damage often occurs to the 
 supraspinatus muscle , which is one of the components of the shoulder , with repetitive use 
 and small impacts1 .
this is mainly because 
 the strength of the small muscles of the shoulder joint that endure the stress from 
 repetitive use is small3 .
the supraspinatus muscle is the muscle that forms the rotator cuff of the shoulder joints , 
 and it is located on the top of the scapula . it plays a role in raising the arms above the 
 head .
functional disability does 
 not occur in accordance with the level of pain , but sometimes disability does occur in daily 
 life when the level of pain is severe2 , 4 . furthermore ,
according to previous research , the main reason for damage of the supraspinatus muscle is 
 unstable adjustment of the humeral head by the spheroidal joint or ball and socket 
 joint6 .
also , when exercise is performed 
 that utilizes the shoulder joint , the supraspinatus , which is the small rotator muscle , has 
 to endure it . according to previous research , 190 out of 191 rotator cuff tear patients had 
 rupture of the supraspinatus muscle7 .
patients with a damaged supraspinatus muscle must go through a period of inflammation and 
 convalescence that has no relationship with the decision regarding surgical treatment . a 
 previous study on the treatment process for patients after a rupture in the rotator
cuff 
 reported that inflammatory response of a subacromial mucous cyst induces a patient s 
 symptoms8 . in this kind of damage in the 
 rotator cuff
, there is a high interest in reducing pain through improvement of blood flow 
 within the muscle .
also , with the purpose of rehabilitation , even after surgery , exercise 
 utilizing the proprioceptive neuromuscular facilitation ( pnf ) method is executed within the 
 range of no pain to normalize the supraspinatus muscle and at the same time maintain 
 suitable stability for performance of functional activities .
in other words , the pnf 
 treatment method is an important treatment to enhance the flexibility , stability , strength , 
 and neuromuscular control of the supraspinatus muscle9 .
however , damage to the supraspinatus muscle of the shoulder joint 
 has a high possibility of recurrence .
there is little information regarding pnf treatment methods in 
 this area , and the treatment results are controversial .
thus , the present study examined the muscle recovery level in detail by determining the 
 speed of blood flow within the muscle and change in pain subjectively after treatment with 
 simple exercise and pnf treatment methods in for supraspinatus muscle tear patients .
it was approved by 
 kyungsung university s human research ethics committee . written informed consent was 
 obtained from all subjects after a full explanation of the experimental purpose and the 
 protocol of the study .
the subjects of this study were patients who had visited a hospital due to shoulder joint 
 pain and had been diagnosed with a muscle tear on mri .
they included patients who had a 
 normal range of movement in the shoulder joint , had a post - trauma medical history , or had 
 had shoulder joint surgery and those who had been diagnosed with two or more instances of 
 complete rupture of the supraspinatus muscle , adhesive capsulitis , or shoulder instability . 

