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Myotherapy: Glenohumeral Joint Pain Treatment

Neck pain and stiffness that radiates to the shoulder, glenohumeral, elbow, and wrist-Chapmans Reflexes Blog Image

Patients can come in with pain and stiffness from the neck that can refer to and causes elbow wrist and shoulder pain- acromioclavicular (AC) joint and the glenohumeral (GH) joint. Typically, it impedes movements such as lifting of the arms, brushing the teeth, or holding a golf club. It may be described as a moderate pain or a chronic pain that could affect sleep especially if it’s the shoulder you sleep on.

Shoulder Anatomy

You can help them by applying a variety of techniques to relieve uncomfortable pain or sensations in and around that area. But first, let's understand the shoulder anatomy. Since it is one of the most unstable joints in the body with the most movement, it can be complex to understand its structure and functionality.

Shoulder Structure and the three kind of bones, glenohumeral joint- Chapmans Reflexes Blog Image

The two shoulder joints that are prone to injury are the acromioclavicular (AC) joint and the glenohumeral (GH) joint. 

  • The acromioclavicular joint is situated where the clavicle is in contact with the acromion and the scapula. 
  • The glenohumeral joint is where the socket of the scapula connects with the rounded head of the humerus. It is responsible for the wide range of motion of the shoulder including flexion, extension, internal and external rotation, adduction and abduction and circumduction. 

There are  eight muscles attached to the bones of the shoulder. They are responsible for the form we see of the shoulder and underarm, they aid in its range of movement, and help protect the GH joint which is the main primary joint involved in function.

The deltoid muscle, which you may also know as the deltoideus muscle, is the shoulder muscle considered to be the largest and responsible for stabilization of the shoulder joint for the prevention of dislocations. 

The other muscles which work with the deltoid for shoulder movement and its functions include:

  • Infraspinatus - for arm raise and lowering
  • Triceps brachii - arm straightening
  • Pectoralis major - connects to the sternum
  • Pectoralis minor - stabilizes the scapula
  • Teres major - arm rotation 
  • Biceps brachii - rotates the forearm; flexes the elbow
  • Latissimus dorsi - helps with arm rotation and movement away from and close to the body
  • Subscapularis - aids to rotate the humerus 
  • Supraspinatus - help to raise arm away from the body

Shoulder Pains and Problems

Muscle Energy Technique

When any of the aforementioned muscles become dysfunctional, inhibited and reduced in their passive resting length, they tend to pull the humerus forward. According to OrthoInfo, shoulder problems that patients can experience fall into these categories:

  • Tendon inflammation - can be bursitis or tendinitis
  • Shoulder Instability - stretched lining of the shoulder joint, labrum, or ligaments 
  • Arthritis - joint tenderness and swelling
  • Fracture - can be caused by trauma or injury from a fall, sports activities, vehicular accident, or a direct hit to the shoulder

Other causes for shoulder pain that are less common include infections, tumors, and nerve related problems.

See Related Video: Shoulder Pathologies: Different Causes and Cool Tubing Treatments

In this article, we are going to focus on glenohumeral joint pain and an amazing muscle energy technique that could improve the humerus’s resting position. This will improve the quality and range of motion and reduce the notable pain felt by your patient. 

Almost any joint in the body can be safely treated with these techniques. Many sportsmen utilize them to avoid future muscle and joint injuries. It's primarily used by people who have restricted range of motion in their neck and back due to facet joint dysfunction found in the neck and back, for those who have broader issues like shoulder pain, sciatica, scoliosis, unsymmetrical legs, hips, or arms, and to treat chronic muscle pain, stiffness, or injury.

See Related Video: BEST exercises for the majority of shoulder problems using the water

Conducting the Assessment

You can clearly see how  far forward the humerus of the patient is. To conduct the test, ask them to be seated comfortably. Stand behind the patient and place your hand over their shoulder. Press your thumb into the tissue, as is in the picture below, until you can palpate the humerus. Note how far forward the humerus is, you can apply a second finger along with your thumb for a more clearer view.

Conducting the assessment for shoulder pain, glenohumeral joint and problems-Chapmans Reflexes Blog Image

Upon confirming that the humerus is anteriorized and checking if any symptoms of pain locally, and/or radiating up in the neck down to the elbow and wrists are present, you can go ahead with this simple muscle energy technique that will improve length of restricted tissue and bring the humerus back into the glenohumeral joint.

