The Effect of Isolytic and Static Stretching Training in Individuals With Subacromial Impingement Syndrome

Study Overview
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Brief Summary
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The purpose of this study is to investigate and compare the effect of isolytic and static stretching training in individuals having subacromial impingement syndrome with glenohumeral internal rotation deficit. Isolytic group will receive isolytic stretching in modified cross body stretching position and standard physiotherapy program. Static group will receive static stretching in modified cross body stretching position and standard physiotherapy program. Control group will receive only standard physiotherapy program.

Detailed Description
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The effectiveness of static stretching on various parameters such as range of motion or pain is studied and proved in literature. Static stretching in cross body position was also found helpful for improving shoulder range of motion with some disadvantages. In modified cross body position, the patient is positioned in a more advantageous way for him/her. Usually this stretching is done as active-assistive static stretching with the physiotherapist. Proof is still needed for the effectiveness of active-assistive static stretching in modified cross body position. Furthermore, there is no research about the effect of isolytic stretching which is relatively new technique compare to static stretches in subacromial impingement syndrome. In isolytic stretching, when the patient contracts the agonist muscle group with 20% muscle force active-assistive streching in agonist muscle group by the physiotherapist at the same time is done for 2-4 seconds. A fast isolytic stretching is applied in order to break the fibrous tissue. Our purpose is to investigate and compare the effect of isolytic and static stretching training in individuals having subacromial impingement syndrome with glenohumeral internal rotation deficit . Stretching groups will receive either isolytic or static stretching in modified cross body stretching position and standard physiotherapy program. There is a control group. Control group will receive only standard physiotherapy program. Standard physiotherapy program includes TENS, hotpack, posture and strengthening training program. Treatment program will last four times a week (4-4-4-3) for four weeks, 15 sessions in total.

Official Title
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The Effect of Isolytic and Static Stretching Training in Individuals Having Subacromial Impingement Syndrome With Glenohumeral Internal Rotation Deficit

Conditions
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Subacromial Impingement Syndrome

Intervention / Treatment
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* Other: Isolytic Stretching group
* Other: Static Stretching group
* Other: Control group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of subacromial impingement syndrome Glenohumeral internal rotation range of motion of the affected shoulder should be less than other shoulder and bilateral shoulder internal rotation range of motion difference should be ≥15 º Pain with resisted arm elevation or external rotation as well as a minimum of 3 of 5 positive subacromial impingement syndrome tests, painful arc, pain or weakness with resisted external rotation, Neer, Hawkins and Jobe tests. Ability to complete the entire study procedure Exclusion Criteria: A 50% limitation of passive shoulder range of motion in >2 planes of motion Pain >7/10 A history of fracture to the shoulder girdle Systemic musculoskeletal disease History of shoulder and cervical surgery Glenohumeral instability (positive apprehension, relocation, or positive sulcus test) or positive findings for a full-thickness rotator cuff tear (positive lag sign, positive drop arm test, or marked weakness with shoulder external rotation) Neck and shoulder pain with active/passive cervical spine movement A diagnosis of chest deformity or scoliosis Regularly performing posterior shoulder stretching exercises

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: There are 3 groups. First group will receive isolytic stretching in modified cross body stretching position and standard physiotherapy program. Second group will receive static stretching in modified cross body stretching position and standard physiotherapy program. Control group will receive only standard physiotherapy program. In standard physiotherapy program, there are TENS, hotpack, posture and strengthening training program. Treatment program will last four weeks.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Isolytic stretching group<br>The participants in this group will receive isolytic stretching in modified cross body position. Additionally they will receive standard physiotherapy. | Other: Isolytic Stretching group<br>* In modified cross body position, isolytic stretching exercises will perform five times each for 15 seconds. After each stretching patient will rest for 5 seconds. When the patient contracts the agonist muscle group with 20% muscle force, the agonist muscle group is stretched at the same time for 2-4 seconds. Isolytic stretching exercises will perform four times a week for four weeks. It's obligatory to receive at least 15 sessions in total. They will also receive standard physiotherapy program four times a week for four week, 15 sessions in total.<br>* Other names: Standard physiotherapy;|
| Experimental: Static stretching group<br>The participants in this group will receive static stretching in modified cross body position. Additionally they will receive standard physiotherapy. | Other: Static Stretching group<br>* In modified cross body position, active-assistive static stretching exercises will be performed 5 times each for 15 seconds. This stretching exercise is performed 5 times with 5 seconds intervals. Static stretching exercises will perform four times a week for four weeks. It's obligatory to receive at least 15 sessions in total. They will also receive standard physiotherapy program four times a week for four week, 15 sessions in total.<br>* Other names: Standard physiotherapy;|
| Active Comparator: Control group<br>The participants in this group will receive only standard physiotherapy. | Other: Control group<br>* They will receive only standard physiotherapy program, four times a week for four weeks, 15 sessions in total.<br>* Other names: Standard physiotherapy;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shoulder internal rotation range of motion | Change of shoulder internal rotation range of motion (with bubble inclinometer) | Baseline and 4 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Glenohumeral internal rotation deficit | Change of difference in shoulder internal rotation range of motion between the affected and non-affected shoulder (with bubble inclinometer) | Baseline and 4 weeks | 
| Posterior shoulder tightness | Change of posterior shoulder tightness (with bubble inclinometer) | Baseline and 4 weeks | 
| Shoulder external rotation range of motion | Change of shoulder external rotation range of motion (with bubble inclinometer) | Baseline and 4 weeks | 
| Shoulder total rotational range of motion | Change of shoulder total rotational range of motion (Sum of the internal and external rotation motion) | Baseline and 4 weeks | 
| Resting and activitiy pain in shoulder | Change of visual analog scale score in activity and rest pain | Baseline and 4 weeks | 
| Subacromial space | Change of subacromial space at arm resting at the side (0°), and at 60° of scapular plane elevation (with Ultrasound) | Baseline and 4 weeks | 
| Supraspinatus tendon thickness | Change of supraspinatus tendon thickness (with Ultrasound) | Baseline and 4 weeks | 
| Concentric strength | Change of rotattor cuff muscles concentric strength (in kg, with hand held dynamometer) | Baseline and 4 weeks | 
| Eccentric strength | Change of shoulder abduction eccentric strength (in kg, with hand held dynamometer) | Baseline and 4 weeks | 
| Shoulder Function | Change of Modified Constant-Murley Score | Baseline and 4 weeks | 
| Upper extremity function | Change of disabilities of the arm, shoulder, and hand (Quick-DASH) score | Baseline and 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Shoulder pain, Physical therapy, Rehabilitation, Ultrasonography