Preconditioning is correlated with altered collagen fiber alignment in ligament

Although the mechanical phenomena associated with preconditioning are well-established, the underlying mechanisms responsible for this behavior are still not fully understood. Using quantitative polarized light imaging, this study assessed whether preconditioning alters the collagen fiber alignment of ligament tissue, and determined whether changes in fiber organization are associated with the reduced force and stiffness observed during loading. Collagen fiber alignment maps of facet capsular ligaments (n?=?8) were generated before and after 30 cycles of cyclic tensile loading, and alignment vectors were correlated between the maps to identify altered fiber organization. The change in peak force and tangent stiffness between the 1st and 30th cycle were determined from the force-displacement response, and the principal strain field of the capsular ligament after preconditioning was calculated from the fiber alignment images. The decreases in peak ligament force and tangent stiffness between the 1st and 30th cycles of preconditioning were significantly correlated (R ≥ 0.976, p?相似文献   

Anomalous fiber realignment during tensile loading of the rat facet capsular ligament identifies mechanically induced damage and physiological dysfunction

Many pathophysiological phenomena are associated with soft tissue loading that does not produce visible damage or tissue failure. As such, there is an unexplained disconnect between tissue injury and detectable structural damage during loading. This study investigated the collagen fiber kinematics of the rat facet capsular ligament to identify the onset of subfailure damage during tensile loading conditions that are known to induce pain. Quantitative polarized light imaging was used to determine the collagen fiber orientation in the capsular ligament (n=7) under tension, and an alignment vector correlation measurement was employed to identify local anomalous fiber realignment during loading. During the initial portion of loading when tissue stiffness was increasing, anomalous realignment was more likely to be detected than mechanical evidence of structural damage, and as a result, anomalous fiber realignment was identified significantly (p=0.004) before gross failure. The occurrence of anomalous fiber realignment was significantly associated (p=0.013) with a decrease in tangent stiffness during loading (ligament yield), suggesting this optical metric may be associated with a loss of structural integrity. The presence of localized anomalous realignment during subfailure loading in this tissue may explain the development of laxity, collagen fiber disorganization, and persistent pain previously reported for facet joint distractions comparable to that required for anomalous realignment. These optical data, together with the literature, suggest that mechanically induced tissue damage may occur in the absence of any macroscopic or mechanical evidence of failure and may produce local pathology and pain.     

An innovative application of a small-scale motion analysis technique to quantify human skin deformation in vivo

This study highlights a new experimental method developed to measure full-field deformation of human skin in vivo. The technique uses a small-scale Qualisys (Sweden) 3D motion capture system and an array of reflective markers placed on the forearm of five healthy volunteers. A load of up to 1.5 N was applied to induce skin deformation by pulling a fine wire attached to the centre of the marker configuration. Loading and marker displacements were recorded simultaneously. 3D marker trajectory data was generated for three different load directions. Tests were repeated to investigate accuracy and repeatability. Calibration results indicate the accuracy of the motion capture system with an average residual of 0.05 mm. The procedure was found to be repeatable and accurate for five repeated tests of measured displacements with a maximum variance of 5%. Experimental data are presented to demonstrate robustness and the ability to produce significant outputs. For all five subjects, at 1 N load, the mean and standard deviations of skin axial and lateral displacements were found to be 11.7±1.6 mm and 12.3±3.3 mm, respectively. The axial displacements ratio (u₉₀/u₀) ranges from 0.63 to 1.45 with mean±standard deviation of 0.982±0.34 and 0.982±0.32 for left and right arms, respectively. The experiments generated useful and accurate data that can be used to study the viscoelastic, hyperelastic or anisotropic behaviour of human skin. The measured displacements will be analysed further to determine the mechanical properties of skin using inverse Finite Element Analysis and Ogden model.     