Related article: Shoulder Pathologies: Different Causes and Cool Tubing Treatments

Treatment

Let’s begin with the treatment steps. Here’s what you can do:

  1. Have your patient lie on their back (supine).
  2. Put your four fingers behind the humerus while your thumb and wrist sits on top of the humerus.
  3. Slide your thumb down until you get into a firm position.
  4. Push the top end of the humerus down, letting it press onto the table. At the same time, let your other hand elevate the elbow. Continue to do this seesaw-like motion that gently moves the humerus in the capsule a couple of times. Since it can be quite tender, remember not to apply too much force. 
  5. Apply gentle pressure until you can feel the bony end range and ask the patient to push their elbow to the floor and hold it for about 10 seconds. 
  6. Let the patient take a deep breath and when they release their breath you reduce the pressure applied to the limb whilst ensuring that the joint remains in an isometric position. 
  7. Repeat steps four to seven: You apply a rhythmic rocking back and forth motion of the humerus within the joint space for approximately 30 - 45 seconds or until it has a softer feel on the movement, it will start to have a smoother end feel. Continue with the gentle push while the patient takes a deep breath. When they breathe out, stop applying pressure as a counterforce on their humerus. When you apply the muscle energy technique, here are several tips to remember. When pushing down gently, hold it for about 10 seconds and ask the patient to exert 30% to 40% of their effort. Let them take a deep cleansing breath in and when they breathe out, that's when they stop contracting. You can do this three times before reassessing the joint position again. This should make headway into better movement patterns and reduced myofascial pain of the shoulder and surrounding compromised structures.

Watch This Video

Here's a short video where you can see how the steps are carried out. Watch to learn more how to follow through with the muscle energy technique. Try it from your clinic and you will see positive changes in your patients pain and function.

hand over painful neck

Stiff Neck Causes and Remedial Self-Massage for Relief

The pain a stiff neck brings about can be very bothersome and serve as a hindrance when it comes to carrying out the tasks that we need to do everyday. But what exactly causes this tightness in our necks? I was thinking about just general ways that I can give you a little bit of help with some aches and pains. As you know, I've tried to specialize in musculoskeletal, hence the name. We also look at what's going on with the connective tissue as well. Things about joints, the fascia, the nervous system and ways to actually make you feel like you are feeling stable. Today, I'm going to focus on the neck and give you some tips on how you can relieve a ropy and bandy scalene if you’re on your own or cannot come into the clinic to see someone like me.  

Causes of Stiff Neck:

  • Looking down for a long period while reading, writing, or using your phone;
  • Excessive or vigorous movement of the neck;
  • Sleeping in the wrong position, which exerts too much pressure on the neck
  • Clenching the jaw;
  • High stress levels;
  • Medical conditions such as osteoarthritis and spinal disorders
  • Trauma to the neck or back due to injuries, a hunched posture, or picking heavy weights; and
  • Sudden movement of the head due to whiplash, which can pull your neck muscles and also can give rise to other serious symptoms.
Source: Vaughan, J. (2021)

Treatment:

  • Feel along the suboccipital ridge all the way along, both sides, to see if they feel even.
  • The area that feels painful, is not the area of complaint.
  • Gently tuck your chin down and feel around the back of the lower part of your skull (the top 3 survival muscles) and feel around the lateral joints.
  • Feel with two fingers and do some cross-fiber work .
  • Keep your shoulders down so you do not activate the trapezius muscles.
  • Once you find the tight ridge, palpate and see if you can feel into the area where the ribs are.
  • Feel for the upper trapezius and duck anteriorly to it, then press your fingers down into that tight space.
  • Palpate around the other side to see if it’s the same or different.
  • Drop your ear down to give a little bit of softness to the tissue of the lateral neck which will allow you to really sink deeper into the muscle.
  • Press and depress onto that region of the lower neck, it is the area that feels like it would be accessing your first rib, by doing this movement we are also making small changes to the restrictions or tightness over the second rib.
  • Laterally flex away from the area and give yourself a little active stretch while sinking down a little deeper.
  • As you work along your neck, press towards it and then gently glide away.
  • Repeat the process one more time this time moving a little more medially. Come closer to the neck dropping down and in.
  • Start to pull away and take the chin away, then try to access those fibers for posterior scalene, dropping down and back then coming along and forward.
  • Palpate and see if that made a difference. The scalene should be feeling less taught and bandy, and you should feel better through the range.
I want you to think about the things that make a difference to the neck. Sometimes we have to look at other distal attachments. We can apply joint play on our first and second ribs if they are stiff, palpate along the clavicle where the subclavius is and work on those fibres. Focusing also on the pectoralis major and minor to improve functional movement of the clavicle and shoulder joints. Assess one side versus the other to see if the problems felt in the neck can be compared to and aligned with the tightness felt in the chest tissues. Watching the video attached to this blog will assist you greatly in some self-treatment options whenever you feel restricted in the neck. References: Source: Vaughan, J. (2021) How to Get Rid of a Stiff Neck. eMediHealth. Retrieved from https://www.emedihealth.com/bones-joints/manage-stiff-neck#some_causes_of_a_stiff_neck
inner leg tightness exercise

