Effects of Kinetic Chain Exercises on Pain, Range of Motion and Disability in Shoulder Impingement Syndrome

PROJECT SUMMARY Shoulder pain is secondary only to lower back pain in occurrence. Impingement is one of the most common shoulder disorders. The aim of this study is to evaluate the effects of kinetic chain exercises on pain, ROM and disability in patients with shoulder impingement syndrome which is important in establishing eveidence for a holistic and potentially more effective rehabilitation method for shoulder impingement syndrome. This study will be a randomized control trial and will be conducted in Riphah International University associated hospital and physiotherapy outpatient department of Jinnah hospital Lahore.

Non probability consecutive sampling will be used. Sample size of 32 subjects with age group 30 to 50 years will be taken. Data will be collected from patients having present complaint of shoulder pain due to shoulder impingement. Outcome measures will be taken using numeric pain rating scale(NPRS) for pain, universal Goniometer for ROM and Shoulder pain and disability index (SPADI) for function. An informed consent will be taken. Subjects will be selected on the basis of inclusion and exclusion criteria and will be equally divided into two groups. Group A will receive kinetic chain exercises (both open and closed chain exercises) and group B will receive conventional physical therapy treatment. Data analysis will be done by SPSS version 28

Study Overview

• Status: Completed
• Conditions: Shoulder Impingement Syndrome
• Intervention / Treatment: Other: Kinetic chain exercises; Other: conventional physical therapy treatment

Detailed Description

PROJECT SUMMARY Shoulder pain is secondary only to lower back pain in occurrence. Impingement is one of the most common shoulder disorders. The aim of this study is to evaluate the effects of kinetic chain exercises on pain, ROM and disability in patients with shoulder impingement syndrome which is important in establishing eveidence for a holistic and potentially more effective rehabilitation method for shoulder impingement syndrome. This study will be a randomized control trial and will be conducted in Riphah International University associated hospital and physiotherapy outpatient department of Jinnah hospital Lahore.

Non probability consecutive sampling will be used. Sample size of 32 subjects with age group 30 to 50 years will be taken. Data will be collected from patients having present complaint of shoulder pain due to shoulder impingement. Outcome measures will be taken using numeric pain rating scale(NPRS) for pain, universal Goniometer for ROM and Shoulder pain and disability index (SPADI) for function. An informed consent will be taken. Subjects will be selected on the basis of inclusion and exclusion criteria and will be equally divided into two groups. Group A will receive kinetic chain exercises (both open and closed chain exercises) and group B will receive conventional physical therapy treatment. Data analysis will be done by SPSS version 28

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54792
      • RC Medical Centre

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• • Age group 30-50 years

  • Males and Females
  • Subjects with history of pain in upper lateral aspect of arm with a NPRS score between >3 to <8 on a 0-10 scale
  • Neers impingement test positive
  • Hawkins- Kennedy test positive
  • Painful arc positive
  • Empty can (Jobe test) positive

Exclusion Criteria:

• • Subjects having Capsular Pattern +ve

  • Individuals with OA of GH joint
  • Type III acromion process decreasing the sub-acromial space leading to sub-acromial impingement (on X-ray evaluation)
  • AC joint arthritis
  • Rheumatoid Arthritis
  • Fracture history involving upper limb
  • Shoulder surgery on affected side.
  • Subjects with signs of total rotator cuff tears i.e. gross weakness in abduction.
  • Subjects who received corticosteroid injections in last three months

