Kinetic Chain Approach for Rotator Cuff Tendinopathy

Effectiveness of Kinetic Chain Approach for Rotator Cuff Tendinopathy

The aim of this research is to determine the effectiveness of the kinetic chain approach on pain, functional disability and kinesiophobia in patient with rotator cuff tendinopathy. Randomized controlled trials done at National institute of rehabilitation and medicine. The sample size was 44. The subjects were divided in two groups, 22 subjects in Group A that received Conventional Treatment and 22 subjects in Group B that received Kinetic chain approach and conventional treatment. Study duration was of 6 months. Sampling technique applied was non probability connivance sampling technique. Patient with age between 40 to 65 years, Clinically diagnosed and Patients who meet the diagnostic criteria ≥ three positives in five shoulder impingement tests: Neer's sign, Hawkins and Kennedy test, Empty Can test, painful arc of abduction, and external rotation (ER) resistance test, Patients in acute (4 weeks) and sub-acute stage (4-6 weeks).Patients with positive scapular assistance test (SAT) and scapular retraction test (SRT). Were included. Tools used in the study are NPRS (Numeric Pain Rating Scale). SPADI (Shoulder Pain and Disability) .Tampa Scale for Kinesiophobia TSK-11. Data was be analyzed through SPSS -25

Study Overview

• Status: Completed
• Conditions: Rotator Cuff Tendinopathy
• Intervention / Treatment: Other: Kinetic chain approach; Other: Conventional treatment

• Study Type: Interventional
• Enrollment (Actual): 44
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Islamabad, Punjab Province, Pakistan, 46000
      • National institute of rehabilitation medicine , polyclinic islamabad

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Both male and female.
• Age between 40 to 65 years.
• Clinically diagnosed and Patients who meet the diagnostic criteria ≥ three positives in five shoulder impingement tests: Neer's sign, Hawkins and Kennedy test, Empty Can test, painful arc of abduction, and external rotation (ER) resistance test (14)
• Patients in acute (4 weeks) and sub-acute stage (4-6 weeks).
• Patients with positive scapular assistance test (SAT) and scapular retraction test (SRT).

Exclusion Criteria:

• Patients with Cervical radiculopathy or previous shoulder surgery.

  • Any Participants with a full thickness tear of rotator cuff tendon.
  • History of glenohumeral dislocation, or other traumatic injury to the shoulder
  • Diagnosed patients of rheumatoid arthritis and osteoarthritis.
  • Hemiplegia affecting the shoulder and lower extremity
  • A complex myofascial pain syndrome.
  • History of significant lower extremity problems, including severe joint pain, recent fractures, or major musculoskeletal disorders (e.g. chronic ligament injuries)

