A Comparison of the Long Term Effects of the Traditional and Modified Posterior Shoulder Stretching Exercise in Subacromial Impingement Syndrome

NCT04660682 | Completed DMC

• 1 other identifier: 3032-GOA
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is to investigate and compare the long term effects of traditional and modified static cross-body posterior shoulder stretching training in individuals with subacromial impingement syndrome (SIS) having glenohumeral internal rotation deficit (GIRD). Modified cross body posterior shoulder stretching group will receive static stretching in the modified cross-body stretching position and standard physiotherapy program. The traditional cross body posterior shoulder stretching group will receive static stretching and standard physiotherapy program. The Control group will receive only sham stretching and standard physiotherapy program.

Conditions

Subacromial Impingement Syndrome

Keywords

Glenohumeral Internal Rotation Deficit, Modified Cross-body Stretching

Outcome Measures

Primary Outcomes (2)

• Shoulder internal rotation range of motion

  Change of shoulder internal rotation range of motion (with bubble inclinometer)

  Baseline, 8 weeks, 12 weeks, 24 weeks

• Glenohumeral internal rotation deficit

  Change of glenohumeral internal rotation deficit (with bubble inclinometer)

  Baseline, 8 weeks, 12 weeks, 24 weeks

Secondary Outcomes (11)

• Posterior shoulder tightness

  Baseline, 8 weeks, 12 weeks, 24 weeks

• Pain intensity

  Baseline, 8 weeks, 12 weeks, 24 weeks

• Joint position sense

  Baseline, 8 weeks, 12 weeks, 24 weeks

• Isometric strength

  Baseline, 8 weeks, 12 weeks, 24 weeks

• Subacromial space

  Baseline, 8 weeks, 12 weeks, 24 weeks

Study Arms (3)

Modified static cross-body posterior shoulder stretching group

EXPERIMENTAL

The participants will perform active-assistive static stretching in the modified cross-body stretching position. Additionally, they will receive standard physiotherapy program.

Other: Modified static cross-body posterior shoulder stretching

Traditional static cross-body posterior shoulder stretching group

EXPERIMENTAL

The participants will perform active-assistive static stretching in the traditional standing cross-body stretching position. Additionally, they will receive standard physiotherapy program.

Other: Traditional static cross-body posterior shoulder stretching

Control Group

ACTIVE COMPARATOR

The participants in this group will receive sham stretching and standard physiotherapy.

Other: Control Group

Interventions

Modified static cross-body posterior shoulder stretching OTHER

For the modified cross-body position patient will be positioned in the side-lying position to limit the scapular abduction, and the patient aligned his/her forearms to limit the ER of the humerus while moving into horizontal adduction (HAdd). First, we will ask the patient to pull his/her arm into HAdd to the physiological barrier of the ROM, and then the patient will perform active-assistive static stretching with the help of the other hand for 30 seconds. The stretching will perform five repetitions with 10-sec rest between stretches. Each stretching will begin from a new physiological barrier of the HAdd ROM. Patients will also receive the standard physiotherapy program consists of physical agents, posture, proprioceptive, and strengthening exercises. The treatment program will be performed 5 days a week under the physiotherapist's supervision and 2 days a week as a home program for 8 weeks.

Modified static cross-body posterior shoulder stretching group

Traditional static cross-body posterior shoulder stretching OTHER

For the traditional static cross-body posterior shoulder stretching, in the standing position, the patient will perform cross-body stretch alone by active-assistive pulling the humerus across the body into HAdd with the opposite arm, without concern for scapular stabilization for 30 sec. The stretching will perform five repetitions with 10-sec rest between stretches. Each stretching will begin from a new physiological barrier of the HAdd ROM. Patients will also receive the standard physiotherapy program consists of physical agents, posture, proprioceptive, and strengthening exercises. The treatment program will be performed 5 days a week under the physiotherapist's supervision and 2 days a week as a home program for 8 weeks.

Traditional static cross-body posterior shoulder stretching group

Control Group OTHER

In sham stretching, the patient will be positioned in the traditional static cross body posterior shoulder stretching position, and then the patient will perform active-assistive HAdd ROM without enough stretching of the relevant tissue. Active assistive ROM will be stopped before reaching the individual PST measurement result (in this way, sham stretching will be performed without proper stretching of the relevant tissue). The HAdd ROM exercise will be performed 5 times. Patients will also receive the standard physiotherapy program consists of physical agents, posture, proprioceptive, and strengthening exercises. The treatment program will be performed 5 days a week under the physiotherapist's supervision and 2 days a week as a home program for 8 weeks.

Control Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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

You may not qualify if:

• 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 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)

Sponsors & Collaborators

• Dokuz Eylul University: lead

Study Sites (1)

Dokuz Eylül University Physical Therapy and Rehabilitation Department

Izmir, Balçova, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Shoulder Impingement Syndrome

Interventions

Control Groups

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases; Shoulder Injuries; Wounds and Injuries

Intervention Hierarchy (Ancestors)

Epidemiologic Research Design; Epidemiologic Methods; Investigative Techniques; Research Design; Methods

Study Officials

• Sevgi Sevi YESILYAPRAK, PhD, PT

  Dokuz Eylul University Physical Therapy and Rehabilitation Department

  STUDY DIRECTOR

• Mehmet ERDURAN, MD

  Dokuz Eylul University

  STUDY DIRECTOR

• Onur BAŞÇI, MD

  Dokuz Eylul University

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: All of the participants must have subacromial impingement syndrome with glenohumeral internal rotation deficit (Bilateral IRROM difference ≥ 15º )
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: MSc

Model Details: There are 3 groups. The first group will receive the modified static cross-body posterior shoulder stretching and the standard physiotherapy program. The second group will receive traditional static cross-body posterior shoulder stretching and the standard physiotherapy program. The Control group will receive sham stretching and the standard physiotherapy program. In standard physiotherapy program, there are TENS, hot-pack, posture, proprioceptive, and strengthening training. The treatment program will last for eight weeks. Patients will receive the treatment program 5 days a week under the physiotherapist's supervision and 2 days a week as a home program.

Study Record Dates

• First Submitted: November 28, 2020
• First Posted: December 9, 2020
• Study Start: September 21, 2021
• Primary Completion: September 21, 2024
• Study Completion: September 21, 2024
• Last Updated: November 5, 2024

Record last verified: 2024-11

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)