The Effect of Biomechanical Scapular Mobilization With Movement and Motor Learning (BSMWM)

The Effect of Biomechanical Scapular Mobilization With Movement and Motor Learning in Shoulder Impingement Patients

the study about new mobilization technique used in shoulder impingement syndrome patient to increase the range of motion of elevation, decrease the pain, and increasing the function level, this technique is based on normal mechanics that occur inside the joint during certain movement.

The study is about a new technique of mobilization based on normal biomechanics that occurs during the movements of a joint. For example, shoulder abduction or elevation needs the scapula to move upward rotation with posterior tilt and external rotation. Moreover, needs glenohumeral (GH) joint glide inferior and posterior these movements occur normally to permit us to elevate our shoulder without any restriction and the full range of motion(ROM). so in the patients with shoulder problems and have difficulties reaching full ROM of elevation the investigators applied mobilization of scapula toward upward rotation with external rotation and posterior tilt and by using mobilization belt applied posterior and inferior glide to GH joint. However, mobilization techniques have a short-term effect to enhance this effect, the investigators adding a motor learning approach to achieve a long-term effect and prevent recurrent .the investigators applied this technique 3 times per week for 3 weeks.

Patients were divided randomly in two equal groups (A and B): Group A (controlled group): They were received traditional physical therapy program including: passive range of motion (PROM)/ active assisted range of motion (AAROM)/ active range of motion (AROM), strengthen of rotator cuff, biceps, shoulder and scapular muscles, ultrasound (5 min. - 1.5 W/c.m2 - 1 MHZ), electrical stimulation ( interferential bipolar technique for 20 min. on shoulder joint). Group B (study group): they have received the same physical therapy program as in group A, in addition to Biomechanical scapular mobilization with movement and motor learning.

received passive range of motion (PROM)/ active assisted range of motion (AAROM)/ active range of motion (AROM) exercises, strengthen of rotator cuff, biceps, shoulder and scapular muscles, ultrasound (5 min. - 1.5 W/c.m2 - 1 MHZ), electrical stimulation ( interferential bipolar technique for 20 min. on shoulder joint). This treatment was repeated three times per weeks with 24 hours rest for 3 weeks.

All patients in group B received biomechanical scapular mobilization with movement and motor learning and traditional methods.

the therapist applied posterior tilt and exteral rotation with upward rotation mobilization to scapula and therapist also warp bilt around GH joint to applied inferior and posterior glid then ask patient to elevate his arm. then we applied motor learning approach by asking patient to elevate his arm with maintaining of external rotation with posterior glid of scapula.

1. Visual Analogue Scale: was used to evaluate the intensity of pain, which The pain VAS is a continuous scale comprised of a horizontal (HVAS) or vertical (VVAS) line, usually, 10 centimetres in length, anchored by 2 verbal descriptors, one for each symptom extreme. For pain intensity, the scale is most commonly anchored by "no pain" (score of 0) and "pain as bad as it could be" or "worst imaginable pain" (score of 10 centimetres).

Universal goniometer: was used to measure the available range of motion at a joint. where used to measure an available range of motion of abduction and flexion of the shoulder joint.

Inclusion Criteria: clinical diagnosis: shoulder impingement syndrome. History of shoulder pain when they elevated their arm. Limited range of motion due to the pain. Pain localized at the painful point at proximal anterolateral shoulder region or medical diagnosis of shoulder impingement syndrome with at least 2 positive impingement tests including Neer, Hawkins, or Jobe test. Exclusion Criteria: Fibromyalgia. Fracture, dislocation, or subluxation of the shoulder. history of trauma. shoulder surgery. numbness or tingling in the upper limb. Corticosteroids injection within 1 year. systemic illness. ligamentous laxity

Surenkok O, Aytar A, Baltaci G. Acute effects of scapular mobilization in shoulder dysfunction: a double-blind randomized placebo-controlled trial. J Sport Rehabil. 2009 Nov;18(4):493-501. doi: 10.1123/jsr.18.4.493.

Neumann, D. D. (2010). kinesology of musculoskeletal system. In Mosby, Inc., an affiliate of Elsevier Inc. The book described normal biomechanics of the shoulder during the elevation.

the posterior glid and inferior glid of GH joint is increasing the range of motion and decreasing the pain