Multiscale mechanics of the cervical facet capsular ligament,with particular emphasis on anomalous fiber realignment prior to tissue failure

The facet capsular ligaments encapsulate the bilateral spinal facet joints and are common sources of painful injury due to afferent innervation. These ligaments exhibit architectural complexity, which is suspected to contribute to the experimentally observed lack of co-localization between macroscopic strain and microstructural tissue damage. The heterogeneous and multiscale nature of this ligament, combined with challenges in experimentally measuring its microscale mechanics, hinders the ability to understand sensory mechanisms under normal or injurious loading. Therefore, image-based, subject-specific, multiscale finite-element models were constructed to predict the mechanical responses of the human cervical facet capsular ligament under uniaxial tensile stretch. The models precisely simulated the force–displacement responses for all samples (\(\textit{R}^{2}=0.99\pm 0.01\)) and showed promise in predicting the magnitude and location of peak regional strains at two different displacements. Yet, there was a loss of agreement between the model and experiment in terms of fiber organization at large tissue stretch, possibly due to a lack of accounting for tissue failure. The mean fiber stretch ratio predicted by the models was found to be significantly higher in regions that exhibited anomalous fiber realignment experimentally than in regions with normal realignment (\(\textit{p}<0.002\)). The development of microstructural abnormalities was associated with the predicted fiber-level stretch (\(\textit{p}<0.009\)), but not with the elemental maximum principal stress or maximum principal strain by logistic regression. The multiscale models elucidate a potential mechanical basis for predicting injury-prone tissue domains and for defining the relationships between macroscopic ligament stretch and microscale pathophysiology in the subfailure regime.     

The failure response of the human cervical facet capsular ligament during facet joint retraction

Studies implicate the cervical facet joint and its capsule as a primary anatomical site of injury during whiplash exposures to the neck. Although the facet joint is known to undergo stretch as the superior vertebra is retracted relative to the inferior vertebra during the whiplash kinematic, the response of the facet capsular ligament and its microstructure during failure in joint retraction is unknown. Polarized light imaging and vector correlation analysis were used to measure the collagen fiber alignment in the human capsular ligament, together with traditional mechanical metrics, during joint retraction sufficient to induce ligament failure. Anomalous fiber realignment occurs at 2.95±1.66mm of displacement, which is not different from the displacement when the ligament first yields (2.77±1.55mm), but is significantly lower (p=0.016) than the displacement at tissue failure (5.40±1.65mm). The maximum principal strain at the first detection of anomalous fiber realignment (0.66±0.39) also is significantly lower (p=0.046) than the strain at failure (1.39±0.64), but is not different from the strains at yield or partial failure. The onset of collagen fiber realignment determined in this study corresponds to the ligament's yielding and supports assertions that the facet capsule can undergo tissue injury during joint retraction. Further, such microstructural responses may indicate tissue damage in the absence of rupture.     

Effects of eight different ligament property datasets on biomechanics of a lumbar L4-L5 finite element model

Ligaments assist trunk muscles in balancing external moments and providing spinal stability. In absence of the personalized material properties for ligaments, finite element (FE) models use dispersed data from the literature. This study aims to investigate the relative effects of eight different ligament property datasets on FE model responses. Eight L4-L5 models distinct only in ligament properties were constructed and loaded under moment (15 N m) alone or combined with a compressive follower load (FL). Range of motions (RoM) of the disc-alone model matched well in vitro data. Ligament properties significantly affected only sagittal RoMs (∼3.0–7.1° in flexion and ∼3.8–5.8° in extension at 10 N m). Sequential removal of ligaments shifted sagittal RoMs in and out of the corresponding in vitro ranges. When moment was combined with FL, center of rotation matched in vivo data for all models (3.8 ± 0.9 mm and 4.3 ± 1.8 mm posterior to the disc center in flexion and extension, respectively). Under 15 N m sagittal moments, ligament strains were often smaller or within the in vitro range in flexion whereas some posterior ligament forces approached their failure forces in some models. Ligament forces varied substantially within the models and affected the moment-sharing and internal forces on the disc and facet joints. Intradiscal pressure (IDP) had the greatest variation between models in extension. None of the datasets yielded results in agreement with all reported measurements. Results emphasized the important role of ligaments especially under larger moments and the need for their accurate representation in search for valid spinal models.     

In situ deformation of growth plate chondrocytes in stress-controlled static vs dynamic compression

