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  • Author: Gul Baltaci x
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Elif Turgut, Irem Duzgun and Gul Baltaci

Context: Increasing soft tissue flexibility and joint mobility is one of the important aims of studies to treat subacromial impingement syndrome (SIS). Objective: The aim of this study was to investigate the effects of a stretching program on posterior capsule tightness, pectoralis minor tightness, pain severity, and disability status in SIS. Design: Single-group pretest posttest design. Setting: University outpatient clinic. Participants: 18 participants diagnosed with SIS (34.8±9.4 y, symptoms duration 5.8±4.9 months) were included in the study. Intervention: The 6-week self-stretching program for pectoralis minor, posterior capsule, levator scapula, and latissimus dorsi was performed. Main Outcome Measures: Posterior capsule tightness, pectoralis minor tightness, pain severity (visual analog scale), and self-reported shoulder-related pain and disability status (Shoulder Pain and Disability Index) were used to assess changes in flexibility and symptoms. Results: Comparisons showed that there was significantly less posterior capsule and pectoralis minor tightness, less pain severity on activity and at night, and a lower disability score reported after the 6-week stretching program (P < 0.05). There was no statistically significant difference in pain severity at rest after the 6-week stretching program (P > 0.05). Conclusions: The findings of the study showed that flexibility, pain severity, and disability gains can be achieved with a 6-week stretching exercise training for participants with SIS. Therefore, shoulder girdle stretching exercises should be recommended early in shoulder rehabilitation program.

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Derya Celik, Ahmet Dirican and Gul Baltaci

Context: Handheld dynamometry (HHD) is considered an objective method of measuring strength, but the reliability of the procedure can be compromised by inadequate tester strength and insufficient stabilization of the dynamometer especially, for the scapular muscles. Objective: Primarily, to determine the intrarater reliability of HHD when testing shoulder and scapular muscle strength, and secondarily, to report reliability when corrected for body-mass index (BMI). Design: Technical report. Setting: University physiotherapy department. Participants: 57 adults (17 men, 40 women; mean age = 35.05 ± 13.5 y), both healthy individuals and patients with shoulder impingement. Intervention: HHD. Main Outcome Variables: Muscle strength of the upper, middle, and lower trapezius; anterior deltoid; serratus anterior; supraspinatus; and latissimus dorsi determined by HHD. Each muscle was assessed 3 times, and the mean value was calculated. The subjects were divided into 3 groups according to BMI. Group 1: BMI ≤ 20 kg/m2 (n = 22); Group 2: BMI ≤ 24.9 kg/m2 (n = 54); and Group 3: BMI ≤ 29.9 kg/m2 (n = 38). Results: Correlations were calculated for each pair of strength scores. Intraclass correlation coefficients (ICCs) ranged from .77 to .99 in healthy subjects and from .75 to .99 in patients, for all muscle groups except the upper trapezius (P < .05). Reliability values ranged from good to high in healthy subjects but were less consistent for the upper trapezius (ICC .45-.65). The relationship with BMI and muscle strength illustrates that as BMI increases, there is a decrease in reliability values of the lower trapezius (ICC = .35-.65). Conclusion: The study demonstrates that evaluating the strength of scapular and shoulder muscles using HHD presents reliable results for both patients with impingement syndrome and healthy subjects. Reliability values were compressed when testing the trapezius in subjects with higher BMI. This is likely a result of the examiner's difficulty in overcoming the patients with this maneuver.

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Ozgur Surenkok, Aydan Aytar and Gul Baltaci

Objective:

The aim of this study was to evaluate the initial effects of scapular mobilization (SM) on shoulder range of motion (ROM), scapular upward rotation, pain, and function.

Design:

Pretest–posttest for 3 groups (SM, sham, and control).

Setting:

A double-blinded, randomized, placebo-controlled trial was conducted to evaluate the initial effect of the SM at a sports physiotherapy clinic.

Participants:

39 subjects (22 women, 17 men; mean age 54.30 ± 14.16 y, age range 20-77 y).

Interventions:

A visual analog scale, ROM, scapular upward rotation, and function were assessed before and just after SM. SM (n = 13) consisted of the application of superoinferior gliding, rotations, and distraction to the scapula. The sham (n = 13) condition replicated the treatment condition except for the hand positioning. The control group (n = 13) did not undergo any physiotherapy and rehabilitation program.

