The Effect of Isolytic and Static Stretching Training in Individuals With Subacromial Impingement Syndrome

The Effect of Isolytic and Static Stretching Training in Individuals Having Subacromial Impingement Syndrome With Glenohumeral Internal Rotation Deficit

The purpose of this study is to investigate and compare the effect of isolytic and static stretching training in individuals having subacromial impingement syndrome with glenohumeral internal rotation deficit. Isolytic group will receive isolytic stretching in modified cross body stretching position and standard physiotherapy program. Static group will receive static stretching in modified cross body stretching position and standard physiotherapy program. Control group will receive only standard physiotherapy program.

Study Overview

• Status: Completed
• Conditions: Subacromial Impingement Syndrome
• Intervention / Treatment: Other: Isolytic Stretching group; Other: Static Stretching group; Other: Control group

Detailed Description

The effectiveness of static stretching on various parameters such as range of motion or pain is studied and proved in literature. Static stretching in cross body position was also found helpful for improving shoulder range of motion with some disadvantages. In modified cross body position, the patient is positioned in a more advantageous way for him/her. Usually this stretching is done as active-assistive static stretching with the physiotherapist. Proof is still needed for the effectiveness of active-assistive static stretching in modified cross body position. Furthermore, there is no research about the effect of isolytic stretching which is relatively new technique compare to static stretches in subacromial impingement syndrome. In isolytic stretching, when the patient contracts the agonist muscle group with 20% muscle force active-assistive streching in agonist muscle group by the physiotherapist at the same time is done for 2-4 seconds. A fast isolytic stretching is applied in order to break the fibrous tissue. Our purpose is to investigate and compare the effect of isolytic and static stretching training in individuals having subacromial impingement syndrome with glenohumeral internal rotation deficit . Stretching groups will receive either isolytic or static stretching in modified cross body stretching position and standard physiotherapy program. There is a control group. Control group will receive only standard physiotherapy program. Standard physiotherapy program includes TENS, hotpack, posture and strengthening training program. Treatment program will last four times a week (4-4-4-3) for four weeks, 15 sessions in total.

• Study Type: Interventional
• Enrollment (Actual): 70
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Balçova
    • İzmir, Balçova, Turkey
      • Dokuz Eylul University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• 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

Exclusion Criteria:

• 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 and cervical 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)
• Neck and shoulder pain with active/passive cervical spine movement
• A diagnosis of chest deformity or scoliosis
• Regularly performing posterior shoulder stretching exercises

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Isolytic stretching group; The participants in this group will receive isolytic stretching in modified cross body position. Additionally they will receive standard physiotherapy.	Other: Isolytic Stretching group; In modified cross body position, isolytic stretching exercises will perform five times each for 15 seconds. After each stretching patient will rest for 5 seconds. When the patient contracts the agonist muscle group with 20% muscle force, the agonist muscle group is stretched at the same time for 2-4 seconds. Isolytic stretching exercises will perform four times a week for four weeks. It's obligatory to receive at least 15 sessions in total. They will also receive standard physiotherapy program four times a week for four week, 15 sessions in total.; Other Names: Standard physiotherapy
EXPERIMENTAL: Static stretching group; The participants in this group will receive static stretching in modified cross body position. Additionally they will receive standard physiotherapy.	Other: Static Stretching group; In modified cross body position, active-assistive static stretching exercises will be performed 5 times each for 15 seconds. This stretching exercise is performed 5 times with 5 seconds intervals. Static stretching exercises will perform four times a week for four weeks. It's obligatory to receive at least 15 sessions in total. They will also receive standard physiotherapy program four times a week for four week, 15 sessions in total.; Other Names: Standard physiotherapy
ACTIVE_COMPARATOR: Control group; The participants in this group will receive only standard physiotherapy.	Other: Control group; They will receive only standard physiotherapy program, four times a week for four weeks, 15 sessions in total.; Other Names: Standard physiotherapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Shoulder internal rotation range of motion	Change of shoulder internal rotation range of motion (with bubble inclinometer)	Baseline and 4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Glenohumeral internal rotation deficit	Change of difference in shoulder internal rotation range of motion between the affected and non-affected shoulder (with bubble inclinometer)	Baseline and 4 weeks
Posterior shoulder tightness	Change of posterior shoulder tightness (with bubble inclinometer)	Baseline and 4 weeks
Shoulder external rotation range of motion	Change of shoulder external rotation range of motion (with bubble inclinometer)	Baseline and 4 weeks
Shoulder total rotational range of motion	Change of shoulder total rotational range of motion (Sum of the internal and external rotation motion)	Baseline and 4 weeks
Resting and activitiy pain in shoulder	Change of visual analog scale score in activity and rest pain	Baseline and 4 weeks
Subacromial space	Change of subacromial space at arm resting at the side (0°), and at 60° of scapular plane elevation (with Ultrasound)	Baseline and 4 weeks
Supraspinatus tendon thickness	Change of supraspinatus tendon thickness (with Ultrasound)	Baseline and 4 weeks
Concentric strength	Change of rotattor cuff muscles concentric strength (in kg, with hand held dynamometer)	Baseline and 4 weeks
Eccentric strength	Change of shoulder abduction eccentric strength (in kg, with hand held dynamometer)	Baseline and 4 weeks
Shoulder Function	Change of Modified Constant-Murley Score	Baseline and 4 weeks
Upper extremity function	Change of disabilities of the arm, shoulder, and hand (Quick-DASH) score	Baseline and 4 weeks

Collaborators and Investigators

• Sponsor: Dokuz Eylul University

Study record dates

Study Major Dates

• Study Start (ACTUAL): August 28, 2017
• Primary Completion (ACTUAL): June 20, 2019
• Study Completion (ACTUAL): July 20, 2019

Study Registration Dates

• First Submitted: August 8, 2017
• First Submitted That Met QC Criteria: August 8, 2017
• First Posted (ACTUAL): August 11, 2017

Study Record Updates

• Last Update Posted (ACTUAL): July 18, 2022
• Last Update Submitted That Met QC Criteria: July 14, 2022
• Last Verified: July 1, 2022

More Information

Terms related to this study

• Keywords: Rehabilitation; Physical therapy; Ultrasonography; Shoulder pain
• Additional Relevant MeSH Terms: Pathologic Processes; Wounds and Injuries; Disease; Joint Diseases; Musculoskeletal Diseases; Rupture; Shoulder Injuries; Tendon Injuries; Syndrome; Rotator Cuff Injuries; Shoulder Impingement Syndrome
• Other Study ID Numbers: 3413-GOA

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No