Effect of Box Taping as an Adjunct to Stretching-Strengthening Exercise Program in Correction of Scapular Alignment in People with Forward Shoulder Posture: A Randomised Trial
Objective. The objective of this study was to provide preliminary estimates of effects of box taping as an adjunct to stretching-strengthening exercise program on scapular alignment in healthy subjects with forward shoulder posture (FSP). Methods. Sixty subjects were screened and 38 asymptomatic subjects with FSP were allocated into box taping and standard treatment group using block randomization. Both groups received a supervised stretching-strengthening exercise program and postural advice for 15 sessions over 3 weeks. In addition, box taping was applied to the intervention group. Static and dynamic scapular alignment was recorded at baseline, 7th and 15th sessions. Differences over time and between the treatment groups were determined using repeated measures of analysis of variance (ANOVA). Results. Twenty subjects completed the study. Both interventions were well tolerated and resulted in improvements in static and dynamic postural indicators over time in both groups ( ) except for dynamic scapular alignment by the 15th session. We were under powered to detect differences between the groups ( ). Conclusions. This study suggests postural exercises improve scapular alignment; but a large RCT is required to determine whether the addition of box taping is indicated, and whether this preventative approach reduces the incidence of upper quarter musculoskeletal disorders. This trial is registered with CTRI/2013/10/004095. 1. Introduction Patients referred to physical therapy with impaired upper extremity function, often exhibit postural alterations [1]. Forward shoulders is a common maladaptive posture which occurs in up to 73% of the group of healthy subjects between the ages of 20 and 50 years [2, 3]. Kendall et al. described forward shoulders as abduction and elevation of the scapula and a forward position of the shoulders, giving an appearance of a hollow chest [4, 5]. Forward Shoulder Posture (FSP) is characterized by a protracted, downwardly rotated, and anteriorly tipped scapula position with increased cervical lordosis and upper thoracic kyphosis [6]. This pattern may be associated with tightness of serratus anterior, pectoralis minor, pectoralis major and upper trapezius muscle, and weakness of middle and lower trapezius [3]. The imbalance in muscle function is believed to result in reduction of amplitude in posterior tilting and lateral rotation of the scapula during arm elevation [7–9]. The literature has shown that altered scapular kinematics and associated muscle imbalance in FSP places the anterior acromion in close proximity to rotator cuff
References
[1]
Johnson and Borstad, “Project title: Forward shoulder asymmetry: prevalence and pathology,” http://www.docstoc.com/docs/103976375/Forward-Shoulder-Asymmetry.
[2]
P. Griegel-Morris, K. Larson, K. Mueller-Klaus, and C. A. Oatis, “Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects,” Physical Therapy, vol. 72, no. 6, pp. 425–431, 1992.
[3]
D. E. Peterson, K. R. Blankenship, J. B. Robb et al., “Investigation of the validity and reliability of four objective techniques for measuring forward shoulder posture,” Journal of Orthopaedic and Sports Physical Therapy, vol. 25, no. 1, pp. 34–42, 1997.
[4]
F. P. Kendall, E. K. McCreary, and P. G. Provance, Muscles Testing and Function with Posture and Pain, Lippincott Williams and Wilkins, Baltimore, Md, USA, 4th edition, 2005.
[5]
H. O. Kendall, F. P. Kendall, and D. A. Boynton, Posture and Pain, Edited by E. Robert, Krieger Publishing Company, Huntington, NY, USA, 1970.
[6]
C. K. Wong, D. Coleman, V. diPersia, J. Song, and D. Wright, “The effects of manual treatment on rounded-shoulder posture, and associated muscle strength,” Journal of Bodywork and Movement Therapies, vol. 14, no. 4, pp. 326–333, 2010.
[7]
P. M. Ludewig and J. D. Borstad, “Effects of a home exercise programme on shoulder pain and functional status in construction workers,” Occupational and Environmental Medicine, vol. 60, no. 11, pp. 841–849, 2003.
[8]
P. M. Ludewig and T. M. Cook, “Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement,” Physical Therapy, vol. 80, no. 3, pp. 276–291, 2000.
[9]
J.-S. Roy, H. Moffet, L. J. Hébert, and R. Lirette, “Effect of motor control and strengthening exercises on shoulder function in persons with impingement syndrome: a single-subject study design,” Manual Therapy, vol. 14, no. 2, pp. 180–188, 2009.
[10]
C. A. Thigpen, D. A. Padua, L. A. Michener et al., “Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks,” Journal of Electromyography and Kinesiology, vol. 20, no. 4, pp. 701–709, 2010.
