Effects of Global Postural Reeducation Versus Scapular Stabilization Exercises

Shoulder pain is an experience that most of the people can expect to deal in their lives due to over-exertion or postural asymmetries, which may or may not have it interfering with the normal activities of their daily living. Shoulder pain associated with scapular dyskinesia can be associated with restricted joint range of motion and loss of muscle strength, and is among the most common conditions treated by physical therapists. The patho-mechanisms of shoulder pain are only scarcely known but it is associated with both psychosocial and physical factors. Although there is some evidence of pain reduction, improving range of motion and function occurring following global posture reeducation, scapular stabilizing exercise, it is not known how the training influences the muscle activities of persons shoulder pain associated scapular dyskinesia.

The objective of this study will be to compare the effects of Global Postural Reeducation and Scapular Stabilization Exercises on pain, range of motion, and activity restriction in patient with shoulder Pain. Data will be collected from Hajra complex and Riphah Rehabilitation center Lahore. A sample of 30 patients will be included and divided into two group. One group will receive Global Postural Reeducation and other group will receive Scapular Stabilization Exercises. All subjects will receive a total of ten treatment sessions twice a week over the period of 5 weeks lasting for 40 minutes. Outcome will be measured with Goniometer, NPRS, DASH/PSS. The data will be analyse using SPSS v 25. The normality of the data will be assessed by Shapiro-Wilks test of normality and uniformity, based on which parametric or non-parametric test will be applied to determine within the group and across the group difference in two groups. Independent sample T test / Mann Whitney U test will be applied to determine any significant difference across the two groups. Repeated Measure ANOVA / Friedman ANOVA will be used to determine any significant difference with in each treatment group. A difference with p value less than 0.05 will be considered as significant.

Eligibility Criteria:
Inclusion Criteria:

* Patients of both genders.
* SD of type I with scapular malposition, inferior medial border prominence, coracoid pain and malposition, and dyskinesia of scapular movement (SICK) Scapula Rating Scale, in association to shoulder pain (pain for at least 3 months).
* Pain intensity ranges from 2-9 on scale of shoulder in last month.

Exclusion Criteria:

* Additional cervical or shoulder pathology (cervical stenosis, myelopathy, prolapsed intervertebral disk )
* Pre-diagnosed winged scapula due to lesions of the long thoracic nerve or spinal accessory nerve.
* Patients with shoulder instability
* Medical red flag history (tumor, metabolic diseases, rheumatoid arthritis, osteoporosis or Infection)
* Any Neurological disorder that affects shoulder
* History of Severe trauma or any fracture of shoulder girdle
* Hypertension (Systolic BP\[160, diastolic BP\[100\])
* Cardiovascular diseases (e.g., chest pain during physical exercise, heart failure, myocardial infarction)
* Postoperative conditions in the neck and affected shoulder region Pregnancy