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
Main Article Content
Keywords
subacromial impingement syndrome; functional shoulder exercises; inclinometer; joint position sense; Hand held dynamometer; traditional shoulder strength training
Abstract
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.
References
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7. Bossuyt FM, Arnet U, Brinkhof MWG, Eriks-Hoogland I, Lay V, Müller R, et al. Shoulder pain in the Swiss spinal cord injury community: prevalence and associated factors. Disabil Rehabil. 2018;40(7):798–805.
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9. Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement syndrome of the shoulder. Deutsches Ärzteblatt International. 2017 Nov;114(45):765.
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11. Celik D, Sirmen B, Demirhan M. The relationship of muscle strength and pain in subacromial impingement syndrome. Acta orthopaedica et traumatologica turcica. 2011 Mar 1;45(2):79-84.
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16. Townsend H, Jobe FW, Pink M, Perry J. Electromyographic analysis of the glenohumeral muscles during a baseball rehabilitation program. The American journal of sports medicine. 1991 May;19(3):264-72.
17. Lephart SM, Pincivero DM, Giraido JL, Fu FH. The role of proprioception in the management and rehabilitation of athletic injuries. The American journal of sports medicine. 1997 Jan;25(1):130-7.
18. Barrett DS, Cobb AG, Bentley G. Joint proprioception in normal, osteoarthritic and replaced knees. The Journal of bone and joint surgery. British volume. 1991 Jan;73(1):53-6.
19. Eshoj HR, Rasmussen S, Frich LH, Hvass I, Christensen R, Boyle E, Jensen SL, Søndergaard J, Søgaard K, Juul-Kristensen B. Neuromuscular exercises improve shoulder function more than standard care exercises in patients with a traumatic anterior shoulder dislocation: a randomized controlled trial. Orthopaedic journal of sports medicine. 2020 Jan 30;8(1):2325967119896102.
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23. Consigliere P, Haddo O, Levy O, Sforza G. Subacromial impingement syndrome: management challenges. Orthopedic research and reviews. 2018;10:83.
24. Heron SR, Woby SR, Thompson DP. Comparison of three types of exercise in the treatment of rotator cuff tendinopathy/shoulder impingement syndrome: A randomized controlled trial. Physiotherapy. 2017 Jun 1;103(2):167-73.
25. Ager AL, Roy JS, Gamache F, Hébert LJ. The effectiveness of an upper extremity neuromuscular training program on the shoulder function of military members with a rotator cuff tendinopathy: a pilot randomized controlled trial. Military medicine. 2019 May 1;184(5-6):e385-93.
26. Gumina S, Camerota F, Celletti C, Venditto T, Candela V. The effects of rotator cuff tear on shoulder proprioception. International orthopaedics. 2019 Jan;43(1):229-35.
27. Coinceicao A, Parraca J, Marinho D, Costa M, Louro H, Silva A, Batalha N. Assessment of isometric strength of the shoulder rotators in swimmers using a handheld dynamometer: a reliability study. Acta of bioengineering and biomechanics. 2018;20(4).
28. Ingwersen KG, Jensen SL, Sørensen L, Jørgensen HR, Christensen R, Søgaard K, Juul-Kristensen B. Three months of progressive high-load versus traditional low-load strength training among patients with rotator cuff tendinopathy: primary results from the double-blind randomized controlled RoCTEx trial. Orthopaedic journal of sports medicine. 2017 Aug 23;5(8):2325967117723292.
29. Ronai P. Bilateral Scapular Retraction and Shoulder External Rotation with Resistance Bands. ACSM's Health & Fitness Journal. 2018 Jul 1;22(4):19-24.
30. Vallés-Carrascosa E, Gallego-Izquierdo T, Jiménez-Rejano JJ, Plaza-Manzano G, Pecos-Martín D, Hita-Contreras F, Ochoa AA. Pain, motion and function comparison of two exercise protocols for the rotator cuff and scapular stabilizers in patients with subacromial syndrome. Journal of Hand Therapy. 2018 Apr 1;31(2):227-37.