the patients performed 
 rehabilitation exercise for 12 weeks , and their physical characteristics are shown in table 1table 1.general characteristics of the subjectssubjectpnf ( n=10)se ( n=10)age ( years)47.3  3.350.2  4.4weight ( kg)63.6  2.559.7  4.1height ( cm)161.3  2.6163.41 1.4mean  sd .
the aim of this research was to examine in detail the types of influence on 
 the subjective pain level and speed of blood flow in the supraspinatus muscle resulting from 
 pnf rehabilitation exercise and simple exercise treatments performed for 12 weeks .
thus , the 
 subjects were subjected to testing and then engaged in the rehabilitation treatment for 12 
 weeks .
after the completion of the treatment term , the same tests as before the 12 weeks of 
 treatment were performed using the same methods .
two rehabilitation methods , the pnf 
 treatment method and simple exercise method , were used .
the subjects warmed up 10 minutes in 
 the same way for both methods , and the exercises were mostly stretching and were performed 
 in the range of no pain and within the range of movement of the shoulder joint .
the pnf 
 method was used to increase the range of movement of the shoulder joint with pain in the 
 supraspinatus muscle using relaxation techniques such as contract - relax in 
 extension - adduct - internal rotation and flexion - abduction - external rotation .
the treatment 
 was performed within the range in which pain did not occur for 10 minutes , and the 
 combination of isotonics facilitation method was used within the range of movement to 
 increase muscular strength .
the simple exercise was performed to improve the muscle strength 
 and instability of the aching part through hold - relax and repetitive stretching within the 
 range of movement of the joints in which pain did not occur .
after this exercise was 
 finished , all patients performed finishing exercises - static and dynamic stretching - for about 
 10 minutes . to determine the recovery level of the supraspinatus muscle , an ultrasonic 
 doppler blood flow meter ( es-1000sp ii , hadeco , kawasaki , japan ) was used to measure the 
 speed of blood flow in the supraspinatus muscle .
the area of the supraspinatus muscle 
 rupture was measured a total of 12 times ( every tuesdays ) .
the visual analogue scale ( vas ) 
 was used to determine the level of pain .
the first measurement was obtained before 
 participation in the rehabilitation treatment , and a total of 12 measurements were obtained 
 ( once a week ) . to measure the functional aspects of daily life actions after rupture of the 
 supraspinatus muscle
, the disabilities of the arm , shoulder , and hand ( dash ) questionnaire 
 was used .
the dash questionnaire has 21 items related to everyday actions ( opening a sealed 
 container , writing letters , opening a door with a key , preparing a meal , opening a door , 
 placing an item on a shelf higher than the head , drawing up chores , taking care of a garden 
 or gardening , laying out bedding , carrying a shopping bag or briefcase , carrying a heavy 
 item ( over 5  kg ) , changing a light bulb , washing or drying your hair , washing your back 
 while showering , putting on a sweater , using a knife when cooking , other activities like 
 card games or knitting , activities consuming a lot of energy such as hammering , activities 
 using the arms such as badminton or throwing a frisbee , moving an item to another spot , and 
 sexual life ) , items related to six symptoms ( pain , pain during a certain activity , tingling , 
 indigestion , stiffness , and sleeping disorder ) , and items related to 3 social functions 
 ( difficulty in social life with neighbors , limitations when working or during other 
 activities , and decline in confidence ) .
pasw statistics 18.0 was used to calculate the average and standard deviation 
 for all data in this study .
the difference in dash score , change in subjective pain , and 
 change in speed of blood flow in the supraspinatus muscle of pnf exercise and simple 
 exercise groups were analyzed in peated measures anova .
as a result of observing 20 patients who had a rupture in the supraspinatus muscle for 
 changes in speed of blood flow in the muslce , subjective pain , and dash csore after 12 weeks 
 of pnf treatment and simple exercise , a significant difference was not found between the two 
 groups , which had identical target .
change in the speed of blood flow in the supraspinatus 
 muscle between before and after pnf treatment and simple exercise .
the speed of blood flow 
 in the supraspinatus muscle changed between before and after the pnf treatment and simple 
 exercise for 12 weeks .
the speed of blood flow in the pnf treatment group was initially 7.8 
 m / sec ( sd=2.47 ) .
four weeks later , it was 8.75 m / sec ( sd=3.75 ) ; 8 weeks later , it was 13.22 
 m / sec ( sd=7.34 ) ; and 12 weeks later , it was 13.41 m / sec ( sd=6.32 ) . in the simple exercise 
 group , it was 8.14 m / sec ( sd=2.64 ) before treatment .
four weeks later , it was 9.35 m / sec 
 ( sd=3.87 ) ; 8 weeks later , it was 9.33 m / sec ( sd=4.21 ) ; and 12 weeks later , it was 8.2 m / sec 
 ( sd=5.11 ) .
change in subjective pain ( vas ) between before and after pnf treatment and simple exercise . 

when looking at the change in subjective pain ( vas ) between before and after pnf treatment 
 and simple exercise , pnf the pnf treatment group showed a vas score of 4.33.1 before 
 treatment and a vas score of 3.62.5 after 12 weeks .
the simple exercise group showed a vas 
 score of 4.72.6 before treatment and a vas score of 3.73.7 after 12 weeks . as a result , 

change 
 in dash score between before and after pnf treatment and simple exercise . when looking at 
 the results of the dash questionnaires administered before and after pnf treatment and 
 simple exercise , the pnf treatment group showed a dash score of 23.110.2 before treatment 
 and a dash score of 13.16.7 after 12 weeks , indicating a significant decrease ( p<0.05 ) . 