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 EXERCISES (OPEN AND CLOSED)	Other: Kinetic chain exercises; Kinetic chain exercises work on the stabilizer muscles of scapula, such as the anterior serratus, rhomboids, and trapezius, which are responsible for maintaining the scapula-humeral rhythm. These scapular stabilizers reduce the undesirable movements that would otherwise cause shoulder impingement, therefore reducing stress on the sub-acromial structures. Kinetic chain exercises enhance body's proper movement patterns, improving proprioception, and increase the activation of primary movers. Decreased biomechanical dysfunction results in better arm positioning. By performing exercises that address the entire kinetic chain, these would assist in avoiding the compensatory mechanisms and repetitive strain injuries that act as relapse triggers for SIS. The patients enjoy sustained relief from shoulder impingement syndrome pain and notice less frequency of future shoulder injuries Kinetic chain shoulder therapy exercises involve kinetic link and model called biomechanical model and cranial t; Other: conventional physical therapy treatment; Heating pad for ten minutes; Therapeutic ultrasound for 5 minutes; Active range of motion exercises (two sets of 15 repetitions for each exercise); Codman exercises (two sets of 15 repetitions)
Active Comparator: CONVENTIONAL PHYSIOTHERAPY TREATMENT	Other: conventional physical therapy treatment; Heating pad for ten minutes; Therapeutic ultrasound for 5 minutes; Active range of motion exercises (two sets of 15 repetitions for each exercise); Codman exercises (two sets of 15 repetitions)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric Pain Rating scale	. This scale ranges from 0 to 10 where 0 indicating "no pain" and 10 indicating "worst pain possible"	from start of study to 4 weeks
Shoulder Pain and Disability Index	The Shoulder Pain and Disability Index (SPADI) is a self-administered questionnaire that consisting of two dimensions, one for the pain and other for functional ability of the subject. The pain dimension consists of five questions regarding the severity of an individual's pain intensity	From start of study upto 4 weeks
Universal Goniometer	Health care practitioners often use universal goniometer to obtain objective measurements of joint range of motion (ROM) to find out the baseline functional status and to measure the effectiveness of treatment interventions	From start of study upto 4 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Ali Raza, Ms.PT(OM), Riphah International University

Publications and helpful links

General Publications

• Afzalifard, Z., Soltani, A., & Oskouei, A. E. (2023). The effects of magnet therapy on pain and disability in patients with shoulder impingement syndrome. Middle East Journal of Rehabilitation and Health Studies, 10(1).
• Mitra D, Mitra P, Rau S. Effect of Specific Exercise Program and Conventional Exercise Protocol on Pain and Disability in Patients with Subacromial Impingement Syndrome
• Lo YP, Hsu YC, Chan KM. Epidemiology of shoulder impingement in upper arm sports events. British Journal of Sports Medicine. 1990;24(3):173.
• Saadatian A, Babaei Khorzoghi M, Sahebozamani M, Taghi Karimi M. The Impact of OKC Exercises and TRX Exercises on Shoulder Joint Proprioception in Overhead Athletes With Shoulder Impingement Syndrome: A Randomized Controlled Trial. Physical Treatments - Specific Physical Therapy. 2022;12(2):77-84.
• Kanthanathan Subbiah SR, AS Subhashini, Sailakshmi Ganeshan. Functional Ability and Quality of Life Status following Manual Therapy and Specific Exercise Conditioning in Subacromial Impingement Syndrome: A Randomised Controlled Study. Journal of Clinical and Diagnostic Research. 2023;17(3):YC11- YC6.
• Webb R, Cofré Lizama LE, Galea MP. Moving with ease: feldenkrais method classes for people with osteoarthritis. Evidence-Based Complementary and Alternative Medicine. 2013;2013(1):479142
• Wen, M., Hu, X., & Bao, G. (2025). Scapular dyskinesis-based exercise therapy versus multimodal physical therapy for subacromial impingement syndrome in young overhead athletes with scapular dyskinesis: a randomized controlled trial. BMC Sports Science, Medicine and Rehabilitation, 17(1), 204
• Qamar, M. M., Basharat, A., Kiran, Q., Nazir, A., Ahmad, W., & Basharat, S. (2023). Comparison of the Effects of Conventional Physical Therapy Versus Progressive Overload Training in Patients with Shoulder Impingement Syndrome; A Randomised Clinical Trial. Annals of King Edward Medical University, 29(1), 50-54.
• McKim KR. A comprehensive analysis of the swimmers' shoulder [Text]1998.
• McMullen J, Uhl TL. A kinetic chain approach for shoulder rehabilitation. Journal of athletic training. 2000;35(3):329

Study record dates

Study Major Dates

• Study Start (Actual): July 10, 2025
• Primary Completion (Actual): December 29, 2025
• Study Completion (Actual): December 29, 2025

Study Registration Dates

• First Submitted: March 16, 2026
• First Submitted That Met QC Criteria: March 16, 2026
• First Posted (Actual): March 20, 2026

Study Record Updates

• Last Update Posted (Actual): March 20, 2026
• Last Update Submitted That Met QC Criteria: March 16, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Disability, Impingement syndrome, Kinetic chain exercises, Pain, Range of Motion
• Additional Relevant MeSH Terms: Shoulder Injuries; Neurologic Manifestations; Musculoskeletal Diseases; Wounds and Injuries; Joint Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain; Shoulder Impingement Syndrome
• Other Study ID Numbers: REC/RCR & AHS/24/01100

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