Main Outcome Measures:

Pain severity was assessed with a visual analog scale. Scapular upward rotation was measured with a baseline digital inclinometer. Constant Shoulder Score (CSS) was used to measure shoulder function.

Results:

After SM, we found significant improvements for shoulder ROM, scapular upward rotation, and CSS between pretreatment and posttreatment compared with the sham and control groups. In the sham group, shoulder-ROM values increased or decreased for the shoulder and scapular upward rotation was not changed. Pain, ROM, and physical function of the shoulder were not significantly different in the sham group than in controls (P > .05).

Conclusions:

SM may be a useful manual therapy technique to apply to participants with a painful limitation of the shoulder. SM increases ROM and decreases pain intensity.

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Hande Guney, Gulcan Harput, Filiz Colakoglu and Gul Baltaci

Context:

Glenohumeral (GH) internal-rotation deficit (GIRD) and lower eccentric external-rotator (ER) to concentric internal-rotator (IR) strength (ER:IR) ratio have been documented as risk factors for shoulder injuries, but there is no information on whether GIRD has an adverse effect on ER:IR ratio in adolescent overhead athletes.

Objectives:

The aim of this study was to investigate the effects of GIRD on functional ER:IR ratio of the adolescent overhead athletes.

Design:

Cross-sectional study.

Setting:

University research laboratory.

Participants:

52 adolescent overhead athletes.

Main Outcome Measures:

To determine GIRD, the range of GH IR and ER motion was measured with a digital inclinometer. An isokinetic dynamometer was used to assess eccentric and concentric IR and ER muscle strength of the dominant and nondominant shoulders. One-way ANCOVA where sport type was set as a covariate was used to analyze the difference between athletes with and without GIRD.

Results:

After standardized examinations of all shoulders, the athletes were divided into 2 groups, shoulders with (n = 27) and without GIRD (n = 25). There was a significant difference between groups in functional ER:IR ratio (P < .001). Athletes with GIRD had lower ER:IR ratio (0.56) than athletes without GIRD (0.83).

Conclusions:

As GIRD has an adverse effect on functional ratio of the shoulder-rotator muscles, interventions for adolescent overhead athletes should include improving GH-rotation range of motion.

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Hayri Baran Yosmaoglu, Gül Baltaci, Defne Kaya and Hamza Ozer

Context:

The development pattern of motor coordination, strength, and functional ability during recovery from anterior cruciate ligament (ACL) reconstruction.

Objective:

To investigate the relationship between motor coordination, functional ability, and strength after ACL reconstruction.

Design:

Prospective clinical follow-up study.

Setting:

Sports-injury research laboratory.

Participants:

20 subjects who underwent ACL reconstruction.

Interventions:

Real-time eccentric and concentric motor coordination were tested by a multijoint lower limb tracking-trajectory test, quadriceps and hamstring isokinetic strength were assessed by isokinetic dynamometer, and functional performance was tested with a single-leg-hop test 6 and 12 mo after ACL reconstruction.

Main Outcome Measures:

Percentage deficits of the involved lower extremity for target-tracking ability, peak torque, total work parameters of isokinetic strength, and single-leg-hop distance.

Results:

Deficits in hamstring–quadriceps isokinetic muscle strength and single-leg-hop distance significantly decreased from the 6th to the 12th mo after surgery (P < .05). There were no significant differences in muscle concentric and eccentric motor-coordination deficits of the involved side (P > .05).

Conclusions:

Although muscle strength and functional performance clearly increased from the 6th to the 12th mo after surgery, coordination characteristics of involved side remained low. This pattern demonstrated that motor-coordination progression was not affected by strength development. Patients continued to have significant motor-coordination deficits even 12 mo postsurgery. Therefore, the authors recommend that neuromuscular-coordination exercises be included in long-term rehabilitation programs to improve motor coordination.

