Scapular Dyskinesis
Conditions
Keywords
scapular dyskinesis, shoulder rehabilitation, integrated neuromuscular inhibition technique
Brief summary
The goal of this clinical trial is to learn whether the Integrated Neuromuscular Inhibition Technique (INIT) can influence shoulder motion, muscle strength, and scapular positioning in young adults with Scapular Dyskinesis Type II. This study will also compare INIT with a conventional exercise program. The main questions the study aims to answer are: * Does INIT affect shoulder range of motion compared with conventional exercise? * Does INIT affect shoulder-girdle muscle strength? * Does INIT influence scapular deviation as measured by a palpation meter? Participants will receive either INIT or conventional exercises three times per week for six weeks. Assessments will occur at baseline, week 4, and week 6 using a goniometer, dynamometer, and palpation meter. A physiotherapist that is the Principal Investigator and supervisor will monitor participants throughout the study.
Detailed description
A total of 82 participants will be recruited using a multifaceted approach through pamphlets, emails, and WhatsApp groups. After enrollment, candidates will be screened by the principal investigator and re-evaluated by a clinical co-supervisor. Informed voluntary consent will be obtained before participation. Participants will be randomly allocated via the envelope method into: * Treatment group: Integrated Neuromuscular Inhibition Technique (INIT) * Control group: Conventional therapy Assessments will occur at baseline, week 4, and week 6 using a palpation meter (PALM), goniometer, and hand-held dynamometer. Each session will last 45 minutes and will be conducted three times per week for six weeks. The Scapular Assistance Test will be used initially to identify scapular dyskinesis, followed by PALM measurements-where positive values indicate upward and negative values indicate downward movement. The dynamometer will record peak force (Newtons) in a gravity-eliminated position. An orthopedic surgeon will monitor participant safety and manage any adverse events. Integrated Neuromuscular Inhibition Technique (INIT): INIT combines ischemic compression, strain-counter strain, and muscle energy technique (MET). * Ischemic Compression: Latent trigger points in the upper trapezius, levator scapulae, rhomboids, and serratus anterior are palpated and compressed for 90 seconds, repeated 3-5 times based on participant tolerance. * Strain-Counter Strain: The muscle is placed in a position of ease. For the upper trapezius and levator scapulae, the head is side-bent 10°-20° toward the affected side with the ipsilateral arm in abduction or flexion, held for 20-30 seconds. * Muscle Energy Technique: Using post-isometric relaxation, participants perform gentle isometric contractions of the same muscles, followed by stretching. Conventional Therapy (Control Group): Participants perform stretching and strengthening for the same muscles. * Stretching: Upper trapezius and levator scapulae-2-4 repetitions, holding 15-30 seconds each. * Strengthening: Rhomboids and serratus anterior-10 repetitions × 3 sets, progressing to 15 repetitions × 3 sets using a yellow TheraBand (70-80% elasticity, approximately 1.5 kg/unit). This six-week protocol will provide a standardized framework for comparing the two interventions using planned assessments
Interventions
OTHERIntigrated Neuromuscular Inhibition Technique
The integrated Neuromuscular Inhibition Technique (INIT) combines ischemic compression, strain-counter strain, and muscle energy techniques. The practitioners first identified the latent trigger points to be treated using the palpation method and treated with ischemic pressure. This technique will be done for 90 seconds and repeated 3 to 5 times. After the ischemic compression therapist, the position of ease will be attained by maintaining the part of the desired muscle in the shortened position. It will be maintained for 20-30 sec. MET is a soft tissue manipulation technique in which an individual actively performs muscle contraction in a controlled manner. In this study, isometric contraction using post-isometric relaxation technique with stretching is used
OTHERConventional Exercise
Group B receives conventional exercise that includes stretches and strengthening exercises of muscles involved in SD. For stretching: Should repeat 2-4 times increasing gradually with a 15-30 second hold. For strengthening: Active exercise for ten reps in 3 sets gradually increases for 15 reps in 3 stages. The intensity of exercise will be determined by the RM method using a yellow Thera band with an elastic range of 70%-80% that is i.50 kilograms per unit
Sponsors
Ziauddin University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
A simple random technique will be used with the envelope method for randomization. Two sets of envelopes entitled groups A and B will be presented to the participant before recruitment in the study so that 2 sets of envelopes are mutually exclusive and cannot be replaced in the set again.
Intervention model description
Group A: INIT group The practitioners first identified the latent trigger points to be treated within the using the palpation method and treated with ischemic pressure that the participant can tolerate. Pressure will be maintained at a participant-tolerated level, following standard ischemic compression procedures.. It will be continued until referred or local pain diminishes. This technique will be done for 90 secs and repeated 3 to 5 times After the ischemic compression therapist, the position of ease will be attained by maintaining the part of the desired muscle in the shortened position. MET is a soft tissue manipulation technique in which an individual actively performs muscle contraction in a controlled manner Group B receives conventional exercise that includes stretches and strengthening exercises of muscles involved in SD: For stretching: Should repeat 2-4 times increasing gradually with a 15-30 second hold. For strengthening: Active exercise for ten reps in 3 sets.
Eligibility
Sex/Gender
ALL
Age
20 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* ● Both male and female participants aged between 20-40 years will be diagnosed by an orthopedic consultant and screened by a physiotherapist through Scapular Assistant Test and a PALM meter. * Individuals presenting with scapular malposition and inferior medial border prominence, scapular dyskinesia type II with nonspecific symptoms.
Exclusion criteria
* Any diagnosed neurological deficit, i.e., hemiplegic limb, winged scapula due to lesions of the long thoracic or spinal accessory nerve. * Diagnosed Cervical related pathologies such as stenosis, myelopathy, and prolapsed intervertebral disk. * Diagnosed Shoulder-related pathology such as AC joint instability, rotator cuff pathology, history of shoulder surgery, and recent upper limb fracture. * Individual with neurovascular deficit and rib fracture. * Diagnosed chest deformity and scoliosis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Range of motion | Baseline | The shoulder range of motion (flexion, abduction and external and internal rotation) will be using a goniometer with a reliability ICC=0.94. |
| Muscular strength | Baseline | The strength of spino scapular muscles will be measured by using hand-held dynamometer That measures peak isometric force generated by muscle groups with an inter-rater reliability ICC=0.98 |
| Scapular deviation | Baseline | PALM meter (performance Attainment Associate, St. Paul, MN, USA) will be used to measure Upward scapular deviation. It has calipers and an analogue inclinometer that can be used to calculate the horizontal distance between the scapula position and spine in scaption and coronal plane with an inter-rater reliability ICC=0.90-0.99 |
Countries
Pakistan
Outcome results
None listed