicalTrials.gov: NCT03252444.
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http://dx.doi.org/10.4085/1062-6050-490-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093932PMC
March 2020

Serratus Anterior and Upper Trapezius Electromyographic Analysis of the Push-Up Plus Exercise: A Systematic Review and Meta-Analysis.

J Athl Train 2019 Nov 4;54(11):1156-1164. Epub 2019 Oct 4.

School & Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei.

Context: Whereas the serratus anterior (SA) and the upper trapezius (UT) work as a force couple for scapular motion, weakness of the SA and overactivation of the UT are often present in overhead athletes with shoulder dysfunction. Therefore, researchers addressing an intramuscular imbalance between the SA and UT have focused on finding exercises that target the weak SA and minimally activate the UT.

Objective: To compare the effectiveness of push-up plus (PUP) exercise variants based on the electromyographic (EMG) activity of the SA and UT.

Data Sources: A systematic search of PubMed and Scopus between January 1, 2000, and March 31, 2008.

Study Selection: Studies of PUP exercises that involved EMG analysis.

Data Extraction: We assessed study quality using the Critical Appraisal Skills Program. For the systematic analysis, the following data were extracted: (1) author, year, and study design; (2) participant characteristics; (3) type of PUP intervention; (4) EMG outcome measures; and (5) main results. For the meta-analysis, the EMG data of the SA and UT were calculated using the mean difference of EMG activity with a 95% confidence interval.

Data Synthesis: Based on 19 studies with 356 participants, different hand positions (the distance between the hands, shoulder-flexion angle, and elbow-flexion angle) and different lower extremity positions variably affected the activation of the SA and UT during the PUP exercise. Also, when participants performed the PUP on an unstable surface compared with a stable surface, UT activity increased 2.74% (95% confidence interval = 0.07%, 5.41%).

Conclusions: The standard PUP exercise elicited high EMG activity of the SA. Participants generated higher SA and lower UT EMG activity when they performed the PUP exercise on a stable surface in full elbow extension, with the hands placed shoulder-width apart, shoulder-flexion angles of 110° or 120°, and the ipsilateral lower extremity lifted.
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http://dx.doi.org/10.4085/1062-6050-237-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6863690PMC
November 2019

Kinesiology taping with exercise does not provide additional improvement in round shoulder subjects with impingement syndrome: A single-blinded randomized controlled trial.

Phys Ther Sport 2019 Nov 3;40:99-106. Epub 2019 Sep 3.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan; Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan. Electronic address:

Objective: Round shoulder posture (RSP) may exaggerate symptoms of subacromial impingement. The effects of kinesiology taping with exercise on posture, pain, and functional performance were investigated in subjects with impingement and RSP.

Design: This study was a single-blinded randomized controlled trial.

Setting: An outpatient rehabilitation clinic in a university hospital.

Participants: Thirty-four subjects with subacromial impingement and RSP.

Interventions: Kinesiology taping with and without tension was applied 2 times per week for 4 weeks. Both groups also performed strengthening and stretching exercises 3 times per week for 4 weeks.

Main Outcome Measurements: The pain level, shoulder angle and self-reported score were evaluated at pre-intervention, 2-week post-intervention and 4-week post-intervention time points.

Results: Functional performance improved after intervention in both groups (p = 0.027). A greater decrease in pain level was related to better functional performance of the shoulder in both groups (r = -0.760 and -0.674; p < 0.010). Moderate correlations were found for posture and functional performance of the shoulder in the intervention group (0.48).

Conclusion: Four weeks of strengthening and stretching exercises with or without kinesiology taping improved functional performance in subjects with impingement and RSP. Improvement in clinical symptoms was related to better performance of posture.
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http://dx.doi.org/10.1016/j.ptsp.2019.09.001DOI Listing
November 2019

Effectiveness of stretching exercise versus kinesiotaping in improving length of the pectoralis minor: A systematic review and network meta-analysis.

Phys Ther Sport 2019 Nov 9;40:19-26. Epub 2019 Aug 9.

Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address:

Objective: Shortness of the pectoralis minor (PM) is a potential mechanism underlying shoulder impingement syndrome. Few studies have examined the effects of kinesiotaping and stretching exercise on PM length or index. This systematic review and network meta-analysis investigated the effects of stretching exercise and kinesiotaping on PM length and index in adults.

Methods: This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomised controlled trials including adults with or without symptomatic shoulders were included. Heterogeneity between studies was assessed using I2 statistics, and publication bias was evaluated by constructing a funnel plot.

Results: We extracted data from six randomised controlled trials that included 263 participants (age range: 18-50 years). Compared with usual care, kinesiotaping resulted in greater improvement in PM length (mean difference, 1.15 cm; 95% confidence interval [CI]: 0.20-2.10 cm). Compared with usual care and kinesiotaping, proprioceptive neuromuscular facilitation (PNF) stretching increased PMI significantly, with a mean difference of 1.40 (95% CI: 1.17-1.63) and 1.08 (95% CI: 0.29-1.87) cm, respectively.

