EFFICACY OF ADDING TRUNK INTEGRATED KINETIC CHAIN EXERCISES TO CONVENTIONAL EXERCISE THERAPY PROGRAM IN SUBACROMIAL IMPINGEMENT SYNDROME

April 7, 2025 updated by: Maria Romany Edwar Raoof, Cairo University
The purpose of this study will be to investigate the effect of adding trunk integrated kinetic chain exercises to conventional exercise program on shoulder pain, function, isometric muscle strength, shoulder ROM and scapular orientation in patients with subacromial impingement syndrome.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Shoulder pain is the third most common musculoskeletal condition, affecting 67% of the general population . Shoulder impingement syndrome (SIS) is one of the most prevalent causes of shoulder pain, which is characterized by the compression of the rotator cuff and the subacromial bursa under subacromial space. Shoulder impingement syndrome is accounting for 44% to 65% of all shoulder complaints, with an estimated prevalence of 7% to 34%. In as many as 65% of SIS cases, shoulder pain is located in the anterolateral acromial region that may also spread to the lateral mid-humerus is the classic SIS symptom with a general decline in muscle strength.

New perspective for assessment and treatment of SIS is concentrating on movement-related mechanisms or biomechanical triggering factors. Exercises are effective at an early stage of SIS, which usually refers to stage I or early stage II according to Near's classification , such as training of the periscapular muscles (pectoralis minor, trapezius, serratus, and rhomboids) and strengthening of the rotator cuff (supraspinatus, infraspinatus, teres minor, and subscapularis), which acts as the shoulder joint stabilizers using concentric and eccentric exercises for the dynamic humeral centering effect and reduction of shoulder pain.). However, the best treatment strategy remains unknown If conservative treatment is failed operative treatment should be considered.

The scapula and glenohumeral joints are critical in allowing energy transfer from the trunk to lower limbs. According to Kibler et al, 1995, a 20% drop in kinetic energy transferred from the hip and trunk to the arm needs a 34% increase in shoulder rotational velocity to create the same amount of force to the hand. Deficiencies in the strength and mobility in these areas can have a negative impact on shoulder kinematics, increasing the risk of shoulder and elbow injury.

The defect at any link in the kinetic chain (Kc) will affect force transfer to subsequent segments and other components in the chain need to contribute more to compensate for the energy loss and this is explaining the risk factor for shoulder injury and pain. Recently, physical therapists typically recommend including lower extremity and trunk movements into shoulder rehabilitation protocols to maximize effective energy transfer throughout the entire KC. However, the importance of a KC approach over an isolated local shoulder treatment protocol during shoulder rehabilitation is not fully understood.

Previous studies investigated the efficacy of integrating the KC exercises into shoulder rehabilitation exercises and showed improvement of axio-scapular muscle recruitment, lower trapezius muscle ratios, and decrease the demands on the rotator cuff muscles.

A study examined EMG activity of the serratus anterior (SA) and lower trapezius (LT) during arm elevation this study and showed the highest activity of the SA, LT and Posterior Deltoid compared with the free-motion exercises. The quadruped shoulder flexion (QSF) is a form of KC ex in this study.

An EMG study analysis compared the muscle activation pattern of four Kc exercises to three conventional exercises the results showed that KC exercises resulted in the highest activation of all exercises. And this study is made on healthy subjects; if the examination is done on patients with shoulder pain the results may give different trends.

Furthermore, Yamauchi et al, (2015) investigated the effect of ipsilateral trunk rotation during shoulder exercises on the scapula. All Scaption, external rotations (ERs), and trunk rotation reported an increase of scapular ER or posterior tilt and LT activation. Retraction with 90° and 145° of shoulder abduction with trunk rotation considerably reduced UT activation and the UT/MT and UT/LT ratios. Therefore, the study findings imply that integrated trunk rotation KC ex adopted in this study may be useful in individuals with decreased (LT) activity and excessive (UT) activation or in cases where there is a diminished scapular ER or posterior tilt.

Study Type

Interventional

Enrollment (Actual)

30

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Egypt
      • Giza, Egypt
        • outpatient clinic at faculty of physical therapy - Cairo University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • 1) Patients complaining of subacromial impingement syndrome . 2) Age 20-¬45 years old . 3) If they had at least three of the following 6 criteria: "Neer sign" positive, "Hawkins sign" positive, " Painful active shoulder elevation in scapular plane, painful rotary cuff tendon palpation," painful resisted isometric abduction " history of pain related to C5 dermatome.

    4) A 20 percent or higher score of SPADI (Shoulder Pain and Disability Index) baseline 5) Level of pain (at least 2/10 on VAS) 6) Patient with Body mass index (BMI) with 18 to 29.5 Kg/m2

Exclusion Criteria:

  1. Prior history of cervical radiculopathy symptoms, frozen shoulder
  2. Neurological disorders, inflammatory disorders
  3. Complete RC tear and any previous surgery to the affected shoulder
  4. Infections or tumors

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: control group A (conventional traetment)
conventional treatment including (hot pack, Stretching of the pectoralis minor, Resisted shoulder external rotation , Prone Extension ,Prone Horizontal Abduction with External Rotation ,Side-lying Forward Flexion ,Posterior capsule stretch (sleeper stretch)
Other: Conventional treatment
conventional treatment including (hot pack, Stretching of the pectoralis minor, Resisted shoulder external rotation , Prone Extension ,Prone Horizontal Abduction with External Rotation ,Side-lying Forward Flexion ,Posterior capsule stretch (sleeper stretch)
Other: Experimental group B (Trunk integrated kinetic chain exercises )

This group will receive conventional treatment plus four trunk integrated kinetic chain exercises:

  1. Quadruped shoulder flexion
  2. Shoulder flexion with trunk rotation
  3. Shoulder external rotation from shoulder at 45° internal rotation and the elbow at 90° flexion with trunk rotation
  4. Shoulder external rotation from shoulder at 90° abduction and the elbow at 90° flexion while with trunk rotation
Other: Trunk integrated kinetic chain exercises

This group will receive conventional treatment plus four trunk integrated kinetic chain exercises:

  1. Quadruped shoulder flexion
  2. Shoulder flexion with trunk rotation
  3. Shoulder external rotation from shoulder at 45° internal rotation and the elbow at 90° flexion with trunk rotation
  4. Shoulder external rotation from shoulder at 90° abduction and the elbow at 90° flexion while with trunk rotation

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Digital Goniometer
Time Frame: at baseline, to the end of treatment at 4 weeks
to measure the full shoulder ROM using digital goniometer device in degrees
at baseline, to the end of treatment at 4 weeks
Hand held Dynamometer
Time Frame: at baseline, to the end of treatment at 4 weeks
to measure shoulder and scapular muscle strength using hand held dynamometer , in newton
at baseline, to the end of treatment at 4 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Cairo University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2024

Primary Completion (Actual)

February 15, 2025

Study Completion (Actual)

February 15, 2025

Study Registration Dates

First Submitted

April 7, 2025

First Submitted That Met QC Criteria

April 7, 2025

First Posted (Actual)

April 13, 2025

Study Record Updates

Last Update Posted (Actual)

April 13, 2025

Last Update Submitted That Met QC Criteria

April 7, 2025

Last Verified

April 1, 2025

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • treating shoulder impingement

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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