31. Brukner P. Brukner & Khan's clinical sports medicine. North Ryde: McGraw-Hill; 2012.
32. Panse R, Yeole U, Pawar K, Pawar P. Effects of Blackburn exercises in shoulder impingement on pain and disability in rock climbers. Age. 2018;22:3-57.
33. Ager AL, Roy JS, Gamache F, Hébert LJ. The effectiveness of an upper extremity neuromuscular training program on the shoulder function of military members with a rotator cuff tendinopathy: a pilot randomized controlled trial. Military medicine. 2019 May 1;184(5-6):e385-93.
34. Moezy A, Sepehrifar S, Dodaran MS. The effects of scapular stabilization based exercise therapy on pain, posture, flexibility and shoulder mobility in patients with shoulder impingement syndrome: a controlled randomized clinical trial. Medical journal of the Islamic Republic of Iran. 2014;28:87.
35. Zech A, Huebscher M, Vogt L, Banzer W, Hänsel F, Pfeifer K. Neuromuscular training for
rehabilitation of sports injuries: a systematic review. Medicine & science in sports & exercise. 2009 Oct 1;41(10):1831-41.
36. Sahin E, Dilek B, Baydar M, Gundogdu M, Ergin B, Manisali M, Akalin E, Gulbahar S. Shoulder proprioception in patients with subacromial impingement syndrome. Journal of back and musculoskeletal rehabilitation. 2017 Jan 1;30(4):857-62.
37. Başkurt Z, Başkurt F, Gelecek N, Özkan MH. The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome. Journal of back and musculoskeletal rehabilitation. 2011 Jan 1;24(3):173-9.
38. Thakur D. Forward head posture correction versus shoulder stabilization exercises effect on scapular dyskinesia and shoulder proprioception in athletes: an experimental study (Doctoral dissertation, KLE University, Belagavi, Karnataka).
39. Salles JI, Velasques B, Cossich V, Nicoliche E, Ribeiro P, Amaral MV, Motta G. Strength training and shoulder proprioception. Journal of athletic training. 2015 Mar;50(3):277-80.
40. Saadatian A, Babaei Khorzoghi M, Sahebozamani M, Taghi Karimi M. The Impact of OKC Exercises and TRX Exercises on Shoulder Joint Proprioception in Overhead Athletes With Shoulder Impingement Syndrome: A Randomized Controlled Trial. Physical Treatments-Specific Physical Therapy Journal. 2022 Apr 10;12(2):77-84.
41. Shiravi S, Letafatkar A, Bertozzi L, Pillastrini P, Khaleghi Tazji M. Efficacy of abdominal control feedback and scapula stabilization exercises in participants with forward head, round shoulder postures and neck movement impairment. Sports Health. 2019 May;11(3):272-9.
42. Chaconas EJ, Kolber MJ, Hanney WJ, Daugherty ML, Wilson SH, Sheets C. Shoulder external rotator eccentric training versus general shoulder exercise for subacromial pain syndrome: a randomized controlled trial. International journal of sports physical therapy. 2017 Dec;12(7):1121.
43. Folland JP, Williams AG. Morphological and neurological contributions to increased strength. Sports medicine. 2007 Feb;37:145-68.
44. Kubo K, Kawakami Y, Kanehisa H, Fukunaga T. Measurement of viscoelastic properties of tendon structures in vivo. Scandinavian journal of medicine & science in sports. 2002 Feb;12(1):3-8.
45. Shahpar FM, Rahnama N, Salehi S. The effect of 8 weeks open and closed kinetic chain strength training on the torque of the external and internal shoulder rotator muscles in elite swimmers. Asian Journal of Sports Medicine. 2019 Jun 30;10(2).
46. Moghadam AN, Mohammadi R, Arab AM, Kazamnajad A. The effect of shoulder core exercises on isometric torque of glenohumeral joint movements in healthy young females. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2011 Dec;16(12):1555.
47. Weier AT, Pearce AJ, Kidgell DJ. Strength training reduces intracortical inhibition. Acta physiologica. 2012 Oct;206(2):109-19.
