Prone Row Exercise Versus Lateral Pull Down Exercise In Shoulder Impingement Syndrome With Scapular Dyskinesia
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Descrição detalhada
Shoulder impingement syndrome (SIS) is a common musculoskeletal disorder, accounting for approximately 44-65% of all shoulder pain complaints. Normal scapular stability includes the ability to keep the scapula's normal position while the arms are at your sides and throughout all upper-limb movements . The upper, middle, and lower trapezius muscles couple with the serratus anterior and rhomboid muscles to form "force couples," which are thought to be important for appropriate scapular orientation.
Scapular dyskinesis occurs when the scapular stabilizing muscles (upper, middle, and lower trapezius, serratus anterior, and latissimus dorsi) are unable to preserve typical scapular movement, and is considered potentially harmful when it results in increased anterior tilting, downward rotation, and protraction, all of which reorient the acromion to reduce the subacromial space width.
Bilateral prone rowing has demonstrated clear clinical benefits for patients with subacromial impingement syndrome. In a four week, supervised program where 16 individuals with stage II SIS performed low rowing three times per week, The Lateral Pull down exercise is widely recognized for its activation of the latissimus dorsi, but it also significantly recruits scapular stabilizers such as the lower trapezius and rhomboids, especially when performed with proper scapular depression and retraction. This makes it an effective exercise for improving scapular muscle strength and control in both healthy individuals and those undergoing shoulder rehabilitation .
Fifty-four male and female patients, with age between 40-65 years (mean age of 52.5 ± 6.25 years) (Yilmaz et al., 2023), will be recruited through direct referrals from orthopedic doctors. They will be asked to sign the informed consent form.
The study will employ a two experimental group protocol. Each group will follow a distinct exercise intervention. Group A will perform the prone row exercise, while Group B will engage in the lateral pull-down exercise. Both groups will also receive selected physical therapy treatment, which includes stretches to pectoralis minor, Posterior soft tissue. Codman's exercise, scapular sets and Wall slides and Postural exercises like thoracic extensions, Chin tuck and Scapular retraction exercises . The intervention period will last for 6 weeks, with sessions conducted three times per week under physiotherapist supervision.
Outcome measures:
- Isometric muscle strength testing of latissimus dorsi, middle trapezius, lower trapezius and rhomboids muscles using handheld dynamometer
- Function using SPADI
- Pain using VAS
- Lateral scapular slide test using Kinovea The results of this study will help determine the most effective exercise approach for improving clinical outcomes in patients with shoulder impingement syndrome and scapular dyskinesia and may provide evidence to guide physical therapy practice.
Tipo de estudo
Inscrição (Estimado)
Estágio
- Não aplicável
Contactos e Locais
Contato de estudo
- Nome: mennatallah maher, MSc
- Número de telefone: 0201096430623
- E-mail: mennaallah.maher@cu.edu.eg
Locais de estudo
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Cairo, Egito
- Faculty of Physical Therapy, Cairo University
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Contato:
- EBTESSAM FAWZY GOMAA, ASS. Professor
- Número de telefone: 0201004818240
- E-mail: ibtisam.fawzy@pt.cu.edu.eg
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
- Adulto
- Adulto mais velho
Aceita Voluntários Saudáveis
Descrição
Inclusion Criteria:
- -Fifty-four male and female.
- Individuals diagnosed with SIS and aged between 40-65 years with right-hand dominance (Andrea et al., 2024).
- Participants experiencing shoulder pain persisting for a minimum duration of 3 months (Lucas et al., 2022).
- Subjects with a primary complaint of shoulder impingement and scapular dyskinesia according to Neer's classification specifically in stages I and II are referred by an orthopedist (El Melhat et al., 2025).
- Body mass index (BMI) is ≥ 25 kg/m² (Maryam et al., 2023).
- Individuals with a positive Lateral Scapular Slide Test (LSST), defined as a side-to-side scapular difference of 1.5 cm or more in any of the three arm positions, indicating scapular asymmetry associated with dyskinesis (Kibler, 2003; Odom, 2001).
- All participants must have the cognitive ability to understand instructions and provide informed consent, consistent with standards highlighted in recent informed consent meta-analyses (Tam et al., 2015).
Exclusion Criteria:
- History of shoulder surgery, dislocation, or fracture (Crawshaw et al., 2010).
- History of neurological disorders (Crawshaw et al., 2010).