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Kinetic chain approach; Kinetic chain approach Shoulder flexion with ipsilateral anterior step-up, Shoulder-dump exercise Starting position with Body weight is on the contralateral-side leg with trunk flexion and rotation. Finishing position. With Body weight is on the ipsilateral-side leg with thoracic extension. Modified shoulder-dump Exercise Sternal-lift starting position with head and trunk flexed forward. Finishing position with emphasizing thoracic extension. Tubing fencing exercise starting position with body weight on the ipsilateral leg. Elbow is at the hip; thoracic extension and scapular retraction are encouraged, Athletic stance during ball-stabilization exercise. Axially loaded wall-slide exercise. Motion at the hips and trunk complements the sliding pattern of the hand.Perform each exercise for 3 Days (twice a day) a week for 6 weeks. 10 reps ,2 sets According to FITT protocol, 10 reps, two sessions per day, and three days per week for 6 consecutive weeks.	Other: Kinetic chain approach; Kinetic chain approach Shoulder flexion with ipsilateral anterior step-up, Shoulder-dump exercise Starting position with Body weight is on the contralateral-side leg with trunk flexion and rotation. Finishing position. With Body weight is on the ipsilateral-side leg with thoracic extension. Modified shoulder-dump Exercise Sternal-lift starting position with head and trunk flexed forward. Finishing position with emphasizing thoracic extension. Tubing fencing exercise starting position with body weight on the ipsilateral leg. Elbow is at the hip; thoracic extension and scapular retraction are encouraged, Athletic stance during ball-stabilization exercise. Axially loaded wall-slide exercise. Motion at the hips and trunk complements the sliding pattern of the hand.Perform each exercise for 3 Days (twice a day) a week for 6 weeks. 10 reps ,2 sets According to FITT protocol, 10 reps, two sessions per day, and three days per week for 6 consecutive weeks.
Active Comparator: conventional treatment; 10 min moist heat pack Self-assisted anterior capsular stretching Hold for 30 sec and repeat 5 times with 10 sec rest between each stretch Self-assisted posterior capsular stretching Hold for 30 sec and repeat 5 times with 10 sec rest between each stretch Self -assisted inferior capsule stretching Hold for 30 sec and repeat 5 times with 10 sec rest between each stretch Codman's pendular exercises 10 reps Muscle strengthening exercises (after 4 weeks); Internal rotators and External rotators isometrics Hold for 5-8 seconds and repeat 10 times; chair press According to FIIT protocol 10 reps progressing to 20 and 30 repetitions in 5th and 6th week with two session in a day, three days per week for six consecutive weeks	Other: Conventional treatment; 10 min moist heat pack Self-assisted anterior capsular stretching Hold for 30 sec and repeat 5 times with 10 sec rest between each stretch Self-assisted posterior capsular stretching Hold for 30 sec and repeat 5 times with 10 sec rest between each stretch Self -assisted inferior capsule stretching Hold for 30 sec and repeat 5 times with 10 sec rest between each stretch Codman's pendular exercises 10 reps Muscle strengthening exercises (after 4 weeks); Internal rotators and External rotators isometrics Hold for 5-8 seconds and repeat 10 times; chair press According to FIIT protocol 10 reps progressing to 20 and 30 repetitions in 5th and 6th week with two session in a day, three days per week for six consecutive weeks

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
NPRS (Numeric Pain Rating Scale)	NPRS (Numeric Pain Rating Scale) the NPRS is an 11-point ordinal system, used measure subject perceived level of pain .Assess pain intensity at baseline, 9 session and after 18 session	6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
SPADI (Shoulder Pain and Disability Index)	SPADI (Shoulder Pain and Disability Index) is a patient completed questionnaire with 13 items. The pain subscale has 5-items and the Disability subscale has 8-items. Assess outcome at baseline , 9th session and after 18 session	6 weeks
Tampa Scale for Kinesiophobia TSK-11	Tampa Scale for Kinesiophobia TSK-11 Originally 17 item scale, used to identify fear or movement or re-injury. Assess outcome at baseline, after 9th session and after 18th session	6 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Aneela Zia, MsOMPT, Riphah International University

Study record dates

Study Major Dates

• Study Start (Actual): January 21, 2024
• Primary Completion (Actual): August 28, 2025
• Study Completion (Actual): August 29, 2025

Study Registration Dates

• First Submitted: November 25, 2024
• First Submitted That Met QC Criteria: February 20, 2025
• First Posted (Actual): February 21, 2025

Study Record Updates

• Last Update Posted (Estimated): September 3, 2025
• Last Update Submitted That Met QC Criteria: September 1, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: pain; kinesiophobia; functional disability; Rotator cuff injury; kinetic chain approach
• Additional Relevant MeSH Terms: Shoulder Injuries; Neurologic Manifestations; Mental Disorders; Wounds and Injuries; Rupture; Tendon Injuries; Phobic Disorders; Anxiety Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Rotator Cuff Injuries; Kinesiophobia; Pain
• Other Study ID Numbers: REC/MS-PT/02004 Tayyaba Jabeen

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