Changes in Subjects With Posterior Capsule Tightness

Biomechanical and Neurophysiological Changes in Subjects With Posterior Capsule Tightness - Evaluation and Treatment

To identify biomechanical and sensibility changes in people with posterior capsule tightness in people with and without shoulder pain.

Some studies have shown that posterior capsule tightness can be related with shoulder dysfunctions and kinematics alterations. This study will be divided in two studies. The purpose of study 1 will be to assess the scapular and humeral kinematics, the strength of the shoulder external rotators and the pressure pain threshold in subjects with posterior capsule tightness with and without shoulder pain. Study 2 will verify the effects of two different treatments in subjects with posterior capsule tightness and shoulder pain on the same variables of study 1. One-hundred subjects will participate in the first study and will be divided in 4 groups: Group 1 - 25 subjects with shoulder pain and posterior capsule tightness; Group 2 - 25 subjects with no shoulder pain and no posterior capsule tightness; Group 3 - 25 subjects with shoulder pain and no posterior capsule tightness; and group 4 - 25 subjects with no shoulder pain and no posterior capsule tightness. All subjects will complete the DASH and Shoulder Pain and Disability Index questionnaires. External and internal rotation range of motion, strength of the external rotators, scapular kinematics and humeral translations during arm elevation, and pressure pain threshold will be measured. For the second study 50 subjects with shoulder pain and posterior capsule tightness will be recruited. The subjects will be randomly divided in 2 groups: experimental group or control group. The experimental group will receive glenohumeral posterior mobilization, stretching of posterior capsule and strengthening of the shoulder external rotators. The control group will do ultrasound;, stretching for the upper trapezius and scapular squeezing. Both groups will receive intervention for 3x/week/4 weeks. All subjects will be supervised for one physiotherapist and same variables from study 1 will be analyzed at pre and post-intervention.

This group will perform during 4 weeks: placebo ultrasound during 5min ; scapular squeezing in the sitting position (3x10repetitions); upper trapezius stretching (in sitting position, 3x30s and 30s of rest).

This group will perform during 4 weeks: posterior shoulder mobilizations during 5min (mobilizations during 30s and 30s of rest); external rotators strengthening in sidelying positions with load (3x10repetitions); posterior capsule stretching (sleeper stretch in sidelying position, 3x30s and 30s of rest).

A second investigator performed 5min of posterior capsule shoulder mobilization for the experimental group, 3times/week during 4 weeks.

Individuals performed 3x10 repetitions of external rotators strengthening in sidelying position 3times/week during 4 weeks.

A second investigator performed 5min of placebo ultrassound for the control group, 3times/week during 4 weeks.

For these measures, the SPADI (Shoulder Pain and Disabilities Index) questionnaire was used, pre and post treatment. The is a self-assessment questionnaire with 5 questions about pain and 8 about functional activities. The final score (0-100) of the questionnaire is provided in percentage and a maximum score of 100 implies the worst possible condition.

Inclusion Criteria: all subjects should have posterior capsule tightness and shoulder pain. So they should have: low flexion test (flexion + internal rotation) > 7°, between arms; symptoms consistent to shoulder impingement and arm elevation close to 150° as determined by digital inclinometer. The diagnosis for SIS was made based on a clinical examination and self-reported history. To be classified as having shoulder impingement, subjects had to present with at least 3 of the following: positive Neer test, positive Hawkins test, positive Jobe test, pain with passive or isometric resisted shoulder lateral rotation, pain with active shoulder elevation, and pain in the anterolateral shoulder region. Exclusion Criteria: Individuals from both groups were excluded if they: were pregnant; had ligamentous laxity based on positive Sulcus test, Apprehension test or anterior drawer; had history of clavicle, scapula or humerus fracture; history of shoulder surgery or traumatic lesion; -had adhesive capsulitis or scoliosis; - had systemic illnesses; transpore tape allergy; body mass index > 28kg/m2; physical therapy treatment in the last 6 months; bilateral symptoms; steroid injection in the last 6 weeks; drugs with muscle relaxant in the last 72 hours.