48. Nuzzo JL, Barry BK, Jones MD, Gandevia SC, Taylor JL. Effects of four weeks of strength training on the corticomotoneuronal pathway. Med Sci Sports Exerc. 2017 Nov 1;49(11):2286-96.
49. Del Vecchio A, Casolo A, Negro F, Scorcelletti M, Bazzucchi I, Enoka R, Felici F, Farina D. The increase in muscle force after 4 weeks of strength training is mediated by adaptations in motor unit recruitment and rate coding. The Journal of physiology. 2019 Apr;597(7):1873-87.
2. Schopflocher D, Taenzer P, & Jovey R. The prevalence of chronic pain in Canada. Pain Res Manag. 2011; 16(6): 445–450
3. Urwin M, Symmons D, Allison T. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis 1998; 557: 649–55.
4. Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The Prevalence of Chronic Pain in United States Adults: Results of an Internet- Based Survey, The Journal of Pain, 2010; 11 (11): 1230–1239.
5. Hill CL, Gill TK, Shanahan E and Taylor AW. Prevalence and correlates of shoulder pain and stiffness in a population‐based study: The North West Adelaide Health Study. International Journal of Rheumatic Diseases, 2010; 13: 215–222.
6. Yeldan I, Cetin E, Ozdincler AR. The effectiveness of low-level laser therapy on shoulder function in subacromial impingement syndrome. Disabil Rehabil. 2009;31(11):935–40.
7. Bossuyt FM, Arnet U, Brinkhof MWG, Eriks-Hoogland I, Lay V, Müller R, et al. Shoulder pain in the Swiss spinal cord injury community: prevalence and associated factors. Disabil Rehabil. 2018;40(7):798–805.
8. Dhillon KS. Subacromial impingement syndrome of the shoulder: a musculoskeletal disorder or a medical myth?. Malaysian orthopaedic journal. 2019 Nov;13(3):1.
9. Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement syndrome of the shoulder. Deutsches Ärzteblatt International. 2017 Nov;114(45):765.
10. Anderson VB, Wee E. Impaired joint proprioception at higher shoulder elevations in chronic rotator cuff pathology. Archives of physical medicine and rehabilitation. 2011 Jul 1;92(7):1146-51.
11. Celik D, Sirmen B, Demirhan M. The relationship of muscle strength and pain in subacromial impingement syndrome. Acta orthopaedica et traumatologica turcica. 2011 Mar 1;45(2):79-84.
12. Page MJ, Green S, McBain B, Surace SJ, Deitch J, Lyttle N, Mrocki MA, Buchbinder R. Manual therapy and exercise for rotator cuff disease. Cochrane Database of Systematic Reviews. 2016(6).
13. Yavuz F, Duman I, Taskaynatan MA, Tan AK. Low-level laser therapy versus ultrasound therapy in the treatment of subacromial impingement syndrome: a randomized clinical trial. Journal of back and musculoskeletal rehabilitation. 2014 Jan 1;27(3):315-20.
14. Haik MN, Alburquerque-Sendín F, Moreira RF, Pires ED, Camargo PR. Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials. British journal of sports medicine. 2016 Sep 1;50(18):1124-34.
15. Bang MD, Deyle GD. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement
syndrome. Journal of Orthopaedic & Sports Physical Therapy. 2000 Mar;30(3):126-37.
16. Townsend H, Jobe FW, Pink M, Perry J. Electromyographic analysis of the glenohumeral muscles during a baseball rehabilitation program. The American journal of sports medicine. 1991 May;19(3):264-72.
17. Lephart SM, Pincivero DM, Giraido JL, Fu FH. The role of proprioception in the management and rehabilitation of athletic injuries. The American journal of sports medicine. 1997 Jan;25(1):130-7.
18. Barrett DS, Cobb AG, Bentley G. Joint proprioception in normal, osteoarthritic and replaced knees. The Journal of bone and joint surgery. British volume. 1991 Jan;73(1):53-6.