Longitudinal bone growth in children/adolescents occurs through endochondral ossification at growth plates and is influenced by mechanical loading, where increased compression decreases growth (i.e., Hueter-Volkmann Law). Past in vivo studies on static vs dynamic compression of growth plates indicate that factors modulating growth rate might lie at the cellular level. Here, in situ viscoelastic deformation of hypertrophic chondrocytes in growth plate explants undergoing stress-controlled static vs dynamic loading conditions was investigated. Growth plate explants from the proximal tibia of pre-pubertal rats were subjected to static vs dynamic stress-controlled mechanical tests. Stained hypertrophic chondrocytes were tracked before and after mechanical testing with a confocal microscope to derive volumetric, axial and lateral cellular strains. Axial strain in hypertrophic chondrocytes was similar for all groups, supporting the mean applied compressive stress’s correlation with bone growth rate and hypertrophic chondrocyte height in past studies. However, static conditions resulted in significantly higher lateral (p < 0.001) and volumetric cellular strains (p ≤ 0.015) than dynamic conditions, presumably due to the growth plate’s viscoelastic nature. Sustained compression in stress-controlled static loading results in continued time-dependent cellular deformation; conversely, dynamic groups have less volumetric strain because the cyclically varying stress limits time-dependent deformation. Furthermore, high frequency dynamic tests showed significantly lower volumetric strain (p = 0.002) than low frequency conditions. Mechanical loading protocols could be translated into treatments to correct or halt progression of bone deformities in children/adolescents. Mimicking physiological stress-controlled dynamic conditions may have beneficial effects at the cellular level as dynamic tests are associated with limited lateral and volumetric cellular deformation.     

Bone orientation and position estimation errors using Cosserat point elements and least squares methods: Application to gait

The aim of this study was to analyze the accuracy of bone pose estimation based on sub-clusters of three skin-markers characterized by triangular Cosserat point elements (TCPEs) and to evaluate the capability of four instantaneous physical parameters, which can be measured non-invasively in vivo, to identify the most accurate TCPEs. Moreover, TCPE pose estimations were compared with the estimations of two least squares minimization methods applied to the cluster of all markers, using rigid body (RBLS) and homogeneous deformation (HDLS) assumptions. Analysis was performed on previously collected in vivo treadmill gait data composed of simultaneous measurements of the gold-standard bone pose by bi-plane fluoroscopy tracking the subjects' knee prosthesis and a stereophotogrammetric system tracking skin-markers affected by soft tissue artifact. Femur orientation and position errors estimated from skin-marker clusters were computed for 18 subjects using clusters of up to 35 markers. Results based on gold-standard data revealed that instantaneous subsets of TCPEs exist which estimate the femur pose with reasonable accuracy (median root mean square error during stance/swing: 1.4/2.8 deg for orientation, 1.5/4.2 mm for position). A non-invasive and instantaneous criteria to select accurate TCPEs for pose estimation (4.8/7.3 deg, 5.8/12.3 mm), was compared with RBLS (4.3/6.6 deg, 6.9/16.6 mm) and HDLS (4.6/7.6 deg, 6.7/12.5 mm). Accounting for homogeneous deformation, using HDLS or selected TCPEs, yielded more accurate position estimations than RBLS method, which, conversely, yielded more accurate orientation estimations. Further investigation is required to devise effective criteria for cluster selection that could represent a significant improvement in bone pose estimation accuracy.     

Response analysis of the lumbar spine during regular daily activities—A finite element analysis

A non-linear poroelastic finite element model of the lumbar spine was developed to investigate spinal response during daily dynamic physiological activities. Swelling was simulated by imposing a boundary pore pressure of 0.25 MPa at all external surfaces. Partial saturation of the disc was introduced to circumvent the negative pressures otherwise computed upon unloading. The loading conditions represented a pre-conditioning full day followed by another day of loading: 8 h rest under a constant compressive load of 350 N, followed by 16 h loading phase under constant or cyclic compressive load varying in between 1000 and 1600 N. In addition, the effect of one or two short resting periods in the latter loading phase was studied.The model yielded fairly good agreement with in-vivo and in-vitro measurements. Taking the partial saturation of the disc into account, no negative pore pressures were generated during unloading and recovery phase. Recovery phase was faster than the loading period with equilibrium reached in only ～3 h. With time and during the day, the axial displacement, fluid loss, axial stress and disc radial strain increased whereas the pore pressure and disc collagen fiber strains decreased. The fluid pressurization and collagen fiber stiffening were noticeable early in the morning, which gave way to greater compression stresses and radial strains in the annulus bulk as time went by. The rest periods dampened foregoing differences between the early morning and late in the afternoon periods. The forgoing diurnal variations have profound effects on lumbar spine biomechanics and risk of injury.     