[11]
P. W. McClure, J. Bialker, N. Neff, G. Williams, and A. Karduna, “Shoulder function and 3-dimensional kinematics in people with shoulder impingement syndrome before and after a 6-week exercise program,” Physical Therapy, vol. 84, no. 9, pp. 832–848, 2004.
[12]
T. Holmgren, H. B. Hallgren, B. ？berg, L. Adolfsson, and K. Johansson, “Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study,” British Medical Journal, vol. 344, no. 7846, article e787, 2012.
[13]
C. A. Thigpen, S. S. Lynch, J. P. Mihalik, W. E. Prentice, and D. Padua, “The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers,” British Journal of Sports Medicine, vol. 44, no. 5, pp. 376–381, 2010.
[14]
S. Sahrmann, “Movement impairment syndromes of the shoulder girdle,” in Diagnosis and Treatment of Movement Impairment Syndrome, pp. 193–245, Mosby, St Louis, Mo, USA, 2001.
[15]
E. Ayub, “Posture and the upper quadrant,” in Physical Therapy of the Shoulder, R. A. Donatelli, Ed., chapter 4, p. 81, Churchill Livingstone, New York, NY, USA, 2nd edition, 1997.
[16]
J. W. Howell, “Evaluation and management of thoracic outlet syndrome,” in Physical Therapy of the Shoulder, R. A. Donatelli, Ed., Churchill Livingstone, New York, NY, USA, 2nd edition, 1991.
[17]
J. G. Travell and D. G. Simons, Myofascial Pain and Dysfunction. The Trigger Point Manual, vol. 1, Williams & Wilkins, Baltimore, Md, USA, 2nd edition, 1999.
[18]
H. P. Kopel and W. A. L. Thompson, Peripheral Entrapment Neuropathies, Robert E. Krieger, New York, NY, USA, 2nd edition, 1976.
[19]
T. S. Ellenbecker and A. Cools, “Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review,” British Journal of Sports Medicine, vol. 44, no. 5, pp. 319–327, 2010.
[20]
W. Ben Kibler, A. D. Sciascia, T. L. Uhl, N. Tambay, and T. Cunningham, “Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation,” American Journal of Sports Medicine, vol. 36, no. 9, pp. 1789–1798, 2008.
[21]
M. L. Voight and B. C. Thomson, “The role of the scapula in the rehabilitation of shoulder injuries,” Journal of Athletic Training, vol. 35, no. 3, pp. 364–372, 2000.
[22]
A. M. Cools, V. Dewitte, F. Lanszweert et al., “Rehabilitation of scapular muscle balance: which exercises to prescribe?” American Journal of Sports Medicine, vol. 35, no. 10, pp. 1744–1751, 2007.
[23]
J. S. Lewis, A. Green, and C. Wright, “Subacromial impingement syndrome: the role of posture and muscle imbalance,” Journal of Shoulder and Elbow Surgery, vol. 14, no. 4, pp. 385–392, 2005.
[24]
B. Greenfield, P. A. Catlin, P. W. Coats, E. Green, J. J. McDonald, and C. North, “Posture in patients with shoulder overuse injuries and healthy individuals,” Journal of Orthopaedic and Sports Physical Therapy, vol. 21, no. 5, pp. 287–295, 1995.
[25]
S. Raine and L. T. Twomey, “Head and shoulder posture variations in 160 asymptomatic women and men,” Archives of Physical Medicine and Rehabilitation, vol. 78, no. 11, pp. 1215–1223, 1997.
[26]
J. D. Borstad, “Resting position variables at the shoulder: evidence to support a posture-impairment association,” Physical Therapy, vol. 86, no. 4, pp. 549–557, 2006.
[27]
J. S. Lewis, C. Wright, and A. Green, “Subacromial impingement syndrome: the effect of changing posture on shoulder range of movement,” Journal of Orthopaedic and Sports Physical Therapy, vol. 35, no. 2, pp. 72–87, 2005.
[28]
M. P. Bullock, N. E. Foster, and C. C. Wright, “Shoulder impingement: the effect of sitting posture on shoulder pain and range of motion,” Manual Therapy, vol. 10, no. 1, pp. 28–37, 2005.
[29]
C. Hrysomallis and C. Goodman, “A review of resistance exercise and posture realignment,” The Journal of Strength & Conditioning Research, vol. 15, no. 3, pp. 385–390, 2001.
