Segmental Muscle Vibration for Subacromial Impingement Syndrome
Effectiveness of Adding Segmental Muscle Vibration to Conventional Rehabilitation Treatment for Subacromial Impingement Syndrome
University of L'Aquila
30 participants
Apr 26, 2021
Interventional
Conditions
Summary
Subacromial impingement syndrome (SIS), is a condition characterized by pain, without a history of trauma, located in the rotator cuff tendons, subacromial bursa, biceps tendon and shoulder capsule or in a combination of these structures, which can ultimately lead to shoulder dysfunction, compromising work, sport, or activity of daily living. SIS, accounting for 44% up to 65% of shoulder disorders, is the leading cause of shoulder’s pain, with an increasing incidence by age. Prevalence is particularly higher in some categories of population, like overhead athletes or manual workers, as consequence of the type and repeatability of the movement. Conservative treatment usually consist of nonsteroidal anti-inflammatory drugs, joint mobilization and manipulation, physical therapy modalities, local steroid injection, and stretching and strengthening exercises. Among the aforementioned treatments only exercises have shown effectiveness in the treatment of SIS, whereas modalities (i.e., lasers, ultrasounds, etc.) have not been shown to provide additional benefits to exercises in the management of patients with SIS. Recently, a particular type of segmental muscle vibration, at high frequency (100 Hz) and low amplitude (0.2–0.5 mm), has been shown significant improvement of endurance, strength, power, joint stiffness control, and body image perception both in healthy and in impaired individuals. To our knowledge, no clinical studies have been performed to assess the effectiveness of segmental muscle vibration adding to a convention rehabilitation treatment compared with a conventional rehabilitation treatment alone in patients with SIS. our hypothesis is that the vibratory energy added to the conventional rehabilitation treatment contributes to improve the effectiveness of the rehabilitation treatment by increasing the range of motion and the strength of the shoulder, compared to the only conventional rehabilitation treatment. Therefore, the purpose of this clinical study will be to compare the effectiveness of segmental muscle vibration adding to conventional rehabilitation treatment with that of conventional rehabilitation treatment alone in patients with SIS.
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Interventions
This is an interventional prospective study. All intervention will be performed by an experienced physiotherapist Group 1: Conventional rehabilitation treatment plus segmental vibration treatment. Group 1 will undergo conventional rehabilitation treatment plus segmental vibration energy treatment, 3 times a week for 12 weeks. Each treatment session took 60 minutes, including 10 minutes of segmental vibration treatment and 50 minutes of conventional rehabilitation treatment. Segmental vibration treatment will administered via a 28 cm transducer connected with the NEMES Bosco System (SterLin CO, Athens, Greece) device, and will include three sets of 30 seconds each of segmental vibration, at a frequency of 25 Hz. Each patient will be required to strongly hold the vibrating transducer in 3 positions: 1) upper limb in adduction position (arm at the side), with a 3 kg band around the wrist to distract the arm; 2) Starting position: 90° abduction. The patient will be required to adduct in a frontal plane against a fixed resistance while holding the transducer (humeral head depression); 3) Upper limb at the side, elbow at 90° of flexion, the patient will be required to externally rotate against a fixed resistance, without activating deltoid muscle , while holding the transducer. The conventional rehabilitation treatment will consist of active Range of Motion exercises, stretching and strengthening exercises. Range of Motion exercises will include shoulder retraction (athletes will actively perform external rotation of the shoulder while keeping elbow in a flexed position), pendulum exercise (participants will perform swinging movement of the shoulder joint in a clockwise and counterclockwise direction), active training of scapula muscle (participants will perform scapular pullbacks keeping arms at their sides), active-assisted exercises with the cane (participants will perform medial and lateral rotations, flexion and diagonal elevation by holding a cane with both hands and applying force mainly from the normal side) and posture exercises (participants will be taught to self-correct their abnormal shoulder excursion while performing active shoulder elevation in front of a mirror). Participants will also be instructed to perform stretching of the anterior shoulder (participants will placing their forearms and hand on the wall, stand at an arm’s length and then lean forward) and posterior shoulder capsule (participants will stand against the wall and while anchoring the affected side scapula they will bring the affected shoulder into cross-body adduction in such a way that the stretch will be felt in the back of the shoulder). Strengthening exercises will include internal and external rotations (i.e., infraspinatus, teres minor, and subscapularis) performed using TheraBand and ShoulderRX device, and Scapular stabilization exercises (i.e. rhomboids, lower trapezius, serratus anterior and latissimus dorsi) performed using TheraBand. The progression pattern of the strengthening exercises comprised graduating the repetition counts from starting 2 sets of 10 reps to 3 sets of 10 reps. Treatment were administered face-to-face by experienced physiotherapists. During each session, the patients were observed for substitution or compensatory movements and corrected when required. Since the intervention is face to face, the patient's adherence to treatment will be recorded directly by the physiotherapist for each patient in each session
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ACTRN12622000191796