Ligand-based CoMFA and CoMSIA studies on chromone derivatives as radical scavengers

The antioxidant activity for a series of chromone compounds, evaluated by DPPH free radical scavenging assay, were subjected to 3D-QSAR studies using comparative molecular field analysis (CoMFA) and comparative molecular similarity indices analysis (CoMSIA). All 48 chromone derivatives were geometry optimized by AM1 and HF/6-31G^* calculations. The CoMFA and CoMSIA results were compared between different alignment strategies. The best CoMFA model obtained from HF/6-31G^* optimization with field fit alignment gave cross-validated r² (q²) = 0.821, noncross-validated r² = 0.987, S = 0.095, and F = 388.255. The best CoMSIA model derived from AM1 optimized structures and superimposition alignment gave q² = 0.876, noncross-validated r² = 0.976, S = 0.129, and F = 208.073, including electrostatic, hydrophobic, hydrogen bond donor and acceptor fields. The contour maps provide the fruitful structure–radical scavenging activity relationships which are useful for designing new compounds with higher activity.     

Retrospective assessment of a single fiducial marker tracking regimen with robotic stereotactic body radiation therapy for liver tumours

AimTo investigate tumour motion tracking uncertainties in the CyberKnife Synchrony system with single fiducial marker in liver tumours.BackgroundIn the fiducial-based CyberKnife real-time tumour motion tracking system, multiple fiducial markers are generally used to enable translation and rotation corrections during tracking. However, sometimes a single fiducial marker is employed when rotation corrections are not estimated during treatment.Materials and methodsData were analysed for 32 patients with liver tumours where one fiducial marker was implanted. Four-dimensional computed tomography (CT) scans were performed to determine the internal target volume (ITV). Before the first treatment fraction, the CT scans were repeated and the marker migration was determined. Log files generated by the Synchrony system were obtained after each treatment and the correlation model errors were calculated. Intra-fractional spine rotations were examined on the spine alignment images before and after each treatment.ResultsThe mean (standard deviation) ITV margin was 4.1 (2.3) mm, which correlated weakly with the distance between the fiducial marker and the tumour. The mean migration distance of the marker was 1.5 (0.7) mm. The overall mean correlation model error was 1.03 (0.37) mm in the radial direction. The overall mean spine rotations were 0.27° (0.31), 0.25° (0.22), and 0.23° (0.26) for roll, pitch, and yaw, respectively. The treatment time was moderately associated with the correlation model errors and weakly related to spine rotation in the roll and yaw planes.ConclusionsMore caution and an additional safety margins are required when tracking a single fiducial marker.     

Deformation and recovery of cartilage in the intact hip under physiological loads using 7 T MRI

Accurate measurement of cartilage deformation in loaded cadaver hip joints could be a valuable tool to answer clinically relevant research questions. MRI is a promising tool, but its use requires an understanding of cartilage deformation and recovery properties in the intact hip. Our objective was to answer the following questions: (1) How long does it take for hip cartilage to reach a deformed steady-state thickness distribution under simulated physiological load, and how much does the cartilage deform? (2) How long does it take for hip cartilage to return to the original cartilage thickness distribution once the load is removed?MethodsFive human hip specimens were axially loaded to 1980 N in a 7 T MR scanner and scanned every 15 min throughout loading. One specimen was scanned every hour throughout recovery from load. One repeatability specimen was loaded and scanned every day for 4 days. Hip cartilage was segmented as a single unit and thickness was measured radially.ResultsThe hip cartilage reached a steady-state thickness distribution after 225 min of load, and 16.5 h of recovery. Mean strain after 225 min of load was 30.9%. The repeatability specimen showed an average day-to-day change in mean cartilage thickness of 0.10 mm over 4 days of data collection. The amount of deformation (0.96 mm) was far greater than the image resolution (0.11 mm) and error due to repeatability (0.10 mm).ConclusionUsing an ex vivo model, this method has potential for assessing changes in hip cartilage strain due to injury or surgical intervention.     

Applying a follower load delivers realistic results for simulating standing

The exact loads acting on the lumbar spine during standing remain hitherto unknown. It is for this reason that different loads are applied in experimental and numerical studies. The aim of this study was to compare intersegmental rotations, intradiscal pressures and facet joint forces for different loading modes simulating standing in order to ascertain, the results for which loading modes are closest to data measured in vivo.A validated osseoligamentous finite element model of the lumbar spine ranging from L1 to the disc L5–S1, was used. Six load application modes were investigated as to how they could simulate standing. This posture was simulated by applying a vertical force of 500 N at the centre of the L1 vertebral endplate with different boundary conditions, by applying a follower load, and by applying upper body weight and muscle forces. The calculated intersegmental rotations and intradiscal pressures were compared to in vivo values.Intersegmental rotations at one level vary by up to 8° for the different loading modes simulating standing. The overall rotation in the lumbar spine varies between 2.2° and 19.5°. With a follower load, the difference to the value measured in vivo is 3.3°. For all other loading cases studied, the difference is greater than 6.6°. Intradiscal pressures vary slightly with the loading mode. Calculated forces in the facet joints vary between 0 and nearly 80 N.Applying a follower load of 500 N is the only loading mode simulating standing for which the calculated values for intervertebral rotations and intradiscal pressures agreed well with in vivo data from literature.     