the simple exercise group showed a dash score of 21.311.2 before treatment and a dash score 
 of 18.17.5 after 12 weeks , indicating a significant difference ( p<0.05 ) .
in this research , 20 shoulder joint rupture patients were subjected to pnf treatment or 
 simple exercise therapy for 12 weeks to observe their influences on the speed of blood flow 
 in the supraspinatus muscle , change in subjective pain , and functional aspects of the 
 shoulder joint ; thus , the factors above were analyzed , and they are discussed below .
the muscles in the human shoulder joint are divided into the deltoid , subscapularis muscle , 
 supraspinatus muscle , teres minor muscle , and teres major muscle .
these muscles play a role 
 in moving the shoulder joint in flexion , extension , abduction , adduction , internal rotation , 
 and external rotation .
it appears that rupture of the supraspinatus muscle occurs mostly 
 from rupture of the rotator cuff of the muscles2 .
this lesion in particular results in the most limitation and highest pain level 
 compared with other parts of the rotator cuff10 .
this is because rupture easily occurs in the joint capsule , and 
 the ligament is also damaged due to repetitive movement in the area of the supraspinatus 
 muscle .
the diagnosis for the supraspinatus muscle was confirmed by a radiology specialist through 
 echography in this study . in 1984 ,
crass first used echography to diagnose rotator cuff 
 rupture , and it was found that echography had a level of accuracy similar to mri11 . according previous research , 8090% of 
 cases of supraspinatus muscle rupture can be determined through echography12 . in this
context , analysis of our supraspinatus muscle patients revealed that , the pnf 
 treatment group showed an average increase of 71% in the speed of blood flow between before 
 and after treatment . as a result , through the exercise on advance study shoulder joint pain 
 patients , it showed that the increase in bloodstream speed of muscle , research related to 
 pain relief , and the increase in blood flow of muscle were correspondent with partial . 

the results of the present research 
 indicate that the pnf treatment method is more effective for muscle function recovery in 
 patients . on the other hand , regarding the change in subjective pain , there was an average 
 decrease of 16% between before and after the pnf treatment , whereas the average decrease was 
 21% between before and after simple exercise .
this relaxes the contract of peripheral 
 vascular and hypertonic of sympathetic nervous system due to hypertonic muscle due to 
 advanced research pain .
moreover , blood circulation is accelerated for excrete colorific 
 substances , which cuts the circulation of vicious circle14 , 15 it showed different 
 results with the research .
blood flow increased by 71% as a result of pnf treatment , and the level of subjective pain 
 decreased by 16% .
blood flow increased by 0.7% as a result of simple exercise , and the level 
 of subjective pain decreased by 21% .
a significant change was not found statistically of 
 subjective pain decrease , increase of blood flow , and the results of advanced research . in the dash items concerning the functional aspects of patients with a damaged 
 supraspinatus muscle , the total average score decreased by an average of 43% as a result of 
 pnf treatment , but they did not show decrease rate in the requirements of using the hand 
 such as writing , opening a door , and preparing a meal , which they felt uncomfortableness . 

the total average score decreased by an average of 15% as a result of simple exercise .
there 
 was no decrease in scores for putting an item on a shelf higher than the head , washing or 
 drying your hair , and putting on a sweater .
thus , supraspinatus muscle rupture patients 
 would not be satisfied with a treatment that results in a decrease in the total average dash 
 score .
the total average score decreased , but both treatment methods had certain limitations 
 that have clinical implications .
the methods used for treatment in this research show difference with the research of 
 advanced researchers .
decrease in pain was identified in the increase of blood flow , but 
 this has a possibility of an error during the diagnosis through echography of the damage 
 level of the supraspinatus muscle16 .
the 
 supraspinatus muscle rupture patients did not experience pain , but there was an advanced 
 research that patients had limitations in everyday activity like dash17 .
these were limitation of this research , and future 
 research should use mri and echography for diagnosis both and only utilize patients who 
 experiencing their first case of supraspinatus muscle damage to reduce the level of 
 errors .
 [ purpose ] the aim of this study was to examine the effects of proprioceptive 
 neuromuscular facilitation techniques and simple exercise on subjective pain reduction and 
 blood flow velocity in supraspinatus tear patients and to evaluate muscle recovery . 
 [ subjects and methods ] the 20 subjects of this study were diagnosed with supraspinatus 
 tears by mri . 
 the subjects have performed pnf techniques and simple exercise for 12 weeks . 
 
 [ results ] after 12 weeks of proprioceptive neuromuscular facilitation techniques and 
 simple exercise , the blood flow velocity , visual analogue scale , and disabilities of the 
 arm , shoulder , and hand score showed statistically significant difference . also , the 
 difference between the proprioceptive neuromuscular facilitation techniques and simple 
 exercise was statistically significant . 
 [ conclusion ] in conclusion , 12 weeks of 
 proprioceptive neuromuscular facilitation treatment and simple exercise therapy had no 
 effect on pain reduction in patients with supraspinatus tear , but in terms of 
 functionality , the proprioceptive neuromuscular facilitation treatment was effective . 