Treat Inner Leg Tightness Fast With This Simple Trick!

Long and Short Adductor Muscles

What are the adductor muscles how can we treat them? The adductor muscles are called adductor muscles because they add or adduct in. Anatomically, when we think of them, they are going to be attached to the pubic bone, and attach to either the femur or the pes anserine. The latter being our two longer joint adductors. Our adductor muscles assist us when it comes to moving the leg inwards. When the leg moves toward the body, it uses the longer adductors as the primary movers, and when the knee is in flexion, it uses mostly the shorter ones including brevis, and etcetera. The adductor muscles play a huge role in hip stability and pelvic control. They need to be treated if we see pain or instability of the ilia, the knee, in general tightness with sitting wide legged or cross legged. Moreover, it is also an indication for treatment if there has been sporting injuries where the pubic bone or soft tissue of the hip, thigh or pelvis is present.

Treating the Adductor Muscles

If you are going to treat someone who has any of the symptoms listed above the best way to do so is by having them lay sideways. To begin, we should first asses the ability to list the affected leg in both straight and knee bent movements. Why do we do this? It is so we can get an understanding of whether the short or longer adductors (or both) need to be treated. In the video demonstration below we can see that there is more weakness and incorrect lifting when the knee is bent and the longer adductors removed from the assessment. This meant my focus of treatment would be closer to the upper leg (proximal) rather than if she was weak and felt pain with a straight knee.

Steps to Follow

  1. Start to feel around the inner leg and gently palpate for muscle hypertonicity (muscle feels tight).
  2. With some lotion or lubricant, place your hands at around a 45 degree angle towards the upper inner thigh and slowly glide along the tissue—starting from just above the knee, towards the pubic bone.
  3. If you come across any taught bands, you can cross fiber across the belly of the muscle/s using a gentle action. There are loads of nerves housed along the inner thighs so this can be painful if too deep or too quickly frictioned.
  4. We can also work into the muscle groups palpating for long bands of firm or tight muscles. These normally run along the line of the femur and not across it. To address these restrictions, let us apply a positional release technique. The bands can start anywhere above the knee and soften midway along the femur or in nasty restricted cases all the way up to the pubic attachments.
  5. Now, making use of both your hands, place each thumb on the area where the tautness begins and  push your thumbs towards each other. This is called the positional release technique, which is an excellent way to change the tension between two ends of the muscle fiber. We actually shorten the muscle belly by physically bunching it into the middle. Think about an uncooked sausage and if you apply pressure at each end and direct towards the middle, then that area has less tension.
  6. Hold the positional release until you can feel a sensation at the tendons where it feels like it’s softening. For about 90 seconds or until you feel that the muscles start to give. It should feel slightly uncomfortable but not dreadful.
  7. Start to feel around the inner leg once again, and gently palpate for any further restrictions of the muscle. If there is still some tightness, repeat the process.
The video below shows me treating Kristen’s adductor muscles. We can see that in the start of the video she is experiencing hip flexion as well as difficulty when lifting her lower leg. Then after completing all these steps, we can see that she is feeling less tenderness in her adductor muscles and can actually lift her leg more easily in a better range. Watch the full video instruction below: Sources: Hank Grebehttps://www.istockphoto.com/photo/male-hip-adductor-complex-muscles-anterior-view-isolated-on-human-skeleton-gm1271838675-374300620?utm_source=unsplash&utm_medium=affiliate&utm_campaign=srp_photos_top&utm_content=https%3A%2F%2Funsplash.com%2Fs%2Fphotos%2Fadductor-muscles&utm_term=adductor%20muscles%3A%3Asearch-aggressive-affiliates-v1%3Aa Adductor Magnus. (2012). Physiopedia. https://www.physio pedia.com/Adductor_Magnus
closed eyes woman cupping her neck with both hands

Neck and Shoulder Pain At Work? Try this!

