The Effect of Lower Limb Kinetic Chain Exercise in Shoulder Impingement

Effects of Lower Limb Kinetic Chain Exercise to Shoulder Rehabilitation Program in Patients With Shoulder Impingement Syndrome

The goal of this clinical trial study is to investigate the effect of performing lower limb kinetic chain exercise on muscle activation of scapular muscle strength ratio in patients with shoulder impingement. the main question it aims to answer is:

Does the addition of lower limb kinetic chain exercise to a shoulder exercise program improve scapular muscles strength ratio in patients with shoulder impingement? participants will be devided into two groups to be compared: The first group will be given a rehabilitation program consisting of strengthening exercises (for scapular stabilizers and rotator cuff) and stretching exercises (for pectoralis major, pectoralis minor, latissimus dorsi, levator scapula) The second group will be given the same exercises in addition to lower limb kinetic chain exercise

Study Overview

• Status: Recruiting
• Conditions: Shoulder Impingement Syndrome
• Intervention / Treatment: Other: exercise

Detailed Description

The term "kinetic chain" (KC) describes the sequential activation of body segments during functional movement patterns (Wilk et al., 2016). An effective KC will produce, summate, and enable effective mechanical energy transmission along the entire chain, which will support function. Any link in the KC that is inefficient has the potential to adversely affect force transfer to nearby segments (Ben kibler et al., 2000 & Martic et al., 2014). Consequently, therapists usually recommend incorporating trunk and lower extremity movements into shoulder rehabilitation programs in order to maximize efficient energy transfer throughout the entire KC (Sciascia et al., 2012 & Magarey et al., 2003). Thus, the investigators hypothesize that adding a lower limb (LL) kinetic chain exercise to a shoulder exercise program will improve scapular muscles strength ratio.

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ahmed El Melhat, Phd; Phone Number: 01112595022; Email: ahmed.elmelhat@cu.edu.lb
• Study Contact Backup: Name: Lamia Khalil, BSc; Phone Number: 76910480; Email: lamia.khalil02@gmail.com

Study Locations

• Egypt
  • Giza, Egypt, 2334
    • Recruiting
    • Outpatient physical therapy, Faculty of physical therapy
    • Contact: Ahmed ElMelhat; Phone Number: 01112595022; Email: ahmed.elmelhat@cu.edu.eg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age ranges between 20 and 45 years old
• Unilateral shoulder pain lasting more than 6 weeks

• At least one positive finding in each of these categories:

  1. Painful arc of movement during flexion or abduction
  2. Positive Neer or Hawkins-Kennedy impingement signs
  3. Pain on resisted lateral rotation, abduction or Jobe test

Exclusion Criteria:

• History of surgery
• History of fracture or dislocation
• Type III acromion
• Rotator cuff tear
• Long head of biceps tendon tear
• Cervical radiculopathy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Shoulder Impingement Rehabilitation; rehabilitation program consisting of strengthening exercises (for scapular stabilizers and rotator cuff) and stretching exercises (for pectoralis major, pectoralis minor, latissimus dorsi, levator scapula). Exercises done 3 times per weeks, 3 repetitions per exercise for 3 months	Other: exercise; Exercises done 3 times per weeks, 3 repetitions per exercise for 3 months
Experimental: Shoulder Impingement Rehabilitation with LL KC Exercise; rehabilitation program consisting of strengthening exercises (for scapular stabilizers and rotator cuff) and stretching exercises (for pectoralis major, pectoralis minor, latissimus dorsi, levator scapula) in addition to lower limb kinetic chain exercise. Exercises done 3 times per weeks, 3 repetitions per exercise for 3 months	Other: exercise; Exercises done 3 times per weeks, 3 repetitions per exercise for 3 months

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Electromyography to evaluate the activation patterns, timing and ratio of scapular muscles during movement	EMG activity of the three trapezius parts (upper, middle and lower) and Serratus anterior will be evaluated.; Electrodes for registration of upper trapezius activity are placed halfway between the spinous process of C7 and the posterior acromion.; Electrodes for registration of middle trapezius activity are placed halfway on the horizontal line between the thoracic spine and the root of the scapular spine.; Electrodes for registration of Lower trapezius activity are placed obliquely upward and laterally along a line between the intersection of the scapular spine with the vertebral border of the scapula and the seventh thoracic spinous process.; Electrodes for registration of Serratus Anterior activity are applied anterior to the latissimus dorsi and posterior to the pectoralis major	baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Shoulder pain and disability Index	To test pain and functional disability before and after interventions. 0-20: mild shoulder pain and disability 21-40: moderate shoulder pain and disability 41-60: severe shoulder pain and disability 61-80: very severe shoulder pain and disability 81-100: extremely severe shoulder pain and disability	baseline

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Study Director: Ahmed El Melhat, PhD, Cairo University

Publications and helpful links

General Publications

• Wilk KE, Arrigo CA, Hooks TR, Andrews JR. Rehabilitation of the Overhead Throwing Athlete: There Is More to It Than Just External Rotation/Internal Rotation Strengthening. PM R. 2016 Mar;8(3 Suppl):S78-90. doi: 10.1016/j.pmrj.2015.12.005.
• Sciascia A, Thigpen C, Namdari S, Baldwin K. Kinetic chain abnormalities in the athletic shoulder. Sports Med Arthrosc Rev. 2012 Mar;20(1):16-21. doi: 10.1097/JSA.0b013e31823a021f.

Study record dates

Study Major Dates

• Study Start (Actual): January 20, 2024
• Primary Completion (Estimated): September 1, 2024
• Study Completion (Estimated): October 1, 2024

Study Registration Dates

• First Submitted: December 25, 2023
• First Submitted That Met QC Criteria: December 25, 2023
• First Posted (Actual): January 8, 2024

Study Record Updates

• Last Update Posted (Actual): August 21, 2024
• Last Update Submitted That Met QC Criteria: August 19, 2024
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Wounds and Injuries; Disease; Joint Diseases; Musculoskeletal Diseases; Shoulder Injuries; Syndrome; Shoulder Impingement Syndrome
• Other Study ID Numbers: kinetic chain exercise

Drug and device information, study documents

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