Influence of Kinetic Chain Training on the Treatment Outcome of Overhead Athletes With Impingement

University Ghent38 enrolled

Overview

A randomized controlled trial will be conducted to examine the effectiveness of a traditional home exercise program versus 2 kinetic chain home exercise programs on treatment outcome of overhead athletes with shoulder impingement syndrome. Primary outcome measures are reduction of pain and disability, and improvement in functionality and sports performance. Secondary outcome measures are strength, mobility, flexibility and functional performance.

Participant are randomly assigned in 3 home exercise groups. 1. The traditional program: consists of solely strengthening the rotator cuff muscles and scapular muscles (e.g. external rotation) 2. Separate kinetic chain program: same exercises as the first group but they also receive an exercise program to separately train the core and lower body. (e.g. external rotation separately and squat separately) 3. Integrated kinetic chain program: same exercises as the first group but all exercises are performed while simultaneously activating the kinetic chain. (e.g. external rotation while squatting).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Shoulder Impingement Syndrome

Interventions

Traditional trainingOTHER

Separate kinetic chain trainingOTHER

Integrated kinetic chain trainingOTHER

Eligibility

Sex: ALLMin age: 18 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Symptoms of shoulder impingement on the dominant side for at least 3 months and at least 3 of the following tests are considered positive * Jobe * Hawkins * Neer * Painful arc during elevation * Pain or lack of force production with isometric external rotation * Apprehension test * Relocation test * Performing overhead sports at least 3 hours/week * Shoulder pain interferes with sports activities * They have not had treatment for this shoulder pain Exclusion Criteria: * History of shoulder dislocation or subluxation * History of orthopedic surgery * No complaints of pain or dysfunction in the upper limb (except impingement related complaints in the dominant shoulder), lower limb or spine at the last 6 months * Currently taking nonsteroidal anti-inflammatory medication * Received a steroid injection in the past 12 months * Participating in another study * Known systemic diseases * Known structural diseases

Locations (1)

Vakgroep REVAKI (Ghent University - Ghent University hospital)

Ghent, Belgium

Outcomes

Primary Outcomes

Changes in Shoulder Pain And Disability Index (SPADI) score

Patients will fill in the SPADI questionnaire to evaluate shoulder pain and function. The SPADI is a valid, reliable and frequently used questionnaire for shoulder pain patients consisting of 13 items divided in 2 subscales: pain (5 items) and disability (8 items). Each item was scored on a 10-point numeric rating scale. Total and subscale scores were summed and transformed to a score out of 100 (%) were a higher score indicates a higher level of pain and/or disability

Time frame: At baseline and within one week after the 6-weeks training program

Changes in Western Ontario Shoulder Stability index (WOSI) score

The WOSI is a patient-evaluated disease-specific quality of life scoring questionnaire that has been developed for shoulder instability patients. This 21-item questionnaire consists of 4 subscales: physical symptoms (10 items), sport/recreation/work (4 items), lifestyle (4 items), and emotions (3 items). Each item was scored on a 100-mm visual analogue scale. Total and subscale scores were summed and transformed to a score out of 100 (%) where a higher score indicates more limitations in shoulder related quality of life

Time frame: At baseline and within one week after the 6-weeks training program

Subjective perception of shoulder improvement

A Global Rating of Change (GROC) scale was used to quantify patient-perceived improvement of overall shoulder function after 6 weeks treatment as "improved", "unchanged" or "worse". In case they improved or got worse, the amount of change was reflected on a 5-point scale: very little change, little change, some change, a large change, a very large change. An "unchanged" condition scored 0, "improved" between 1 and 5, and "worse" between -1 and -5 points. amount of change was scored on a 5-point scale (very little change, little change, some change, a large change, a very large change)

Time frame: 6-weeks training program

Secondary Outcomes

Changes in shoulder muscle isokinetic strength (Biodex system 4)

Data from ClinicalTrials.gov

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Isokinetic strength of shoulder internal and external rotators will be measured bilateral with the Biodex device (Biodex system 4, Biodex Medical Systems, Inc., Shirley, New York, USA). For further analysis, concentric peak torque (PT) (rotation) or peak force (PF) (protraction-retraction) values were normalized to body weight (BW). A higher value represents more strength and thus a better outcome.