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Berkiye Kirmizigil, Jeffry Roy Chauchat, Omer Yalciner, Gozde Iyigun, Ender Angin and Gul Baltaci

Context: Kinesio taping (KT) is a popular taping technique used in the recovery process; however, in the relevant literature, there is no real consensus on its efficacy. Objective: To investigate whether rectus femoris KT application after delayed onset muscle soreness enhances recovery of muscle soreness, edema, and physical performance. Participants: A total of 22 healthy amateur male athletes participated in this study. Design: Randomized, crossover study. Setting: Human performance laboratory of the university. Interventions: Participants performed an exercise protocol inducing delayed onset muscle soreness. They accomplished 2 distinct trials, with or without KT. The washout period between trials was 6 weeks. For the KT condition, KT inhibition technique was used and applied immediately after exercise bilaterally on rectus femoris. Main Outcome Measures: Range of motion, muscle soreness, and edema were measured at baseline, 30 minutes, 24, 48, and 72 hours postexercise. Dynamic balance, sprint, and horizontal jump were evaluated at similar time frame except for 30-minute postexercise. Results: The findings showed that there were no significant differences between the KT group (KTG) and control group for all outcome variables (P > .05). Muscle soreness returned to baseline values 72 hours postexercise only within the KTG (P > .05). Although the horizontal jump performance decreased substantially from baseline to 24 and 48 hours postexercise only within the control group (P < .05), the performance increased significantly from 24 to 72 hours postexercise within the KTG (P < .05). Balance increased significantly from baseline to 48 hours postexercise (P < .05) in both groups. Balance also increased significantly from baseline to 72 hours postexercise only within the KTG (P < .05). The effect size of soreness which is our primary outcome was large in both groups (r > .5). Conclusions: KT is favorable in the recovery of muscle soreness after delayed onset muscle soreness. KT has beneficial effects on horizontal jump performance and dynamic balance.

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Aydan Aytar, Gul Baltaci, Tim Uhl, Handan Tuzun, Pinar Oztop and Metin Karatas

Objective:

To determine the effects of scapular mobilization on function, pain, range of motion, and satisfaction in patients with subacromial impingement syndrome (SAIS).

Design:

Randomized, double-blind, placebo-controlled clinical trial.

Setting:

University hospital clinics in Turkey.

Participants:

66 participants (mean ± SD age 52.06 ± 3.71 y) with SAIS.

Interventions:

Participants were randomized into 3 groups: scapular mobilization, sham scapular mobilization, and supervised exercise. Before the interventions transcutaneous electrical stimulation and hot pack were applied to all groups. Total intervention duration for all groups was 3 wk with a total of 9 treatment sessions.

Main Outcome Measures:

Shoulder function and pain intensity were primary outcome measures; range of motion and participant satisfaction were secondary outcome measures. Shoulder function was assessed with the short form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH). A visual analog scale was used to evaluate pain severity. Active range of motion was measured with a universal goniometer. A 7-point Likert scale was used to evaluate satisfaction. Outcome measurements were performed at baseline, before visits 5 and 10, 4 wk after visit 9, and 8 wk after visit 9.

Results:

There was no group difference for DASH score (P = .75), pain at rest (P = .41), pain with activity (P = .45), pain at night (P = .74), and shoulder flexion (P = .65), external rotation (P = .63), and internal rotation (P = .19). There was a significant increase in shoulder motion and function and a significant decrease in pain across time when all groups were combined (P < .001). The level of satisfaction was not significantly different for any of the questions about participant satisfaction between all groups (P > .05).

Conclusion:

There was not a significant advantage of scapular mobilization for shoulder function, pain, range of motion, and satisfaction compared with sham or supervised-exercise groups in patients with SAIS.

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Gulcan Harput, H. Erkan Kilinc, Hamza Ozer, Gul Baltaci and Carl G. Mattacola

Context:

There is lack of information related to quadriceps and hamstring strength recovery during the early period of rehabilitation after anterior cruciate ligament reconstruction (ACLR) using hamstring-tendon graft (HTG).

Objective:

To investigate quadriceps and hamstring isometric strength at 4-, 8-, and 12-wk time points after ACLR and to document the strength changes of these muscles over time.

Design:

Longitudinal study.

Participants:

24 patients (age 28.1 ± 8.1 y) who underwent unilateral single-bundle anatomic ACLR with 4-strand semitendinosus and gracilis tendon graft.

Main Outcome Measures:

The isometric strength of quadriceps and hamstring muscles was measured on an isokinetic dynamometer at a 60° knee-flexion angle 4, 8, and 12 wk after surgery.