Even before Covid, people have been prone to spending hours in front of a computer, either for work, school, or even just for entertainment. This is what we are going to fix here by doing some simple neck and shoulder exercises for office workers.  And when we’re in front of computers, we tend to disregard our posture. Most people who sit in front of their computers all day tend to lean their necks forward. Long periods in this position are bound to give referral pain patterns. It is important to do short exercises that will get them into neck extension. Before we even begin with exercises, there is an important thing to consider. The chairs that you or your patients use must be of the right height for the legs and back. It must have back support and elbow rests. This is important because often, an uncomfortable chair can affect our posture when we sit, which is one of the leading causes of neck and shoulder pain.

Step-by-Step Guide for the Neck and Shoulder Office Exercise

In this article, I will share with you a few easy exercises to check your range. It is important to see how comfortable you are when you go into flexion, extension, and rotation. These exercises (neck and shoulder office exercises) will help determine whether you feel any restrictions in your movement whatsoever.

For the neck:

  1. Sit up straight, slowly tilt your head forward, bringing your chin to the chest.
  2. From this position, slowly tilt your head upward, until you are looking at the ceiling.
  3. Return to the starting position, looking straight ahead.
  4. Turn your head gently to the left, then to the right. Return to the starting position.
  5. Lastly, slowly lower your head to your right shoulder. You should be able to do this at a 45-degree angle without any restrictions. The shoulders should not hitch up, and instead, remain still.
  6. Return to the starting position, and repeat, slowly tilting towards the left shoulder.

Arm ranges to check with adductions, abductions, and flexions:

  1. For the starting position, hold your arms out on both sides.
  2. Raise both hands up overhead. Repeat 5 times. this is to check elevation.
  3. Return to starting position. Then slowly swing your arms forward to check horizontal flexion. Repeat 5 times.
  4. Return to starting position, then stretch them backward to check extension. Pull your shoulders back as far you can. Repeat 5 times.
  5. Lastly, do figure of 8 movements.

For the elbows:

  1. Hold out your arms in front of you, palms up.
  2. Bend your elbows up towards you. Repeat this 5 times, then return to the starting position.
  3. Twist your arms outward gently. This is to test internal and external rotation.
  4. Lastly, try to do the figure of 8s movement with your elbows.

For the wrists and hands:

  1. You will start with the same starting position as the one from elbows. Bend your wrists upward five times.
  2. Then, move them from side to side.
  3. Lastly, do figure of 8 movements.
  4. Go back to starting position, then flip your hand over so that your palms are facing down.
  5. Bend your fingers 5 times.
  6. Then stretch them out, holding them apart from each other. Repeat this five times
  7. Lastly, try making piano movements with your fingers.

Another tip for your neck and shoulder office exercises

After these neck and shoulder office exercises, make them go through the neck ranges again, to see if they get any changes. Another tip I have today is to tuck the chin back into your neck. I always use the analogy of pretending that someone you really don’t like is coming up to you and is trying to give you a great big kiss on the chin. Naturally, you would be recoiling your head back.
  1. Tuck the chin in. This is the starting position.
  2. Hold your arms out to your sides, and then pull your shoulders back, like step 4 for the arm movements. hold for 10 seconds.
  3. Relax.
  4. Repeat it 5 more times.
I recommend doing these 2 to 3 times every day, as doing so will give you a lot more flexibility as well as reduce the pain in your neck and shoulders. For a demonstration of the movements, please watch the video.
both hands massaging man's neck

Target Platysma or Neck Pain Easily using this Method!

This is one of my 3 favourite muscle names in the body – it’s in your neck and it’s called the platysma! First of all, what is the platysma? It is a muscle that begins at the jawline, right at the mandible, and runs down in a fan shape to the superior portion of the clavicle. It is responsible for helping the mouth and lips to move. Specifically, it is the muscle that we use when we react with fear or fright – when our mouth is drawn down or to the side.