Molecular characterization of the capsular antigens of Pasteurella multocida isolates using multiplex PCR

The use of molecular techniques for detection and characterization of the Pasteurella multocida is very important for rapid and specific detection and characterization of the organism. During the period from 15th February, 2014 to 15th April, 2015, 425 nasopharyngeal swabs and 175 lung and spleen samples were collected and examined by conventional methods, 80 strains (18.82%) of P. multocida were isolated from the calves, sheep and goat with respiratory manifestation. Meanwhile, 77 strains (44%) were isolated from emergency slaughtered animals. All the recovered strains were positive for specific PCR for detection of P. multocida strains previously identified as P. multocida by standard microbiological techniques. Multiplex PCR for molecular typing of the capsular antigens of the recovered P. multocida revealed positive amplification of 1044 bp fragments specific to the capsular antigen type A with 105 strains (66.88%), and amplification 511 bp fragments of the capsular antigen type E with 52 strain (33.12%) and absence of B, D and F antigens. Multiplex PCR for molecular typing of the capsular antigens of P. multocida can be used as a simple, sensitive, rapid, reliable technique instead of the serological techniques for identification of the capsular antigens of P. multocida     

Three-dimensional comparison of static and dynamic scapular motion tracking techniques

The shoulder is complex and comprised of many moving parts. Accurately measuring shoulder rhythm is difficult. To classify shoulder rhythm and identify pathological movement, static measures have been the preferred method. However, dynamic measures are also used and can be less burdensome to obtain. The purpose of this paper was to determine how closely dynamic measures represent static measures using the same acromion marker cluster scapular tracking technique. Five shoulder angles were assessed for 24 participants using dynamic and static tracking techniques during humeral elevation in three planes (frontal, scapular, sagittal). ANOVAs were used to identify where significant differences existed for the factors of plane, elevation angle, and tracking technique (static, dynamic raising, dynamic lowering). All factors were significantly different for all shoulder angles (p < 0.001), except for elevation plane in scapulothoracic protraction/retraction (p = 0.955). Tracking techniques were influential (p < 0.001), but the grouped mean differences fell below a clinically relevant 5° benchmark. There was large variation in mean differences of the techniques across individuals. While population averages are similar, individual static and dynamic shoulder assessments may be different. Caution should be taken when dynamic shoulder assessments are performed on individuals, as they may not reflect those obtained in static scapular motion tracking.     

Advanced glycation end-products diminish tendon collagen fiber sliding

Connective tissue aging and diabetes related comorbidity are associated with compromised tissue function, increased susceptibility to injury, and reduced healing capacity. This has been partly attributed to collagen cross-linking by advanced glycation end-products (AGEs) that accumulate with both age and disease. While such cross-links are believed to alter the physical properties of collagen structures and tissue behavior, existing data relating AGEs to tendon mechanics is contradictory. In this study, we utilized a rat tail tendon model to quantify the micro-mechanical repercussion of AGEs at the collagen fiber-level. Individual tendon fascicles were incubated with methylglyoxal (MGO), a naturally occurring metabolite known to form AGEs. After incubation in MGO solution or buffer only, tendons were stretched on the stage of a multiphoton confocal microscope and individual collagen fiber stretch and relative fiber sliding were quantified. Treatment by MGO yielded increased fluorescence and elevated denaturation temperatures as found in normally aged tissue, confirming formation of AGEs and related cross-links. No apparent ultrastructural changes were noted in transmission electron micrographs of cross-linked fibrils. MGO treatment strongly reduced tissue stress relaxation (p < 0.01), with concomitantly increased tissue yield stress (p < 0.01) and ultimate failure stress (p = 0.036). MGO did not affect tangential modulus in the linear part of the stress–strain curve (p = 0.46). Microscopic analysis of collagen fiber kinematics yielded striking results, with MGO treatment drastically reducing fiber-sliding (p < 0.01) with a compensatory increase in fiber-stretch (p < 0.01). We thus conclude that the main mechanical effect of AGEs is a loss of tissue viscoelasticity driven by matrix-level loss of fiber–fiber sliding. This has potentially important implications to tissue damage accumulation, mechanically regulated cell signaling, and matrix remodeling. It further highlights the importance of assessing viscoelasticity – not only elastic response – when considering age-related changes in the tendon matrix and connective tissue in general.     

