Comparative Effects of Conscious Abdominal Contraction and Closed Kinetic Chain Exercises

Study Overview
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Brief Summary
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Subacromial pain syndrome is a general term used to describe pain which originates from the shoulder and can spread towards the neck or down the arm. It's the most common reason for shoulder pain. The aim of study will be to compare the effects of conscious abdominal contraction and closed kinetic chain exercises on the activation of peri-scapular muscles in badminton players with sub-acromial pain syndrome.

Detailed Description
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A Randomized Clinical Trial will be conducted at Sir Syed Sports Complex Sargodha, through convenience sampling technique on 52 patients which will be allocated using random sampling through computerized generated number into Group A and Group B. Group A will be treated with closed kinetic chain exercises. Group B was treated with abdominal contraction exercises for periscapular activation. These exercises will be done in 3 sets with 10 repetitions. There will be 3 sessions per week. Baseline measurement will be taken on 1st day of evaluation and post treatment will be taken on 4th week. Data will be analyzed during SPSS software version 25. After assessing normality of data by Shapiro-Wilk test, it will be decided either parametric or non-parametric test will be used within a group or between two groups.

Official Title
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Comparative Effects of Conscious Abdominal Contraction and Closed Kinetic Chain Exercises on the Activation of Periscapular Muscles in Badminton Players With Subacromial Pain Syndrome

Conditions
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Subacromial Impingement

Intervention / Treatment
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* Other: Closed kinetic chain exercises
* Other: Abdominal contraction exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male Badminton players Age 20 to 40 years Unilateral shoulder pain Pain with overhead activities Positive Hawkins Kennedy test Positive painful arc(60-120 degrees) Positive Neer impingement test Positive external rotation test Numeric pain Rating Scale NPRS value(3-7) Exclusion Criteria: Adhesive capsulitis Know shoulder instability Neck pain Radiating pain from shoulder to hand Receiving any intervention for shoulder injury. Previous history of 6 month shoulder trauma. Previous history of shoulder surgery. Taking any critical care medicine

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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Male

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
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group A<br>Group A will be treated with closed kinetic chain exercises | Other: Closed kinetic chain exercises<br>* Group A will be treated with closed kinetic chain exercises. Group A: Group A will be treated with closed kinetic chain exercises. Closed kinetic chain exercises enhance the proprioception by coordinating the mechanical receptors as well as the strength of the external shoulder rotator muscles, reduce the pain and improve the shoulder. Closed kinetic chain exercises include: Push up Scapular push up Scapular dip Crab walk Common Treatment: Cryotherapy 10 minutes 2 times per day. Ultrasonography 1Mhz frequency, 0.4 watt/cm for 10 minutes. Transcutaneous electrical stimulation (TENS) 10 minutes, modulation mode, frequency 280, wavelength 80. Cross arm stretching 5 times 30 sec hold. Shoulder isometric exercises 10 repetitions 3 sets for 3 times per week.<br>|
| Experimental: Group B<br>Group B was treated with abdominal contraction exercises for periscapular activation | Other: Abdominal contraction exercises<br>* Group B was treated with abdominal contraction exercises for periscapular activation that includes: Wall slide, knee pushup, external rotation kneeling, Full can and External rotation with elevation and isometric low row. Common Treatment: Cryotherapy 10 minutes 2 times per day. Ultrasonography 1Mhz frequency, 0.4 watt/cm for 10 minutes. Transcutaneous electrical stimulation (TENS) 10 minutes, modulation mode, frequency 280,wavelength 80. Cross arm stretching 5 times 30 sec hold. Shoulder isometric exercises 10 repetitions 3 sets for 3 times per week.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| NPRS | Patient level of pain will be assessed using this scale. In a Numerical Rating Scale (NRS), this scale ranges from 0 to 10. 0 indicates no pain and 10 indicates worst pain patients are asked to circle the number between 0 and 10, that fits best to their pain intensity. NRS scores ≤ 5 correspond to mild, scores of 6-7 to moderate and scores ≥8 to severe pain in terms of pain-related interference with functioning. Zero usually represents 'no pain at all' whereas the upper limit represents 'the worst pain ever possible. The NPRS is a widely used subjective pain measure that has good test-retest reliability (r=. 79-. 96) and validity of NPRS range from 0.86 to 0.95. | upto 4-week | 
| SPADI | The Shoulder Pain and Disability Index (SPADI) consists of 13 items that have two main domains; in which subscale of 5-item that measures the pain and subscale of 8- item measures disability. The reliability of SPADI ranged from 0.90 to 0.94 and the validity ranged from 0.87 to 0.89. The Shoulder Pain and Disability Index (SPADI) is a self-administered questionnaire that consists of two dimensions, one for pain and the other for functional activities. The pain dimension consists of five questions regarding the severity of an individual's pain. Functional activities are assessed with eight questions designed to measure the degree of difficulty an individual has with various activities of daily living that require upper-extremity use. The SPADI takes 5 to 10 minutes for a patient to complete and is the only reliable and valid region-specific measure for the shoulder. | upto 4-week | 
| Universal Goniometer | A goniometer will be used in the study to measure shoulder flexion, internal rotation and external rotation. Goniometer is an instrument that measures the available range of motion at a joint. To .measure the range of motion physical therapists most commonly use a goniometer. Therapist can use a goniometer to assess what the range of motion is at the initial assessment. The validity of UG (r=0.84 to 0.93) and high intra-rater reliability of goniometer on repeated measures of shoulder range of motions (ICC=0.98-0.99). | upto 4-week | 
| Dynamometer | A dynamometer will be used in study to measure the strength of serratus anterior muscle, latissimus dorsi muscle, upper and lower trapezius muscles It is is a device that can measure force. The hand-held dynamometer is a small device that fits in the examiner's hand and is placed at precise locations on a subject's limb in an effort to assess the force generated by various muscles or groups of muscles. Inter-tester and intra-tester reliability of digital dynamometer were excellent for all movements (ICC ≥ 0.855) and validity is > 0.913. | upto 4-week |