Effects of a Movement Training for Subacromial Pain Syndrome (MTforSPS)

Effects of a Movement Training Oriented Rehabilitation Program on Symptoms, Functional Limitations and Acromiohumeral Distance in Individuals With Subacromial Pain Syndrome

Objectives: Evaluate the effects of a rehabilitation program based on movement training on symptoms, functional limitations and acromiohumeral distance (AHD) in individuals with SPS. Methods: Twenty-five participants with SPS participated in a 6-week program. Outcomes of both groups were evaluated at baseline and 6 weeks. Changes in symptoms and functional limitations were assessed. Changes in AHD for both groups were assessed using ultrasonographic measures.

Background: Multiple factors have been associated with the presence of a subacromial pain syndrome (SPS), including deficits in performance of scapular and glenohumeral muscles. Such deficits can lead to inadequate kinematics and decreased acromiohumeral distance (AHD). Exercises that aim at correcting these deficits, such as movement training, were suggested to improve symptoms and functional limitations. To date, few studies have assessed outcomes following an intervention focused on movement training. Objectives: Evaluate the effects of a rehabilitation program based on movement training on symptoms, functional limitations and AHD in individuals with SPS. Design: Prospective single group pre-post design. Methods: Twenty-five participants with SPS (SPS group) participated in a 6-week program. Twenty asymptomatic volunteers were recruited for normative AHD values (control group). Outcomes of both groups were evaluated at baseline and 6 weeks, i.e. immediately following intervention for the SPS group. Changes in symptoms and functional limitations for SPS group were assessed using the Western Ontario Rotator Cuff index (WORC) and Disability of the Arm Shoulder and Hand questionnaire (DASH). Changes in AHD for both groups were assessed using ultrasonographic measures.

Rehabilitation Program: The program was developed to target the deficits described in individuals with SPS. It included movement training, manual therapy, strengthening and stretching exercises, and patient education. Each supervised session lasted around 30 minutes, with 75% of the session for movement training. Three treating physiotherapists supervised the program and initially attended a training session to standardize the program.

Movement training: To re-educate control of movement, exercises of increasing difficulty in terms of movement plane, range of motion, speed and resistance were performed. Strengthening: Using extremities weight, free weights or elastic bands, scapulothoracic and scapulohumeral strengthening was performed to increase strength and control of shoulder muscles. Stretching & Manual Therapy: These modalities, performed only if needed, were aimed at addressing stiffness of posterior and inferior glenohumeral capsule and pectoralis minor. Patient education: Participants received education regarding posture and body mechanics. They were instructed on preferred shoulder positioning during sleep, activities, work and sports

Upper limb symptoms and functional limitations were assessed using the Disability of the Arm Shoulder and Hand (DASH) questionnaire. DASH has 30 items that measures upper limb physical disability and symptoms. Final scores range from 0 to 100 (most severe disability).

Shoulder symptoms and functional limitations was assessed using the Western Ontario Rotator Cuff (WORC) index. The WORC is a disease-specific questionnaire designed for patients with RC disorders. Scores vary from 0 to 100 (high functional status).

Measurement of AHD is defined as the tangential distance between the bony landmarks of humeral head and inferior edge of acromion, corresponding to the anterior outlet of subacromial space.Measurements were taken in a sitting position with the arm at rest, and at 45° and 60° of active abduction.

Inclusion Criteria: painful arc of movement during flexion or abduction positive Neer or Kennedy-Hawkins impingement signs pain on resisted lateral rotation, abduction or empty can test. Exclusion Criteria: previous shoulder surgery shoulder pain reproduced by neck movement clinical signs of full-thickness RC tears shoulder capsulitis.

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