Conclusion: Compared with no intervention, kinesiotaping is beneficial for lengthening the PM. Intervention with static stretching alone has no effect on PM length. Compared with kinesiotaping alone and no intervention, PNF stretching increases PMI.
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http://dx.doi.org/10.1016/j.ptsp.2019.08.003DOI Listing
November 2019

Practice Variability Combined with Task-Oriented Electromyographic Biofeedback Enhances Strength and Balance in People with Chronic Stroke.

Behav Neurol 2018 26;2018:7080218. Epub 2018 Nov 26.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.

Objectives: To investigate the effects of practice variability combined with task-oriented electromyographic biofeedback (EMGBFB) on strength and balance in people with chronic stroke.

Methods: Thirty-three participants were randomly assigned into the constant force EMGBFB tibialis anterior (TA) exercise (constant) group, the variable force EMGBFB tibialis anterior exercise (variable) group, or the upper extremity exercise without EMGBFB (control) group. Subjects in each group received 6 weekly sessions of exercise training (18 sessions, 40 minutes each). Motor outcomes were TA strength, balance (anteroposterior sway amplitude defined by limits of stability test in dynamic posturography), walking speed, Timed Up and Go test (TUGT), and six-minute walk test (6MWT). Data were measured at baseline, 1 day, 2 weeks, and 6 weeks posttraining.

Results: TA strength increased significantly in both the constant and variable groups after training. Balance significantly improved only in the variable group. All participants showed improvements in walking speed, TUGT, and 6MWT.

Conclusions: Task-oriented EMGBFB-assisted TA exercise training improved muscle strength in people with chronic stroke. Practicing to reach varying force levels during EMGBFB-assisted tibialis anterior exercises facilitated improvements in the ability to sway in the anteroposterior direction while standing. Our findings highlight the importance of task-oriented and motor learning principles while using the EMGBFB as an adjunct therapy in stroke rehabilitation. This trial was registered with trial registration number NCT01962662.
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http://dx.doi.org/10.1155/2018/7080218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287124PMC
April 2019

Pain quality descriptors and sex-related differences in patients with shoulder pain.

J Pain Res 2018 11;11:1803-1809. Epub 2018 Sep 11.

Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan.

Background: Pain quality assessment is applicable to pain evaluation and treatment. However, shoulder pain quality descriptors mostly remain unknown. Furthermore, sex-related differences considerably affect clinical pain experience. The aim of this study was to investigate pain quality descriptors and to compare sex-related differences in using pain descriptors among patients with shoulder pain.

Materials And Methods: A sample of 120 patients (41 males and 79 females) with shoulder pain was recruited from Department of Physical Medicine and Rehabilitation. Shoulder pain quality descriptors were investigated using a 36-item pain quality list. Sex-related differences in the number and frequency of pain quality descriptors were compared using independent -test and test, respectively.

Results: Fifteen commonly used shoulder pain quality descriptors were identified. Among them, "sore" was the most frequently used, followed by "pulled". Deep pain sensations (eg, sore, pulled, torsion, and taut) were relatively more predominant than superficial pain sensations (eg, pricking and lacerating). In terms of sex-related differences, female patients used more pain quality descriptors than the male patients (5.5 vs 3.7, <0.001). The frequency of paroxysmal, dullness, and constriction-related pain quality descriptors, such as "shooting", "faint", "clicking", and "squeezing", were higher in females than in males (all <0.05).

Conclusion: The results provide commonly used shoulder pain quality descriptors that are useful for assessing shoulder pain and for developing a new shoulder pain assessment tool. Because the shoulder pain quality profiles differed between male and female participants, clinicians and researchers should consider sex-related differences in assessing and treating shoulder pain.
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http://dx.doi.org/10.2147/JPR.S169006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140732PMC
September 2018

Progressive conscious control of scapular orientation with video feedback has improvement in muscle balance ratio in patients with scapular dyskinesis: a randomized controlled trial.

J Shoulder Elbow Surg 2018 Aug 6;27(8):1407-1414. Epub 2018 Jun 6.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan. Electronic address:

Background: Video feedback (VF) can guide patients to consciously control scapular orientation without inappropriate substitution. This study investigated whether progressive conscious control with VF improves scapular muscle activation and movements during arm elevation in patients with subacromial impingement and scapular dyskinesis.

Methods: The study recruited 38 amateur overhead athletes with subacromial impingement and scapular medial border prominence who were randomly assigned to the VF or control group. The participants in both groups controlled the scapular position and progressively practiced from 0° to 45° and from 0° to 90° of arm elevation. Participants in the VF group also controlled the scapular position with a video presentation of the scapula on a screen. We investigated the scapular kinematics, muscle activation, and balance ratio for outcome collection in the preintervention and postintervention conditions with and without VF conditions.