[30]
C. Hrysomallis, “Effectiveness of strengthening and stretching exercises for the postural correction of abducted scapulae: a review,” Journal of Strength and Conditioning Research, vol. 24, no. 2, pp. 567–574, 2010.
[31]
T. Zmierski, S. Kegerreis, and J. Scarpaci, “Scapular muscle strengthening,” Journal of Sport Rehabilitation, vol. 4, no. 4, pp. 244–252, 1995.
[32]
K. Baker-Sawyer, P. McClure, and K. Fitzgerald, “The effect of a scapular retraction exercise program on scapular position and scapular muscle force,” Journal of Orthopaedic & Sports Physical Therapy, vol. 23, pp. 75–76, 1996.
[33]
C.-H. Wang, P. McClure, N. E. Pratt, and R. Nobilini, “Stretching and strengthening exercises: their effect on three- dimensional scapular kinematics,” Archives of Physical Medicine and Rehabilitation, vol. 80, no. 8, pp. 923–929, 1999.
[34]
M. Kluemper, T. Uhl, and H. Hazelrigg, “Effect of stretching and strengthening shoulder muscles on forward shoulder posture in competitive swimmers,” Journal of Sport Rehabilitation, vol. 15, no. 1, pp. 58–70, 2006.
[35]
T. S. Roddey, S. L. Olson, and S. E. Grant, “The effect of pectoralis muscle stretching on the resting position of the scapula in persons with varying degrees of forward head/rounded shoulder posture,” Journal of Manual and Manipulative Therapy, vol. 10, no. 3, pp. 124–128, 2002.
[36]
H. H. Host, “Scapular taping in the treatment of anterior shoulder impingement,” Physical Therapy, vol. 75, no. 9, pp. 803–812, 1995.
[37]
D. Kneeshaw, “Shoulder taping in the clinical setting,” Journal of Bodywork and Movement Therapies, vol. 6, no. 1, pp. 2–8, 2002.
[38]
W. Gilleard, J. McConnell, and D. Parsons, “The effect of patellar taping on the onset of vastus medialis obliquus and vastus lateralis muscle activity in persons with patellofemoral pain,” Physical Therapy, vol. 78, no. 1, pp. 25–32, 1998.
[39]
P. Miller and P. Osmotherly, “Does scapula taping facilitate recovery for shoulder impingement symptoms? A pilot randomized controlled trial,” Journal of Manual & Manipulative Therapy, vol. 17, no. 1, pp. E6–E13, 2009.
[40]
J.-H. Lee and W.-G. Yoo , “Effect of scapular elevation taping on scapular depression syndrome: a case report,” Journal of Back and Musculoskeletal Rehabilitation, vol. 25, no. 3, pp. 187–191, 2012.
[41]
J. S. Lewis, C. Wright, and A. Green, “Subacromial impingement syndrome: the effect of changing posture on shoulder range of movement,” Journal of Orthopaedic and Sports Physical Therapy, vol. 35, no. 2, pp. 72–87, 2005.
[42]
M. D. Thelen, J. A. Dauber, and P. D. Stoneman, “The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial,” Journal of Orthopaedic and Sports Physical Therapy, vol. 38, no. 7, pp. 389–395, 2008.
[43]
B. Ackermann, R. Adams, and E. Marshall, “The effect of scapula taping on electromyographic activity and musical performance in professional violinists,” Australian Journal of Physiotherapy, vol. 48, no. 3, pp. 197–203, 2002.
[44]
M. J. Smith and V. Sparkes, “The immediate effect of scapular taping on surface electromyo-graphic activity of the scapular rotators in swimmers with subacromial impingement symptoms,” Physical Therapy in Sport, vol. 7, Proceedings of the Physical Therapy in Sport International Conference:Enhancing Recovery and Performance in Sport Birmingham, UK, no. 4, pp. 171–180, 2006.
[45]
C. M. Norris, Sports Injuries, Diagnosis and Management, Butterworth Heinmann, London, UK, 3rd edition, 2005.
[46]
M. H. Gibson, G. V. Goebel, T. M. Jordan, S. Kegerreis, and T. W. Worrell, “A reliability study of measurement techniques to determine static scapular position,” Journal of Orthopaedic and Sports Physical Therapy, vol. 21, no. 2, pp. 100–106, 1995.
[47]
J. DiVeta, M. L. Walker, and B. Skibinski, “Relationship between performance of selected scapular muscles and scapular abduction in standing subjects,” Physical Therapy, vol. 70, no. 8, pp. 470–476, 1990.