19. Eshoj HR, Rasmussen S, Frich LH, Hvass I, Christensen R, Boyle E, Jensen SL, Søndergaard J, Søgaard K, Juul-Kristensen B. Neuromuscular exercises improve shoulder function more than standard care exercises in patients with a traumatic anterior shoulder dislocation: a randomized controlled trial. Orthopaedic journal of sports medicine. 2020 Jan 30;8(1):2325967119896102.
20. Zech A, Huebscher M, Vogt L, Banzer W, Hänsel F, Pfeifer KL. Neuromuscular training for rehabilitation of sports injuries: a systematic review. Med Sci Sports Exerc. 2009 Oct 1;41(10):1831-41.
21. Zech A, Hübscher M, Vogt L, Banzer W, Hänsel F, Pfeifer K. Balance training for neuromuscular control and performance enhancement: a systematic review. Journal of athletic training. 2010 Jul;45(4):392-403.
22. Abbas SH, Karvannan H, Prem V. Effect of neuromuscular training on functional throwing performance and speed in asymptomatic cricket players. Journal of Bodywork and Movement Therapies. 2019 Jul 1;23(3):502-7.
23. Consigliere P, Haddo O, Levy O, Sforza G. Subacromial impingement syndrome: management challenges. Orthopedic research and reviews. 2018;10:83.
24. Heron SR, Woby SR, Thompson DP. Comparison of three types of exercise in the treatment of rotator cuff tendinopathy/shoulder impingement syndrome: A randomized controlled trial. Physiotherapy. 2017 Jun 1;103(2):167-73.
25. Ager AL, Roy JS, Gamache F, Hébert LJ. The effectiveness of an upper extremity neuromuscular training program on the shoulder function of military members with a rotator cuff tendinopathy: a pilot randomized controlled trial. Military medicine. 2019 May 1;184(5-6):e385-93.
26. Gumina S, Camerota F, Celletti C, Venditto T, Candela V. The effects of rotator cuff tear on shoulder proprioception. International orthopaedics. 2019 Jan;43(1):229-35.
27. Coinceicao A, Parraca J, Marinho D, Costa M, Louro H, Silva A, Batalha N. Assessment of isometric strength of the shoulder rotators in swimmers using a handheld dynamometer: a reliability study. Acta of bioengineering and biomechanics. 2018;20(4).
28. Ingwersen KG, Jensen SL, Sørensen L, Jørgensen HR, Christensen R, Søgaard K, Juul-Kristensen B. Three months of progressive high-load versus traditional low-load strength training among patients with rotator cuff tendinopathy: primary results from the double-blind randomized controlled RoCTEx trial. Orthopaedic journal of sports medicine. 2017 Aug 23;5(8):2325967117723292.
29. Ronai P. Bilateral Scapular Retraction and Shoulder External Rotation with Resistance Bands. ACSM's Health & Fitness Journal. 2018 Jul 1;22(4):19-24.
30. Vallés-Carrascosa E, Gallego-Izquierdo T, Jiménez-Rejano JJ, Plaza-Manzano G, Pecos-Martín D, Hita-Contreras F, Ochoa AA. Pain, motion and function comparison of two exercise protocols for the rotator cuff and scapular stabilizers in patients with subacromial syndrome. Journal of Hand Therapy. 2018 Apr 1;31(2):227-37.
31. Brukner P. Brukner & Khan's clinical sports medicine. North Ryde: McGraw-Hill; 2012.
32. Panse R, Yeole U, Pawar K, Pawar P. Effects of Blackburn exercises in shoulder impingement on pain and disability in rock climbers. Age. 2018;22:3-57.
33. Ager AL, Roy JS, Gamache F, Hébert LJ. The effectiveness of an upper extremity neuromuscular training program on the shoulder function of military members with a rotator cuff tendinopathy: a pilot randomized controlled trial. Military medicine. 2019 May 1;184(5-6):e385-93.
34. Moezy A, Sepehrifar S, Dodaran MS. The effects of scapular stabilization based exercise therapy on pain, posture, flexibility and shoulder mobility in patients with shoulder impingement syndrome: a controlled randomized clinical trial. Medical journal of the Islamic Republic of Iran. 2014;28:87.
