Effect of Neuromuscular Training on Shoulder Proprioception and Isometric Internal Rotators Muscle Strength in Patients with Shoulder Impingement Syndrome: A Double-Blinded Randomized Controlled Trial

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Aya Ahmed Elnour
Maha Mostafa Mohammed
Nadia Fayaz
Ahmed Hassan Waly
Dina M. A. Al Hamaky


subacromial impingement syndrome; functional shoulder exercises; inclinometer; joint position sense; Hand held dynamometer; traditional shoulder strength training


Background: The most common musculoskeletal condition affecting the upper extremities is shoulder impingement syndrome, it is a chronic painful shoulder condition produced by a reduction in the subacromial space. It has also been demonstrated that rotator cuff injuries result in lower shoulder proprioception. The most important characteristic of shoulder impingement syndrome is decrease in isometric strength of the shoulder muscles; it might be due to the subsequent deconditioning of the muscles or due to deficits in motor control of the muscles. neuromuscular training exercises encourage both afferent signals and cerebral mechanisms that maintain dynamic joint stability to facilitate unconscious motor responses.
Purpose: To investigate the effect of neuromuscular training on shoulder impingement syndrome in terms of shoulder proprioception and internal rotators muscle strength.
Methods: Through non-probability sampling, thirty four patients of both sexes were chosen. Their ages ranged from 25 to 45 and were diagnosed with shoulder impingement syndrome (Neer’s stage II). They were assigned into one of two groups at random. Traditional strength training group (I). Upper extremity neuromuscular training exercises group (II). Patients were assessed before and after therapy (6 weeks) using an inclinometer to assess shoulder proprioception and a hand-held dynamometer to assess the isometric muscle strength of the shoulder internal rotators. 

Results: In both groups, there was a significant improvement in shoulder proprioception and shoulder internal rotator muscle strength (P< 0.05). There was a significant difference between both groups regarding shoulder proprioception (P<0.05) while there was no significant difference between them regarding shoulder internal rotators muscle strength.
Conclusion: neuromuscular training was superior to traditional strength training in improving shoulder proprioception.

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