Effects of Shoulder Stabilization Exercises in the Office Workers With Shoulder Protraction

Rapid upper limb assessment (RULA) tool

Ergonomic risk factors will be determined through direct observation of employees' postures by the dominant side in their workplace using the RULA tool. RULA assesses biomechanical and postural loading on the upper limbs. It is divided into two segments (A and B). Segment A includes steps regarding the assessment of upper arm, lower arm and wrist, whereas segment B is related with the assessment of neck, trunk and legs. Zero and 1 points were added to A and B scores by depending on the muscle use (static postures held for longer than one minute or repeated more than four times per minute) and force (total hours of work in a day) and consequently C and D scores were achieved. Then, C and D scores were combined in a table to obtain a Grand Score. The grand score ranges from 1 to 7 in which a score of 1 or 2 is acceptable, a score of 3 or 4 needs further investigation, 5 or 6 needs investigation and changes sooner and a score of 7 needs immediate investigation and change.

Time frame: 5 minute

Pectoralis minor length measurement

Participants will be instructed to stand in a normal, relaxed posture during data collection. The examiner palpate the medial-inferior angle of the coracoid process of the scapula and just lateral to the sternocostal junction of the inferior aspect of the fourth rib and measured the distance between these landmarks with caliper. Three measurements will be taken; the average is divided by the participant's height and multiplied by 100 to calculate the pectoralis minor length index for analysis

Time frame: 2 minute

Passive internal rotation (IR) and external rotation (ER) mobility flexibility

Using standard goniometer techniques, passive shoulder IR and ER with the subject supine and the arm abducted 90˚, elbow flexed to 90 ˚and the forearm in neutral rotation. Passive ER will be measured by moving the subject's extremity into ER, maintaining positions of the abduction, elbow flexion and forearm rotation. The extremity will be rotated externally until end range of motion is obtained. To measure IR, the subject's arm is internally rotated while an anterior force will be applied to the coracoid and humerus to ensure that scapular compensation don't occur. All measurements will be taken three times, and a mean of the three measurements will be calculated in degree.

Time frame: 5 minute

Active internal rotation (IR) and external rotation (ER) mobility flexibility

Spinous process of the cervical 7 (C7) and thoracic 5 (T5) vertebra will be identified as reference points. The subject is standing with feet shoulder width apart. With thumb extended, the subject reached extremity upwards and towards the midline to a maximum hand behind back position. Tape measure will be used to record the distance in centimetres from the thumb tip to T5 spinous process for active IR mobility. Also subject will be asked to make maximum external rotation by moving harm behind neck with the thumb pointing down and the distance from thumb to C7 will be measured with tape measure for active ER mobility.

Time frame: 5 minute

Muscle Strength Measurement

Upper, middle and lower trapezius, anterior, middle and posterior deltoid, serratus anterior, supraspinatus, infraspinatus, latissimus dorsi and pectoralis major-minor muscle strength measurement will be performed by hand-held dynamometer.3 repetitions at 30 seconds intervals and the average value will be recorded.

Time frame: 40 minute

Closed Kinetic Chain Upper Extremity Stability test

The Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) is examining upper limb stability. It consists of counting how many times the subject performs alternating touches on the opposite hand in a closed kinetic chain position (push-up) over 15 seconds, with three trials. The normalized score is obtained by dividing the number of touches by subject height.

Time frame: 5 minutes

Passive glenohumeral (GH) horizontal adduction mobility flexibility

To assess GH horizontal adduction, subjects are positioned supine with both shoulders flush against a standard examination table. Shoulder and elbow is in 90˚ of both abduction and flexion. The tester's passively move the humerus into horizontal adduction. To measure GH horizontal adduction, the digital inclinometer is aligned with the ventral midline of the humerus. The angle is created by the end position of the humerus with respect to 0˚ of horizontal adduction (perpendicular plane to the examination table, as determined by the digital inclinometer) is then recorded as the total amount of GH horizontal adduction motion in degree.

