Subacromial Impingement Syndrome
Conditions
Keywords
Shoulder pain, Physical therapy, Rehabilitation, Ultrasonography
Brief summary
The purpose of this study is to investigate and compare the effect of isolytic and static stretching training in individuals having subacromial impingement syndrome with glenohumeral internal rotation deficit. Isolytic group will receive isolytic stretching in modified cross body stretching position and standard physiotherapy program. Static group will receive static stretching in modified cross body stretching position and standard physiotherapy program. Control group will receive only standard physiotherapy program.
Detailed description
The effectiveness of static stretching on various parameters such as range of motion or pain is studied and proved in literature. Static stretching in cross body position was also found helpful for improving shoulder range of motion with some disadvantages. In modified cross body position, the patient is positioned in a more advantageous way for him/her. Usually this stretching is done as active-assistive static stretching with the physiotherapist. Proof is still needed for the effectiveness of active-assistive static stretching in modified cross body position. Furthermore, there is no research about the effect of isolytic stretching which is relatively new technique compare to static stretches in subacromial impingement syndrome. In isolytic stretching, when the patient contracts the agonist muscle group with 20% muscle force active-assistive streching in agonist muscle group by the physiotherapist at the same time is done for 2-4 seconds. A fast isolytic stretching is applied in order to break the fibrous tissue. Our purpose is to investigate and compare the effect of isolytic and static stretching training in individuals having subacromial impingement syndrome with glenohumeral internal rotation deficit . Stretching groups will receive either isolytic or static stretching in modified cross body stretching position and standard physiotherapy program. There is a control group. Control group will receive only standard physiotherapy program. Standard physiotherapy program includes TENS, hotpack, posture and strengthening training program. Treatment program will last four times a week (4-4-4-3) for four weeks, 15 sessions in total.
Interventions
In modified cross body position, isolytic stretching exercises will perform five times each for 15 seconds. After each stretching patient will rest for 5 seconds. When the patient contracts the agonist muscle group with 20% muscle force, the agonist muscle group is stretched at the same time for 2-4 seconds. Isolytic stretching exercises will perform four times a week for four weeks. It's obligatory to receive at least 15 sessions in total. They will also receive standard physiotherapy program four times a week for four week, 15 sessions in total.
In modified cross body position, active-assistive static stretching exercises will be performed 5 times each for 15 seconds. This stretching exercise is performed 5 times with 5 seconds intervals. Static stretching exercises will perform four times a week for four weeks. It's obligatory to receive at least 15 sessions in total. They will also receive standard physiotherapy program four times a week for four week, 15 sessions in total.
OTHERControl group
They will receive only standard physiotherapy program, four times a week for four weeks, 15 sessions in total.
Sponsors
Dokuz Eylul University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
All of participants must have subacromial impingement syndrome with glenohumeral internal rotation deficit.
Intervention model description
There are 3 groups. First group will receive isolytic stretching in modified cross body stretching position and standard physiotherapy program. Second group will receive static stretching in modified cross body stretching position and standard physiotherapy program. Control group will receive only standard physiotherapy program. In standard physiotherapy program, there are TENS, hotpack, posture and strengthening training program. Treatment program will last four weeks.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Diagnosis of subacromial impingement syndrome * Glenohumeral internal rotation range of motion of the affected shoulder should be less than other shoulder and bilateral shoulder internal rotation range of motion difference should be ≥15 º * Pain with resisted arm elevation or external rotation as well as a minimum of 3 of 5 positive subacromial impingement syndrome tests, painful arc, pain or weakness with resisted external rotation, Neer, Hawkins and Jobe tests. * Ability to complete the entire study procedure
Exclusion criteria
* A 50% limitation of passive shoulder range of motion in \>2 planes of motion * Pain \>7/10 * A history of fracture to the shoulder girdle * Systemic musculoskeletal disease * History of shoulder and cervical surgery * Glenohumeral instability (positive apprehension, relocation, or positive sulcus test) or positive findings for a full-thickness rotator cuff tear (positive lag sign, positive drop arm test, or marked weakness with shoulder external rotation) * Neck and shoulder pain with active/passive cervical spine movement * A diagnosis of chest deformity or scoliosis * Regularly performing posterior shoulder stretching exercises
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Shoulder internal rotation range of motion | Baseline and 4 weeks | Change of shoulder internal rotation range of motion (with bubble inclinometer) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Posterior shoulder tightness | Baseline and 4 weeks | Change of posterior shoulder tightness (with bubble inclinometer) |
| Shoulder external rotation range of motion | Baseline and 4 weeks | Change of shoulder external rotation range of motion (with bubble inclinometer) |
| Shoulder total rotational range of motion | Baseline and 4 weeks | Change of shoulder total rotational range of motion (Sum of the internal and external rotation motion) |
| Resting and activitiy pain in shoulder | Baseline and 4 weeks | Change of visual analog scale score in activity and rest pain |
| Subacromial space | Baseline and 4 weeks | Change of subacromial space at arm resting at the side (0°), and at 60° of scapular plane elevation (with Ultrasound) |
| Glenohumeral internal rotation deficit | Baseline and 4 weeks | Change of difference in shoulder internal rotation range of motion between the affected and non-affected shoulder (with bubble inclinometer) |
| Concentric strength | Baseline and 4 weeks | Change of rotattor cuff muscles concentric strength (in kg, with hand held dynamometer) |
| Eccentric strength | Baseline and 4 weeks | Change of shoulder abduction eccentric strength (in kg, with hand held dynamometer) |
| Shoulder Function | Baseline and 4 weeks | Change of Modified Constant-Murley Score |
| Upper extremity function | Baseline and 4 weeks | Change of disabilities of the arm, shoulder, and hand (Quick-DASH) score |
| Supraspinatus tendon thickness | Baseline and 4 weeks | Change of supraspinatus tendon thickness (with Ultrasound) |
Countries
Turkey (Türkiye)
Outcome results
None listed