Results: Decreased upper trapezius (UT) activation (3%-13%, P < .0083), increased lower trapezius (LT) activation (3%-17%, P < .0083), restored UT/LT ratios (0.67-3.13, P < .0083), and decreased scapular internal rotation (1.8°-6.1°, P < .003) relative to the preintervention condition were demonstrated in the 2 postintervention conditions in both groups. The VF group also demonstrated decreased UT/serratus anterior ratios (0.21-0.30, P < .0083) in 2 postintervention conditions relative to the preintervention condition.

Conclusions: The progressive control of scapular orientation with or without VF can be used to reduce the UT/LT ratio and improve scapular internal rotation during arm elevation. Control training with VF can further decrease the UT/serratus anterior ratio.
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http://dx.doi.org/10.1016/j.jse.2018.04.006DOI Listing
August 2018

Acute effects of different dynamic exercises on hamstring strain risk factors.

PLoS One 2018 1;13(2):e0191801. Epub 2018 Feb 1.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Zhongzheng District, Taipei City, Taiwan.

The purpose of the study was to examine the acute effects of different dynamic exercise interventions on hamstring muscle performance. Thirty-six young men with poor hamstring flexibility were randomly assigned to three intervention groups: jogging combined with dynamic open kinetic chain stretching (DS), jogging combined with dynamic closed kinetic chain stretching (lunge with eccentric hamstring windmills, LEC), and jogging only (CON) groups. Hamstring flexibility, muscle stiffness (area under the curve, AUC), joint position sense (JPS), maximal eccentric strength (ECC), and angle of peak torque (APT) were recorded before and immediately after the exercise interventions. The results showed that the hamstring flexibility increased in DS (p < 0.001); muscle stiffness decreased in DS and was lower than jogging (p < 0.001). Moreover, ECC increased in LEC and was higher than jogging and DS (p < 0.001). APT was different among 3 groups (p < 0.001). Decreased accuracy of JPS was found in DS and jogging (p < 0.001). In conclusion, the dynamic closed kinetic chain stretching (LEC) as compared to open kinetic chain stretching (DS) or jogging group, may be an effective technique to enhance muscle performance during the pre-competition warm-up routine.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0191801PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5794078PMC
March 2018

Effects of trapezius kinesio taping on scapular kinematics and associated muscular activation in subjects with scapular dyskinesis.

J Hand Ther 2019 Jul - Sep;32(3):345-352. Epub 2017 Nov 28.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address:

Study Design: Crossover repeated-measure design.

Introduction: Scapular dyskinesis rehabilitation programs that focus on inhibiting upper trapezius (UT) and activating the lower trapezius (LT) may assist in restoring scapular movements. We hypothesized that taping may be able to normalize scapular movements and associated muscular recruitment.

Purpose Of The Study: The purpose of this study was to investigate the immediate effects of kinesio taping over trapezius on scapular kinematics and muscular activation in different dyskinesis patterns. We expected that taping can improve scapular kinematics and muscular activation in subjects with dyskinesis.

Methods: Fifty-four participants with inferior angle prominence (pattern I), medial border prominence (pattern II), and mixed pattern (pattern I + II) were recruited. Kinesio taping was applied over 3 parts of trapezius muscles, including UT, middle trapezius (MT), and LT. The scapular kinematics and electromyographic data of trapezius and serratus anterior were collected during scapular plane elevation without taping and after each taping application.

Results: UT taping decreased UT activity (5%-7%; P = .001-.003) in 72% of participants with pattern II and pattern I + II dyskinesis, with increased posterior tipping (2.2°-2.5°; P = .003) in pattern II dyskinesis. MT taping increased UT activity (3%; P = .003) in 48% of participants with pattern II dyskinesis.

Discussion: The taping over the trapezius muscle may help to restore coordinated scapular muscle balance and increased upward rotation of the scapula, especially in pattern II dyskinesis. Although no electromyography or kinematic difference was found with LT taping in each dyskinesis pattern, methods of applying LT taping need to be further investigated.

Conclusion: Reduced UT muscle activity and scapular posterior tipping are appropriate when applying taping over UT muscle in patterns II and I + II dyskinesis. Caution should be taken when applying taping over MT and LT muscles in terms of increased UT activity, especially in pattern II dyskinesis.
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http://dx.doi.org/10.1016/j.jht.2017.10.012DOI Listing
January 2020

Measurement of scapular medial border and inferior angle prominence using a novel scapulometer: A reliability and validity study.

Musculoskelet Sci Pract 2017 12 15;32:120-126. Epub 2017 Aug 15.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 100 Taipei, Taiwan; Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan. Electronic address:

Background: Previous studies have proposed various ways to assess scapular dyskinesis. In clinic, assessment tools designed to measure the posterior displacement of the inferior angle of the scapula with reference to the posterior thoracic cage are needed.

Objectives: A novel scapulometer was developed to measure scapular medial border and inferior angle prominence.