Results:

Quadriceps and hamstring strength significantly increased over time for both the involved limb (quadriceps F 2,46 = 58.3, P < .001; hamstring F 2,46 = 35.7, P < .001) and uninvolved limb (quadriceps F 2,46 = 17.9, P < .001; hamstring F 2,46 = 56.9, P = .001). Quadriceps and hamstring indexes significantly changed from 4 wk (QI 57.9, HI 54.4) to 8 wk (QI 78.8, HI 69.9) and from 8 wk to 12 wk (QI 82, HI 75.7) (P < .001); however, there was no difference between indexes at the 12-wk time point (P = .17).

Conclusions:

The results of this study serve as a reference for clinicians while directing a rehabilitation protocol for HTG ACLR patients to better appreciate expected strength changes of the muscles in the early phase of recovery.

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Derya Ozer Kaya, Irem Duzgun, Gul Baltaci, Selma Karacan and Filiz Colakoglu

Objective:

To assess and compare the effects of 6 mo of Pilates and calisthenics on multijoint coordination and proprioception of the lower limbs at the 3rd and 6th mo of training.

Design:

Randomized, controlled, assessor-blinded, repeated-measures.

Setting:

University research laboratory.

Participants and Intervention:

Healthy, sedentary, female participants age 25–50 y were recruited and randomly divided into 3 groups: a calisthenic exercise group (n = 34, mean age ± SD 40 ± 8 y, body-mass index [BMI] 31.04 ± 4.83 kg/m2), a Pilates exercise group (n = 32, mean age ± SD 37 ± 8 y, BMI 31.04 ± 4.83 kg/m2), and a control group (n = 41, mean age ± SD 41 ± 7 y, BMI 27.09 ± 4.77 kg/m2). The calisthenics and Pilates groups underwent related training programs for 6 mo, while the controls had no specific training.

Main Outcome Measures:

Coordination and proprioception of the lower extremities with concentric and eccentric performances in the closed kinetic chain assessed with the monitored rehab functional squat system at baseline and at the 3rd and 6th mo of training.

Results:

For the within-group comparison, coordinative concentric and eccentric deviation values were significantly decreased for both dominant and nondominant lower limbs at pretraining and at the 3rd and 6th mo posttraining in the calisthenics group (P < .05). In contrast, there was no improvement in the Pilates group throughout the training. However, for comparisons between groups, the baseline values of coordinative concentric and eccentric deviations were different in the calisthenics group than in Pilates and the controls (P < .05). There were no differences in the proprioception values of either visible or nonvisible movement in any group throughout the training (P > .05).

Conclusions:

It seems that calisthenic exercises are more likely to improve coordination of the lower extremity after 3 and 6 mo of training than Pilates exercises. Calisthenic exercises may be useful for individuals who require improved coordination.

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Irem Duzgun, Gul Baltaci, Filiz Colakoglu, Volga Bayrakci Tunay and Derya Ozer

Objective:

To investigate the effect of a 12-wk weighted-jump-rope training program on shoulder strength.

Design:

Pretest to posttest experimental design.

Setting:

University sports physiotherapy laboratory.

Participants:

24 healthy volleyball players age 13-16 y.

Intervention:

Group 1 took weighted-rope training (n = 9), group 2 took unweighted-rope training (n = 8), and group 3 did not train with any specific program (n = 7).

Main Outcome Measures:

Players’ strength determined with an isokinetic dynamometer (Isomed 2000) at 180 and 60°/s on external and internal rotators, supraspinatus peak torque, and total work of the dominant shoulder. Kruskal–Wallis and Mann–Whitney U tests were used to determine the difference among the groups.

Results:

At pretraining evaluation, there were no significant differences in the test scores of the isokinetic test of full can and empty can between the groups at 60 and 180°/s. There was no statistically significant difference for 60 and 180°/s between pretraining and posttraining assessment (P > .05) except that total eccentric work increased in groups 1 and 3 but decreased in group 2 at 180°/s during the full can (P < .05). There was no significant difference among the groups between the pretraining and posttraining testing at both 180 and 60°/s for the empty can (P > .05). Internal-rotation values at 60 and 180°/s decreased for both peak torque and total work for all groups. External-rotation peak torque and total work at 60°/s increased for group 1. External-rotation peak torque and total work at 180°/s increased for all groups.

Conclusions:

The results indicate that a jump-rope training program is a good conditioning method for overhead athletes because of its potential benefits to shoulder strength.