The Visual Analog Scale (VAS) was used to assess
patients’ shoulder joint pain and for measurement of the
range of pain. To measure the pressure pain threshold (PPT)
of the upper trapezius, subjects sat in the neutral position.
At the point between the spinous process and acromion process,
the pressure pain threshold meter was placed vertically on the surface of the skin, and the subject was instructed to give a vocal signal when the pain started. The pressure pain threshold was measured in units of kg/cm2. The pressure pain meter is quantifiable to the accurate trigger point of the pain and the pressure sensitivity of the muscle. Therefore,good use is made of the pressure point of the myofascial pain syndrome14). We used the mean value of three measurements taken at intervals of one minute. To assess changes of the round shoulder posture (RSP), the length was measured
to 1/20 mm using a vernier caliper. In use of the supine method, the RSP noted the interval between the floor of the table and the acromion process. This was used to measure the length of the pectoralis major, however, it has good credibility (ICC 0.88) with or without symptoms of shoulder position related to scapular location regarding the shoulder joint15). In this study, subjects wore a sleeveless shirt in order to expose the acromion. A vernier caliper can cause discomfort when making direct contact with skin. Therefore, to reduce the discomfort of the subject, a 15 cm ruler was placed over the skin at the point of contact. The subject lay on the table in the neutral position and the length between the table and the floor to the acromion was measured using a vernier caliper. Prior to the conduct of each test, the vernier
caliper was adjusted to zero three times, and the mean value was used. An upper limb closed chain exercise test was used to test the stability of the upper limb16). In performance of the closed chain exercise test, the starting position, which
had a width of 90 cm, was marked on the floor and both hands were placed on the marker dots in order to form a push-up position. In order to reduce changes in position, the
width was reduced to 80 cm. The subject placed one hand over the other, alternately. Placement of one hand over the other counted as one and was performed for 15 seconds and the number was counted. At this time, maintenance of the supine position was essential. In between performance of each test, the subject had a one-minute break; measurements were performed two times, and the mean value was used. The SPSS 17.0 program was used for statistical analyses. The Shapiro-Wilk test was used to determine the general properties and variables of the subjects. The paired t test was used for comparison of pretest and posttest results within each group, and the independent t test was performed for comparison of the two groups before and after training. Values of p value