Upward pulling plus exercise improves scapulocostal pain and scapular position.

Only one participant was described, so the results cannot show what will happen in other patients. The paper reports one participant and no comparison condition, so the change cannot be separated from time or other treatment. The first phase combined stretching, massage, and push-up plus, so any change after that phase cannot be assigned to one component. The second phase followed the first phase, so the contribution of upward pulling with shoulder retraction alone cannot be separated from the earlier treatment. Measurements were reported only after each phase, so the paper does not show whether pain or scapular distance remained changed later. The paper reports the measured distances but does not state whether the change from 10.5 cm to 8.3 cm is clinically important.

Do not conclude that upward pulling plus shoulder retraction exercise is an effective treatment for scapulocostal pain. This was one case report, and the earlier phase included stretching, massage, and push-up plus, so the contribution of any single component cannot be separated.