Methods: A novel scapulometer was designed to measure the distance from the root of the spine (ROS) and the inferior angle (INF) of the scapula to the thorax wall in 29 participants with scapular dyskinesis bilaterally. Two raters measured the ROS and INF distance of the scapula 3 times bilaterally. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were calculated to determine the inter-rater and intra-rater reliability. Validity was based on correlations (convergent: ROS and internal/external rotation, and INF and tilt; divergent: ROS/INF and upward rotation of the scapula) using a FASTRAK Polhemus 3-D motion tracking system assessing scapular tilt, internal/external rotation, and upward/downward rotation.

Results: The average ROS and INF displacements were 13.7 ± 5.0 mm and 12.5 ± 6.3 mm, respectively. The results showed excellent intra-rater and inter-rater reliability, with ICC = 0.88-0.99 and 0.95-0.99 (SEM = 0.7-0.8 mm), respectively. Correlations were 0.35/0.19 (convergent validity) and 0.07/0.09 (divergent validity).

Conclusions: The novel scapulometer has excellent reliability and fair validity to quantify medial border and inferior angle prominence of the scapula. Further research utilizing this instrument is recommended.
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http://dx.doi.org/10.1016/j.msksp.2017.08.004DOI Listing
December 2017

Movement Pattern of Scapular Dyskinesis in Symptomatic Overhead Athletes.

Sci Rep 2017 07 26;7(1):6621. Epub 2017 Jul 26.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 100, Taipei, Taiwan.

This study investigated the characteristics of arm elevation via principal component analysis in symptomatic overhead athletes with scapular dyskinesis. One hundred-thirty-four overhead athletes with scapular dyskinesis [24: inferior angle prominence (pattern I); 46: medial border prominence (pattern II), 64: pattern I + II] were evaluated by three-dimensional electromagnetic motion and electromyography to record the scapular kinematics (upward rotation/posterior tipping/exterior rotation) and muscle activation (upper trapezius: UT; middle trapezius: MT; lower trapezius: LT; serratus anterior: SA) during lowering phase of arm elevation. The results showed: (1) for pattern I and II, the first 3 principal component (PCs) explained 41.4% and 42.6% of total variance of movement; (2) the first PCs were correlated with MT, LT activity (r = 0.41~0.61) and upward rotation, posterior tipping (r = -0.59~-0.33) in pattern I, and UT, MT, SA (r = 0.30~0.70) activity in pattern II; (3) contour plots of muscle activity demonstrated that muscle activities varied with dyskinesis patterns. In summary, for the pattern I, the major characteristics are coactivation of MT and LT and corresponding scapular posterior tipping and upward rotation. For the pattern II, the major characteristics are coactivation of UT, MT and SA without corresponding scapular external rotation.
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http://dx.doi.org/10.1038/s41598-017-06779-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5529546PMC
July 2017

Effects of Femoral Rotational Taping on Dynamic Postural Stability in Female Patients With Patellofemoral Pain.

Clin J Sport Med 2017 Sep;27(5):438-443

*Department of Health Promotion and Gerontological Care, Taipei College of Maritime Technology, New Taipei City, Taiwan; †School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; and ‡Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL.

Objective: To investigate the effects of femoral rotational taping on task performance, dynamic postural control, and pain during the Star Excursion Balance Test (SEBT) in patients with patellofemoral pain (PFP) compared to healthy controls.

Design: Case-control study, pretest-posttest.

Setting: Laboratory.

Participants: Twenty-four female participants (16 with PFP, 8 controls).

Interventions: Participants in both the PFP and control groups performed SEBT with no taping, sham taping, and femoral rotational taping.

Main Outcome Measures: The maximum anterior excursion distance, 3-dimensional hip and knee kinematics of the stance leg, and pain score (VAS) during SEBT were recorded. The coefficients of variance (CV) of kinematic data gathered from electromagnetic sensors on pelvis and femur were calculated to represent segmental stability.

Results: When performing the SEBT in the anterior direction, application of femoral rotational taping increased maximum excursion distance (65.57% vs 66.15% leg length, P = 0.027), decreased hip adduction excursion (47.6 vs 32.1 degrees, P = 0.010), and pain (3.34 vs 2.38, P = 0.040) in the PFP group. Femoral rotational taping also improved the medial-lateral (7.1 vs 4.6, P = 0.015) and proximal-distal stability (7.5 vs 4.5, P = 0.020) of the pelvis, and medial-lateral stability (7.2 vs 6.1, P = 0.009) of the femur.

Conclusions: The results support the use of femoral rotational taping for improving dynamic postural control and reducing pain during SEBT.

Clinical Relevance: Femoral rotational taping could be used in the management of young female patients with PFP.
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http://dx.doi.org/10.1097/JSM.0000000000000392DOI Listing
September 2017

Scapular dyskinesis: Patterns, functional disability and associated factors in people with shoulder disorders.

Man Ther 2016 Dec 13;26:165-171. Epub 2016 Sep 13.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan. Electronic address:

Background: Patterns of scapular dyskinesis have unique scapular kinematics and associated muscular activation. The characteristics of unique dyskinesis patterns may be associated with functional disability.

Objectives: To investigate whether the shoulder function level and primary dysfunction items were different in unique dyskinesis pattern. The factors associated with shoulder dysfunction in different dyskinesis patterns were identified.

