Effect of Pilates Exercises and Diaphragm Manual Therapy Techniques in Rotator Cuff Tendinopathy

Study Overview
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Brief Summary
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To investigate the effect of Pilates exercises program on pain intensity, pain threshold, shoulder lateral rotator strength, abduction strength and shoulder function in patients with (RCT). To investigate the effect of diaphragm manual therapy techniques on pain intensity, pain threshold, shoulder lateral rotator strength, abduction strength and shoulder function in patients with (RCT). To determine the effect of combination between Pilates exercises program and diaphragm manual therapy techniques on pain intensity, pain threshold, shoulder lateral rotator strength, abduction strength and shoulder function in patients with (RCT).

Detailed Description
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Musculoskeletal complains are common work-related problems in Egypt. Egyptian preparatory school teachers were 96% (El Gendy and Korish,2017). Dental society revealed high response rate (93%) with 53.8% have complains related to neck/shoulder (Diaa Eldien et al.,2021).Physical therapists (PTs) are frequently exposed to work-related musculoskeletal disorders .Shoulder problems represent (47.7%) (Abu-Taleb and Rehan, 2021).Printing workers and municipal solid waste collectors are another group having high prevalence of work-related musculoskeletal disorders that might be related to some individual factors (age, BMI, and duration of employment) (Abou-ElWafa et al.,2012 and Mourad, 2021). Since pilates shoulder exercise influence shoulder function and pain and to considering the relationship between shoulder muscles and the thoracic cage expansion. Consequently, it is worthy to investigate the efficacy of Pilates exercises program with diaphragm manual therapy techniques in pain intensity, pain threshold, shoulder lateral rotator strength, abduction strength and shoulder function on patient with rotator cuff tendinopathy aiming for function improvement and pain decrease. Therefore, this study is being conducted for this purpose.

Official Title
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Effect of Pilates Exercises and Diaphragm Manual Therapy Techniques in Rotator Cuff Tendinopathy

Conditions
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Shoulder Tendinitis, Shoulder Rotator Cuff Tendinopathy

Intervention / Treatment
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* Other: pilates exercise and diaphragm manual technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients diagnosed with rotator cuff tendinopathy for duration greater than three months (Eda and Emin,2016). 40 and 60 years of age from both genders (Yamamoto et al.,2019) Patient's BMI within normal range between 18.5 and 24.9 (Gumina et al.,2014) patients complain of shoulder pain at the tip of the shoulder and the upper, outer arm. The pain is aggravated by reaching, pushing, pulling, lifting, positioning the arm above the shoulder level, or lying on the side (Stiphen and Micheal,1021). The arm pain during resisted testing (usually abduction and/or lateral rotation) (Eda and Emin, Exclusion Criteria: 1. Stiff shoulder such as adhesive capsulitis 2. Any previse dislocation or sublation of shoulder joint. 3. Previous shoulder surgery 4. Glenohumeral joint and acromioclavicular joint degeneration 5. Neurological deficit in the neck or arm 6. Heavy Smokers. 7. Any Cardiopulmonary pathology. 8. Recent Thoracic surgery 9. Any deformity of spine 10. History of Thyroid Disorders 11. Cognitive impairment

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 60 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: Patients diagnosed with rotator cuff tendinopathy for duration greater than three months (Eda and Emin,2016). 40 and 60 years of age from both genders (Yamamoto et al.,2019) Patient's BMI within normal range between 18.5 and 24.9 (Gumina et al.,2014) patients complain of shoulder pain at the tip of the shoulder and the upper, outer arm. The pain is aggravated by reaching, pushing, pulling, lifting, positioning the arm above the shoulder level, or lying on the side (Stiphen and Micheal,1021). The arm pain during resisted testing (usually abduction and/or lateral rotation) (Eda and Emin,
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group A<br>fifteen patients diagnosed with shoulder rotator cuff tendinopathy for at least 3 months randomly selected from ministry of health units will receive Pilates exercises program additional to traditional (RCT) physical therapy program containing Hot-Pack (HP), Therapeutic Ultrasound (US) and upper extremity strengthening and stretching exercise program) The assessment of pain intensity was carried out by visual analog scale The assessment of pain threshold was carried out by pressure algometer. The assessment of lateral rotation strength and abduction strength were carried out by hand heled dynamometer. The assessment of shoulder function was carried out by Arabic version of the Disability of the Arm, Shoulder and Hand (DASH-Arabic) The assessment of the functional exercise performance was carried out by Six-min walk test | Other: pilates exercise and diaphragm manual technique<br>* pilates exercises<br>* Other names: exercises;|
| Experimental: Group B<br>fifteen patients diagnosed with shoulder rotator cuff tendinopathy for at least 3 months randomly selected from ministry of health units will receive diaphragm manual therapy techniques and traditional rotator cuff tendinopathy physical therapy program containing Hot-Pack (HP), Therapeutic Ultrasound (US) and upper extremity strengthening and stretching exercise program) The assessment of pain intensity was carried out by visual analog scale The assessment of pain threshold was carried out by pressure algometer. The assessment of lateral rotation strength and abduction strength were carried out by hand heled dynamometer. The assessment of shoulder function was carried out by Arabic version of the Disability of the Arm, Shoulder and Hand (DASH-Arabic) The assessment of the functional exercise performance was carried out by Six-min walk test | Other: pilates exercise and diaphragm manual technique<br>* pilates exercises<br>* Other names: exercises;|
| Experimental: Group c<br>fifteen patients diagnosed with shoulder rotator cuff tendinopathy for at least 3 months randomly selected from ministry of health units will receive 15 received traditional rotator cuff tendinopathy physical therapy program containing Hot-Pack (HP), Therapeutic Ultrasound (US) and upper extremity strengthening and stretching exercise program) The assessment of pain intensity was carried out by visual analog scale The assessment of pain threshold was carried out by pressure algometer. The assessment of lateral rotation strength and abduction strength were carried out by hand heled dynamometer. The assessment of shoulder function was carried out by Arabic version of the Disability of the Arm, Shoulder and Hand (DASH-Arabic) The assessment of the functional exercise performance was carried out by Six-min walk test | Other: pilates exercise and diaphragm manual technique<br>* pilates exercises<br>* Other names: exercises;|
| Experimental: Group D<br>fifteen patients diagnosed with shoulder rotator cuff tendinopathy for at least 3 months randomly selected from ministry of health units will receive traditional rotator cuff tendinopathy physical therapy program containing Hot-Pack (HP), Therapeutic Ultrasound (US) and upper extremity strengthening and stretching exercise program) The assessment of pain intensity was carried out by visual analog scale The assessment of pain threshold was carried out by pressure algometer. The assessment of lateral rotation strength and abduction strength were carried out by hand heled dynamometer. The assessment of shoulder function was carried out by Arabic version of the Disability of the Arm, Shoulder and Hand (DASH-Arabic) The assessment of the functional exercise performance was carried out by Six-min walk test | Other: pilates exercise and diaphragm manual technique<br>* pilates exercises<br>* Other names: exercises;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| shoulder pain | visual analog scale pain threshold will be carried out by pressure algometer | 4 weeks | 
| strength of shoulder muscle | hand heled dynamometer | 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Shoulder Tendinitis, shoulder rotator cuff tendinopathy, Pilates exercise, diaphragmatic respiratory technique, physical therapy