- Participants will be excluded if they had cervical spine pain or any signs of cervical radiculopathy (Magee, 2014).
- Individuals with chronic low back pain will be also excluded (Mohamed et al., 2022).
- Pregnant women will be excluded from participation in this study.
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
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Experimental: Group A: Prone Row exercise and selected physical therapy program group
Prone rowing and selected physical therapy treatment, which includes stretches to pectoralis minor, Posterior soft tissue.
Codman's exercise, scapular sets and Wall slides and Postural exercises like thoracic extensions, Chin tuck and Scapular retraction exercises (Dabholkar & Yardi 2015).
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prone row exercise: freely off the side and the head in a neutral position, supported if needed. The starting position involves 90-degree shoulder flexion with full elbow extension (0-degree elbow flexion), transitioning into 0-degree shoulder flexion with 90-degree elbow flexion. From this position, a bilateral vertical pulling movement is performed, involving scapular retraction and shoulder extension against resistance. The motion ends with the elbow flexed at 90 degrees, the shoulder extended, and the scapula fully retracted towards the spine, with control throughout the movement. selected physical therapy treatment, which includes stretches to pectoralis minor, Posterior soft tissue. Codman's exercise, scapular sets and Wall slides and Postural exercises like thoracic extensions, Chin tuck and Scapular retraction exercises |
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Experimental: Group B:the Lateral Pull Down exercise and selected physical therapy program received by Group A
Lateral Pull Down exercise and selected physical therapy treatment, which includes stretches to pectoralis minor, Posterior soft tissue.
Codman's exercise, scapular sets and Wall slides and Postural exercises like thoracic extensions, Chin tuck and Scapular retraction exercises
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The patient is seated on the pulldown machine with an upright trunk and feet flat on the floor, maintaining a stable posture. The starting position includes gripping the straight bar with a wide overhand (pronated) grip, marked to ensure a between-hands distance equal to 1.6 times the biacromial distance which is the horizontal distance between the most lateral points of the right and left acromion processes (shoulder tip). From this position, the participant performs a downward pulling movement, bringing the bar down in front of the face toward the upper chest near the clavicle in a smooth and controlled manner. selected physical therapy treatment, which includes stretches to pectoralis minor, Posterior soft tissue. Codman's exercise, scapular sets and Wall slides and Postural exercises like thoracic extensions, Chin tuck and Scapular retraction exercises |
O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Lateral scapular slide test
Prazo: (pre-intervention) and after 6 weeks (post-intervention)
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Lateral Scapular Slide Test (LSST), defined as a side-to-side scapular difference of 1.5 cm or more in any of the three arm positions, indicating scapular asymmetry associated with dyskinesis (Odom, 2001; Kibler, 1998).
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(pre-intervention) and after 6 weeks (post-intervention)
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Isometric muscle strength testing of latissimus dorsi, middle trapezius, lower trapezius and rhomboids muscles using Handheld dynamometer (HHD)
Prazo: (pre-intervention) and after 6 weeks (post-intervention)
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Lafayette HHD revealed mostly good to excellent reliability (coefficients ≥ 0.70) for all LL muscles measurements.
Also, it has good validity for most measures of isometric LL strength and power in healthy population.
Lafayette HHD is a reliable instrument to measure the foot and ankle strength of young and older adults, for both intra-rater (ICC (3,1) = 0.78-0.94)
and interrater (ICC (3,1) = 0.77-0.88)
comparisons.
(Celik et al., 2012).
|
(pre-intervention) and after 6 weeks (post-intervention)
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Pain using the Visual Analogue Scale (VAS)
Prazo: (pre-intervention) and after 6 weeks (post-intervention)
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The Visual Analogue Scale (VAS) will be used to measure pain.
The VAS is a straight line, with one end representing 0 (no pain) and the other end representing 10 (worst pain possible).
The number 0 indicates no problem, and 10 represents the worst possible condition (Huskisson, 1974).
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(pre-intervention) and after 6 weeks (post-intervention)
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Function using SPADI
Prazo: (pre-intervention) and after 6 weeks (post-intervention)
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Shoulder pain and disability index (SPADI) is demonstrated to be a validated and reliable measure of shoulder pain and disability (Roach et al., 1991). The translated version of SPADI in the Arabic language showed excellent internal consistency and test-retest reliability and construct validity based on substantial correlations of Arabic SPADI with Quick DASH, NRS, and active shoulder ROM. SPADI is recommended for the evaluation of patients with shoulder dysfunction (Alsanawi et al.,2015) |
(pre-intervention) and after 6 weeks (post-intervention)
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Colaboradores e Investigadores
Patrocinador
Publicações e links úteis
Publicações Gerais
- Baskurt Z, Baskurt F, Gelecek N, Ozkan MH. The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil. 2011;24(3):173-9. doi: 10.3233/BMR-2011-0291.