Design: Cross-sectional study.

Methods: Fifty-one participants with unilateral shoulder pain were classified as having a single dyskinesis pattern (inferior angle prominence, pattern I; medial border prominence, pattern II) or a mixed dyskinesis pattern (patterns I + II). Clinical measurements with the Flexilevel Scale of Shoulder Function (FLEX-SF), shoulder range of motion and pectoralis minor index were recorded. These clinical measurements, 3-D scapular kinematics (electromagnetic-based motion analysis), and associated muscular activation (electromyography on the upper/middle/lower trapezius and serratus anterior muscles) during arm elevation were analyzed for associations with functional disability.

Results: We found FLEX-SF scores and primary dysfunction items were similar among the patterns of dyskinesis. In inferior angle prominence, increased shoulder function was associated with decreased upper trapezius activity (R = 0.155, p = 0.035), which accounted for approximately 16% of the variance of FLEX-SF scores. In medial border prominence, increased shoulder function was associated with increased lower trapezius activity (R = 0.131, p = 0.017), which accounted for approximately 13% of the variance of FLEX-SF scores.

Conclusion: Upper and lower trapezius activities are important to consider in the evaluation of patients with pattern I and II, respectively. No other factors were related to shoulder dysfunction due to insufficient challenge of arm elevation tasks.
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http://dx.doi.org/10.1016/j.math.2016.09.002DOI Listing
December 2016

Alterations of scapular kinematics and associated muscle activation specific to symptomatic dyskinesis type after conscious control.

Man Ther 2016 Dec 4;26:97-103. Epub 2016 Aug 4.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan, ROC. Electronic address:

Background: Scapular orientation and movements can affect the function of the shoulder. However, evidence is limited on whether symptomatic subjects can actively maintain the scapula in a neutral position through conscious control.

Objective: To investigate whether symptomatic subjects with scapular dyskinesis can achieve optimal scapular movements and associated muscle activities through conscious control.

Design: A cross-sectional study.

Methods: Sixty subjects with scapular dyskinesis (16 inferior angle pattern I, 16 medial border pattern II, and 28 mixed pattern) performed 3 selected exercises (arm elevation, side-lying elevation, and side-lying external rotation) with and without conscious control. Three-dimensional electromagnetic motion and electromyography were used to record the scapular kinematics and muscle activation during the exercises.

Results: For scapular kinematics, significant increases in scapular external rotation (4.6 ± 3.2°, p < 0.0125) were found with conscious control during arm elevation and side-lying elevation in three groups. Significant increases in activation of the middle and lower trapezius (MT: 4.9 ± 2.4% MVIC; LT: 10.2 ± 6.8% MVIC, p < 0.0 25) were found with conscious control in 3 exercises among the 3 dyskinesis groups. Increased serratus anterior activation (SA: 11.2 ± 4.8% MVIC, p < 0.0 25) was found in the concentric phase of side-lying external rotation in the pattern I and I + II groups.

Conclusion: Conscious control of the scapula can alter scapular orientation and MT, LT, and SA activation during 3 selected exercises in subjects with symptomatic dyskinesis. Specifically, conscious control during side-lying external rotation can be applied to increase SA activity in pattern I and I + II dyskinesis.
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http://dx.doi.org/10.1016/j.math.2016.07.013DOI Listing
December 2016

Kinesio taping and manual pressure release: Short-term effects in subjects with myofasical trigger point.

J Hand Ther 2016 Jan-Mar;29(1):23-9. Epub 2015 Nov 6.

Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.

Study Design: Randomized controlled trial.

Introduction: Myofascial pain syndrome is characterized by myofascial trigger points (MTrPs) and fascia tenderness.

Purpose Of The Study: We investigated the effects of manual pressure release (MPR) alone or in combination with taping (MPR/MKT) in subjects with MTrPs.

Methods: Fifteen and 16 subjects received MPR and MPR/MKT respectively. Outcomes including Pressure pain threshold, muscle stiffness, mechanomyography were assessed at baseline, post-intervention and 7-days later.

Results: Pressure pain threshold improved significantly (d = 1.79, p < 0.005) in both groups. Significant improvement in muscle stiffness in the MPR/MKT group (0.27-0.49 mm) as compared to the MPR group (-0.02-0.23 mm). Mechanomyography amplitude in the MPR/MKT group was significantly higher than that of the MPR group (p < 0.05).

Conclusion: MPR and MPR/MKT are effective in reducing pain in these subjects. MPR/MKT has a greater effect on muscle stiffness and contraction amplitude.

Level Of Evidence: IV.
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http://dx.doi.org/10.1016/j.jht.2015.10.003DOI Listing
November 2016

Specific kinematics and associated muscle activation in individuals with scapular dyskinesis.

J Shoulder Elbow Surg 2015 Aug 19;24(8):1227-34. Epub 2015 Feb 19.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan. Electronic address:

Background: Knowledge of the kinematics and associated muscular activity in individuals with scapular dyskinesis may provide insight into the injury mechanism and inform the planning of treatment strategies. We investigated scapular kinematics and associated muscular activation during arm movements in individuals with scapular dyskinesis.

