Latissimus Dorsi Strengthening Exercises in Rotator Cuff Tendinopathy

NCT ID: NCT07053566

Last Updated: 2025-09-15

Basic Information

• Recruitment Status: ENROLLING_BY_INVITATION
• Clinical Phase: NA
• Total Enrollment: 47 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-05-23
• Study Completion Date: 2027-09-22

Brief Summary

The aim of this study is to investigate the effects of strengthening exercises targeting the latissimus dorsi muscle on acromiohumeral distance, shoulder function, and pain levels in individuals with rotator cuff tendinopathy. By increasing the activation of the latissimus dorsi, one of the shoulder adductor muscles, the exercises are expected to facilitate inferior gliding of the humeral head and improve subacromial distance.

Individuals aged between 18 and 50 years with a diagnosis of rotator cuff tendinopathy will be included in the study. A total of 47 participants will be enrolled and randomly assigned to one of three groups:

A group performing exercises targeting only the rotator cuff muscles, A group performing exercises targeting the latissimus dorsi muscle, A group performing a combination of both rotator cuff and latissimus dorsi exercises.

The exercise interventions will be applied over a 12-week period. Before and after the intervention, the following outcomes will be assessed:

Acromiohumeral distance (via ultrasound), Range of motion, Shoulder function and pain using the SPADI and WORC questionnaires, and Avoidance behavior using the Adap-Tr questionnaire.

Detailed Description

Subacromial pain syndrome, also referred to as rotator cuff-related shoulder pain (RCS), is characterized by pain localized to the proximal lateral aspect of the upper arm arising from the rotator cuff and other subacromial structures. Although the etiology of RCS is multifactorial, dynamic narrowing of the subacromial space due to impingement of soft tissues within this region has been proposed as a leading cause of chronic rotator cuff pathology. A lack of coordination between the rotator cuff and scapulothoracic muscles may impair shoulder neuromuscular control, leading to varying degrees of microtrauma and degenerative pathophysiological changes in the rotator cuff muscles and surrounding tissues. This dysfunction can result in further narrowing of the subacromial space. Specifically, inadequate superior rotation and posterior tilt of the scapula, combined with the inability of the rotator cuff muscles to resist the superior translation of the humeral head caused by deltoid contraction, may cause impingement of the subacromial soft tissues during overhead dynamic activities. In healthy shoulders, the acromiohumeral distance (AHD) is reported to range between 8 and 15 mm, whereas narrowing of the subacromial space (AHD < 7 mm) is considered a significant indicator of large rotator cuff tears. Moreover, in patients with rotator cuff tears, proximal migration of the humeral head is associated with tear size and decreased acromiohumeral distance.

In a young and healthy shoulder, the cranially directed forces generated during abduction are balanced by the coordinated contraction of the rotator cuff muscles. This mechanism prevents superior migration of the humerus toward the acromion and subsequent impingement of the subacromial tissues. When the contribution of the rotator cuff muscles to the abduction movement decreases, the deltoid muscle compensates for this deficit. However, this compensatory mechanism results in a force vector that is more cranially oriented rather than mediocranial. The reduction in the stabilizing force of the rotator cuff muscles may impair the ability to counteract the superior forces generated by the deltoid. Both of these changes can lead to superior migration of the humerus and pain in the subacromial tissues.

Insufficient depression of the humeral head during the abduction movement has been associated with pain patterns. During arm abduction, the rotator cuff muscles continue to be the focus of both research and clinical practice. However, several studies have demonstrated that the arm adductors-particularly the latissimus dorsi, teres major, and to a lesser extent the pectoralis major-contribute significantly to humeral head depression during abduction. Activation of these adductor muscles may reduce the mechanical load on subacromial structures during abduction. Elevation movements performed at various angles combined with adductor muscle activity may lead to a physiological increase in the subacromial space. This finding suggests the possibility of conservative treatment in patients with rotator cuff tears (RCT) by strengthening the adductor muscles.

OInvestigation of arm adductor contraction patterns during abduction has shown decreased adductor activation in individuals with rotator cuff tendinopathy. Reduced adductor activation may result in insufficient caudal forces on the humerus, leading to overload of subacromial tissues and persistence of symptoms.Therefore, adductor muscle training programs may be clinically effective in patients with rotator cuff tears. The application of neuromuscular electrical stimulation to increase activation of the teres major and pectoralis major muscles has been associated with a short-term increase in acromiohumeral distance in elderly individuals with rotator cuff tears.

The aim of this study is to increase the activation of the latissimus dorsi muscle, one of the adductor muscles, through targeted exercises, thereby increasing the acromiohumeral distance and facilitating inferior gliding of the humeral head.

Conditions

Rotator Cuff Related Shoulder Pain; Rotator Cuff Tendinopathy; Subacromial Impingement Syndrome

Study Design

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

Study Groups

Rotator Cuff Exercise Group (RCEG)

Progressive strengthening program for rotator cuff muscles.

Group Type: EXPERIMENTAL

Rotator Cuff Strengthening Exercises

Intervention Type: BEHAVIORAL

Progressive exercise program focused on rotator cuff muscles

Latissimus Dorsi Exercise Group (LDEG)

Progressive strengthening program for latissimus dorsi muscle.

Group Type: EXPERIMENTAL

Latissimus Dorsi Strengthening Exercises

Intervention Type: BEHAVIORAL

Progressive exercise program targeting the latissimus dorsi muscle

Combined Exercise Group (CEG)

Combined strengthening program for rotator cuff and latissimus dorsi muscles

Group Type: EXPERIMENTAL

Rotator Cuff Strengthening Exercises

Intervention Type: BEHAVIORAL

Progressive exercise program focused on rotator cuff muscles

Latissimus Dorsi Strengthening Exercises

Intervention Type: BEHAVIORAL

Progressive exercise program targeting the latissimus dorsi muscle

Interventions

Rotator Cuff Strengthening Exercises

Progressive exercise program focused on rotator cuff muscles

Intervention Type: BEHAVIORAL

Latissimus Dorsi Strengthening Exercises

Progressive exercise program targeting the latissimus dorsi muscle

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• Age between 18 and 50 years
• At least 3 months of ongoing shoulder pain
• At least 3 positive tests out of 5 (Neer, Hawkins-Kennedy, Jobe, Painful Arc Sign, Pain on Resisted External Rotation)
• Ultrasound diagnosis of rotator cuff tendinopathy
• Shoulder pain during activity rated greater than 3 out of 10 on the Numeric Pain Scale
• Central Sensitization Inventory score below 40

Exclusion Criteria

• Bilateral shoulder pain
• History of surgery or dislocation in the symptomatic shoulder
• Acromioclavicular degeneration
• Presence of shoulder capsulitis (restriction in passive glenohumeral range of motion in 2 or more directions)
• Full-thickness rotator cuff tear
• Shoulder osteoarthritis, rheumatoid arthritis, systemic inflammatory or neurological disease
• Any injection to the symptomatic shoulder within the past 6 weeks
• BMI greater than 30 kg/m2
• Refusal to participate in the study

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 50 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Hacettepe University

OTHER

Sponsor Role: lead

Responsible Party

Irem Duzgun

Professor and Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Hacettepe University Faculty of Physical Therapy and Rehabilitation

Ankara, , Turkey (Türkiye)

Countries

Turkey (Türkiye)

Other Identifiers

LDRCT

Identifier Type: -

Identifier Source: org_study_id