- Huskisson EC. Measurement of pain. Lancet. 1974 Nov 9;2(7889):1127-31. doi: 10.1016/s0140-6736(74)90884-8. No abstract available.
- Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care Res. 1991 Dec;4(4):143-9.
- McClure PW, Bialker J, Neff N, Williams G, Karduna A. Shoulder function and 3-dimensional kinematics in people with shoulder impingement syndrome before and after a 6-week exercise program. Phys Ther. 2004 Sep;84(9):832-48.
- Celik D, Dirican A, Baltaci G. Intrarater reliability of assessing strength of the shoulder and scapular muscles. J Sport Rehabil. 2012 Feb 29;21(1):1-5. doi: 10.1123/jsr.2012.TR3. Print 2012 Feb 1.
- Alsanawi HA, Alghadir A, Anwer S, Roach KE, Alawaji A. Cross-cultural adaptation and psychometric properties of an Arabic version of the Shoulder Pain and Disability Index. Int J Rehabil Res. 2015 Sep;38(3):270-5. doi: 10.1097/MRR.0000000000000118.
- Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med. 1998 Mar-Apr;26(2):325-37. doi: 10.1177/03635465980260022801.
- Ronai, P. (2017). The barbell row exercise. ACSM's Health & Fitness Journal, 21(2), 25-28.
- Obikili, E. N. (2006). Biacromial and Biiliac Diameters in a Young Adult Southeastern Nigerian Population. Journal of Experimental and Clinical Anatomy, 5(1), 22-25.
- Dabholkar Ajit, S., & Yardi Sujata, S. (2015). Effects of scapular muscle strengthening on shoulder function and disability in shoulder impingement syndrome (SIS)-A randomized controlled trial
- Cools, A. M., Dewitte, V., Lanszweert, F., Notebaert, D., Roets, A., Soetens, B., & Witvrouw, E. (2007). Scapular muscle rehabilitation exercises in overhead athletes with impingement symptoms: Effect of a 6-week training program on scapular muscle recruitment and functional outcome. British Journal of Sports Medicine, 41(11), 818-824
- Yilmaz Gokmen G, Akcay B, Kecelioglu S, Ozen MS, Yuce H. Physical and well-being effect of scapular kinesio taping combined with conventional physiotherapy in shoulder impingement syndrome: A randomized controlled study. J Back Musculoskelet Rehabil. 2023;36(6):1375-1383. doi: 10.3233/BMR-220396.
- Odom CJ, Taylor AB, Hurd CE, Denegar CR. Measurement of scapular asymetry and assessment of shoulder dysfunction using the Lateral Scapular Slide Test: a reliability and validity study. Phys Ther. 2001 Feb;81(2):799-809. doi: 10.1093/ptj/81.2.799.
- Noguchi M, Chopp JN, Borgs SP, Dickerson CR. Scapular orientation following repetitive prone rowing: implications for potential subacromial impingement mechanisms. J Electromyogr Kinesiol. 2013 Dec;23(6):1356-61. doi: 10.1016/j.jelekin.2013.08.007. Epub 2013 Aug 31.
- Lehman GJ, Buchan DD, Lundy A, Myers N, Nalborczyk A. Variations in muscle activation levels during traditional latissimus dorsi weight training exercises: An experimental study. Dyn Med. 2004 Jun 30;3(1):4. doi: 10.1186/1476-5918-3-4.
- Helgadottir H, Kristjansson E, Einarsson E, Karduna A, Jonsson H Jr. Altered activity of the serratus anterior during unilateral arm elevation in patients with cervical disorders. J Electromyogr Kinesiol. 2011 Dec;21(6):947-53. doi: 10.1016/j.jelekin.2011.07.007. Epub 2011 Sep 1.
- Fischer J, Burger C, Seguel JM, Rodoplu C, Paternoster FK, Tilp M, Konrad A. Impact of different ranges of motion in the prone barbell row on muscle excitation. J Electromyogr Kinesiol. 2025 Aug;83:103025. doi: 10.1016/j.jelekin.2025.103025. Epub 2025 Jun 9.
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