35. Zech A, Huebscher M, Vogt L, Banzer W, Hänsel F, Pfeifer K. Neuromuscular training for
rehabilitation of sports injuries: a systematic review. Medicine & science in sports & exercise. 2009 Oct 1;41(10):1831-41.
36. Sahin E, Dilek B, Baydar M, Gundogdu M, Ergin B, Manisali M, Akalin E, Gulbahar S. Shoulder proprioception in patients with subacromial impingement syndrome. Journal of back and musculoskeletal rehabilitation. 2017 Jan 1;30(4):857-62.
37. Başkurt Z, Başkurt F, Gelecek N, Özkan MH. The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome. Journal of back and musculoskeletal rehabilitation. 2011 Jan 1;24(3):173-9.
38. Thakur D. Forward head posture correction versus shoulder stabilization exercises effect on scapular dyskinesia and shoulder proprioception in athletes: an experimental study (Doctoral dissertation, KLE University, Belagavi, Karnataka).
39. Salles JI, Velasques B, Cossich V, Nicoliche E, Ribeiro P, Amaral MV, Motta G. Strength training and shoulder proprioception. Journal of athletic training. 2015 Mar;50(3):277-80.
40. Saadatian A, Babaei Khorzoghi M, Sahebozamani M, Taghi Karimi M. The Impact of OKC Exercises and TRX Exercises on Shoulder Joint Proprioception in Overhead Athletes With Shoulder Impingement Syndrome: A Randomized Controlled Trial. Physical Treatments-Specific Physical Therapy Journal. 2022 Apr 10;12(2):77-84.
41. Shiravi S, Letafatkar A, Bertozzi L, Pillastrini P, Khaleghi Tazji M. Efficacy of abdominal control feedback and scapula stabilization exercises in participants with forward head, round shoulder postures and neck movement impairment. Sports Health. 2019 May;11(3):272-9.
42. Chaconas EJ, Kolber MJ, Hanney WJ, Daugherty ML, Wilson SH, Sheets C. Shoulder external rotator eccentric training versus general shoulder exercise for subacromial pain syndrome: a randomized controlled trial. International journal of sports physical therapy. 2017 Dec;12(7):1121.
43. Folland JP, Williams AG. Morphological and neurological contributions to increased strength. Sports medicine. 2007 Feb;37:145-68.
44. Kubo K, Kawakami Y, Kanehisa H, Fukunaga T. Measurement of viscoelastic properties of tendon structures in vivo. Scandinavian journal of medicine & science in sports. 2002 Feb;12(1):3-8.
45. Shahpar FM, Rahnama N, Salehi S. The effect of 8 weeks open and closed kinetic chain strength training on the torque of the external and internal shoulder rotator muscles in elite swimmers. Asian Journal of Sports Medicine. 2019 Jun 30;10(2).
46. Moghadam AN, Mohammadi R, Arab AM, Kazamnajad A. The effect of shoulder core exercises on isometric torque of glenohumeral joint movements in healthy young females. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2011 Dec;16(12):1555.
47. Weier AT, Pearce AJ, Kidgell DJ. Strength training reduces intracortical inhibition. Acta physiologica. 2012 Oct;206(2):109-19.
48. Nuzzo JL, Barry BK, Jones MD, Gandevia SC, Taylor JL. Effects of four weeks of strength training on the corticomotoneuronal pathway. Med Sci Sports Exerc. 2017 Nov 1;49(11):2286-96.
49. Del Vecchio A, Casolo A, Negro F, Scorcelletti M, Bazzucchi I, Enoka R, Felici F, Farina D. The increase in muscle force after 4 weeks of strength training is mediated by adaptations in motor unit recruitment and rate coding. The Journal of physiology. 2019 Apr;597(7):1873-87.
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Apr 15, 2023
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Aya Ahmed Elnour, Maha Mostafa Mohammed, Nadia Fayaz, Ahmed Hassan Waly, & Dina M. A. Al Hamaky. (2023). 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. Journal of Population Therapeutics and Clinical Pharmacology, 30(7), 97–109. https://doi.org/10.47750/jptcp.2023.30.07.012
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