[48]
L. Neiers and T. W. Worrell, “Assessment of scapular position,” Journal of Sport Rehabilitation, vol. 2, no. 1, pp. 20–25, 1993.
[49]
J. Nijs, N. Roussel, F. Struyf, S. Mottram, and R. Meeusen, “Clinical assessment of scapular positioning in patients with shoulder pain: state of the art,” Journal of Manipulative and Physiological Therapeutics, vol. 30, no. 1, pp. 69–75, 2007.
[50]
J. S. Lewis and R. E. Valentine, “The pectoralis minor length test: a study of the intra-rater reliability and diagnostic accuracy in subjects with and without shoulder symptoms,” BMC Musculoskeletal Disorders, vol. 8, article 64, 2007.
[51]
J. Nijs, N. Roussel, K. Vermeulen, and G. Souvereyns, “Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests,” Archives of Physical Medicine and Rehabilitation, vol. 86, no. 7, pp. 1349–1355, 2005.
[52]
F. Struyf, J. Nijs, J.-P. Baeyens, S. Mottram, and R. Meeusen, “Scapular positioning and movement in unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability,” Scandinavian Journal of Medicine and Science in Sports, vol. 21, no. 3, pp. 352–358, 2011.
[53]
F. Struyf, J. Nijs, J. De Graeve, S. Mottram, and R. Meeusen, “Scapular positioning in overhead athletes with and without shoulder pain: a case-control study,” Scandinavian Journal of Medicine and Science in Sports, vol. 21, no. 6, pp. 809–818, 2011.
[54]
D. C. Sobush, G. G. Simoneau, K. E. Dietz, J. A. Levene, R. E. Grossman, and W. B. Smith, “The Lennie test for measuring scapular position in healthy young adult females: a reliability and validity study,” Journal of Orthopaedic and Sports Physical Therapy, vol. 23, no. 1, pp. 39–50, 1996.
[55]
D. Morrissey, “Proprioceptive shoulder taping,” Journal of Bodywork and Movement Therapies, vol. 4, no. 3, pp. 189–194, 2000.
[56]
L. G. Portney and M. P. Watkins, Foundations of Clinical Research: Applications to Practice, Prentice Hall Health, Upper Saddle River, NJ, USA, 3rd edition, 2009.
[57]
I. G. Horsley, J. Pearson, A. Green, and C. Rolf, “A comparison of the musculoskeletal assessments of the shoulder girdles of professional rugby players and professional soccer players.,” Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology, vol. 4, no. 1, article 32, 2012.
[58]
A. M. Cools, E. E. Witvrouw, L. A. Danneels, and D. C. Cambier, “Does taping influence electromyographic muscle activity in the scapular rotators in healthy shoulders?” Manual Therapy, vol. 7, no. 3, pp. 154–162, 2002.
[59]
J.-J. Lin, C.-J. Hung, and P.-L. Yang, “The effects of scapular taping on electromyographic muscle activity and proprioception feedback in healthy shoulders,” Journal of Orthopaedic Research, vol. 29, no. 1, pp. 53–57, 2011.
[60]
G. E. Morin, D. Tiberio, and G. Austin, “The effect of upper trapezius taping on electromyographic activity in the upper and middle trapezius region,” Journal of Sport Rehabilitation, vol. 6, no. 4, pp. 309–318, 1997.
[61]
R. M. Paine and M. Voight, “The role of the scapula,” Journal of Orthopaedic and Sports Physical Therapy, vol. 18, no. 1, pp. 386–391, 1993.
[62]
C. Hall, “The shoulder girdle,” in Therapeutic Exercise. Moving Toward Function, C. Hall and L. T. Brody, Eds., Lippincott Williams and Wilkins, Philadelphia, Pa, USA, 1999.
[63]
C. M. Alexander, M. McMullan, and P. J. Harrison, “What is the effect of taping along or across a muscle on motoneurone excitability? A study using triceps surae,” Manual Therapy, vol. 13, no. 1, pp. 57–62, 2008.
[64]
C. M. Alexander, S. Stynes, A. Thomas, J. Lewis, and P. J. Harrison, “Does tape facilitate or inhibit the lower fibres of trapezius?” Manual Therapy, vol. 8, no. 1, pp. 37–41, 2003.
[65]
E. Kaya, M. Zinnuroglu, and I. Tugcu, “Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome,” Clinical Rheumatology, vol. 30, no. 2, pp. 201–207, 2011.