Image from Wikipedia

Many therapists miss out on getting the best outcomes because they overlook this little muscle. In fact, did you know that a lot of neck-related pain can be traced to the platysma? As therapists, 75% of people entering our clinic complain of either neck or lower back pain! If you are focusing your techniques at the back, which is quite often joint-related or soft tissue around the traps, splenius, etc, then can I ask you to try this simple technique on your next neck pain client?

I could go as far as to say unless we address the tightness in the platysma. We won't get full neck movement.

Your First Moves

First, you must assess your client’s neck range. From a relaxed, sitting position, have your client lookup or go into full neck extension. Watch and be vigilant on the lift to note any tightness of the anterior neck esp the flat band of the platysma. Have your clients return to neutral or as neutral as they can. This video will show you step by step how I teach the muscle and surrounding soft tissue via way of an active glide. This way both of you are working together. Plus, they are increasing their afferent and efferent nervous system. They will also increase their agonists and antagonists, and myofascial trains.

Active Glide

For therapists out there, when we do active movements, it means that both you and your client or patients are actually actively involved in the process.

1. Stand on the treating side, in this case, stand on the right and have the client turn their head to the right, as far as they can go comfortably. 2. Place two fingers or knuckles. If you have OA issues just above their right clavicle at the midline closest to the supraclavicular notch and sink into the tissues. The fingers will be facing out towards the AC joint on the superior line of the clavicle so that you can take up the tissue along with its attachments. 3. Have your client slowly rotate their head back towards the left as far as they can go comfortably. 4. As they move their head allow your fingers to glide along with their muscle. Work with a pace that mimics the speed of the rotation and at the tension of the hypertonic muscle/fascia. 5. I always apply any technique three times before I re-assess. NB* make sure you DO re-assess! 6. Repeat the same process on the other side.

The Results

As you’re doing this, it should feel “tight” and “stretchy” or “burny” to your clients – all signs of fascia, muscle, and/or tendon. Have your clients test their range again, by moving their heads up, down, and side to side. The results can be astronomical in pain management, posture, and range. You should be able to see the tissues are not as taut as this time around.

The beauty of this work is that you can offer it to clients as homecare.  This is an attempt to release any ongoing restrictions felt in the neck. This is another cool technique that adds value along with the other ways to assist in neck pain that we've discussed in earlier videos.

Have fun and hope this helps you and your clients in the future!  
teaching proper breathing

Can’t Breathe Properly? Fix It In Just 120 Seconds!

Are you in a constant state of stress? With everything that has been happening in the world right now, I cannot blame you. Several things can trigger stress, such as sudden changes in your environment, feeling pressure, and anxiety. There is such a thing as ‘good’ stress, which can help us when trying to meet deadlines, or when our body acts on instinct when we are in danger. However, too much stress can be quite draining emotionally and physically. One physical aspect it triggers significantly is our breathing. Breathing is usually an involuntary act, which means that your body does it even without conscious effort. This is important because our entire body needs oxygen to function properly. Proper breathing has multiple benefits such as mental clarity, better cognition, improved posture, helps the quality of our sleep and even aid in proper digestion. But when our body is experiencing stress, it hinders our effective breathing. Everyone experiences stress occasionally, so when that happens, we will need to work on our conscious breathing. This requires the use of the cortex of the brain. Stimulating the motor cortex helps the brain stem to work with up and down regulators to improve things such as posture, pain regulation and overall oxygen efficiency.

