The Acute Effects of Different Stretching Methods 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 acute effects 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 position. Static group will receive static stretching in modified cross body position. Stretching groups will be evaluated before and just after stretching exercise. Control group will receive no stretching. Control group will be evaluated for the first time and then will be waited until the duration of the stretching exercise program. Afterwards, second evaluation will be performed

Detailed Description
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There is no information in literature about the acute effects of isolytic stretching exercise in individuals having subacromial impingement syndrome with glenohumeral internal rotation deficit. The purpose of this study is to investigate and compare the acute effects of isolytic and static stretching training in individuals having subacromial impingement syndrome with glenohumeral internal rotation deficit. In modified cross body position, static stretching group will perform active-assistive static stretching by the physiotherapist whereas isolytic stretching group will perform active-assistive isolytic stretching. Stretching exercises will be applied five times each for 15 seconds. After each stretching there will be a resting period for 5 seconds. Control group will receive no stretching. They will be handed a brochure about the stretching techniques and its role in injury prevention. Isolytic and static stretching groups will be evaluated before and just after stretching exercise. Control group will be evaluated for the first time and then will be passively waited until the duration of the stretching exercise program (approximately 4-5 min). Afterwards, second evaluation will be performed.

Official Title
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The Acute Effects of Different Stretching Methods on Posterior Shoulder Tightness, Pain, Joint Range of Motion, Subacromial Space and Strength in Individuals Having Subacromial Impingement Syndrome With Glenohumeral Internal Rotation Deficit

Conditions
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Subacromial Impingement Syndrome, Glenohumeral Internal Rotation Deficit

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: An inability to elevate the involved arm greater than 140 degree in the scapular plane 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 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)

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 position. Second group will receive static stretching in modified cross body position. The stretching exercise will be applied five times each for 15 seconds. After each stretching there will be a resting period for 5 seconds. Control group will receive no stretching. They will be handed a brochure about the stretching techniques and its role in injury prevention. Isolytic and static stretching groups will be evaluated before and just after stretching exercise. Control group will be evaluated for the first time and then will be passively waited until the duration of the stretching exercise program (approximately 4-5 min). Afterwards, second evaluation will be performed.
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. | 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. Afterwards active-assistive stretching is done. Evaluations will be done before and just after stretching exercise.<br>|
| Experimental: Static stretching group<br>The participants in this group will receive static stretching in modified cross body position. | 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. Evaluations will be done before and just after stretching exercise.<br>|
| Active Comparator: Control group<br>The participants in this group will receive no stretching. They will only be evaluated. | Other: Control group<br>* Control group will receive no stretching. They will be handed a brochure about the stretching techniques and its role in injury prevention. Control group will be evaluated for the first time and then will be passively waited until the duration of the stretching exercise program (approximately 4-5 min). Afterwards, second evaluation will be performed.<br>|

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 just after stretching exercise | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Posterior shoulder tightness | Change of posterior shoulder tightness (with bubble inclinometer) | Baseline and just after stretching exercise | 
| Concentric strength | Change of trapezius muscles, rotattor cuff muscles concentric strength (in kg, with hand held dynamometer) | Baseline and just after stretching exercise | 
| Eccentric strength | Change of shoulder abduction and external rotation eccentric strength (in kg, with hand held dynamometer) | Baseline and just after stretching exercise | 
| Subacromial space | Change of subacromial space ( with Ultrasound) | Baseline and just after stretching exercise | 
| Pain | Change of visual analog scale score in activity and rest | Baseline and just after stretching exercise | 
| Shoulder external rotation range of motion | Change of shoulder external rotation range of motion (with bubble inclinometer) | Baseline and just after stretching exercise | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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isolytic stretching, static stretching, Glenohumeral Internal Rotation Deficit