Effects of Scapular Therapeutic Exercise on Essential Biomechanical and Neurophysiological Parameters in Shoulder Pain Conditions With Scapular Impairments

Study Overview
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Brief Summary
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Shoulder pain is a prevalent and recurrent condition. After a period of shoulder pain, some adaptations could be found, as in scapular muscles and kinematics and/or in nervous system. It seems important to assess several biomechanical and neurophysiological outcomes to better characterize shoulder pain conditions and to program an intervention plane. Therapeutic exercise is one of the treatments used for shoulder pain, however there are still doubts and controversial findings regarding exercise focusing the scapular musculature. Thus, the present study aims to assess the effects of an intervention protocol based on scapular therapeutic exercise.

Official Title
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Effects of Scapular Therapeutic Exercise on Essential Biomechanical and Neurophysiological Parameters in Shoulder Pain Conditions With Scapular Impairments

Conditions
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Shoulder Pain

Intervention / Treatment
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* Other: Experimental Scapular Therapeutic Exercise Group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 to 65 years old Chronic (more than 3 months), continuously or intermittently, non-specific or associated with a diagnostic (except if mentioned in the exclusion criteria) shoulder pain of, at least, moderate intensity Presenting scapular alterations as scapular dyskinesis (identified at rest or during motion) Exclusion Criteria: History of shoulder fracture, dislocation, tears, infection or neoplasm Shoulder surgery Cervical and/or thoracic pathologies or pain associated with active movements of these regions Neurological disease Body mass index out of the range 18,5-30 kg/m2 and muscular skinfold higher than 20mm Inability to perform the exercises Current practice of competitive/high-level exercise/sport focusing the upper limb

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 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
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental Scapular Therapeutic Exercise Group<br>Patients in this group will perform therapeutic exercises, recommended for subjects with shoulder pain and focusing the neuromuscular control, stretching and/or strengthening of the scapular muscles | Other: Experimental Scapular Therapeutic Exercise Group<br>* All subjects will perform a program of scapular therapeutic exercises including: neuromuscular control/strength - scapular therapeutic exercises that leads to, at least, moderate muscular activity levels; and stretching exercises. The intervention period will be of 8 weeks, considering in-person and/or home sessions.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in shoulder pain | The intensity of pain will be measured with a self-reported 11-point scale (Numerical Rating Pain Scale), with scores ranging from 0 (no pain) to 10 (maximum pain) | Baseline and one week after intervention | 
| Change in shoulder function | Shoulder functional status will be measured with a self-reported 13 items scale (SPADI), which ranges from 0 (fully functional) to 100 (maximum degree of disability). | Baseline and one week after intervention | 
| Change in scapular muscles activity levels | Scapular muscles activity levels, during shoulder analytical movements and during a functional task, will be recorded superficially by a wireless electromyographic signal detector system | Baseline and one week after intervention | 
| Change in scapular muscles ratio | Ratio between scapular muscles activity levels, during shoulder analytical movements and during a functional task, will be calculated considered the superficially eletromyographic data measured by a wireless electromyographic signal detector system. | Baseline and one week after intervention | 
| Change in kinematics | Scapular kinematics and scapulohumeral rhythm, during shoulder analytical movements and during a functional task, will be measured by inertial sensors and described in degrees (°) | Baseline and one week after intervention | 
| Change in movement quality through time variables | Movement quality will be assessed considering time to peak acceleration and task completion time, calculated according to the data recorded with inertial sensors | Baseline and one week after intervention | 
| Change in movement quality through trunk compensation | Movement quality will be also assessed considering the trunk motion, calculated according to the data recorded with inertial sensors | Baseline and one week after intervention | 
| Change in movement quality through smoothness | Smoothness will be calculated by jerk logarithm of data recorded with inertial sensors | Baseline and one week after intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in muscle stiffness | Scapular muscles stiffness will be assessed by myotonometry (using a digital palpation device) | Baseline and one week after intervention | 
| Change in pressure pain threshold | An assessment point in the shoulder area will be assessed by the application of a mechanical pressure by an algometer | Baseline and one week after intervention | 
| Change in pain-related fear | Assessed with self-reported scales - Tampa Scale for Kinesiophobia, which ranges from 13 (best) to 52 (worst) | Baseline and one week after intervention | 
| Change in pain catastrophization | Assessed with a self-reported scale - Pain Catastrophizing Scale, which ranges from 0 (better) to 52 (worst) | Baseline and one week after intervention | 
| Self-impression of change | The patient's individual perspective about his/her condition and changes felt considering the intervention received will be assessed by a self-reported scale - Patient global impression of change scale, which range from 0 [no change (or condition has got worse)] to 7 (a great deal better, and a considerable improvement that has made all the difference) | One week after intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Shoulder pain, Scapular muscles, Scapular kinematics, Therapeutic exercise