Scapular PNF Versus Shoulder Strengthening Exercises in Patients With Lateral Epicondylitis.

NCT ID: NCT05947968

Last Updated: 2023-07-17

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 52 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-11-15
• Study Completion Date: 2023-10-31

Brief Summary

The purpose of this study is to compare between the effect of scapular proprioceptive neuromuscular facilitation versus shoulder and scapular strengthening exercise on pain, functional outcome and grip strength in patients with lateral epicondylitis.

Detailed Description

There is no standard treatment for lateral epicondylitis, it is always a combination of physical therapy modalities aimed to reduce pain and increase the ability to return functional activities participation. Accordingly, many researchers have added shoulder strengthening exercise to the rehabilitation plan for treating lateral epicondylitis.

Consequently, development of new concept of scapula motor control exercise using proprioceptive neuromuscular facilitation to add proximal stability to patients with lateral epicondylitis may be beneficial. We believe that this study can serve as a step toward documenting the evidence of scapular proprioceptive neuromuscular facilitation exercise in the treatment of patients with lateral epicondylitis which was not available before.

Patients with lateral epicondylitis will be recruited after approval of ethical committee of the faculty of physical therapy, Cairo University. All participants will sign a written informed consent form. After group assignment, patients' demographics will be collected, and then assessment of pain, function and grip strength will be performed. The same assessment procedure will be conducted by the end of the treatment (by the end of the 12th visit).

The study will be two comparative groups, pre-post experimental design, the subjects will be randomly assigned into one of two groups:

• Group (I) : will receive scapular proprioceptive neuromuscular facilitation exercises.
• Group (II) : will receive shoulder strengthening exercises.

Conditions

Lateral Epicondylitis

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Group A (Scapular PNF)

will receive scapular proprioceptive neuromuscular facilitation exercise plus conventional treatment of lateral epicondylitis for 12 sessions (3 sessions per week for four weeks).

The conventional treatment of lateral epicondylitis will be:

1. Pulsed ultrasound over the lateral epicondyle for 5 min.

2. Five minutes of deep friction massage. It will be consisted of deep circular motions using the fingertips over the area of maximal tenderness at the lateral epicondyle.

3. Stretching exercise for extensor carpi radialis longus and brevis for 3 repetitions, each repetition will be 45 seconds with 30 seconds' rest.

4. Strengthening exercise for wrist extensors, eccentric exercise for wrist extensors will be as follow: 3 sets, 10 repetitions, 1 min rest interval between each set.

Group Type: EXPERIMENTAL

Scapular PNF

Intervention Type: OTHER

Scapular proprioceptive neuromuscular facilitation exercise: will be applied in two diagonals:

1. anterior elevation and posterior depression

2. posterior elevation and anterior depression for 3 sets of 10 repetitions, The rest interval between sets will be 20 seconds.

Patients will lay on the unaffected side while the therapist stands in the line of desired motion. Firstly, the therapist will give preparatory instructions. In the beginning of the pattern, the therapist pulls the scapula to the elongated position and then gives instructions for the desired movement.

Group B (Shoulder exercises)

will receive shoulder strengthening exercise plus conventional treatment of lateral epicondylitis for 12 sessions (3 sessions per week for four weeks).

Same conventional treatment in group (A)

Group Type: EXPERIMENTAL

Shoulder strengthening exercises

Intervention Type: OTHER

Shoulder strengthening exercises:

The following four exercises will focus on shoulder and scapular strengthening. Before starting the program, the patients will be thoroughly instructed in the four exercises, and illustrations with specific exercise instructions will be provided. All subjects will perform the exercises with the affected side for three sets of 10 repetitions for each exercise, with a 1-minute rest between sets.

1. Standing shoulder external rotation with elastic resistance.

2. Bilateral external rotation with scapular retraction exercise.

3. Resisted scapular retraction with shoulder external rotation (Middle trapezius muscle).

4. Weighted scapular retraction and downward rotation Y-shape (lower trapezius muscle).

Interventions

Scapular PNF

Scapular proprioceptive neuromuscular facilitation exercise: will be applied in two diagonals:

1. anterior elevation and posterior depression

2. posterior elevation and anterior depression for 3 sets of 10 repetitions, The rest interval between sets will be 20 seconds.

Patients will lay on the unaffected side while the therapist stands in the line of desired motion. Firstly, the therapist will give preparatory instructions. In the beginning of the pattern, the therapist pulls the scapula to the elongated position and then gives instructions for the desired movement.

Intervention Type: OTHER

Shoulder strengthening exercises

Shoulder strengthening exercises:

The following four exercises will focus on shoulder and scapular strengthening. Before starting the program, the patients will be thoroughly instructed in the four exercises, and illustrations with specific exercise instructions will be provided. All subjects will perform the exercises with the affected side for three sets of 10 repetitions for each exercise, with a 1-minute rest between sets.

1. Standing shoulder external rotation with elastic resistance.

2. Bilateral external rotation with scapular retraction exercise.

3. Resisted scapular retraction with shoulder external rotation (Middle trapezius muscle).

4. Weighted scapular retraction and downward rotation Y-shape (lower trapezius muscle).

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Patients will be included if they have the following criteria:

• Fifty-two male and female subjects.
• Patients complaining of chronic lateral epicondylitis (more than three months).
• Age between 20-50.

Exclusion Criteria

• Patients will be excluded if they had any of the following conditions:

• Received physiotherapy in last 3 months.
• Received corticosteroids injection in lateral epicondyle in last 3 months.
• Receiving anti-inflammatories medications on regular basis.
• Had neurologic problems in shoulder, neck and thoracic regions.
• Had history of rheumatic disease.
• Had cooperation difficulties due to cognitive disorders. All Patients will be instructed to keep away from activities that aggravate the symptoms such as grasping, lifting, knitting and using a screwdriver during the treatment period.

• Minimum Eligible Age: 20 Years
• Maximum Eligible Age: 50 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Cairo University

OTHER

Sponsor Role: collaborator

Mahmoud Essam Abu Elfetouh Ghallab

OTHER

Sponsor Role: lead

Responsible Party

Mahmoud Essam Abu Elfetouh Ghallab

researcher

Responsibility Role: SPONSOR_INVESTIGATOR

Locations

Cairo University

Giza, , Egypt

Site Status: RECRUITING

Countries

Egypt

Central Contacts

Mahmoud Ghallab, Master

Role: CONTACT

mahmoudasam93@hotmail.com

00201001899452

Mohamed Ahmed, Lecturer

Role: CONTACT

00201223631604

Facility Contacts

Mahmoud Ghallab, Master

Role: primary

mahmoudasam93@hotmail.com

00201001899452

Mohamed Ahmed, Lecturer

Role: backup

00201223631604

Other Identifiers

Lateral epicondylitis

Identifier Type: -

Identifier Source: org_study_id