Two Breathing Techniques

To help with that, I recommend using your diaphragm when breathing. This is also called belly breathing. I have two techniques for you to practice being able to get a feel for diaphragmatic breathing.
  1. Lie face up, with your knees bent and your feet flat on the ground.
  2. Place a book of your choice on your belly.
  3. Breathe in deeply and visualize the muscles of your lower regions of your thorax activating whilst taking the air in through the nose.
  4. Exhale through the mouth. Repeat this process at least ten times.
You should be able to see the book on your belly rise and down as you use your diaphragm to breathe.  However, if you are still having trouble, I will share with you another technique which involves locking down your upper ribcage. Doing so will restrict the top end of the breathing cycle and will consequently work the lower end of the breathing cycle. To do this technique, you will begin as you did the with the first exercise, lying face up with the knees bent and feet flat on the ground.
  1. From this position, take one hand and place it underneath your buttocks.
  2. Then, take the opposite hand, reach across your chest and wrap it halfway down your upper arm.
  3. Again mindfully taking each breathe in through your nose.
  4. Exhale through the mouth. Repeat this exercise ten times.
Both techniques are truly helpful to stimulate oxygen throughout the body. I ask my patients to do this each morning when they wake up or whenever they are feeling stressed and have a place they can stop for 2 minutes. Firstly I make sure they have stimulated their neuro lymphatic points aka Chapmans Reflexes, you can literally do this anywhere at all. For a better view of this exercise, have a look at this Youtube video.

woman twisting her upper body to the right

Improve Your Breathing and Upper Back using these Stretches!

How life has changed since 2019!! We see lack of movement caused by so many different things now. The usual sedentary lifestyle from poor motivation, restrictions in where and how to get exercise  AS WELL AS the increase in working from home. This has all amassed to increases in sitting, both on the computer and then in front of the television. The outcome is restriction and stiffness in the full spine and specifically poor thoracic spine mobility. We also need to consider those people who have recently experienced violent trauma as which includes motor vehicle accidents, bad falls, sporting injuries etc. These insults also induce pain and immobility on our thoracic vertebrae. Other precursors to a stiff and painful thoracic spine include people suffering from Osteoporosis in jobs requiring strenuous lifting, patients with a history of cancer, drug abuse, HIV, or partial or complete suppression of the immune response/prolonged use of corticosteroids. These are just a few of those I see in my clinic complaining of “a bad upper back”.

Muscles Involved

The muscles involved in Thoracic Rotations are: “During rotation, the external oblique (EO), rectus abdominis (RA) and lumbar multifidus (MF) muscles act contralaterally, whereas the latissimus dorsi (LD), internal oblique (IO), and transversus abdominis (TrA) muscle act ipsilaterally3,4,5,6). Trunk rotation is a motion involving both thoracic and lumbar vertebrae.1” Some of the most commonly known treatments for pain in the thoracic region include stretching, massage, and some other counter (OTC) medicines.  Others, also try heat and/or cold therapy which helps lessen the muscle pain and stiffness in the short term but have little evidence around the long-term benefits. So what can YOU do to help if you have a stiff, painful back? If you struggle to get up in the morning, find it difficult to twist to look over your shoulder when driving or simply turning in seated or standing positions. Here is a quick exercise you can do just about anywhere to help relieve this tension and limited thoracic rotations. Stretch twists of the torso can help improve rib mobility, muscle restrictions, and ultimately diaphragm integrity which is probably the biggest benefit when we consider the need for blood enriched with oxygen.

Twist and Stretch Exercise

I want to offer you the feeling of length/balance of the spinal segments, feeling taller or straighter, and the overall state of postural strength of the core.  This is also a very good practice to strengthen your Diaphragm & Upper Torso.
  1. In the first sequence, put one hand underneath your leg locking your sit bones securely onto the table or chair, while your other hand is across your body and grabbing the chair to be able to start you on your way to twisting your spine.
 
  1. Twist as far as you can go and then try to return to the midline using the muscles of your trunk but use that second hand to hold on and resist.
 
  1. Hold that position for about 10 seconds and return back to the centre position so your back is in neutral.
 
  1. Take a deep cleansing breath in/out and then relax.
 
  1. In the second sequence, repeat the twist to as far as you can turn the spine. Then include a head/neck turn in the same direction to apply a small amount of overpressure to the stretch.
 
  1. Hold this position for 10 seconds, return to centre and take another full breath in and out.
 
  1. The third and the most important of the three sequences are including ocular or eye movement. This encourages the motor cortex to add more rotation via the descending pathways and usually assists in further changes in the nervous system along with the muscles and fascia.
 
  1. Rotate both the head and body as far as possible and hold again for 10 seconds.
 
  1. Now, make your eyes look as far around as you can possibly can and add a bit more stretch.
Watch this 2-minute video for a more visual presentation of this Twisting Exercise.

    1 Source: National Center for Biotechnology Information, U.S. National Library of Medicine [Relationship between the spinal range of motion and trunk muscle activity during trunk rotation]
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