Methods: A visual-based palpation method was used to evaluate 82 participants with unilateral shoulder pain. Scapular movements during arm raising/lowering movements were classified as abnormal single pattern (inferior angle prominence, pattern I; medial border prominence, pattern II; excessive/inadequate scapular elevation or upward rotation, pattern III), abnormal mixed patterns, or normal pattern (pattern IV). Scapular kinematics and associated muscular activation were assessed with an electromagnetic motion-capturing system and surface electromyography.

Results: More scapular internal rotation was found in pattern II subjects (4°, P = .009) and mixed pattern I and II subjects (4°, P = .023) than in control subjects during arm lowering. Scapular posterior tipping (3°, P = .028) was less in pattern I subjects during arm lowering. Higher upper trapezius activity (14%, P = .01) was found in pattern II subjects during arm lowering. In addition, lower trapezius (5%, P = .025) and serratus anterior activity (10%, P = .004) were less in mixed pattern I and II subjects during arm lowering.

Conclusions: Specific alterations of scapular muscular activation and kinematics were found in different patterns of scapular dyskinesis. The findings also validated the use of a comprehensive classification test to assess scapular dyskinesis, especially in the lowering phase of arm elevation.
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http://dx.doi.org/10.1016/j.jse.2014.12.022DOI Listing
August 2015

Comprehensive classification test of scapular dyskinesis: A reliability study.

Man Ther 2015 Jun 7;20(3):427-32. Epub 2014 Nov 7.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan, ROC. Electronic address:

Background: Assessment of scapular dyskinesis (SD) is of clinical interest, as SD is believed to be related to shoulder pathology. However, no clinical assessment with sufficient reliability to identify SD and provide treatment strategies is available.

Objectives: The purpose of this study was to investigate the reliability of the comprehensive SD classification method.

Design: Cross-sectional reliability study.

Method: Sixty subjects with unilateral shoulder pain were evaluated by two independent physiotherapists with a visual-based palpation method. SD was classified as single abnormal scapular pattern [inferior angle (pattern I), medial border (pattern II), superior border of scapula prominence or abnormal scapulohumeral rhythm (pattern III)], a mixture of the above abnormal scapular patterns, or normal pattern (pattern IV). The assessment of SD was evaluated as subjects performed bilateral arm raising/lowering movements with a weighted load in the scapular plane. Percentage of agreement and kappa coefficients were calculated to determine reliability.

Results: Agreement between the 2 independent physiotherapists was 83% (50/60, 6 subjects as pattern III and 44 subjects as pattern IV) in the raising phase and 68% (41/60, 5 subjects as pattern I, 12 subjects as pattern II, 12 subjects as pattern IV, 12 subjects as mixed patterns I and II) in the lowering phase. The kappa coefficients were 0.49-0.64.

Conclusions: We concluded that the visual-based palpation classification method for SD had moderate to substantial inter-rater reliability. The appearance of different types of SD was more pronounced in the lowering phase than in the raising phase of arm movements.
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http://dx.doi.org/10.1016/j.math.2014.10.017DOI Listing
June 2015

Acute effects of static active or dynamic active stretching on eccentric-exercise-induced hamstring muscle damage.

Int J Sports Physiol Perform 2015 Apr 17;10(3):346-52. Epub 2014 Sep 17.

Center for Physical Education, National Dong Hwa University, Hualien, Taiwan.

Objectives: To examine whether an acute bout of active or dynamic hamstring-stretching exercises would reduce the amount of muscle damage observed after a strenuous eccentric task and to determine whether the stretching protocols elicit similar responses.

Design: A randomized controlled clinical trial.

Methods: Thirty-six young male students performed 5 min of jogging as a warm-up and were allocated to 1 of 3 groups: 3 min of static active stretching (SAS), 3 min of dynamic active stretching (DAS), or control (CON). All subjects performed eccentric exercise immediately after stretching. Heart rate, core temperature, maximal voluntary isometric contraction, passive hip flexion, passive hamstring stiffness (PHS), plasma creatine kinase activity, and myoglobin were recorded at prestretching, at poststretching, and every day after the eccentric exercises for 5 d.

Results: After stretching, the change in hip flexion was significantly higher in the SAS (5°) and DAS (10.8°) groups than in the CON (-4.1°) group. The change in PHS was significantly higher in the DAS (5.6%) group than in the CON (-5.7%) and SAS (-6.7%) groups. Furthermore, changes in muscle-damage markers were smaller in the SAS group than in the DAS and CON groups.

Conclusions: Prior active stretching could be useful for attenuating the symptoms of muscle damage after eccentric exercise. SAS is recommended over DAS as a stretching protocol in terms of strength, hamstring range of motion, and damage markers.
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http://dx.doi.org/10.1123/ijspp.2014-0206DOI Listing
April 2015

Effects of femoral rotational taping on pain, lower extremity kinematics, and muscle activation in female patients with patellofemoral pain.

