PNF in Subacromial Impingement Syndrome

NCT ID: NCT04794933

Last Updated: 2021-06-30

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 45 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2013-12-31
• Study Completion Date: 2015-04-30

Brief Summary

Although proprioceptive neuromuscular facilitation (PNF) techniques have been used in the treatment of different shoulder problems, PNF techniques in scapular and upper trunk patterns with extremity pattern have not been considered as a possible option for the treatment of Subacromial Impingement Syndrome (SIS). The aim of this study was to evaluate the effects of different PNF patterns in SIS.

Detailed Description

This randomized controlled trial was conducted in the Outpatient Clinic of a Physiotherapy and Rehabilitation Department in Ankara, Turkey. The demographic and clinical characteristics of the patients were recorded. Voluntary patients with SIS were regarded as eligible for the study if they met the inclusion criteria. Pain, posture and functionality were assessed before and after intervention. Patients who met the inclusion criteria and agreed to participate were randomly allocated to Group 1 [Conventional therapy (CT)], Group 2 [CT+ PNF in extremity pattern] and Group 3 [CT+ PNF in extremity pattern+PNF in scapula and upper trunk patterns]. A simple randomization method was used with opaque sealed envelopes containing "A", "B" or "C". Group allocation was performed by an independent therapist, not involved in the study. All patients received physiotherapy for approximately 60 mins each session, 3 sessions per week for 6 weeks. Conventional therapy consisted of cold pack (15 minutes); pulsed ultrasound therapy (1 watt/cm², 3 MHz, 1:2 pulsed mode; 3 minutes); transcutaneous electrical nerve stimulation (60-120 Hz; 20 minutes) and exercises (20 minutes). The exercises included stretching, strengthening and posture exercises. The exercises, and the duration and intensity of conventional physiotherapy were selected according to previous studies which showed that a physiotherapy program 3 times a week for 6 weeks was effective in improving function and relieving pain in SIS. The physiotherapy program was applied to all patients at the same intensity by the same physiotherapist and patients did the exercises every day throughout the 6-week period. The patients were also advised to avoid overhead activities.

Conditions

Subacromial Impingement Syndrome

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Conventional therapy (CT)

Cold pack (15 minutes); pulsed ultrasound therapy (1 watt/cm², 3 MHz, 1:2 pulsed mode; 3 minutes); transcutaneous electrical nerve stimulation (60-120 Hz; 20 minutes) and exercises (20 minutes). The exercises included stretching, strengthening and posture exercises.

Group Type: ACTIVE_COMPARATOR

Conventional therapy

Intervention Type: OTHER

CT+ PNF in extremity pattern

PNF in the extremity pattern, were instructed to actively move through the PNF flexion-abduction-external rotation diagonal pattern for 10 repetitions with manual facilitation and the treatment was performed within the range in which pain did not occur. Rhythmic stabilization and repeated contractions were applied from the PNF techniques.

Group Type: EXPERIMENTAL

Conventional therapy

Intervention Type: OTHER

CT+ PNF in extremity pattern

Intervention Type: OTHER

CT+ PNF in extremity pattern+PNF in scapula and upper trunk patterns

PNF in scapula and upper trunk patterns in addition to PNF in the extremity pattern. The scapular pattern application was performed by positioning the affected extremity in a relaxed position above the stable side in the side-lying position. Rhythmic stabilization and repeated contractions were applied from the anterior-elevation position in the direction of posterior-depression. Extension, lateral flexion and rotation to the affected side were performed in the trunk patterns in rhythmic stabilization and repeated contractions.

Group Type: EXPERIMENTAL

Conventional therapy

Intervention Type: OTHER

CT+ PNF in extremity pattern

Intervention Type: OTHER

CT+ PNF in extremity pattern+PNF in scapula and upper trunk patterns

Intervention Type: OTHER

Interventions

Conventional therapy

Intervention Type: OTHER

CT+ PNF in extremity pattern

Intervention Type: OTHER

CT+ PNF in extremity pattern+PNF in scapula and upper trunk patterns

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• patients diagnosed with SIS,
• aged between 18 and 65 years,
• shoulder pain ongoing for more than four weeks,
• loss of active shoulder motion or painful ROM,
• no treatment related to the shoulder in the last 6 months.

Exclusion Criteria

• history of frozen shoulder,
• disorders of the acromioclavicular joint,
• possession of a curved or hooked acromion,
• shoulder instability,
• degenerative arthritis of the glenohumeral joint,
• calcifying tendonitis,
• post-traumatic disorders,
• shoulder surgery and/or elbow, hand, wrist and cervical spine disorders,
• diseases that can cause positional vertigo.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Ankara Yildirim Beyazıt University

OTHER

Sponsor Role: lead

Responsible Party

Ertuğrul Demirdel

Assistant Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Ertuğrul Demirdel, PhD

Role: PRINCIPAL_INVESTIGATOR

Ankara Yildirim Beyazıt University

Locations

Ankara Yıldırım Beyazıt University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation

Ankara, , Turkey (Türkiye)

Countries

Turkey (Türkiye)

References

Cools AM, Struyf F, De Mey K, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med. 2014 Apr;48(8):692-7. doi: 10.1136/bjsports-2013-092148. Epub 2013 May 18.

Reference Type: BACKGROUND

PMID: 23687006 (View on PubMed)

Escamilla RF, Yamashiro K, Paulos L, Andrews JR. Shoulder muscle activity and function in common shoulder rehabilitation exercises. Sports Med. 2009;39(8):663-85. doi: 10.2165/00007256-200939080-00004.

Reference Type: BACKGROUND

PMID: 19769415 (View on PubMed)

Green S, Buchbinder R, Hetrick S. Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev. 2003;2003(2):CD004258. doi: 10.1002/14651858.CD004258.

Reference Type: BACKGROUND

PMID: 12804509 (View on PubMed)

Gumina S, Di Giorgio G, Postacchini F, Postacchini R. Subacromial space in adult patients with thoracic hyperkyphosis and in healthy volunteers. Chir Organi Mov. 2008 Feb;91(2):93-6. doi: 10.1007/s12306-007-0016-1. Epub 2008 Mar 3.

Reference Type: BACKGROUND

PMID: 18320381 (View on PubMed)

Hanratty CE, McVeigh JG, Kerr DP, Basford JR, Finch MB, Pendleton A, Sim J. The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. Semin Arthritis Rheum. 2012 Dec;42(3):297-316. doi: 10.1016/j.semarthrit.2012.03.015. Epub 2012 May 18.

Reference Type: BACKGROUND

PMID: 22607807 (View on PubMed)

Hickey D, Solvig V, Cavalheri V, Harrold M, Mckenna L. Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis. Br J Sports Med. 2018 Jan;52(2):102-110. doi: 10.1136/bjsports-2017-097559. Epub 2017 Jul 22.

Reference Type: BACKGROUND

PMID: 28735288 (View on PubMed)

Holmgren T, Hallgren HB, Oberg B, Adolfsson L, Johansson K. Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. Br J Sports Med. 2014 Oct;48(19):1456-7. doi: 10.1136/bjsports-2014-e787rep.

Reference Type: BACKGROUND

PMID: 25213604 (View on PubMed)

Hunter DJ, Rivett DA, McKeirnan S, Smith L, Snodgrass SJ. Relationship Between Shoulder Impingement Syndrome and Thoracic Posture. Phys Ther. 2020 Apr 17;100(4):677-686. doi: 10.1093/ptj/pzz182.

Reference Type: BACKGROUND

PMID: 31825488 (View on PubMed)

Other Identifiers

2015

Identifier Type: -

Identifier Source: org_study_id