THE EFFECTIVENESS OF EXERCISE THERAPY AND MYOFASCIAL RELEASE WITH TOOLS FOR SCAPULAR DYSKINESIS IN PATIENTS WITH ROTATOR CUFF RELATED SHOULDER PAIN

A.Ζ. Cheimonidou¹, K. Fousekis², G. Papathanasiou³, G. Tsatsakos⁴, P. Rentzias¹, G. Ploutarchou¹, D. Lamnisos¹, D. Stasinopoulos³

Background: Scapular dyskinesis is a motor dysfunction associated with the rotator cuff related shοulder pain  (RCRSP). The primary role in rehabilitation has the exercise therapy focused on scapula in combination with stretching. After the review of the literature,  was found that there are conflicting data about the physiotherapy interventions in patients with rotator cuff related shoulder pain  (RCSRP) and scapular dyskinesis. Also, no findings were found that investigated the effect of therapeutic exercise and myofascial release (MFR) with tools in this dysfunction. This scientific gap is being filled by the present research study.

Purpose: The aim of this study was to investigate the effect of exercise therapy and MFR with tools in scapular dyskinesis in patients with RCSRP.

Methods: 46 patients participants with RCRSP and scapular dyskinesis were randomized in 2 different exercise groups: (A) exercise therapy for scapula stabilization based on a kinetic approach, stretching and patient education (B) exercise program in combination with myofascial release with tools, (C ) general exercises at home (control group). The outcome measures evaluated at baseline, after 6 weeks and after 12 weeks of the physiotherapy program: pain (VAS 0-10), functionality (Shoulder Rating Questionnaire), shoulder ROM (Clinometer Pro), scapula upward rotation (Clinometer Pro), strength (muscle tests-Microfet), protraction shoulder (Αcromial Τable Index and Pectoralis Muscle Length Index), posture (craniovertebral angle and thoracic curvature - photogrammetry).

Results: Statistically significant differences p <0.05 were observed for group A (exercise therapy) and B (exercise therapy and MFR with tools) compared to the group of general exercises at home after 6 and 12 weeks.Τhere was significant improvement (p<0,05) in the strength of the shoulder and scapular muscles (except the upper trapezius), ROM, pain, functionality, in posture and the protraction of the shoulder. Scapular dyskinesis also improved by 53% and 56% for groups A and B at 12 weeks, respectively. The exercise and MFR group (B)  appeared to be superior to the exercise group (A) in the 6th week for pain and functionality. Also in the 6th and 12th the combination of MFR and exercise therapy had statistically significant (p <0.05) greater improvement than exercise only (group A) for the scapula upward rotation in 90ο and 135o elevation of the arm, for the lower trapezoid strength, and the strength and range of motion of flexion, abduction, external rotation and posture.

Conclusion(s): Exercise therapy – scapula stabilization exercises based on motor control, patient education, stretching is a treatment plan that can decrease the pain and improve functionality in patients with scapular dyskinesis and RCRSP. Myofascial release technique with tools contribute to the effect of the therapeutic exercise program.

Implications: This study has implications for clinical practice and the development of physiotherapy treatment plans to address patients with scapular dyskinesis and rotator cuff related shoulder pain the burden of lower limb musculoskeletal pain and disability.

Funding, acknowledgements: The authors have no funding or grants to report and have received no financial benefits.

Keywords: scapular dyskinesis, rotator cuff related shoulder pain, exercise therapy

Topic: Musculoskeletal: upper limb

Did this work require ethics approval? Yes

Institution: European University Cyprus

Committee: Cyprus National Bioethics Committee

Ethics number: 2019.01.167