J Sci Med Sport 2015 Jul 24;18(4):388-93. Epub 2014 Jul 24.

Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, USA.

Objectives: To explore the hip and knee joint kinematics as well as muscle activation between participants with patellofemoral pain syndrome (PFPS) and controls, and to investigate the immediate effect of proximal femoral rotational taping on pain, joint kinematics, and muscle activation during single-leg squat (SLS).

Design: Cross-sectional study.

Methods: Sixteen female participants with PFPS, and eight healthy female controls participated. Three-dimensional hip and patellar kinematics measured by electromagnetic tracking system, hip (gluteus maximus and gluteus medius) and thigh (rectus femoris) muscle activation measured by EMG, and subjective report of pain were recorded during SLS in three randomized conditions of no tape, sham taping, and femoral rotational taping with kinesiotape.

Results: Without taping, compared with controls, PFPS group had increased hip adduction angle (23.5±11.3° vs. 15.8±7.3°) during SLS. Additionally, PFPS group exhibited lesser rectus femoris activity during the initial 0-15° of SLS. Application of both femoral rotational and sham tapes reduced pain for PFPS group. Compared with no tape or sham tape, femoral rotational tape significantly shifted the patella into more posterior (1.59±0.83cm in no tape vs. 1.54±0.87cm in sham tape vs. 1.32±0.72cm in femoral rotational tape) and distal (-2.49±0.95cm vs. -2.64±0.80cm vs. -3.11±0.77cm) positions in the PFPS group.

Conclusions: Femoral rotational taping could alter patellofemoral kinematics and decrease pain in treatment of young female participants with PFPS.
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http://dx.doi.org/10.1016/j.jsams.2014.07.009DOI Listing
July 2015

Shoulder physical activity, functional disability and task difficulties in patients with stiff shoulders: interpretation from RT3 accelerator.

Man Ther 2014 Aug 5;19(4):349-54. Epub 2014 Mar 5.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.

We determined whether the degree of symptom-related functional disability was related to daily physical activity of the shoulder in subjects with stiff shoulders (SSs). Responsiveness and a clinically meaningful level of discrimination between improvement and non-improvement for shoulder physical activity (SPA) were determined. Twenty-six subjects with SSs participated. Shoulder physical activity was assessed by RT3 accelerometers fixed on the humerus during daily 14-h data collection periods twice a week for 2 weeks. A moderate correlation coefficient was found between SPA and functional disability (β = .47). Based on our cohort design and sample, we suggest that SPA (higher than 101.8 counts, hard-moderate or hard tasks) during daily activity are associated with (with at least 83% probability) non-improvement in an individual with SS. Compared to the non-improvement group, the improvement group had less duration of sedentary activity, less frequency and duration of hard tasks, and more frequency and duration of easy tasks (p < 0.01). Appropriate guidance on shoulder physical activities for subjects with SS is important to consider in rehabilitation strategies for these subjects. In our sample, a hard level of shoulder physical activity and sedentary activity should be cautious for these subjects. Further study is needed to validate therapeutic effect of physical activity on the course of patient improvement in subjects with SSs.
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http://dx.doi.org/10.1016/j.math.2014.02.005DOI Listing
August 2014

EMG biofeedback effectiveness to alter muscle activity pattern and scapular kinematics in subjects with and without shoulder impingement.

J Electromyogr Kinesiol 2013 Feb 2;23(1):267-74. Epub 2012 Nov 2.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.

Background: Muscle imbalance between serratus anterior (SA), upper trapezius (UA), middle trapezius (MT), and lower trapezius (LT) muscles has been observed in subjects with subacromial impingement syndrome (SAIS).

Objective: (1) To investigate the effect of electromyography (EMG) biofeedback training on muscle balance ratios and scapular kinematics in healthy adults and subjects with SAIS. (2) To investigate whether the effects of EMG biofeedback on muscle balance ratios are different between groups.

Design: Twelve healthy adults and 13 subjects with SAIS were recruited in this study. EMG was used to record the activity of scapular muscles. The ratios (UT/SA, UT/MT, and UT/LT) during exercises with/without EMG biofeedback were calculated. Scapular kinematics were recorded before and after exercises with/without EMG biofeedback.

Results: For the subjects with SAIS, muscle balance ratios were lower during forward flexion with EMG biofeedback than during exercise only (UT/SA: 70.3-45.2; UT/LT: 124.8-94.6). Additionally, similar results were found during side-lying external rotation (UT/MT: 58.5-36.4). For the scapular upward rotation and tipping in both groups, there were no significant differences with and without EMG biofeedback.

Conclusion: EMG biofeedback improved the scapular muscular balance during training exercises in both groups. Further clinical trials should investigate the long-term effects of EMG biofeedback.
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http://dx.doi.org/10.1016/j.jelekin.2012.09.007DOI Listing
February 2013

Two stretching treatments for the hamstrings: proprioceptive neuromuscular facilitation versus kinesio taping.

