Scapular-focused exercise treatment protocol for shoulder impingement symptoms: Three-dimensional scapular kinematics analysis

Abstract

BackgroundThe present study aimed to describe the effects of a periscapular strengthening and neuromuscular training protocol in three-dimensional scapular kinematics and resting positioning in participants with shoulder impingement symptoms. Self-reported function was also evaluated. MethodThe study group comprised 50 subjects with shoulder impingement syndrome (control group, n=25; treatment group, n=25). The treatment group underwent 8weeks of neuromuscular training and periscapular strengthening. Scapular kinematics was measured using an electromagnetic tracking device, and the Brazilian version of the Shoulder Pain and Disability Index (SPADI-Br) questionnaire was carried out before and after the treatment. FindingsIn the resting position, treated subjects had lower (p<0.01) internal rotation of the scapula compared to the control group, with a large effect size (2.4). On the coronal plane, the treated group had less scapular upward rotation (p<0.01) and less internal rotation (p<0.05), with a medium effect size. On the sagittal plane, the treated group had less internal rotation (p<0.01), less upward rotation (p<0.05), and less scapular anterior tilt (p<0.01), with a medium effect size. On the scapular plane, a reduction in upward rotation (p<0.01) after the intervention was observed, with a large effect size. Moreover, a reduction in the total SPADI-Br score was found, with a mean difference of 32.4 [24.4; 40.4] points (p<0.01) after the implementation of the protocol and a large effect size (2.0). InterpretationThe results provide biomechanical support for the clinical rationale for indicating therapeutic exercises focused on the periscapular muscles to improve scapular dynamics.