Time frame: 5 minutes

Total scapula distance

The distance from the anterior aspect of the acromion to the T3 spinous process will be measured with a caliper while the subject is standing in a relaxed position. Distance will be recorded in cm

Time frame: 2 minutes

Scapula upward rotation measurement

All subjects will assessed in a relaxed, standing (barefoot) position and asked to perform full extension at the elbow, neutral wrist position, and with the thumb leading in the coronal plane. One inclinometer will be attached parallel to the humerus with use of a tape. Scapular upward rotation will be measured using the second inclinometer. Subjects are asked to actively move their arms (dominant or non-dominant randomly) from rest position to 45˚, from rest position to 90˚and from rest position to 135˚ abduction and to hold arm in these positions for measurement (measured with first inclinometer) in frontal plane (randomly). Three trials with a 30 s rest between trials wiil be performed for each shoulder (at rest position, 45˚, 90˚ and 135˚ abduction) and means of them will be calculated.

Time frame: 10 minutes

Lateral Scapular Slide Test (LSST)

LSST will be used for assessing scapular asymmetry under varying load positions. Measurements of scapular position are taken while scapular position with the arm abducted 0, 45, and 90 degrees in the coronal plane. Distance from the inferior angle of the scapula to the spinous process of the thoracic vertebra in the same horizontal plane will be measured in all 3 position. If the distance is greater than 1.5cm, it means LSST is positive.

Time frame: 5 minutes

Cervical posture analysis by photographing method

Tripod and camera (Canon Rebel T5i, 18.0 megapixel) will be located 0.8 meters away from the participant, at C7 alignment in a position, where the lens of the camera will be vertical to the individual's sagittal level. Reflective markers will be placed on the lateral canthus of the eye, the tragus of the ear, the spinous process of C7. The sagittal head angle will be formed at the intersection of a horizontal line through the tragus of the ear and a line joining the tragus of the ear and the lateral canthus of the eye. The cervical angle is highly reliable to assess the forward head position. It is the angle formed at the intersection of a horizontal line through the spinous process of C7 and a line to the tragus of the ear. Triangular screen ruler program will be used for calculate angles.

Time frame: 10 minutes

Sagittal shoulder posture analysis by photographing method

Tripod and camera (Canon Rebel T5i, 18.0 megapixel) will be located 0.8 meters away from the participant, at C7 alignment in a position, where the lens of the camera will be vertical to the individual's sagittal level. Reflective markers will be placed on the the spinous process of C7 and lateral shoulder. Where a horizontal line passing through the lateral shoulder meets the line drawn from C7 to the lateral shoulder, the point of intersection forms the sagittal shoulder-C7 angle. It indicates the degree of roundedness of the shoulders. A protracted shoulder would yield a lesser value of this angle. Triangular screen ruler program will be used for calculate angle.

Time frame: 10 minutes

Coronal shoulder posture analysis by photographing method

Tripod and camera (Canon Rebel T5i, 18.0 megapixel) will be located 0.8 meters away from the front of participant. Reflective markers will be placed on the left and right coracoid processes. It is defined as the angle between a horizontal line and a line joining the coracoid processes. It is used to determine whether the left and the right shoulders are level or not. Its normal value should be 180 degrees. Triangular screen ruler program will be used for calculate angle.

Time frame: 10 minutes

Thoracic posture analysis by photographing method

Tripod and camera (Canon Rebel T5i, 18.0 megapixel) will be located 0.8 meters away from the participant, at C7 alignment in a position, where the lens of the camera will be vertical to the individual's sagittal level. Reflective markers will be placed on the spinous process of C7 and the spinous process of thoracic 12 (T12). The point where lines (perpendicular to the skin surface) produced through T12 and C7 markers intersect each other forms the thoracic flexion angle. The lesser the value, the less is the kyphosis. Triangular screen ruler program will be used for calculate angle.

Time frame: 10 minutes