J Sport Rehabil 2013 Feb 11;22(1):59-66. Epub 2012 Oct 11.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.

Context: Recent studies have shown that the static stretch (SS) may adversely affect leg-muscle performance.

Objectives: The authors examined the short-term effects of 2 stretching exercises on hamstrings muscle before and after exercise.

Design: Crossover.

Setting: Laboratory.

Participants: 9 healthy, physically active men.

Interventions: There were 3 protocols in a randomized order with a 7-d interval: nonstretching (CON protocol), hamstrings static stretching (SS) with proprioceptive neuromuscular facilitation (PNF), and SS with kinesio-taping application on the hamstrings.

Main Outcome Measures: Outcome measures included first-felt and maximum tolerant-felt range of motion (FROM and TROM), maximal knee-flexion peak torque (PT) at 180°/s, and hamstrings muscle stiffness.

Results: Groups were not different at prestretching in terms of hamstrings flexibility, PT, and muscle stiffness. At poststretching, both stretching protocols showed significant increases in FROM and TROM (P < .05). Stiffer hamstrings muscle and decreased PT were found in both SS+PNF and CON protocols (P < .05). However, there was no significant difference in the SS+Taping protocol (P > .05).

Conclusion: The stretching protocols improve hamstrings flexibility immediately, but after exercise hamstrings peak torque is diminished in the SS+PNF but not in the SS+Taping group. This means that SS+Taping can prevent negative results from exercise, which may prevent muscle injury.
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http://dx.doi.org/10.1123/jsr.22.1.59DOI Listing
February 2013

Relationship between trapezius muscle activity and typing speed: taping effect.

Ergonomics 2012 17;55(11):1404-11. Epub 2012 Aug 17.

School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, 100, Taiwan.

Clinically, over-activation of upper trapezius (UT) muscular activity is a common cause of symptoms in computer users. The purpose of this study was to investigate the correlation between trapezius muscular activity and typing speed with and without taping. Twelve participants performed a typing task for 15 min with and without taping on the UT muscle. Electromyography (EMG) of the muscular activity of UT and lower trapezius (LT) was recorded. With or without taping, there was a significantly positive correlation (r = 0.40, p = 0.04) between typing speed and UT/LT. Additionally, UT and UT/LT ratios were lower with taping than without taping (difference = 5.2% and 26.9%). The LT ratio was higher with taping than without taping (difference = 5.8%). Taping can alter the muscular activity of the trapezius during typing and may have the potential to be applied in computer users to prevent over-activation of UT muscular activity. Practitioner Summary: The effect of taping was tested on typing speed and trapezius muscular activity. With or without taping, typing speed was correlated with trapezius activity. The muscle activity of the trapezius, however, was lower with taping than without taping. Thus, taping has the potential to prevent over-activation of UT muscular activity during typing.
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http://dx.doi.org/10.1080/00140139.2012.709543DOI Listing
November 2013

Effects and predictors of shoulder muscle massage for patients with posterior shoulder tightness.

BMC Musculoskelet Disord 2012 Mar 27;13:46. Epub 2012 Mar 27.

Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.

Background: Clinical approaches like mobilization, stretching, and/or massage may decrease shoulder tightness and improve symptoms in subjects with stiff shoulders. We investigated the effect and predictors of effectiveness of massage in the treatment of patients with posterior shoulder tightness.

Methods: A randomized controlled trial was conducted in a hospital-based outpatient practice (orthopedic and rehabilitation). Forty-three women and 17 men (mean age = 54 years, range 43-73 years) with posterior shoulder tightness participated and were randomized into massage and control groups (n = 30 per group). A physical therapist provided the massage on the posterior deltoid, infraspinatus, and teres minor of the involved shoulder for 18 minutes [about 6 minutes for each muscle] two times a week for 4 weeks. For the control group, one therapist applied light hand touch on the muscles 10 minutes two times a week for 4 weeks. Glenohumeral internal rotation ROM, functional status, and muscle tightness were the main outcomes. Additionally, the potential factors on the effectiveness of massage were analyzed by multivariate logistic regression. For this analysis, patients with functional score improvement at least 20% after massage were considered responsive, and the others were considered nonresponsive.

Results: Fifty-two patients completed the study (29 for the massage and 23 for the control). The overall mean internal rotation ROM increased significantly in the massage group compared to the control (54.9° v.s. 34.9°; P ≤ 0.001). There were 21 patients in the responsive group and 8 in the nonresponsive group. Among the factors, duration of symptoms, functional score, and posterior deltoid tightness were significant predictors of effectiveness of massage.

Conclusions: Massage was an effective treatment for patients with posterior shoulder tightness, but was less effective in patients with longer duration of symptoms, higher functional limitation, and less posterior deltoid tightness.

Trial Registration: This clinical trial is registered at Trial Registration "Trial registration: Clinicaltrials.gov NCT01022827".
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http://dx.doi.org/10.1186/1471-2474-13-46DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339516PMC
March 2012
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