Comparison of Open Chain Kinetic Exercises and Forward Head Posture Correction in Type II Scapular Dyskinesia
Condition: Dyskinesias
MeSH terms: Dyskinesias
Study type: Interventional

Summary: 
      The objective of this study is to compare the effect of open chain kinetic exercises and
      forward head posture correction on scapular symmetry and glenohumeral disability in office
      workers with type II scapular dyskinesis.
    

Detailed description: 
      The scapula plays a crucial role in coordinating and maintaining complex shoulder kinematics.
      The rotator cuff (RC) and the scapula control energy and force transfer for glenohumeral (GH)
      and scapulothoracic (ST) movements. From a biomechanical perspective, the shoulder range of
      motion (ROM) covers almost 65% of a spherical joint whose stability is ensured by several
      factors such as bone integrity, muscle activity, and ligaments.The RC and scapula allow for
      three-dimensional movements of the shoulder by limiting excessive translations that may
      compromise the joint integrity.The overall prevalence of scapular dyskinesis was 90.08%, and
      the highest frequency was found at the resting position.

      Association between ergonomic risk level and scapular dyskinesis in office workers in 2020.
      It was a cross sectional study A lateral scapular slide test (LSST) was used to evaluate
      scapular dyskinesis, and the quick exposure check (QEC) method was used to analyze the
      ergonomic risk level. results indicate that patients with scapular dyskinesis have a high
      ergonomic risk level.

      A defective scapular posture, caused by muscular imbalances, also generates imbalances of
      length and muscular strength in the muscles, altering the mechanics of the glenohumeral
      joint. A forward bending of the scapula is associated with a retracted minor pectoral muscle
      and possibly anterior serratus weakness or trapezius. This scapular posture alters the
      humeral posture on the glenoid, assuming a relatively abducted and internally rotated
      position, resulting in retracted glenohumeral internal rotators and elongated or weak lateral
      rotators.

      SW Christensen et al has stated in an article that the key group that might be related with
      scapular dyskinesis and work-related pain in office workers is the axioscapular muscles.
      These muscles attach between the scapula to the axis of the body consisted of serratus
      anterior, Pectoralis minor, rhomboids, levator scapulae and three parts of trapezius.

      Study in 2016 in which the deeper lying (Levator Scapulae, Pectoralis Minor (Pm) and Rhomboid
      major) and superficial lying (Trapezius and Serratus Anterior) scapulothoracic muscles'
      activity was investigated with fine-wire and surface EMG, concluded that In the presence of
      idiopathic neck pain, higher Pectoralis minor activity during the towel wall slide was found.
      Patients with neck pain and scapular dyskinesis showed lower MT(middle trapezius) activity in
      comparison with healthy controls with scapular dyskinesis during scaption.

      In 2018 The results showed high incidence of axioscapular muscle adaptations including of
      decreased flexibility of pectoralis minor, upper trapezius and levator scapulae in all
      subtypes as well as decreased performance of serratus anterior, middle trapezius, lower
      trapezius and rhomboids. The high incidence of postural deviations including forward head,
      rounded shoulder and thoracic hyper-kyphosis were also found in all subtypes of scapular
      dyskinesis. The participants were symptomatic office workers with different subtypes of
      scapular dyskinesis. They were evaluated the subtypes of scapular dyskinesis corresponded
      with flexibility of pectoralis minor, upper trapezius and levator scapulae using muscle
      length tests. The performances of serratus anterior, upper trapezius, middle trapezius, lower
      trapezius and rhomboids were also examined using manual muscle test. The postural deviations
      of cervical, shoulder and thoracic were also investigated using postural analysis methods.

      Conventional therapeutic exercise programs are commonly used to treat patients with scapular
      dyskinesis. It is common for physical therapists to treat patients with shoulder pain and
      scapular dyskinesis. Treatment techniques to address dyskinesis include manual neuromuscular
      facilitation, tactile cueing, visual feedback, electrical stimulation, supervised exercise,
      mobilization, strengthening, electromyography, and other interventions.

      An RCT in which eleven asymptomatic university students representing 15 scapulae with a
      positive Scapular Dyskinesis Test were recruited as subjects. Participants were randomized
      into exercise and electrical stimulation (ESTherex) or exercise and sham electrical
      stimulation (ShamTherex) and stated that Electrical stimulation with exercises for scapular
      dyskinesis showed improvements in spine to scapula distance at 120 degrees of shoulder
      abduction.

      The literature has proved that shoulder stabilization training strengthens the scapular
      muscles, closed chain and open chain kinetic exercises are also beneficial thereby resolving
      the SD. But as FHP can lead to SD, among the correction of FHP or open chain kinetic
      exercises which one is more effective to treat SD type II it has not been compared before.
      There is also paucity of literature available on open chain kinetic exercises and forward
      head posture correction exercises on scapular symmetry and glenohumeral disability in office
      workers with type II scapular dyskinesis. Hence this study aims to compare the effect of open
      chain kinetic exercises and forward head posture correction on scapular symmetry and
      glenohumeral disability in office workers with type II Scapular dyskinesis.
    

Intervention name(s): Open chain kinetic exercises; Forward head posture correction exercises
Intervention type(s): Other; Other
Intervention description(s): Group A will perform open chain kinetic exercises Before the intervention all the participants will perform 20 minutes of warm up and 10 minutes of cool down. The Open kinematic chain exercises(Three sets of each exercise while one set of each exercise will be performed at the setup and remaining two sets will be guided to the patient as a home plan)-:Blackburn exercises ( 20 repetitions ) , Dynamic hug( 10 repetitions), W exercise(10 repetitions), lunges with dumbbells-forward(10 repetitions with half kg dumbbell), upward and diagonal, and Pectoralis minor stretching(3 to 5 stretches)will be performed; PatienGroup B participants will perform forward head correction exercise(22) Chin tuck Patient will Stand with upper back against a wall, feet shoulder-width apart. • Face forward, tuck your chin down, and pull head back until it meets the wall. • t
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Scapula