Altered collagen fiber kinematics define the onset of localized ligament damage during loading

Detecting the initiation of mechanical injury to biological tissue, and not just its ultimate failure, is critical to a sensitive and specific characterization of tissue tolerance, development of quantitative relationships between macro- and microstructural tissue responses, and appropriate interpretation of physiological responses to loading. We have developed a novel methodological approach to detect the onset and spatial location of structural damage in collagenous soft tissue, before its visible rupture, via identification of atypical regional collagen fiber kinematics during loading. Our methods utilize high-speed quantitative polarized light imaging to identify the onset of tissue damage in ligament regions where mean collagen fiber rotation significantly deviates from its behavior during noninjurious loading. This technique was validated by its ability to predict the location of visible rupture (P = 0.0009). This fiber rotation-based metric of damage identifies potential facet capsular ligament injury beginning well before rupture, at 51 +/- 12% of the displacement required to produce tissue failure. Although traditional macroscale strain metrics fail to identify the location of microstructural damage, initial injury detection determined by altered fiber rotation was significantly correlated (R = 0.757, P = 0.049) with tissue yield (defined by a decrease in stiffness), supporting the capabilities of this method. Damaged regions exhibited higher variance in fiber direction than undamaged regions (P = 0.0412).     

Biceps femoris and semitendinosus tendon/aponeurosis strain during passive and active (isometric) conditions

The purpose of this study was to quantify strain and elongation of the long head of the biceps femoris (BFlh) and the semitendinosus (ST) tendon/aponeurosis. Forty participants performed passive knee extension trials from 90° of knee flexion to full extension (0°) followed by ramp isometric contractions of the knee flexors at 0°, 45° and 90° of knee flexion. Two ultrasound probes were used to visualize the displacement of BFlh and ST tendon/aponeurosis. Three-way analysis of variance designs indicated that: (a) Tendon/aponeurosis (passive) elongation and strain were higher for the BFlh than the ST as the knee was passively extended (p < 0.05), (b) contraction at each angular position was accompanied by a smaller BFlh tendon/aponeurosis (active) strain and elongation than the ST at higher levels of effort (p < 0.05) and (c) combined (passive and active) strain was significantly higher for the BFlh than ST during ramp contraction at 0° but the opposite was observed for the 45° and 90° flexion angle tests (p < 0.05). Passive elongation of tendon/aponeurosis has an important effect on the tendon/aponeurosis behavior of the hamstrings and may contribute to a different loading of muscle fibers and tendinous tissue between BFlh and ST.     

Effects of scapular upward rotation exercises on alignment of scapula and clavicle and strength of scapular upward rotators in subjects with scapular downward rotation syndrome

The purpose of this study was to investigate the effects of a 6-week scapular upward rotation exercise (SURE) on scapular and clavicular alignment and scapular upward rotators strength in subjects with scapular downward rotation syndrome (SDRS). Seventeen volunteer subjects with SDRS were recruited from university populations. The alignment of the scapula and clavicle was measured using radiographic analysis and compared in subjects before and after a 6-week self-SURE program. A hand-held dynamometer was used to measure the strength of the scapular upward rotators. The subjects were instructed how to perform the self-SURE program at home. The 6-week self-SURE program was divided into two sections (the first section with non-resistive SURE during weeks 1–3, and the second section with resistive SURE using thera-band during weeks 4–6). The significance of the difference between pre- and post-program was assessed using a paired t-test, with the level of statistical significance set at p < 0.05. Significant differences between pre- and post-program were found for scapular and clavicular alignment (p < 0.05). Additionally, the comparison between pre- and post-program measurements of the strength of the scapular upward rotators showed significant differences (p < 0.05). The results of this study showed that a 6-week self-SURE program is effective for improving scapular and clavicular alignment and increasing the strength of scapular upward rotator muscles in subjects with SDRS.